Introduction. As reported by the World Health Organization (WHO), annually, there are 1.5 million new infections, with more than 290 million people living with chronic hepatitis B diseases in 2019. Medical students (MSs), a subgroup of health care workers (HCWs), are at high occupational risk for HBV infection since HCWs have a 2–10 times greater risk of getting the virus than the general population. Therefore, they must have a broad understanding of hepatitis B infection. In this study, we aimed to assess the level of knowledge, attitude, and practices among MSs, and to explore its predictors. Methodology. A descriptive cross-sectional research was done among MSs, those who finished their infectious disease course. MSs were asked to participate in a self-administered online-structured questionnaire. Results. 612 MSs were enrolled in our study. 67.5% were females, and 36.9% were in their 6th year. Around half of the participants held a high level of knowledge, attitude, and practices toward HBV infection. MSs in the last year of the study who encountered HBV patients showed to have better knowledge. Male MSs who encountered HBV patients and took extra HBV courses showed better attitudes. High practice level among MSs was associated with being in the 6th year and taking extra HBV courses. Conclusions. This study demonstrated a satisfactory level of knowledge, attitude, and practices toward HBV infection among MSs. However, awareness must be enhanced in some areas especially transmission routes of HBV. Thus, it will strengthen the level of attitude and practices to omit the effect of the stigma while delivering care to HBV patients.

Nader Alaridah

Raba’a F. Jarrar

Rayan M. Joudeh

Haneen Al-Abdallat

Layan Ismail

Zaina Alnajjar

Mohammad Jum’ah

Anas Haidar Abu-Humaidan

Knowledge Gaps and Determination of Attitude and Practice among Medical Students toward Hepatitis B Infection: A Nationwide Cross-Sectional Study

We aimed to analyze the different patient characteristics and treatment outcomes (such as sustained viral response, SVR) between incarcerated patients with chronic hepatitis C (CHC) and those with CHC from the outpatient department through an on-site integrated screening and microelimination program in a detection center. In this retrospective study, which ran from May 2021 to April 2022, we included 32 consenting male prisoners aged at least 20 years who were willing to participate in the study. Members of the control group (who received DAAs in an outpatient setting) were selected from the treated CHC patient databank of individuals who received DAA regimens at Chi Mei Hospital between January 2021 and December 2022. The patients in the two groups did not differ significantly in terms of age, FIB-4 score, HCV RNA, HBV coinfection, hemogram findings, coagulation profiles, and renal function tests. However, the patients in the incarcerated group had a significantly different genotype distribution compared to the control group, significantly lower liver enzyme levels, and higher albumin and bilirubin levels compared to those in the control group. The rate of SVR to DAA treatment obtained among incarcerated patients did not differ significantly from that obtained among patients in the control group. Loss to follow-up (for several reasons) is a major reason for treatment discontinuation among these patients.

Hsuan-Yuan Chang

Su-Hung Wang

Hsing-Tao Kuo

Ming-Jen Sheu

I-Che Feng

Chung-Han Ho

Jui-Yi Chen

Chi-Shu Sun

Chi-Hsing Chen

Cheng-Yi Lin

Chun-Chi Yang

The Efficacy of On-Site Integration Screening and Microelimination Programs for Chronic Hepatitis C in a Detection Center: A Comparison of the Treatment Outcomes and Characteristics of Incarcerated Patients and Outpatients

