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

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

PECULIARITIES OF THE III TYPE INTERFERON GENES’ POLYMORPHISM IN HCV PATIENTS ON THE CROSS-BORDER REGIONS OF RUSSIA AND MONGOLIA

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

Need for continuing medical education for liver disease management in Mongolia

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Low liver disease screening and treatment rates in Mongolia: results from a physician survey

This journal suppl. entitled: Conference Abstracts: 25th Annual Conference of APASL, February 20–24, 2016, Tokyo, JapanPoster Presentation: P-0307BACKGROUND: According to Globocan, Mongolia has the highest worldwide HCC incidence (78.1/100,000, 3.59 higher than China). It is unclear if screening and linkage to care for HBV, HCV, HDV, and HCC have been optimal. Our goal was to evaluate these screening rates, antiviral therapy utilization and barriers to care in Mongolia. METHODS: We conducted an anonymous survey of physicians from all major provinces who attended a 2-day CME liver symposium in Ulaanbaatar analyzing their demography, practice setting/patterns, perceptions, and proposed solutions. RESULTS: A total of 70–95 out of 121 (58–79 %) physician attendees responded to each question. Most were female (87 %), age50 (79 %), sub-specialists (76 %) and practiced in urban vs. rural areas (61 vs. 39 %). Most ([80 %) noted that50 % who need hepatitis or HCC screening receive it. The main perceived barriers to screening were inability to pay for diagnostic tests, lack of guidelines, and poor patient awareness (Figure 1). The major HCC screening barrier was also cost (37 %). Hepatitis treatment rates were low; 83 % treated HCV in10 patients in the past year and 86 % treated HBV in10 patients/month. Treatment barriers were multifactorial with medication cost as a principal barrier. Top proposed solutions were universal screening policies (46 %), removal of financial barriers (28 %), and provider education (20 %). CONCLUSIONS: Physicians from all major regions of Mongolia noted low screening for viral hepatitis (50 %) and even lower treatment rates ([80 % treated10 patients/year for HCV10 patients/month for HBV), and the need to remove financial barriers and increase educational efforts

CLINICAL AND EPIDEMIOLOGICAL MANIFESTATION OF HEPATOCELLULAR CARCINOMA IN PATIENTS BELONGING TO ETHNIC GROUPS OF CAUCASIANS AND ASIANS OF NORTH-EAST ASIA

Aim. The current study is aimed at determining differences of epidemiological and clinical profiles associated with HCC in patients belonging to ethnic groups of Asians from Mongolia and Caucasians from Asian region of Russia. Materials and methods. The studies were carried out in the cross-border regions of Mongolia and Asian part of Russia (Irkutsk region). 300 patients with hepatocellular carcinoma (HCC) of the Caucasian and Mongolian races were enrolled in the study. The level of alpha-fetoprotein (AFP) in the serum was determined by the chemiluminescence technique. Results. The long-term dynamics of the HCC incidence shows more unfavourable trends in the territory of Mongolia compared to Irkutsk region. In both groups, male patients over 60 years of age predominated. Patients from Mongolia often have a history of jaundice and alcohol abuse. Out of the etiological factors, HCC is more often associated with the hepatitis B virus in Mongolia than in the Asian part of Russia. At the same time, in Caucasians, HCC develops primarily on the background of liver cirrhosis. In patients with HCC, AFP level higher than 20 ng / ml were significantly more frequent in the ethnic group of Caucasoids than in Mongoloids. Conclusions. Mongolia in terms of the incidence of HCC belongs to the hyperendemic regions of the world. In this country, among the risk factors for the development of the disease, hepatitis B virus plays a major role, which significantly differs from the Asian part of Russia. For the purpose of early diagnosis of HCC, it is necessary to search for new molecular markers or their combinations due to the insufficient diagnostic efficiency of AFP determination