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Hepatitis E virus is a leading cause of acute-on-chronic liver disease:experience from a tertiary centre in Bangladesh

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Hepatobiliary & Pancreatic Diseases International 2009年第1期8卷 50-52页

作者： Mamun-Al Mahtab salimur rahman Mobin Khan Md.Fazal Karim Department of Hepatology Bangabandhu Sheikh Mujib Medical University

BACKGRoUND:Acute-on-chronic liver failure(ACLF) is common in *** viral E hepatitis is sporadically encountered in this country each year,with a rising incidence in the rainy *** study aimed to identify the etiology of ACLF in Bangladesh. METHoDS:In this retrospective study,69 ACLF patients were *** presented to our department at the Bangabandhu Sheikh Mujib Medical University in *** of diseases was recorded and appropriate investigations were conducted in all patients. RESULTS:Acute hepatitis E virus(HEV)infection was positive in 21.7%(15/69)of the patients,while 14.5% (10/69)had *** gastrointestinal tract hemorrhage was seen in 4.3%of the patients(3/69),while another 4.3%(3/69)had a positive history for alcohol or *** of the patients tested positive for hepatitis A virus infection and no evidence of hepatitis B virus flare was found in any *** specific cause for ACLF could be identified. CoNCLUSIoNS:Acute HEV infection is a leading cause of ACLF in *** patients were thought to have decompensation of cirrhosis,but subsequently were recognized as having ACLF by a retrospective review according to the definition of the Asian Pacific Association for the Study of the Liver Working Party Meeting on ACLF in New Delhi in early 2008.

关键词： acute-on-chronic liver failure hepatitis E virus septicemia

Urinary nuclear magnetic resonance spectroscopy of a Bangladeshi cohort with hepatitis-B hepatocellular carcinoma: A biomarker corroboration study

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World Journal of Gastroenterology 2016年第16期22卷 4191-4200页

作者： I Jane Cox Abil E Aliev Mary ME Crossey Mahvish Dawood Mamun Al-Mahtab Sheikh M Akbar salimur rahman.an.on.o riva Roger Williams Simon D Taylor-Robinson Institute of Hepatology London Foundation for Liver Research Department of Chemistry University College London Division of Digestive Diseases Department of Surgery and Cancer Imperial College London Department of Hepatology Bangabandhu Sheikh Mujib Medical University Department of Medical Sciences Toshiba General Hospital

AIM: To establish if a distinct urinary metabolic profile could be identified in Bangladeshi hepatitis-B hepatocellular carcinoma (HCC) patients compared to cirrhosis patients and ***: Urine samples from 42 Bangladeshi patients with HCC (39 patients with hepatitis-B HCC), 47 with cirrhosis on a background of hepatitis B, 46 with chronic hepatitis B, and seven ethnically-matched healthy controls were analyzed using nuclear magnetic resonance (NMR) spectroscopy. A full dietary and medication history was recorded for each subject. The urinary NMR data were analyzed using principal component analysis (PCA) and orthogonal partial least squared discriminant analysis (oPLS-DA) techniques. Differences in relative signal levels of the most discriminatory metabolites identified by PCA and oPLS-DA were compared between subject groups using an independent samples Kruskal-Wallis one-way analysis of variance (ANoVA) test with all pairwise multiple comparisons. Within the patient subgroups, the Mann-Whitney U test was used to compare metabolite levels depending on hepatitis B e-antigen (HBeAg) status and treatment with anti-viral therapy. A Benjamini-Hochberg adjustment was applied to acquire the level of significance for multiple testing, with a declared level of statistical significance of P ody mass index (P oss the four clinical subgroups. Serum alanine aminotransferase (ALT) was significantly higher in the HCC group compared to controls (P oprotein was generally markedly elevated in HCC compared to controls; and serum creatinine levels were significantly reduced in the HCC group compared to the cirrhosis group (P = 0.004). A three-factor PCA scores plot showed clustering of the urinary NMR spectra from the four subgroups. Metabolites that contributed to the discrimination between the subgr

关键词： Urinary metabolic profiling Hepatocellular carcinoma Nuclear magnetic resonance spectroscopy Hepatitis B Bangladesh

Etiology of fulminant hepatic failure:experience from a tertiary hospital in Bangladesh

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Hepatobiliary & Pancreatic Diseases International 2008年第2期7卷 161-164页

