2^nd International Conference on Hepatitis October 30-30, 2021 London, UK

Track 1: Types of Hepatitis

Hepatitis is defined as the clinical condition characterized by the inflammation of the liver. Hepatitis is commonly caused by virus hence named as viral hepatitis.  Other common causes include alcohol abuse, administrations of certain medications, accumulation of certain toxins, other auto immune disorders, and non-alcoholic steatohepatitis. Auto immune hepatitis is caused when the body’s immune system mistakes liver cells to foreign substance and attacks them. Hepatitis A, B and D can be prevented by the process of immunization. Whereas Hepatitis C should be provide with anti-viral drugs for the treatment. Medications to treat auto immune hepatitis include immune suppressants such as tacrolimus. Hepatitis A usually stays acute, whereas hepatitis B, C and D can turn to chronic conditions. Hepatitis E is said to be dangerous to pregnant women. Hepatitis virus don’t directly induce apoptosis rather infects them which activates the immune system.

• Hepatitis A
• Auto immune hepatitis
• Non- alcoholic steatohepatitis
• Hepatitis D
• Viral hepatitis
• Hepatitis E

Track 2: Epidemiology of Hepatitis

This hepatitis A infection is more dominantly seen in children between the ages 5-14 whatever it is rarely seen in infants. Apart from adults who exhibit serious clinical symptoms the children infected with the Hepatitis A shows mild symptoms only. However Hepatitis A infection is said to impose greater risk to some population groups such as persons suffering from clotting disorders, chronic liver dieses, and persons administering clotting factors. Hepatitis B is most common type of viral Hepatitis seen all over the world. Hepatitis B virus is predominantly found in East Asia, African and sub-Saharan regions. This Hepatitis B infection imposes more risk to persons with intravenous drug administrations, health care workers and people with abnormal sexual behaviour. Hepatitis C virus has less prevalence which can be 30% of the world population. This Hepatitis C viral infection can lead to serious conditions like hepatocellular carcinoma and cirrhosis. Hepatitis D virus spreads through the syringe needles and other mode of contact with the infected person. The geographical regions including United States and northern Europe are more prone to this infection. Hepatitis E spreads by weakening the immune system and is responsible for nearly 55,000 deaths per annum.

• Clotting disorders
• Chronic liver diseases
• Iatrogenic contamination
• Alcoholic hepatitis
• Non-alcoholic steatohepatitis

Track 3: Molecular Biology of Hepatitis A, B, C, D and E Viruses

Hepatitis A virus (HAV) belongs to the family Picornaviridae and genus Hepatovirus. It is usually spherical in shape and non-enveloped. HAV has a positive single stranded RNA which is enclosed inside a protein shell called as capsid. HAV is named as hepatogenous virus. It is said to have a poor internal ribosome entry site. Hepatitis B virus (HBV) belongs to the family of small DNA viruses. HBV undergoes replication in the hepatocytes of the host by reverse transcription of viral RNA. After the infection the virion DNA gets converted to nucleus and assembles to minichromosome forming a template for the viral mRNA synthesis. Hepatitis C virus (HCV) belongs to the genus Hepacivirus and the domestic Flaviviridae. HCV has an outermost covering of lipid membrane envelope. Two glycoproteins E1 and E2 are covalently embedded into the lipid membrane by means of the disulphide bridges. The genome of the HCV is positive sense single stranded RNA. E1 and E2 glycoproteins play a major role in the immune system interactions. Hepatitis D virus (HDV) is also called as hepatitis delta virus. It is spherical shaped enveloped virus. The genome of the HDV is negative sense single stranded closed and circular RNA.Hepatitis E is a single stranded RNA virus with a small envelope belonging to the family Hepeviridae.

• Internal ribosome entry site
• Capsid
• Hepatogenous
• Minichromosomes
• Liver cirrhosis

Track 4: Pathophysiology of Hepatitis

The underlying pathophysiology of hepatitis begins in the liver. There are different types of viruses that cause hepatitis namely hepatitis A, B, C, D and E. The pathway begins when the virus enters the blood stream and spreads to the liver. The viral hepatitis doesn’t induce the apoptosis directly. They infect the hepatocytes and replicate to increase their number. After the infection of the hepatocytes the body’s innate and adaptive immunity systems activates leading to the inflammatory responses followed by the cell damage and death. Depending on the immune strength of the individual this can progress into acute or chronic infection. In case of poor immunity of individual then multiple cycles of inflammation, injury occurs leading to the scarring or fibrosis and hepatocellular carcinoma. In the hepatitis infection the function of the natural killer cells (NK cells belonging to the same family as T and B cells) is disturbed.

