Chronic hepatitis B is caused by persistent infection with the hepatitis B virus (HBV), a unique DNA virus that replicates through an RNA intermediate produced from a stable covalently closed circular DNA molecule. Viral persistence appears to be due to inadequate innate and adaptive immune responses. Chronic infection has a variable course after several decades resulting in cirrhosis in up to one‐third of patients and liver cancer in a proportion of those with cirrhosis. Sensitive assays for HBV DNA levels in serum have been developed that provide important insights into pathogenesis and natural history. Therapy of hepatitis B is evolving. Peginterferon induces long‐term remissions in disease in one‐third of patients with typical hepatitis B e antigen (HBeAg) positive chronic hepatitis B, but a lesser proportion of those without HBeAg. Several oral nucleoside analogues with activity against HBV have been shown to be effective in suppressing viral levels and improving biochemical and histological features of disease in a high proportion of patients with and without HBeAg, at least in the short term. What is uncertain is which agent or combination of agents is most effective, how long therapy should last, and which criteria should be used to start, continue, switch or stop therapy. Long‐term therapy with nucleoside analogues may be the most appropriate approach to treatment, but the expense and lack of data on long‐term safety and efficacy make recommendations difficult. Clearly, many basic and clinical research challenges remain in defining optimal means of management of chronic hepatitis B. (HEPATOLOGY 2007;45:1056–1075.)

Management of hepatitis B: Summary of a clinical research workshop Potential conflict of interest: Dr. Lok is a consultant and received grants from GlaxoSmithKline, Bristol-Myers Squibb, Idenix, Gilead, Roche, and Innogenetics.

In a systematic review and meta-analysis, Jasper Been and colleagues investigate the association between preterm birth and the development of wheezing disorders in childhood. Please see later in the article for the Editors' Summary

https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1001596&type=printable

Preterm Birth and Childhood Wheezing Disorders: A Systematic Review and Meta-Analysis

The guideline of prevention and treatment for chronic hepatitis B (2010 version)

In recent years the epidemiology of chronic hepatitis B in China has changed dramatically and its management also advanced remarkably.After extensive revision and intensive discussion,Chinese Society of Hepatology together with Chinese Society of Infectious Diseases have released the 2010 updates of the Guideline of Prevention and Treatment for Chronic Hepatitis B.This article highlights the major updates on epidemiology,natural history,prevention,and management of chronic hepatitis B,with special focus on the aim,indication,selection of the anti-viral drugs,duration and endpoint of anti-viral treatment.

Major Updates of the Guideline of Prevention and Treatment for Chronic Hepatitis B(2010 Version)

Background: Childhood asthma may have a fetal origin through fetal growth and development of the immunocompetence or respiratory organs. Objective: We examined to which extent short gestational age, low birth weight and fetal growth restriction were associated with an increased risk of asthma hospitalization in childhood. Methods: We undertook a cohort study based on several national registers in Denmark, Sweden and Finland. We included all live singleton born children in Denmark during 1979-2005 (N = 1,538,093), in Sweden during 1973-2004 (N = 3,067,670), and a 90% random sample of singleton children born in Finland during 1987-2004 (N = 1,050,744). The children were followed from three years of age to first hospitalization for asthma, emigration, death, their 18th birthday, or the end of study (the end of 2008 in Denmark, and the end of 2007 in Sweden or Finland), whichever came first. We computed the pseudo-values for each observation and used them in a generalized estimating equation to estimate relative risks (RR) for asthma hospitalization. Results: A total of 131,783 children were hospitalized for asthma during follow-up. The risk for asthma hospitalization consistently increased with lower birth weight and shorter gestational age. A 1000-g decrease in birth weight corresponded to a RR of 1.17 (95% confidence interval (CI) 1.15-1.18). A one-week decrease in gestational age corresponded to a RR of 1.05 (95% CI 1.04-1.06). Small for gestational age was associated with an increased risk of asthma hospitalization in term but not in preterm born children. Conclusions: Fetal growth and gestational age may play a direct or indirect causal role in the development of childhood asthma.

/pdf/birth-weight-gestational-age-fetal-growth-and-childhood-1vlu2bhrhd.pdf

Birth Weight, Gestational Age, Fetal Growth and Childhood Asthma Hospitalization.