作者： Mamun-Al Mahtab salimur rahman Mobin Khan Ayub Al Mamun Shahrin Afroz Department of Hepatology Bangabandhu Sheikh Mujib Medical University DhakaBangladesh Department of Medicine Bangladesh Medical College HospitalDhakaBangladesh

BACKGRoUND: Fulminant hepatic failure (FHF) is not uncommon in our clinical practice in Bangladesh. There was a rise in acute hepatitis E virus (HEV) in Bangladesh after the 2004 floods. At that time, most of the country was under water for more than a month, leading to sewage contamination of the water supply. The aim of this study was to investigate the etiology of FHF in Bangladesh. METHoDS: In this retrospective study, 23 patients with FHF who presented with severe impairment of hepato- cellular function (i.e. encephalopathy, coagulopathy and jaundice) within 6 months of onset of symptoms were included. There were 17 men and 6 women, aged from 18 to 32 years. Four of the women were pregnant. Patients were tested for markers for common hepatotrophic viruses. A relevant history was taken and the Patient Record Book of the Unit was reviewed. RESULTS: 56.52% patients (13/23) had HEV infection, and all were anti-HEV IgM-positive tested by ELISA. HBV infection was detected in 34.78% patients (8/23), all of whom were tested positive for either HBsAg or anti-HBs IgM by ELISA. 8.7% patients (2/23) had a positive history for intake of alcohol and/or drugs. CoNCLUSIoNS: Acute HEV infection is the leading cause of FHF in Bangladesh. Sewage contamination of the water supply following floods contributes to a higher incidence of HEV infection. HBV infection is also important.

关键词： hepatitis E virus fulminant hepatic failure flood

Epidemiology of hepatitis B virus in Bangladeshi general population

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Hepatobiliary & Pancreatic Diseases International 2008年第6期7卷 595-600页

作者： Mamun-Al Mahtab salimur rahman Md.Fazal Karim Mobin Khan Graham Foster Susannah Solaiman Shahrin Afroz Department of Hepatology Bangabandhu Sheikh Mujib Medical University Digestive Diseases Research Centre Bart's and the London Queen Mary's School of Medicine and Dentistry Department of Gastroenterology Bangabandhu Sheikh Mujib Medical University

BACKGRoUND:Hepatitis B virus(HBV)is encountered sporadically the year round in *** results in a wide range of liver diseases,with asymptomatic acute hepatitis at one end to hepatocellular carcinoma(HCC)at the other end of the spectrum. METHoDS:All 1018 individuals of different age groups and sex with varied religious,educational and social backgrounds were tested for HBsAg by *** positive samples were further tested by ELISA for *** testing,blood samples were preserved at-20℃.The study was conducted in a semi-urban location on the outskirts of Dhaka. RESULTS:of the 1018 individuals,5.5%tested positive for *** were tested positive for *** the HBsAg-positive population,58.93%were HBeAg- positive and the rest 41.07%*** was a male predominance and those who were tested positive were mostly between 16 and 50 years of *** risk factors for exposure to HBV appeared to be injudicious use of injectable medications,treatment by unqualified, traditional practitioners,mass-vaccination against cholera and smallpox,barbers and body piercing. CoNCLUSIoN:HBV remains a major cause of morbidity and mortality in Bangladesh and we have a long way to go before we may bid farewell to this deadly menace.

关键词： hepatitis B virus prevalence general population Banglandesh

Viral load speaks little about toll on liver

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Hepatobiliary & Pancreatic Diseases International 2007年第5期6卷 483-486页

作者： Mamun-Al Mahtab salimur rahman Mobin Khan Md Kamal Ayub Al Mamun Md Fazal Karim Department of Hepatology Bangabandhu Sheikh Mujib Medical University DhakaBangladesh Department of Pathology Bangabandhu Sheikh Mujib Medical University DhakaBangladesh

