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Abstract

Treatment of chronic hepatitis B has changed much since the introduction of interferon. Nucleosides have come to replace interferon in some situations like decompensated states. However, there is no clear cut guideline in many fields. Even end of treatment response is low in conventional treatments. This study describes a few scenarios where difficulties were faced. Unresolved questions in the management of chronic hepatitis B involve ‘who to treat, when to treat, how to treat?’ These should be clearly addressed.

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Autoimmune hepatitis is defined as chronic liver disease of unknown aetiology with aberrant autoreactivity and genetic predisposition. It is characterized by female predominance, circulating auto-antibodies, hypergammaglobulinaemia and association with HLA DR3 and HLA DR4 [1]. Differential diagnosis includes chronic viral hepatitis, drug induced hepatitis and alcohol. We present two patients with autoimmune hepatitis representing the two extremes of hepatic involvement in this condition. The first patient is a young lady who was diagnosed with autoimmune chronic hepatitis. The second patient, on the other hand, is an elderly gentleman who presented to us with autoimmune hepatitis-related decompensated cirrhosis of liver.

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Hungarian Medical Journal
Authors: Mamun-Al-Mahtab, Salimur Rahman, Mobin Khan, Fazal Karim, Niaz M. Sharif, and Ananta Shrestha

Introduction: Hepatitis C virus (HCV) is a leading cause of chronic liver disease worldwide including Bangladesh. Approximately 0.84% of our population is infected with HCV. Genotypes of HCV are important in the determination of treatment duration and in predicting the response to treatment in HCV infection. Methodology: 61 consecutive patients who presented to us with chronic hepatitis C (CHC) and who could afford treatment and having no features of decompensation were included in the study. Results: Of the 61 study subjects, 46 were males and 15 females. They were between 12 and 70 years of age. Of them 41% had genotype 3, 31% had mixed genotypes 3 + 4 and 21% had genotype 1. Patients also had genotypes 2, 4, 5 and mixed genotypes 5 + 6, the figure being 1.6% in each case. Conclusion: Genotype 3 is the commonest HCV genotype in Bangladesh, while we also have a high prevalence of mixed HCV genotypes.

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Hungarian Medical Journal
Authors: Fazal Karim, Salimur Rahman, Mobin Khan, AKM Khorshed Alam, Nooruddin Ahmed, KMJ Zaki, Mamun-Al-Mahtab, and Chitta Ranjan Debnath

Background/Aims: Preferential production of immunoregulatory cytokines may play an important role in the pathogenesis of chronic hepatitis B. Patients with chronic hepatitis B infection were evaluated to determine whether serum interleukin-10 (IL-10) levels were changed and whether the degree of these changes in serum levels correlated with HBV DNA levels, histologic activity index (HAI) or serum aminotransferase levels (ALT). Methodology: 15 patients diagnosed of chronic hepatitis B (wild type) with raised ALT, 15 inactive HBsAg carriers, 15 healthy people with resolved acute hepatitis B, and 15 healthy controls without any hepatitis marker positivity were included in the study. Serum IL-10 levels were measured. The associations between liver pathology, HBV DNA and ALT levels were assessed. Result: IL-10 is elevated more in chronic hepatitis B with positive HBeAg and raised ALT in comparison to asymptomatic carrier, resolved acute hepatitis B and control. Conclusions: IL-10 production is increased in chronic hepatitis B patients with HBeAg positivity and raised ALT as compared to other groups ( p < 0.01). No correlation between HBV DNA, HAI or ALT could be established through this study. However, as IL-10 is increased in chronic hepatitis B infection with HBeAg positivity, the HBe antigen may be responsible for the raised IL-10 levels.

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