Exercise induced rhabdomyolysis

Introduction. Rhabdomyolysis is a potentially life threatening disease, characterized by the release of intracellular calcium from skeletal muscles and can result in acute renal failure. Case report. A nineteen year old boy was admitted to the Clinic for Infective Diseases of Clinical Center Novi Sad. The disease was developing gradually and the symptoms were dizziness, muscle pain and dark color of urine. Due to the pathological level of aminotransferase he was hospitalized on the fourth day of the disease beginning with a suspicious diagnosis of acute viral hepatitis. In the hospital course of the disease, a further elevation of serum aminotransferases, creatine kinase and lactate dehydrogenase were registered. Additional serological analyses were done to exclude other possible causes of acute liver lesion. In the neurological status prolonged decontraction of quadriceps muscle was detected and the electromyography was suspicious on neuromyositis. Conclusion. Excessive muscular activity with the strenuous exercise is the leading, but very frequently overlooked, cause of rhabdomyolysis in healthy people. Excessive physical exercise may lead to elevation of the serum activity of aminotransferases and to suspicion of hepatitis

Depression, anxiety and quality of life in patients with chronic hepatitis C virus infection in Vojvodina

© 2021 The Authors. Published by Sestre Milosrdnice University hospital and Institute of Clinical Medical Research. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.20471/acc.2021.60.04.03The objective of this study was to investigate the prevalence of depression and anxiety among patients with chronic hepatitis C and how depression and anxiety correlate with re-spective health-related quality of life (HRQoL) domains, sociodemographic factors, and clinico-epi-demiological characteristics. This prospective study involved 150 patients with chronic hepatitis C awaiting interferon treatment for hepatitis C and 150 healthy subjects. All individuals enrolled in the study completed the Short Form 36 (SF-36) questionnaire and Hospital Anxiety Depression Scale. The symptoms showed greater severity/score among patients with chronic hepatitis C for both depression (t=3.37; p<0.01) and anxiety (t=2.35; p<0.05). Regression analysis was used for estimating the relationship between depression and the set of predictors (domains of the SF-36 questionnaire). Three HRQoL domains (Physical Functioning, Vitality, and Mental Health) were found to have the stron-gest predictive contribution to the occurrence of depression. A series of Kruskal-Wallis and Mann-Whitney tests showed a significant difference in depression level between marital status categories (χ2(2)=7.86, p<0.05). Divorced participants had significantly higher scores compared to married participants (Z=-2.40, p<0.05) and single participants (Z=-2.75, p<0.01). Unemployment was associated with a higher degree of depression and anxiety. There was no association identified between duration of the disease, route of hepatitis C virus transmission, existence of cirrhosis, and depression or anxiety. The findings of this study can assist in developing a standard protocol for the management of chronic hepatitis C that will include psychological assessment and support.Published versio

Hepatitis B Outbreak Among Men Who Have Sex with Men in the Autonomous Province of Vojvodina, Serbia

** From Crossref via Jisc Publications Router.The European Centre for Disease Prevention and Control reported that there were 2896 acute hepatitis B cases in 24 EU/EEA countries in 2013.1 The incidence ranged from 0.1 cases per 100,000 in France and Portugal to 4.3 per 100,000 in Latvia, with a male-to-female ratio of 2.2:1 in EU/EEA countries, and transmission among men who have sex with men (MSM) reported in 9.4% of all cases of acute hepatitis B.1 Some authors consider hepatitis B virus (HBV) infection to be endemic in the MSM population with the incidence 20 times higher in MSM than in the general population worldwide.2 However, data on HBV prevalence among MSM are available for only four EU/EEA countries.3 Six to ten percent of MSM infected with HBV worldwide are co-infected with HIV.4sch_iih5pub4999pub

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Validity of hepatitis B and hepatitis C case definitions

