Search Results (1,519)

Background: Viral hepatitis B and C (HBV and HCV) pose significant public health concern in Nigeria, where access to healthcare and treatment affordability are limited. This study investigated sociodemographic and clinical predictors of health insurance coverage and access to care among patients with HBV and HCV in Nasarawa State, Nigeria. Methods: A cross-sectional facility-based study was conducted at two secondary hospitals in Nasarawa State, Nigeria. Participants included patients diagnosed with HBV, HCV, or both who were ≥18 years old. Data were collected using a structured questionnaire covering sociodemographic and clinical information, health insurance details, and economic impact. Binary logistic regression was used to analyze the relationship between sociodemographic/clinical factors and health insurance status. Results: Out of 303 participants, 68% had health insurance, which mostly covered hepatitis screening and vaccination. Significant predictors of health insurance coverage included being aged 36–40 years (adjusted odds ratio [aOR]: 11.01, 95% confidence interval [CI]: 2.38–50.89, p = 0.002), having post-secondary education (aOR: 25.2, 95% CI: 9.67–65.68, p < 0.001), being employed (aOR: 27.83, 95% CI: 8.85–87.58, p < 0.001), and being HIV-positive (aOR: 4.06, 95% CI: 1.55–10.61, p = 0.004). Nearly all those insured (99%) faced restrictions in insurance coverage for viral hepatitis services. Conclusions: This study reveals that while health insurance coverage is relatively high among viral hepatitis patients in Nasarawa State, significant restrictions hinder access to comprehensive services, especially for vulnerable groups like younger adults, the unemployed, and PLHIV. Key factors influencing coverage include age, education, employment, and HIV status. Expanding benefit packages to include viral hepatitis diagnosis and treatment, raising awareness about viral hepatitis as part of insurance strategy, improving access for underserved populations, and integrating hepatitis services into existing HIV programs with strong policy implementation monitoring frameworks are crucial to advancing universal health coverage and meeting the WHO’s 2030 elimination goals. Full article

Background: Osteoporosis and bone fractures affect health and quality of life. Since bone disease is multifactorial, identifying risk factors is key in prevention. There are multiple reports on how viral hepatitis, especially chronic hepatitis B (CHB) and chronic hepatitis C (CHC), are affecting bone disease, but results vary. Here, we analyzed the potential association between CHB/CHC and osteoporosis or bone fractures in a large outpatient cohort in Germany. Methods: We included 3136 outpatients with CHB and 15,608 matched non-hepatitis individuals as well as 2867 outpatients with CHC and 14,335 matched non-hepatitis individuals from the Disease Analyzer Database between 2005 and 2022. The main outcome was the 5-year cumulative incidence of osteoporosis and bone fractures as a function of either CHB or CHC. Results: Within 5 years of the index date, 2.9% vs. 1.6% of patients with and without CHB were diagnosed with osteoporosis (p = 0.001) and 1.0% vs. 0.4% were diagnosed with bone fractures (p < 0.001). Moreover, 3.3% of CHC patients and 2.2% of individuals without hepatitis C were diagnosed with osteoporosis (p = 0.002). In Cox regression analyses, CHB was significantly associated with an increased risk for osteoporosis (HR: 1.76) and fractures (HR:2.43) and CHC with osteoporosis (HR: 1.54). For both CHB and CHC, the association with osteoporosis was restricted to the female subgroup. Conclusions: CHB and CHC are associated with osteoporosis in women. CHB in male patients is associated with a higher risk of fractures. More research is needed to understand the underlying pathophysiological mechanisms. Full article

miR-122 is the most abundant microRNA (miRNA) in the liver; it regulates several genes mainly involved in cell metabolism and inflammation. Host factors, diet, metabolic disorders and viral infection promote the development of liver diseases, including hepatocellular carcinoma (HCC). The downregulation of miR-122 in tissue is a common feature of the progression of liver injury. In addition, the release of miR-122 in the bloodstream seems to be very promising for the early diagnosis of both viral and non-viral liver disease. Although controversial data are available on the role of circulating miR-122 as a single biomarker, high diagnostic accuracy has been observed using miR-122 in combination with other circulating miRNAs and/or proteins. This review is focused on comprehensively summarizing the most recent literature on the potential role of circulating miR-122, and related molecules, as biomarker(s) of metabolic liver diseases, hepatitis and HCC. Full article

