Measuring HBsAg and HBV DNA Levels in Cilegon

Background: Implication of measuring HBsAg level is still not recognized well. The aim of this study to recognize the correlation of serum HBsAg level and serum HBV DNA level between in HBeAg positive patients and HBeAg negative patients. Method: Quantitative serum HBV DNA were collected retrospectively between January 2006 and May 2009. We stratified the patients into four groups, that were; HBeAg positive and (a) ALT > 2 x upper limited normal (UNL) (group A),( b) ALT < 2 x UNL (group B), HBeAg negative and:( a) ALT > 2 x UNL (group C) (b) ALT < 2 x UNL (group D). We studied the correlation of serum HBsAg and HBV DNA level in each group. In addition, we also studied the accuracy of HBsAg titers to predict serum HBV DNA levels in each group by using receiver operating characteristic (ROC) curve analysis. Results: Eighty nine patients were recruited in this study. Most of them 63 (70%) were male; the mean age of the patients was 38.49 ± 11.21 years. The number of patients with HBeAg positive and negative were 28 and 61 respectively. Based on the group stratification, the A, B, C and D groups we found 16, 12, 11, 50 respectively. There was a positive correlation between HBsAg titers and HBV DNA level in HBeAg positive patients but it was statistically not significant. Similar result was also found in HBeAg negative patients. There were positive correlation in group A, C, and D but they were not statistically significant. In group B the correlation was negative (r = -0.40). We found 100% sensitivity and 100% specificity of predicting serum HBV DNA levels in group A with HBsAg cut-off level of 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL. In group B, C and D the accuracy to predict serum HBV DNA level were not so good . Conclusion: There were positive correlation between HBsAg titers and HBV DNA levels in HBeAg positive and HBeAg negative patients as demonstrated in the three group stratification; however, the correlation was negative in group HBeAg positive and ALT < 2 x UNL. We found excellent (100%) specificity and sensitivity for predicting serum HBV DNA level in group HBeAg positive and ALT > 2 x UNL with HBsAg cut-off level 7.91 IU/mL and baseline serum HBV DNA cut-off level > 20,000 IU/mL; while in other groups, the correlation were not so good

The Role of Specific Cellular Immune System in Chronic Hepatitis C

Hepatitis C virus is a RNA virus with very high speed replication. The clinical course of chronic hepatitis C is frequently asymptomatic like other hepatitis viruses. Infection of hepatitis virus will activate the immune system specifically as well as non-specifically. Mechanism of the immune system regulation is controlled by tissues consisting of antibodies cells and cytokines. In the process, all of the immune systems integrate and coordinate with the main agent-lymphocytes. Lymphocytes recognize antigens through the specific-surface antigen receptors. Following exposure to viral chronic hepatitis virus, viremia takes place within 1-2 weeks. In immuno-competent hosts, viremia will be preceded with the increase in transaminase enzyme and delayed seroconversion of antibodies will occur. Unlike other immunologic processes, these established antibodies are not protective in nature but serve only as the sign that someone has been infected by hepatitis C. In most cases of hepatitis C virus infection, this virus cannot be eradicated in the acute phase. Approximately 80-90% of acute infection progresses to be chronic infection and in 50% of the cases, there is an increase in transaminase enzyme that reveals that there is still liver cell damage. The degree of liver tissue damage in hepatitis depends on the number of virus infecting and the activity of cytotoxic T cells

Benign Recurrent Intrahepatic Cholestases

Benign recurrent intrahepatic cholestasis (BRIC) or idiopathic recurrent intrahepatic cholestasis is a rare case. It is a familial and autosomal recessive. The etiology of BRIC is still unknown. We report the case of a patient with BRIC who suffered from recurrent jaundice 7 times in 7 years that occurred for 1-3 months with spontaneous resolutieon. This patient received ursodeoxycholic acid, cholestiramine and prednisone. And within 2 months, the jaundice resolved together with other complaints