• Natural killer cells
• Adaptive immunity
• Apoptosis
• Hepatic cirrhosis
• Inflammation

Track 5: Liver Diseases Diagnosis

Liver is said to be the largest gland which plays a major role in the detoxification process. To detect the liver diseases there are many available liver function tests. The test mainly focuses on the levels of liver enzymes such as alanine transaminase, aspartame transaminase, serum proteins, serum albumins, partial thromboplastin time. Liver biopsy is another technique used to detect the liver damage. In this method a small piece of liver is collected and examined for extent of damage. In condition of liver damage the levels of coagulating factors and the anticoagulation factors are less because the damaged liver cannot synthesize them like before. Imaging techniques such as transient elastography, magnetic resonance imaging can be used to detect liver tissues and bile ducts.      

• Aspartame transaminase
• Liver biopsy
• Magnetic resonance imaging
• Partial thromboplastin time
• Serum albumin

Track 6: Hepatitis Care

Hepatitis is defined as the clinical condition characterized by the inflammation of the liver. Hepatitis is commonly caused by virus hence named as viral hepatitis.  Other common causes include alcohol abuse, administrations of certain medications, accumulation of certain toxins, other auto immune disorders, and non-alcoholic steatohepatitis. Even after the recovery from hepatitis that person can suffer from serious health risks such as destruction of the liver tissues, hepatic failure, hepatocellular carcinoma and even death in some cases. Hepatitis infection can be treated but cannot be cured completely and hence care should be taken to prevent the infection from attacking. Hepatitis infection can be prevented by immunization with the hepatitis vaccine within the day the child is born. There are available vaccines for Hepatitis A and Hepatitis B but not for Hepatitis C. Based on the fact that the hepatitis D infection occurs only if the person is suffering from the Hepatitis B infection vaccinating with Hepatitis B can protect against Hepatitis D infection. There exists no vaccine for hepatitis which is FDA approved. The risk factors associated with the hepatitis include unprotected sex, poor nutrition, alcohol abuse, long term dialysis and poor sanititation. 

• Immunization
• Hepatocellular carcinoma
• Hepatitis B vaccine
• Food and Drug Administration
• Dialysis
• Non-alcoholic steatohepatitis

Track 7: Viral Hepatitis Management

During hepatitis infection a high calorie diet is required along with moderate physical activity. The important step in the management of hepatitis is the intake of correct drug with correct dosage and frequency. Hepatitis A does not progress into chronic condition and hence the management requires supportive treatment such as intravenous administration of fluid and nutrition. In most cases hepatitis B results into chronic state and hence drug treatment is mandatory. The drugs used for the treatment of hepatitis B include interferon alpha, Pegylated interferon, Lamivudine, Adefovir dipivoxi, Telbivudine and Tenofovir. The drugs used in the management of hepatitis C include telaprevir, boceprevir, dasabuvir. The treatment of hepatitis D is difficult and lacks specific anti-viral drugs. The management of Hepatitis E includes bed rest along with supplementation of proper nutrition.

• Intravenous administration
• Lamivudine
• Tenofovir
• Telbivudine
• Pegylated interferon

 

Track 8: Liver Transplantation and Surgery

Liver transplantation can also be called as hepatic transplantation. It is a surgery that replaces the injured or diseased liver with a healthy liver of another donor person. It is a suggestive option for irreversible and severe liver dysfunction.  The liver transplantation has a greater risk of graft rejection, biliary and vascular complications. The technique of liver transplantation includes the following steps of cooling, hepatic transplantation followed by post-transplant immunosuppression. However this hepatic transplantation is contraindicated in people with

• Dyslipidemia
• Cardiac failure
• Person with advanced hepatic cancer
• HIV infected patient
• Alcohol abuse

 

Track 9: Herbal Medicines for Liver Diseases

Besides the standard treatments used for the management of hepatitis many people choose to turn to alternative therapies such as herbal medications. It was found that around 65% of population facing liver diseases use herbal supplements. Now a day’s many herbal formulations are available in the market to increase the liver health. The top 5 herbs that are used to treat liver diseases are Silymarin which is also known as milk thistle, Ginseng, Green tea, Licorice (Glycyrrhizin), Turmeric, Garlic and Danshen. Phyllanthus is another herb that is used to treat liver diseases. It has fewer side effects and has a positive clearance towards hepatitis B virus. Stronger neominophagen is a Japanese formulation that is believed to increase the liver health. Its formulation includes 0.2% Licorice, 0.1% cysteine, and 2% glyceine. Liv 52 is and ayurvedic formulation which shows hepato protective property.

• Neominophagen
• Danshen
• Phyllanthus
• Silymarin
• Glycyrrhizin

Track 10: Hepatocellular Carcinoma

Liver is an organ that plays a major role in the detoxification, synthesizing of proteins and biochemical agents that are necessary for growth and digestion. The primary cells present in the liver are called as hepatocytes and the cancer developed at that site is named as hepatocellular cancer. This hepatic cancer is of two types. Primary hepatic malignancy starts developing in the liver whereas secondary hepatic malignancy starts developing in other parts of the body and spreads to the liver. The risk factors of hepatic cancer are cirrhosis, aflatoxin, obesity, smoking, alcohol abuse and genetic conditions. The most commonly seen hepatic cancer is hepatocellular cancer. Other types of cancers include