From Elsevier via Jisc Publications RouterHistory: accepted 2019-01-22, epub 2019-07-02, issue date 2019-08-31Article version: VoRPublication status: PublishedAbstract Background Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC). Methods The study involved 150 hospital referrals with suspected cases of hepatitis from a Serbian clinic during 2014/2015. Case definitions of hepatitis B and C were tested for their sensitivity, specificity, positive and negative predictive values. Results EC 2008 and the CDC 2012 case definitions for acute hepatitis B, and the CDC 2012 case definition for probable case of chronic hepatitis B have low sensitivity. Case definitions which rely on laboratory confirmation only have maximal sensitivity. EC case definitions showed maximal sensitivity and specificity for hepatitis C confirmed cases. The CDC case definition for chronic hepatitis C showed low sensitivity (36.8%) and low negative predictive value (65.6%) for probable cases and maximal sensitivity and specificity for confirmed cases. Hepatitis C case definitions requiring presence of clinical criteria have low sensitivity and high specificity, resulting from presence of infection and absence of any clinical manifestation, but have high positive and negative predictive values. Conclusion Syndromic case definitions show low sensitivity and are of limited use. They highlight the importance of laboratory diagnostics (offering maximal sensitivity and specificity, and high positive and negative predictive values), as well as the need for universal case definitions, for confirmed cases only

Validity of hepatitis B and hepatitis C case definitions

Predrag Duric - ORCID: 0000-0001-5770-7224 https://orcid.org/0000-0001-5770-7224Fiona O'May - ORCID: 0000-0003-4417-2819 https://orcid.org/0000-0003-4417-2819Background: Globally, an estimated 257 million people are living with chronic hepatitis B (HBV) infection and an estimated 71 million people with the chronic hepatitis C virus (HCV). The true public health dimensions and impact of hepatitis epidemics are poorly understood. Case definitions are fundamental parts of disease surveillance, representing sets of standardised criteria used to assess whether or not a person has a certain disease. The study evaluated the sensitivity and specificity of hepatitis B and hepatitis C case definitions, current at the time of data collection, recommended by the European Commission (EC) and the Centers for Disease Prevention and Control (CDC).Methods: The study involved 150 hospital referrals with suspected cases of hepatitis from a Serbian clinic during 2014/2015. Case definitions of hepatitis B and C were tested for their sensitivity, specificity, positive and negative predictive values.Results: EC 2008 and the CDC 2012 case definitions for acute hepatitis B, and the CDC 2012 case definition for probable case of chronic hepatitis B have low sensitivity. Case definitions which rely on laboratory confirmation only have maximal sensitivity. EC case definitions showed maximal sensitivity and specificity for hepatitis C confirmed cases. The CDC case definition for chronic hepatitis C showed low sensitivity (36.8%) and low negative predictive value (65.6%) for probable cases and maximal sensitivity and specificity for confirmed cases. Hepatitis C case definitions requiring presence of clinical criteria have low sensitivity and high specificity, resulting from presence of infection and absence of any clinical manifestation, but have high positive and negative predictive values.Conclusion: Syndromic case definitions show low sensitivity and are of limited use. They highlight the importance of laboratory diagnostics (offering maximal sensitivity and specificity, and high positive and negative predictive values), as well as the need for universal case definitions, for confirmed cases only.12pubpub

Efficacy of combined antiviral therapy with pegylated interferon α-2a and ribavirin for chronic hepatitis C infection in intravenous drug users