Background: The combination of anti-angiogenic therapy and immune checkpoint inhibitors has revolutionized the management of unresectable hepatocellular carcinoma (uHCC). While an early-phase study demonstrated promising outcomes for lenvatinib plus pembrolizumab (L+P) in treating uHCC, the LEAP-002 trial did not meet its primary endpoint. However, the comparative efficacy between L+P and atezolizumab plus bevacizumab (A+B) as first-line treatment remains a topic of uncertainty. This study aimed to assess the effectiveness and safety of L+P in contrast to A+B among patients diagnosed with uHCC. Methods: We conducted a retrospective analysis of enrolled patients with uHCC who received L+P or A+B as initial systemic treatment at Chang Gung Memorial Hospital from June 2019 to December 2022. The overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR) by modified RECIST were compared. Results: 121 patients were recruited, with 37 receiving L+P and 84 receiving A+B. Among them, 95 (78.5%) patients were BCLC stage C, and 99 (81.8%) patients had viral etiology for HCC, predominantly chronic HBV (68.6%). Both the L+P and the A+B groups demonstrated comparable OS (18.2 months versus 14.6 months, p = 0.35) and PFS (7.3 months versus 8.9 months, p = 0.75). The ORR and DCR were similar. After propensity score matching, the results remained consistent between the matched patients. Treatment-related adverse events of any grade occurred in 30 (81.1%) in the L+P group and 62 (73.8%) in the A+B group. Conclusions: Our findings suggest that L+P and A+B exhibit comparable efficacy and safety profiles in real-world settings. Full article

Background/Objectives: Antibodies against the hepatitis B surface antigen (anti-HBs) are a marker of immunity against hepatitis B virus (HBV) infections. There is uncertainty about the anti-HBs seroprevalence in the general population of Austria. Methods: We conducted a cross-sectional analysis in blood donors from the Federal State of Tyrol in Austria (August–September 2023) to estimate anti-HBs seroprevalence and median antibody levels. Results: We enrolled 3935 blood donors (median age 47.6 years [25th–75th percentile: 33.3–56.6]; 40.7% female), who were hepatitis B surface antigen negative and had no detectable HBV-DNA. Overall seroprevalence was 51.4% (95% CI: 49.8–52.9%). Anti-HBs seropositivity decreased with higher age (p < 0.001), with 70.3% (66.1–74.3%) being seropositive among participants < 25 years of age and 30.2% (24.2–36.9%) in those aged ≥ 65 years. More females than males were seropositive (54.3% [51.8–56.7%] vs. 49.4% [47.4–51.4%]; p = 0.003). Seroprevalence was significantly higher in urban than in rural areas in participants aged 40 to <55 (p = 0.045) and ≥55 years (p = 0.001). Among 2022 seropositive participants, the overall median anti-HBs antibody level was 539.3 IU/L (25th–75th percentile: 116.3–5417.0). Furthermore, 5% of the participants had an anti-HBs antibody level between 10 and <20 IU/L, 18% between 20 and <100 IU/L, and 77% ≥100 IU/L. Conclusions: Anti-HBs seroprevalence in blood donors from Tyrol, Austria, was 51.4% between August and September 2023 and differed across age, sex, and residence area. Catch-up vaccination programs, especially targeting the elderly living in rural areas, are needed to close HBV immunity gaps. Full article