• Hepatoblastoma
• Intrahepatic cholangiocarcinoma
• Angiosarcoma
• Hemangiosarcoma

Track 11: Hepatorenal Syndrome (HRS)

Hepatorenal syndrome is a life threatening clinical condition characterized by worsening of renal functioning. It is fatal condition without the liver transplant surgery. Renal dialysis can prevent progression of this condition. The main causes of hepatorenal syndrome include cirrhosis, liver dysfunction, over usage of diuretics. Hepatorenal syndrome is of two types.  Type 1 HRS progressively reduces the renal functioning whereas type 2 HRS is associated with the accumulation of fluid in the abdomen. HRS can be diagnosed by the conditions such as haematuria, proteinuria. The common symptoms of HRS include

• Abnormalities in circulation
• Hepatic dysfunction
• Jaundice
• Altered mental status
• Oliguria
• Ascites

Track 12: Cirrhosis

Cirrhosis is defined as a chronic clinical condition which is characterized by rapid degeneration and thickening of hepatic cells. The underlying pathophysiology of cirrhosis includes replacement of normal hepatic parenchyma with the scar tissue. This scar tissue intern results in interruption to normal blood flow through liver. This leads to increase in blood pressure there by leading to damage to the tissue. There is no persistent cure for cirrhosis but preventing the further damage of liver is important. Liver transplant can be an ideal option to treat cirrhosis but donor availability is a big limitation for this method. Some important complication includes hepatic encephalopathy, hepatorenal syndrome and bacterial infections.  The common symptoms of cirrhosis include

• Anorexia
• Fatigue
• Accumulation of bilirubin leading to jaundice
• Weakness
• Nausea
• Weight loss
• Bleeding or bruising

Track 13: Gastroenterology

Gastroenterology is the branch of medicine that deals with the functioning of the digestive system and its related disorders. In the humans the alimentary canal begins from the mouth and ends with the posterior opening the anus. Physicians who practice in this field are called as Gastroenterologists and they focus on the diagnostic and therapeutic procedures related to the alimentary canal. This branch deals with the total understanding of the physiology of the GI organs including the motility of ingested food, its digestion, absorption and elimination. The common disorders dealt by the Gastroenterologists include Bowel syndrome (IBS), pancreatitis, gastroesophageal reflux (GERD) , gallbladder and biliary tract infections, colon polyps, hepatocellular carcinoma, hypochlorhydria, peptic ulcers, lactose intolerance, Celiac disease, crohn’s disease and constipation.

• Irritable bowel syndrome
• Liver
• Gall bladder
• Pancreatitis
• Celiac disease
• Alimentary canal

Track 14: Pancreatic Diseases       

Pancreas is said to be second largest gland in the human body. It is a mixed gland which has both exocrine and endocrine functions. The exocrine function of the pancreas includes digestion by secreting digestive enzymes whereas the endocrine function includes secretion of the hormones. Pancreas is also called as the ductless glands since they secrete their products directly into the blood. The beta cells of the pancreas are responsible for the secretion of the insulin hormone which play a major role in the balancing the blood sugar levels. Diseases related to the pancreas can affect the entire human body. The most commonly seen pancreatic diseases include pancreatitis which is referred to the inflammation of the pancreas which left untreated may result in the onset of diabetes. Other common pancreatic diseases include

• Pancreatic cancer
• Diabetes mellitus
• Pancreas malfunction
• Cystic fibrosis
• Intraductal Papillary Mucinous Neoplasm (IPMN)
• Exocrine pancreatic insufficiency
• Hemosuccus pancreaticus
• Pseudocysts

Track 15: COVID-19 and Corona Viral Hepatitis

COVID-19 is an infectious disease which is caused by severe acute respiratory syndrome coronavirus 2 viral strain (SARS-CoV-2). This infection has been connected to mild to moderate liver injury by exhibiting elevated levels of bilirubin, prothrombin and other liver enzymes. Many studies had revealed those patients with chronic liver diseases like hepatitis viruses (HBV, HCV, HDV and HEV) and other hepatic infections are more vulnerable to COVID-19 infection and may show severe health issues from acute respiratory distress syndrome in comparison to other ill patients. SARS-CoV-2 is also said to cause viral hepatitis by inducing disturbances in the innate immune responses.

• COVID-19
• Liver enzymes
• Acute respiratory distress
• SARS-CoV-2
• Innate immune response

Track 16: Recent Advances in the Viral Hepatitis C Treatment

Till now few drugs are available for the treatment of hepatitis C disease. But now newer drug category is included which are direct acting antiviral agents. The mechanism of action of direct acting anti-viral drugs is they are the protein molecules that target specific stages in the hepatitis C virus lifecycle and disturbs the viral replication process there by inhibiting the infection. The drugs included under this category include

• Sofosbuvir
• Ledipasvir
• Simeprevir
• Daclatasvir
• Paritaprevir/Ritonavir/Ombitasvir plus Dasabuvir
• Elbasvir/Grazoprevir