Background. In spite of the scientific evidence supporting health advantages of mushrooms, some of them are seriously poisonous. The clinical picture of mushroom intoxication ranges from minor gastrointestinal symptoms to organ failure, such as liver failure and death. Method. We provided demographics, clinicopathological characteristics, applied treatments, and outcomes of mushroom poisoning by Lepiota species in a series of 18 cases that were referred from Kermanshah and Lorestan provinces to Abu-Ali-Sina Hospital, Shiraz, Iran. Clinical and paraclinical data were collected by taking history and reviewing of medical documents. Pathologic findings were extracted through a review of hematoxylin and eosin pathologic slides. Results. The patients were between the ages of 18 and 67 years, composed of ten females and eight males. The most frequent clinical manifestations were nausea and vomiting followed by abdominal pain. Four cases presented decreased consciousness on admission. One of them passed away. Three other cases underwent liver transplantation, two of them died after transplantation, and one fully recovered without any major issues. All instances had elevated ALT levels, which ranged from 44 to 9,140 IU/L (mean: <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="35.498pt" style="vertical-align:-0.3499298pt" id="M1" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 35.498 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,12.48,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.013,0,0,-0.013,18.72,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.013,0,0,-0.013,27.867,0)"><path id="g117-37" d="M535 290V340H323V533H265V340H52V290H265V84H323V290H535ZM535 -22V28H52V-22H535Z"/></g></svg><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.273pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="38.3541838 -8.34882 25.273 8.69875"><g transform="matrix(.013,0,0,-0.013,38.404,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,44.644,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,50.884,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,57.126,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g></svg>), with most of them also having concurrent AST elevations (mean: <svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="40.64pt" style="vertical-align:-1.57651pt" id="M2" height="9.92533pt" version="1.1" viewBox="-0.0498162 -8.34882 40.64 9.92533"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-45" d="M95 130C70 130 46 113 46 88C46 72 54 64 59 64C93 55 121 33 121 -3C121 -41 93 -68 44 -88L55 -117C117 -98 186 -56 186 22C186 91 131 130 95 130Z"/></g><g transform="matrix(.013,0,0,-0.013,11.383,0)"><use xlink:href="#g113-52"/></g><g transform="matrix(.013,0,0,-0.013,17.623,0)"><use xlink:href="#g113-55"/></g><g transform="matrix(.013,0,0,-0.013,23.864,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,33.009,0)"><use xlink:href="#g117-37"/></g></svg><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="30.44pt" style="vertical-align:-1.57651pt" height="9.92533pt" version="1.1" viewBox="43.4961838 -8.34882 30.44 9.92533"><g transform="matrix(.013,0,0,-0.013,43.546,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,49.786,0)"><use xlink:href="#g113-45"/></g><g transform="matrix(.013,0,0,-0.013,54.929,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.013,0,0,-0.013,61.169,0)"><use xlink:href="#g113-52"/></g><g transform="matrix(.013,0,0,-0.013,67.409,0)"><use xlink:href="#g113-51"/></g></svg>). Only few patients had modest elevations in alkaline phosphatase. Total and direct bilirubin elevations up to 47.6 and 24 mg/dL, respectively, were found in most cases. Decreased total protein and albumin concentrations and increased BUN and creatinine levels were observed in some patients. In addition, some instances revealed increased LDH, increased WBC, decreased hemoglobin, and decreased platelet count. Most patients had increased prothrombin time; hematuria and positive stool occult blood were observed in few patients. Histopathologic examination of three explanted livers revealed massive necrosis with moderate to severe macrovesicular steatosis, significant ductular reaction, and parenchymal inflammation. Other patients followed a recovery process with a considerable drop in liver enzymes, especially ALT, during hospitalization utilizing conservative treatment. They had no liver problems or relevant issues after a two-year follow-up. Conclusion. In our study, highly elevated liver enzymes with a significantly high ALT/AST ratio were observed in cases of mushroom poisoning by Lepiota species, leading to fulminant liver failure and death in some cases. These laboratory findings were correlated with liver necrosis and macrovesicular steatosis in explanted livers.

Mohammad Hossein Anbardar

Neda Soleimani

Kourosh Kazemi

Zahra Jafarpour

Mahsa Hasani

Sahand Mohammadzadeh

Parnia Torfehnezhad

Sedighe Jafarian

Mahsa Farhadi

Mina Salari Sardari

Severe Hepatotoxicity in Mushroom Poisoning by Lepiota brunneoincarnata from Complete Recovery to Liver Transplantation: A Case Series with Review on Liver Function Tests and Liver Histopathology

Background and Aims. Nonalcoholic fatty liver disease is the leading cause of chronic liver disease globally and can progress to cirrhosis, liver failure, and liver cancer. Current AASLD, AGA, and ADA guidelines recommend assessment for liver fibrosis in all patients with NAFLD. Serum biomarkers for fibrosis, while widely available, have notable limitations. Imaging-based noninvasive testing for liver fibrosis/cirrhosis is more accurate and is becoming more widespread. Methods. We evaluated the feasibility of a novel shear wave absolute vibroelastography (S-WAVE) modality called Velacur® for assessing liver stiffness measurement (LSM) for fibrosis and attenuation coefficient estimation (ACE) in differentiating patients with chronic liver disease from normal healthy controls. Results. Fifty-four healthy controls and 89 patients with NAFLD or cured HCV with a prior known LSM of >8 kPa were enrolled, and all subjects were evaluated with FibroScan® and Velacur®. Velacur® was able to discriminate patients with increased liver stiffness as determined by a FibroScan® score of >8 kPa from healthy controls with an AUC of 0.938 (0.88-0.96). For assessment of steatosis in NAFLD patients only, Velacur® could identify patients with steatosis from healthy controls with an AUC of 0.831 (0.777-0.880). The Velacur® scan quality assessment was superior in healthy controls, as compared to patients, and the scan quality, as assessed by the quality factor (QF) and interquartile range (IQR)/median, was affected by BMI. Velacur® was safe and well tolerated by patients, and there were no adverse events. Conclusion. Velacur® assessment of liver stiffness measurement and liver attenuation is comparable to results obtained by FibroScan® and is an alternative technology for monitoring liver fibrosis progression in patients with chronic liver disease. This trial is registered with <a target="_blank" href="https://classic.clinicaltrials.gov/ct2/show/NCT03957070">NCT03957070</a>.

Michael P. Curry

Edward Tam

Caitlin Schneider

Noha Abdelgelil

Tarek Hassanien

Nezam H. Afdhal

The Use of Noninvasive Velacur® for Discriminating between Volunteers and Patients with Chronic Liver Disease: A Feasibility Study

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International Journal of Hepatology publishes research related to medical, surgical, pathological, biochemical, and physiological aspects of hepatology and management of disorders affecting the liver, gallbladder, biliary tree and pancreas.

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International Journal of Hepatology publishes research related to medical, surgical, pathological, biochemical, and physiological aspects of hepatology and management of disorders affecting the liver, gallbladder, biliary tree and pancreas.

International Journal of Hepatology