Study of Transaminases in Heroin Addicts

A recent increase in the number of drug users particularly of heroin has been noted in the community. A cross-sectional study on the level of transaminases as a representation of liver damage in drug users was done in privated hospital in Jakarta. Exclusion criteria were fever, serious illness or the multiple use of addictive drugs based on a urinary test. The hepatitis B surface antigen (HBsAg) was examined using reverse passive hemaglutination assay (RPHA) and the antibody of hepatitis C virus core-protein (anti- HCV) with dipstick anti-HCV. AST and ALT levels were determined using an automatic chemical analyzer. Of 132 patients who fulfill the criteria, 83.5 % were injection drug users (IDU). Means AST and ALT were significantly higher in IDU. Anti-HCV positive patients with increased AST and ALT were significantly higher compared to anti-HCV negative. The increase of transaminase was also consistent in injection drug users although no viral marker could be detected. In conclusion, the examination of transaminases in drug users especially IDU is important besides tests for hepatitis viral markers because there is often an increase with or without viral infection and this can be associated with hepatocellular damage

Ethnicity, socioeconomic status, transfusions and risk of hepatitis B and hepatitis C infection

This study identifies the risk factors for hepatitis B virus (HBV) and hepatitis C virus (HCV) and measures the prevalence of hepatitis B surface antigen (HBsAg) and antibody to hepatitis C (anti-HCV) in the general population of Jakarta. A population-based sample of 985 people aged 15 and above was surveyed. Risk factors were identified through questionnaires and home visits. Serum was analysed for HBsAg, antibody to hepatitis B surface antigen (anti-HBs), anti-HCV, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The seroprevalence was: 4.0% (39/985) for HBsAg, 17.2% (170/985) for anti-HBs, and 3.9% (38/985) for anti-HCV. The risk factors for hepatitis B and hepatitis C infection had little in common. Low socioeconomic status was a strong risk factor for HBsAg (adjusted odds ratio (OR) 18.09; 95% confidence interval (CI) 2.35–139.50). In addition, the Chinese group has 2.97 higher risk of having HBV infection compared with the Malayan ethnic group (adjusted OR 2.97; 95% CI 1.22–7.83). There was moderate positive trend between family size and risk of HBsAg positivity ( P = 0.130). Age over 50 (adjusted OR 14.72; 95% CI 4.35–49.89) and history of transfusion were significant risk factors for hepatitis C (adjusted OR 3.03; 95% CI 1.25–7.33). Hepatitis B and hepatitis C infections have different risk factors in Jakarta, a high risk in population for both diseases. Hepatitis B transmission is associated with low socioeconomic status, Chinese ethnic group and large family size, while hepatitis C is associated with an older age and a history of transfusions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72591/1/j.1440-1746.1997.tb00365.x.pd

Profile of osteophyte location in different grades of functional status in patients with knee osteoarthritis

Background. Osteophyte is a reparative response to cartilage breakdown in osteoarthritis (OA) and osteophyte formation is a knee stabilizing factor. Disability could be found in patients with knee OA. Objective. To identify the profile of osteophyte formation (location, size, and direction) based on knee radiograph and functional status examination in knee OA patients who presented to the Rheumatology Clinic, Cipto Mangunkusumo Central National General Hospital.Methods. Samples were taken by consecutive approach. Knee radiographs (weight bearing anteroposterior and30 degrees flexion skyline views) and functional status examinations were performed on 100 patients with knee OA (90 females and 10 males with ages ranging from 51 to 74 years old). A radiologist assessed films for osteophyte profile such as location, size, and direction according to standard atlas. One knee with the severe radiological assessment based on OA grade was selected from one patient to be the profile. LequesneAlgofunctional Index was also taken from the patients. Results. The site of osteophyte in patients with knee OA was mostly found at lateral femur (85/100 subjects). Based on specific location, grade 2 osteophyte at lateral femur was the most frequent size (49/100 subjects) and osteophyte extending toward the lower middle atlateral patella (65/100 subjects) was the most frequent direction of osteophyte. The most frequent profile for size and direction of osteophyte at specific location was the grade 2 osteophyte extending toward the lower middle at lateral patella (35/100 subjects). Severe functional status impairment was found in 53% of the patients. The most frequent functional status found according to specific location of osteophyte was severe functionalstatus impairment in patients with oste ophyte at lateral femur (46/100 subjects). The most frequent functional status of OA patients based on the size and direction of osteophyte at specific location was the severe functional impairment in the patients with grade 2  osteophyte at lateral femur (27/100 subjects) and the patients with osteophyte extending towards the lower middle at lateral patella (37/100 subjects) respectively.Conclusions. Osteophyte at lateral femur, osteophyte at lateral tibiofemoral compartment, grade 2 osteophyte at lateral femur, and osteophyte extending toward the lower middle at lateral patella were the profiles of osteophyte which mostly showed severe functional status impairment in patients with knee OA