Introduction. Hepatitis C Virus infection represents not just a medical, but also a socio-economic problem. It is estimated that among 170 million infected, 60% belongs to the category of intravenous drug users (IDUs). Objective. The aim of this paper was to compare the response to the combined therapy of pegylated interferon alfa 2a and ribavirin, in the group of patients with HCV infection who were intravenous drug users (IDUs) and in patients who were identified in the other way of transmission of HCV. Also to identify the influence of the therapy on diseases of addiction, during the course of HCV infection and on the effects of the combined therapy of pegylated interferon alfa 2a and ribavirin. Methods. We conducted a retrospective-prospective study, on 60 patients, treated with combined antiviral therapy-pegylated interferon alfa 2a and ribavirin. 30 patients were from the group of IDUs, and 30 patients from other epidemiological groups. Results. There were significant differences between the age of the patients (30.2±7.1 vs. 39.3±11.2 years; p=0.002), but no significant difference in the duration of the HCV infection between the two groups of patients (8.9±7.4 vs. 13.1±7.0 years; p&gt;0.05). A large number of the patients in the group of IDUs had a problem with the abstinence of the drug abuse. In this group, there was the influence of alcohol (30%) and other substances with potential hepatotoxicity: marihuana (23.3%) and psycho-active drugs (73.6%). Staging of the liver fibrosis was not influenced by those two parameters and was similar in both groups (p&gt;0.05). The genotype 3a was dominant in intravenous drug users (50.0%) and genotype 1b in the control group of the patients (76.6%). In both groups, SVR was achieved at a higher percentage (86% vs. 70.00%; p&gt;0.05), but among the intravenous drug users the relapses of HCV infection were at a lower percentage (3.3% vs. 20.0%; p=0.044). Side effects were noticed in solitary cases in both of the examined groups, but severe side effects were found only in the control group of the patients. Relapse of drug abuse was noticed in 6.66% of cases. Conclusion. We have registered that the group of intravenous drug users has the same or even better response to the antiviral therapy than other epidemiological groups and that the use of drugs does not change the course of HCV infection

The occurrence of liver steatosis in patients with chronic hepatitis C - the experience of the Clinical Center of Vojvodina

Background/Aim. Hepatic steatosis in patients with chronic hepatitis C occurs in about half of the cases. Its occurrence is influenced by factors of the host and viral factors and its importance lies in the fact that it reduces the success of antiviral therapy based on interferon in the treatment of chronic hepatitis C and that, associated with other factors, exacerbates liver disease. The aim of this study was to determine the prevalence and severity of steatosis in patients with chronic hepatitis C and to determine the factors that affect its occurrence. Methods. The study included 123 patients with chronic hepatitis C with diagnosis of liver steatosis made by liver biopsy and histopathological examination according to which ≥ 5% of hepatocytes was affected by fatty change. Based on the presence of steatosis, the patients were divided into two groups: 43 patients with steatosis and 80 patients without steatosis. The influence of certain factors on the occurrence of steatosis was examined using standard statistical methods. Results. Liver steatosis was found in 34.96% of patients with chronic hepatitis C, and a majority of patients (76.74%) had mild steatosis. Of the examined predictive factors for the occurrence of steatosis, statistical significance in its occurrence was connected to elevated body mass index (BMI), genotype 3 hepatitis C virus (HCV) and HCV viremia. Conclusion. Hepatic steatosis often occurs in people with chronic hepatitis C, and most often it is mild. The occurrence of hepatic steatosis in our sample was most often affected by genotype 3 HCV and HCV viremia level. Hepatic steatosis can reduce the success of antiviral therapy based on interferon and negatively affect chronic liver disease course. Therefore, we need to recognize it, treat it and make it withdraw

Autoimmune manifestation of hepatitis C virus infection as a risk for late virological relapse after pegylated interferon and ribavirin therapy

Introduction. We are aware of the risk of late virological relapse (LVR) years after sustained viral response (SVR) by pegylated interferon and ribavirin alfa (PegIFN + RBV) of chronic hepatitis C viral (HCV) infection. We presented three patients with LVR, treated by PegIFN and ribavirin 5 years after the SVR was established. Case report. We analysed 129 (38.8% female, 61.2% male, mean age 37.02 ± SD 11.99) patients treated for chronic HCV with PegIFN + RBV, with at least 5 years from the establishment of SVR. In addition to the biochemical parameters of liver function, the qualitative HCV RNA polymerase chain reaction (PCR) and the quantitative PCR HCV RNA test were made. Five years after establishing SVR in 2.3% (3/129) of patients, the relapse of HCV infection was registered by qualitative and quantitative PCR HCV RNA assay and all of these patients had additional autoimmune diseases: vasculitis, autoimmune hepatitis, and vasculitis of central nervous system. Conclusion. The existence, but low rate of LVR HCV infection was confirmed, dominantly in patients with additional autoimmune diseases. Due to this SVR after therapy by PegIFN + RBV should be considered as an indicator of successful HCV suppresion, not its complete eradication