BACKGRoUND:Bangladesh is situated in the intermediate prevalence region of hepatitis B virus (HBV).The lifetime risk of acquiring HBV infection in Bangladesh is greater than 40%.It has been estimated that this virus is responsible for 10%-35%cases of acute viral hepatitis,35.7%cases of fulminant hepatic failure, 33.3%-40.5%cases of chronic hepatitis and 46.8%cases of hepatocellular carcinoma in *** aim of this study is to compare the correlation between HBV DNA load and grade and stage of liver disease in patients with chronic hepatitis B(CHB). METHoDS:Percutaneous liver biopsies done in 159 CHB patients revealed 62.9%(100 patients)had wild type HBV infection and the rest 37.1%(59)had pre-core/core promoter mutant HBV *** DNA load was measured using PCR in all patients. RESULTS:In the wild type CHB group,97%(97 patients) had moderate to high HBV DNA load and 3%(3)had low to moderate HBV *** the pre-core/core promoter mutant group,74.6%(44 patients)had moderate to high HBV DNA and the rest 25.4%(15)had low to moderate HBV *** patients with moderate to high HBV DNA of the patients with wild type CHB,78.4%(76 patients) had minimal to mild chronic hepatitis(HAI-NI 0-8)and 21.6%(21)had moderate to severe chronic hepatitis(HAI- NI 9-18).66.6%(2 patients)and 33.3%(1)patients with low to moderate HBV DNA load had minimal to mild and moderate to severe chronic hepatitis *** the moderate to high HBV DNA group,77.3%(75 patients) patients had minimal to moderate fibrosis(HAI-F 0-2)and 22.7%(22)(HAI-F 3-4)had severe fibrosis to *** figures were 33.3%(1 patient)and 66.6% (2)respectively in the patients with low to moderate HBV DNA *** the other hand in case of patients with pre-core/core promoter mutant type CHB,in the moderate to high HBV DNA group,79.5%(35 patients)had minimal to mild chronic hepatitis(HAI-NI 0-8)and 20.5%(9)had moderate to severe chronic hepatitis(HAI-NI 9-18).93.3% (14)and 6.7%(1)patients with low to mod

关键词： HBV DNA chronic hepatitis B hepatic necro-inflammation hepatic fibrosis

Dubin-Johnson syndrome with systemic lupus erythematosus: a case report

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Hepatobiliary & Pancreatic Diseases International 2006年第4期5卷 617-619页

作者： Mamun-Al Mahtab Md. Fazal Karim salimur rahman Abul Barkat Muhammad Adnan Department of Hepatology Bangabandhu Sheikh Mujib Medical University Dhaka Bangladesh

BACKGRoUND: Dubin-Johnson syndrome (DJS) is a rare clinical entity. We describe a case of DJS complicated by systemic lupus erythematosus (SLE). METHoDS: A case of congenital hyperbilirubinemia with SLE was evaluated systematically including review of history, physical examination for the stigmata of chronic liver disease, and other investigations. RESULT: Liver biopsy revealed a black liver with preserved architecture suggestive of DJS. CoNCLUSIoNS: SLE may develop in DJS. The relationship between DJS and SLE in this case is most likely a chance occurrence.

关键词： Dubin-Johnson syndrome systemic lupus erythematosus conjugated hyperbilirubinemia autoimmune disorder chance occurrence

Early termination of immune tolerance state of hepatitis B virus infection explains liver damage

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World Journal of Hepatology 2014年第8期6卷 621-625页

作者： Mamun-Al-Mahtab Sheikh Mohammad Fazle Akbar Helal Uddin Sakirul Islam Khan salimur rahman Department of Hepa-tology Bangabandhu Sheikh Mujib Medical University Dhaka 1000 Bangladesh Department of Medical Sci-ences Toshiba General Hospital Tokyo140-0013 Japan Clinical Research organization Dhaka 1213 Ban-gladesh Department of Anatomy and Embryol-ogy Ehime University Graduate School of Medicine Ehime 791-0295 Japan

AIM: To assess an early termination of immune toler-ance state of chronic hepatitis B virus infection in Ban-gladesh and its clinical significance. METHoDS: From a series of 167 treatment-naive chronic hepatitis B patients aged between 12 to 20 years(mean ± SD; 17.5 ± 2.8 years), percutaneous liver biopsies of 89 patients who were all hepatitis B e antigen negative at presentation were done. of them, 81 were included in the study. They had persistently normal or raised serum alanine aminotransferase(ALT) values. A precore mutation(PCM) study was accom-plished in 8 patients who were randomly selected. RESULTS: Forty-four(53.7%) patients had significant necroinflammation(HAI-NI > 7), while significant fi-brosis(HAI-F ≥ 3) was seen in 15(18.5%) patients. Serum ALT(cut off 42 U/L) was raised in 29(35.8%) patients, while low HBV DNA load(opies/mL)was observed in 57(70.4%) patients. PCM was nega-tive in all 8 patients. CoNCLUSIoN: This study indicates that the current concept of age-related immune tolerance state of HBV infection deserves further analyses in different popula-tion groups.

关键词： Chronic hepatitis B Immune tolerance Early termination