need for continuing medical education for liver disease management in mongolia

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Low rates of screening and treatment of chronic hepatitis B, C, D (HBV, HCV, HDV), and hepatocellular carcinoma (HCC), associated barriers, and proposed solutions: results of a survey of physicians from all major provinces of Mongolia

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ОСОБЕННОСТИ ПОЛИМОРФИЗМА ГЕНОВ ИНТЕРФЕРОНА III ТИПА У БОЛЬНЫХ ВИРУСНЫМ ГЕПАТИТОМ С НА СОПРЕДЕЛЬНЫХ ТЕРРИТОРИЯХ РОССИИ И МОНГОЛИИ

Aims: determine the structure of IFNL3/IFNL4 interferon genes’ polymorphism in healthy people and in HCV patients and the frequency of spontaneous viral clearance in ethnic groups of Caucasians and Mongolians, living in the Asian part of Russia (Irkutsk Region) and in Mongolia. Materials and methods: population genetic studies were conducted at 669 patients with hepatitis C, including 567 representatives Caucasian and 102 Mongoloid races. The control group consisted of 1520 healthy individuals, blood donors (800 Caucasians and 720 Mongoloids). Results: it was found that in Caucasians patients with chronic hepatitis C were significantly less common CC genotype rs12979860, TT genotype rs8099917 and TT/TT genotype rs368234815, than in the general population. However, in patients with chronic hepatitis C, the representatives of the Mongoloid race, compared with healthy individuals, significant differences were found only in relation to the TT genotype rs8099917 IFNL3 gene. Spontaneous clearance of the virus was significantly more common in the Mongoloid race than in Caucasians. Conclusions: the spontaneous viral clearance after clinical evidence or latent suffering hepatitis C was significantly more common in the Mongoloid race than in Caucasians that genetically determined high rate of prevalence in the population of the Mongols CC genotype rs12979860, TT genotype rs8099917 and TT/TT genotype rs368234815 polymorphisms of interferon type III genes.Цель исследования: определить структуру полиморфизма генов интерферона IFNL3/IFNL4 у здоровых лиц и больных вирусным гепатитом С и частоту спонтанного клиренса вируса в этнических группах европеоидов и монголоидов, проживающих в азиатской части России (Иркутская область) и Монголии. Материалы и методы: популяционно-генетические исследования проводились у 669 больных хроническим гепатитом С, в том числе у 567 представителей европеоидной и 102 монголоидной рас. Контрольную группу составили 1520 практически здоровых лиц, доноров крови (800 европеоидов и 720 монголоидов). Результаты: обнаружено, что у больных хроническим гепатитом С, представителей европеоидной расы, значимо реже встречались СС-генотип rs12979860, ТТгенотип rs8099917 и ТТ/ТТ-генотип rs368234815, чем в общей популяции здоровых лиц. Вместе с тем, у больных хроническим гепатитом С, представителей монголоидной расы, по сравнению со здоровыми лицами, значимые отличия обнаружены только в отношении ТТ-генотипа rs8099917 гена IFNL3. Спонтанный клиренс вируса значимо чаще (в 1,6 раза) встречался у представителей монголоидной расы, чем у европеоидов. Заключение: спонтанный клиренс вируса после клинически выраженного или латентно перенесенного гепатита С значимо чаще встречается у представителей монголоидной расы, чем у европеоидов, что генетически детерминировано высокой частотой распространенности в популяции монголов СС-генотипа rs12979860, ТТ-генотипа rs8099917 и ТТ/ТТ-генотипа rs368234815 полиморфизмов генов интерферонов III типа

Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

BACKGROUND & AIMS: Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories. METHODS: We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level. RESULTS: After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases. CONCLUSIONS: We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened. IMPACT AND IMPLICATIONS: There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into

Global prevalence and genotype distribution of hepatitis C virus infection in 2015 : A modelling study

Publisher Copyright: © 2017 Elsevier LtdBackground The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation.publishersversionPeer reviewe

A global research priority agenda to advance public health responses to fatty liver disease

Background & aims An estimated 38% of adults worldwide have non-alcoholic fatty liver disease (NAFLD). From individual impacts to widespread public health and economic consequences, the implications of this disease are profound. This study aimed to develop an aligned, prioritised fatty liver disease research agenda for the global health community. Methods Nine co-chairs drafted initial research priorities, subsequently reviewed by 40 core authors and debated during a three-day in-person meeting. Following a Delphi methodology, over two rounds, a large panel (R1 n = 344, R2 n = 288) reviewed the priorities, via Qualtrics XM, indicating agreement using a four-point Likert-scale and providing written feedback. The core group revised the draft priorities between rounds. In R2, panellists also ranked the priorities within six domains: epidemiology, models of care, treatment and care, education and awareness, patient and community perspectives, and leadership and public health policy. Results The consensus-built fatty liver disease research agenda encompasses 28 priorities. The mean percentage of ‘agree’ responses increased from 78.3 in R1 to 81.1 in R2. Five priorities received unanimous combined agreement (‘agree’ + ‘somewhat agree’); the remaining 23 priorities had >90% combined agreement. While all but one of the priorities exhibited at least a super-majority of agreement (>66.7% ‘agree’), 13 priorities had 90% combined agreement. Conclusions Adopting this multidisciplinary consensus-built research priorities agenda can deliver a step-change in addressing fatty liver disease, mitigating against its individual and societal harms and proactively altering its natural history through prevention, identification, treatment, and care. This agenda should catalyse the global health community’s efforts to advance and accelerate responses to this widespread and fast-growing public health threat. Impact and implications An estimated 38% of adults and 13% of children and adolescents worldwide have fatty liver disease, making it the most prevalent liver disease in history. Despite substantial scientific progress in the past three decades, the burden continues to grow, with an urgent need to advance understanding of how to prevent, manage, and treat the disease. Through a global consensus process, a multidisciplinary group agreed on 28 research priorities covering a broad range of themes, from disease burden, treatment, and health system responses to awareness and policy. The findings have relevance for clinical and non-clinical researchers as well as funders working on fatty liver disease and non-communicable diseases more broadly, setting out a prioritised, ranked research agenda for turning the tide on this fast-growing public health threat

Bulk Analysis Method of Gold Determination in Ores Using Epithermal Neutrons of Electron Accelerator Microtron MT22

Bulk analysis method of gold determination in ores by Instrumental Neutron Activation Analysis (INAA) is described. The powder (100200 mesh) samples were irradiated in Cd foils of 1 mm thick with photoneutrons at the Microtron MT22 of the Nuclear Research Center, Mongolian State University (Ulaanbaatar). The sensitivity of 0.1 mg/kg Au can be obtained using 3050 g samples and irradiation time of 12 h

Space geodetic activities at the Astronomical Observatory of Mongolia

We present in this paper some results obtained in the field of space geodesy based on continuous GPS observations at the Astronomical Observatory of Mongolia. Starting with a brief historical overview of the main space geodetic activities carried out by the Astronomical Observatory in the past, we outline here current achievements in the application of GPS techniques in the geosciences research in Mongolia. We setup a local GNSS Data Center of the Mongolian Academy of Sciences to receive, quality control and process into derivative products the observation data coming from its continuously recording stations. The quality check performed on three non-real-time permanent stations reveals that all three stations show smooth trends of each parameter indicating good quality in data record and operation without any anomalous behavior