Objectives: This study aimed to evaluate the risk of hepatitis B virus reactivation (HBVr) in COVID-19 patients receiving immunosuppressive treatment, which has been insufficiently studied to date. Secondarily, we aimed to evaluate the seroprevalence of HBV infection in COVID-19 patients. Methods: We performed HBV screening on all Romanian adults hospitalized in four COVID-19 wards between October 2021 and September 2022. We enrolled patients with positive hepatitis B core antibody (anti-HBc) without protective hepatitis B surface antibody (anti-HBs), HBV treatment, or baseline immunosuppressive conditions, and we conducted a virological follow-up on these patients at 3 months. Results: We identified 333/835 (39.9%) anti-HBc-positive patients. Follow-up was performed for 13 patients with positive hepatitis B surface antigen (HBsAg) and 19 HBsAg-negative/anti-HBc-positive patients. Among those who received immunosuppressants, 4/23 (17.4%) patients experienced HBVr: 1 out of 8 (12.5%) HBsAg-positive patients (with 1.99 log increase in HBV DNA level) and 3 out of 15 (20%) HBsAg-negative/anti-HBc-positive patients (with a de novo detectable HBV DNA level). Conclusions: Administration of COVID-19 immunosuppressants may result in a significant risk of HBVr in co-infected patients. We recommend performing an HBV triple screen panel (HBsAg, anti-HBs, anti-HBc) for all COVID-19 patients receiving immunosuppressive treatment. HBV prophylaxis may be indicated in certain patients. Larger studies are needed in order to establish appropriate and cost-effective management for these patients. Full article

Accurate and efficient streamflow simulations are necessary for sustainable water management and conservation in arid and semi-arid contexts. Conceptual hydrological models often underperform in these catchments due to the high climatic variability and data scarcity, leading to unstable parameters and biased results. This study evaluates the stability of the HBV model across seven sub-catchments of the Oum Er Rabia river basin (OERB), focusing on the HBV model regionalization process and the effectiveness of Earth Observation data in enhancing predictive capability. Therefore, we developed a nested cross-validation framework for spatiotemporal stability assessment, using optimal parameters from a donor-single-site calibration (DSSC) to inform target-multi-site calibration (TMSC). The results show that the HBV model remains spatially transferable from one basin to another with moderate to high performances (KGE (0.1~0.9 NSE (0.5~0.8)). Furthermore, calibration using KGE improves model stability over NSE. Some parameter sets exhibit spatial instability, but inter-annual parameter behavior remains stable, indicating potential climate change impacts. Model performance declines over time (18–124%) with increasing dryness. As a conclusion, this study presents a framework for analyzing parameter stability in hydrological models and highlights the need for more research on spatial and temporal factors affecting hydrological response variability. Full article

It is heavily suggested that one IFNL4 gene polymorphism, rs12979860 (T/C), exerts influence on the outcome of HBV infection, with the rs12979860-T allele being classified as a risk predictor, and the rs12979860-C allele being classified as a protective one. This study investigated whether the rs12979860 IFNL4 gene polymorphism presented any association with the clinical severity for HBV carriers in an admixed population in Northern Brazil. A total of 69 samples were investigated from infected people from the city of Belém-Pará. The rs12979860-T allele was positively associated with HBV infection, suggesting a higher risk of chronicity. This research’s importance is that the polymorphism influence was investigated in a population of HBV carriers with a heterogeneous genetic profile, formed through the extensive admixture of different ethnic groups, including Europeans, Africans, and Natives with indigenous heritage. This analysis is particularly important since highly mixed populations do not always follow the same association patterns previously established by studies using populations classified as more genetically homogeneous, due to a different formation process. Full article

