Day 2 :
National Cancer Institute, Italy
Keynote: Hepatitis C virus (HCV) infection: A global epidemiology up-date of the circulation of HCV genotypes
Time : 09:05-09:45
Arnolfo Petruzziello is the Head of the Virology and Molecular Biology Unit of National Cancer Institute, IRCCS Fondazione G Pascale in Naples, Italy. He has completed his Post graduate degree in Microbiology and Virology and PhD in Molecular and Cellular Pathology, after having completed his Post doctoral studies at University Federico II of Naples he has published numerous research papers in peer-reviewed international journals and has extended his valuable service towards the scientific community with his extensive research work. He is also a Reviewer and Editorial Board Member of World Journal of Gastroenterology and Archives of Microbiology and Biotechnology.
Hepatitis C virus (HCV) is one of the major globally prevalent pathogen and one of the main leading causes of death and morbidity. The last estimates of disease burden showed an increase in seroprevalence over the last 15 years to 2.8%, equating to >185 million infections worldwide. Persistent HCV infection is associated with the development of liver cirrhosis, hepatocellular cancer, liver failure and death and is basically the most common cause of death in HIV-positive patients on highly active antiretroviral therapy. Previous and more recent studies have reported regional level prevalence estimates, but always considering a limited number of countries. This study represent one of the most comprehensive effort to quantify global HCV epidemiology, using the best available published data between 2000 and 2015 from 138 countries (about 90% of the global population), grouped in 20 geographical areas (with the exclusion of Oceania), as defined by the Global Burden of Diseases project (GBD). Total global HCV prevalence is estimated at 2.5% (177.5 millions of HCV infected adults), ranging from 2.9% in Africa and 1.3% in Americas with a global viremic rate of 67% (118.9 millions of HCV RNA positive cases), varying from 64.4% in Asia to 74.8% in Australasia. HCV genotype 1 is the most prevalent worldwide (49.1%), followed by genotype 3 (17.9%), 4 (16.8%) and 2 (11.0%). Genotypes 5 and 6 are responsible for the remaining <5%. While genotypes 1 and 3 are common worldwide, the largest proportion of genotypes 4 and 5 is in lower-income countries. A more precise knowledge of HCV genotype distribution will be helpful to best inform national healthcare models to improve access to new treatments.
Alaaeldin Ibrahim is currently working as a Consultant at Advanced Center for Day Care Surgery (ACDS), UAE. He has published numerous research papers and articles in reputed journals and has various other achievements in the related studies. He has extended his valuable service towards the scientific community with his extensive research work.
The word sepsis comes from Greek meaning ‘decay’ or ‘to putrefy’. Sepsis is an aftermath of the host micro-organism interaction. This interaction progresses through various levels, to ultimately culminate into multiple organ dysfunction syndrome. Systemic inflammatory response is the initial response to invasion by microorganism. The step wise progression includes infection by an organism, induction of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and finally, multiple organ system dysfunction. The annual incidence of sepsis is 300 in 100000 patients or 1 in 100 hospital admission for any cause. In cirrhosis, sepsis is present in 30 to 50% of hospital admissions. In hospital, 15 to 35% of cirrhosis patients develop nosocomial sepsis in comparison to 5 to 7% seen with general population. Down-regulation of monocytic human leukocyte antigen DR expression (mHLA-DR), impairment in antigen presentation, lower complement levels and macrophage dysfunction due to weal Fc receptor mediated bacterial clearance all impair immunity in liver disease. It has been shown that neutrophilic phagocytic activity and intracellular killing is decreased in patients of cirrhosis. The most common bacterial infection in cirrhosis is spontaneous bacterial peritonitis 20%, bacteremia and soft tissue infections (11-12%). (SBP, 25-30%) followed by genitourinary infections (UTI, 20 to 25%), pneumonia (15-20%). Around three fourths of infections in cirrhosis are related to Gram negative bacteria. Sepsis in cirrhotics portend grave prognosis. Even as science has grown vastly and understanding of sepsis has broadened, the mortality associated with this condition in cirrhosis is still quite high. In this lecture, a comprehensive discussion on emerging concepts in pathogenesis of sepsis in the light of cirrhosis has been made. The diagnosis and current cutting edge management of this fatal condition and future treatment modalities are discussed, so as to entertain a holistic management in the critically ill cirrhotic.