This study assesses the impact of climate change on streamflow characteristics in the Lualaba River Basin (LRB), an important yet ungauged watershed in the Congo River Basin. Two conceptual hydrological models, HBV-MTL and GR4J, were calibrated using the reanalysis datasets and outputs of Generalized Circulation Models (GCMs) under CMIP6 during the historical period. The hydrological models were fed with outputs of GCMs under shared socioeconomic pathways (SSPs) 2-45 and 5-85, moderate- and high-radiative future scenarios. The results demonstrate that hydrological models successfully simulate observed streamflow, but their performance varies significantly with the choice of climate data and model structure. Interannual streamflow (Q) percentiles (10, 50, 90) were used to describe flow conditions under future climate. Q10 is projected to increase by 33% under SSP2-45 and 44% under SSP5-85, suggesting higher flow conditions that are exceeded 90% of the time. Q50 is also expected to rise by almost the same rate. However, a considerably higher Q90 is projected to increase by 56% under the moderate- and 80% under the high-radiative scenario. These indicate the overall higher water availability in this watershed to be used for energy and food production and the need for flood risk management. Full article

Hepatitis delta virus (HDV) co-infections more often result in severe hepatitis compared to hepatitis B virus (HBV) infections alone. Despite a high HDV prevalence (7.1%), information regarding circulating HDV clades is very limited in Botswana. We extracted total nucleic acid from confirmed HDV-positive samples and quantified their viral load. We then sequenced the large hepatitis delta antigen (L-HDAg) using Oxford Nanopore Technology (ONT). Genotyping was performed using the HDV Database, and HDV mutation profiling was performed on AliView. All participants with HBV genotypic information belonged to sub-genotype A1, and 80% (4/5) of them had a higher HDV viral load and a lower HBV viral load. We sequenced 75% (9/12) of the HDV-positive samples, which belonged to HDV clade 8. A total of 54 mutations were discovered, with the most prevalent being Q148R (16%), D149P (16%) and G151D (16%). Known mutations such as S117A, K131R, R139K and G151D were detected, while the other mutations were novel. Our results reveal that HDV clade 8 is the predominant clade in Botswana. The significance of all mutations remains unclear. Future studies with a larger sample size to detect other HDV clades that might be circulating in Botswana and functionally characterize the detected mutations are warranted. Full article

This paper explores the application of conceptual hydrological models in optimizing the operation of hydroelectric power plants (HPPs) in steppe regions, a crucial aspect of promoting low-carbon energy solutions. The study aims to identify the most suitable conceptual hydrological model for predicting reservoir inflows from multiple catchments in a steppe region, where spring runoff dominates the annual water volume and requires careful consideration of snowfall. Two well-known conceptual models, HBV and GR6J-CemaNeige, which incorporate snow-melting processes, were evaluated. The research also investigated the best approach to preprocessing historical data to enhance model accuracy. Furthermore, the study emphasizes the importance of accurately defining low-water periods to ensure reliable HPP operation through more accurate inflow forecasting. A hypothesis was proposed to explore the relationship between atmospheric circulation and the definition of low-water periods; however, the findings did not support this hypothesis. Overall, the results suggest that combining the conceptual models under consideration can lead to more accurate forecasts, underscoring the need for integrated approaches in managing HPP reservoirs and promoting sustainable energy production. Full article

Hydropower is becoming an important renewable energy source in Turkey, but the ever-changing atmospheric and climatic conditions of Turkey make it very difficult to be projected efficiently. Thus, an efficient estimation technique is crucial for it to be adopted as a reliable energy source in the future. This study evaluates Turkey’s hydropower potential in the Euphrates–Tigris Basin under changing climatic conditions. We adapted an empirical equation to model reservoir outflows, considering the site-specific characteristics of 14 major dams. Initial results from employing a model with a constant empirical coefficient, α, yielded moderate predictive accuracy, with R² values ranging from 0.289 to 0.612. A polynomial regression identified optimal α values tailored to each dam’s surface area, significantly improving model performance. The adjusted α reduced predictive bias and increased R² values, enhancing forecast reliability. Seasonal analysis revealed distinct hydropower trends: Ataturk Dam showed a notable decrease of 5.5% in hydropower generation up to 2050, while Birecik and Keban Dams exhibited increases of 2.5% and 2.2%, respectively. By putting these discoveries into practice, water resource management may become more robust and sustainable, which is essential for meeting Turkey’s rising energy needs and preparing for future climatic challenges. This study contributes valuable insights for optimizing reservoir operations, ensuring long-term hydropower sustainability, and enhancing the resilience of water resource management systems globally. Full article

In this study, we explore the concept of symmetry as it applies to the dynamics of the Hepatitis B Virus (HBV) epidemic model. By incorporating symmetric principles in the stochastic model, we ensure that the control strategies derived are not only effective but also consistent across varying conditions, and ensure the reliability of our predictions. This paper presents a stochastic optimal control analysis of an HBV epidemic model, incorporating vaccination as a pivotal control measure. We formulate a stochastic model to capture the complex dynamics of HBV transmission and its progression to acute and chronic stages. By leveraging stochastic differential equations, we examine the model’s stationary distribution and asymptotic behavior, elucidating the impact of random perturbations on disease dynamics. Optimal control theory is employed to derive control strategies aimed at minimizing the disease burden and vaccination costs. Through rigorous numerical simulations using the fourth-order Runge–Kutta method, we demonstrate the efficacy of the proposed control measures. Our findings highlight the critical role of vaccination in controlling HBV spread and provide insights into the optimization of vaccination strategies under stochastic conditions. The symmetry within the proposed model equations allows for a balanced approach to analyzing both acute and chronic stages of HBV. Full article

Hepatitis B virus (HBV) infection remains a significant global health challenge, leading to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma (HCC). Covalently closed circular DNA (cccDNA) and integrated HBV DNA are pivotal in maintaining viral persistence. Recent advances in CRISPR/Cas technology offer innovative strategies to inhibit HBV by directly targeting both cccDNA and integrated HBV DNA or indirectly by degrading HBV RNAs or targeting host proteins. This review provides a comprehensive overview of the latest advancements in using CRISPR/Cas to inhibit HBV, with a special highlight on newer non-double-strand (non-DSB) break approaches. Beyond the canonical use of CRISPR/Cas for target inhibition, we discuss additional applications, including HBV diagnosis and developing models to understand cccDNA biology, highlighting the diverse use of this technology in the HBV field. Full article

Dental students are frequently exposed to percutaneous injuries (PCIs) due to the nature of their clinical work, which involves sharp instruments and close patient contact. The COVID-19 pandemic further emphasized the need for stringent biosafety measures and the use of personal protective equipment (PPE). Despite these precautions, injuries remain prevalent, highlighting the need for comprehensive education and training in biosafety and infection control. This study investigates the incidence and causes of injuries among undergraduate dental students during clinical sessions. This study was conducted at the Department of Dentistry, National and Kapodistrian University of Athens, focusing on injuries reported from 2021 to 2024. Data were collected through self-reported clinical records. The primary variables assessed included the type of injury, the instrument involved, the clinical procedure performed, and the immediate actions taken post-injury. Serological testing was conducted on students and patients to assess the risk of the transmission of bloodborne pathogens. The findings reveal a high prevalence of injuries, with needles being the most common cause (51.4%), followed by other tools such as dental probes (25.7%) and burs (8.6%). The most frequent injury type is piercing (74.2%), primarily affecting the fingers (88.6%). Periodontal treatments, restorative procedures, and endodontic treatments are the main activities leading to injuries, with 17.1% of injuries being caused by each. No statistically significant results are recorded. Despite regular medical records for most patients treated by injured students, serological testing shows significant positivity rates for HCV and HBV. Notably, most injured students demonstrate their commitment to safety by adhering to recommended post-exposure protocols, including wound cleaning, disinfecting, and serological testing. Furthermore, the impact of COVID-19 heightened the importance of personal protective equipment (PPE) and reinforced occupational health standards. Our study highlights the critical need for enhanced biosafety awareness and training among undergraduate dental students to reduce injury risks. Full article