To assess the impact of parental asthma on risk of pre-term birth (PTB) and intrauterine growth restriction, and their subsequent association with childhood asthma. Three sequential cross-sectional surveys were conducted in 1993 (3,746), 1998 (1,964) and 2006 (1,074) in the same 15 schools among 5–11 year old children in Merseyside using the same respiratory health questionnaire completed by parents (sample size in brackets). Between 1993 and 2006, prevalence of PTB varied between 12.4 and 15.2 %, and of small for gestational age (SGA or growth restricted) babies between 2.1 and 4.6 %, and maternal asthma prevalence between 8.1 and 13.4 %. For the combined surveys mothers with asthma were more likely to have a PTB than non-asthmatic mothers (OR 1.39, 95 % CI 1.10–1.95, p < 0.001), and in the 2006 survey were more likely to have an SGA baby. 40.9 % of PTBs of asthmatic mothers developed doctor diagnosed asthma compared to 34.3 % for term babies (adjusted OR 1.65, 1.34–2.04, p < 0.001). The corresponding estimates for the symptom triad of cough, wheeze and breathlessness were 19.4 and 17.6 % (adjusted OR 1.78, 0.79–3.98). Conversely SGA babies were less likely to develop doctor diagnosed asthma (adjusted OR 0.49, 0.27–0.90, p < 0.021), or the symptom triad of cough, wheeze and breathlessness (adjusted OR 0.22, 0.05–0.97, p < 0.043), whether or not the mother was asthmatic. Maternal asthma is an independent risk factor for PTB which predisposes to childhood asthma. Intrauterine growth restriction was protective against childhood asthma.

Asthma in Children in Relation to Pre-term Birth and Fetal Growth Restriction

Aim: To assess the long term efficacy and safety of Entecavir in the treatment of CHB in Asian-Arabic patients with genotype D, for both nucleoside-naive as well as experienced, comparing HBeAg positive and negative group.
Methods: This study included 70 CHB consecutive patients who were maintained on Entecavir for at least 36 months retrospectively and followed up prospectively every 3 months for a total of 18 months, at 2 centers in Kuwait (October 2012 and April 2014).
Results: It showed that 23 (32.8%) were HBeAg +ve. All were found to be HBV genotype D, 47.1% naive, 22 (31.4%) females, with a mean age of 42.9 ± (13), 14 (20%) cirrhotic and 1(1.4%) decompensated. There were no significant differences in the pre-treatment HBV-DNA level among HBeAg+ve and HBeAg-ve group, with a mean± SD log 10 of 7.9 ± 5.4 and 7.4 ± 5.0 respectively (P=0.237). There was a significant viral load reduction in both groups after 6 months of treatment with Entecavir. The reduction was more pronounced in the HBeAg–ve compared to HBeAg +ve group. In HBeAg +ve, 19 patients (82.61%) had complete HBV-DNA suppression after a median period of 7 month, while in HBeAg –ve group; all (100%) had complete HBV-DNA suppression after a median period of 5 month duration (P<0.05). None showed primary non response to Entecavir in both groups. In the HBeAg-ve group; one (2.13%) had HBsAg loss at 45 month compared to non in HBeAg+ve group (P<0.001), while in the HBeAg+ve group; 5 (21.74%) showed HBeAg clearance after a median of 16 month during Entecavir treatment. Multivariate analysis identified HBeAg negative status, pre-treatment as the only independent factor affecting complete viral suppression on Entecavir treatment. The drug showed 100% safety, as there were no serious adverse events throughout 54 month of follow up. None showed hepatic decompensation, HCC or need for liver transplantation during follow up. Also, there was no reported death throughout study period in both groups.
Conclusions: In real life data; long term Entecavir treatment for up to 54 months in West Asian CHB patients, with genotype D suppressed HBV-DNA to an undetectable level in 100% of HBeAg-ve, compared to 82% in HBeAg +ve group. Entecavir is considered an effective and safe choice on long term use for treatment CHB patients.

Retrospective-Prospective Study on Efficacy & Safety of Entecavir in ChronicHepatitis B West Asian Patients with Genotype D

Aim: To assess the long-term efficacy and safety of Entecavir in the treatment of CHB. Patients and Methods: This study included 70 CHB consecutive patients on Entecavir for at least 36 months retrospectively, followed prospectively for 18 months. Results:  twenty-three (32.8) were HBeAg +ve, 47.1% naive, 22 (31.4%) females, with a mean age of 42.9±13, 14 (20%) cirrhotic and 1 (1.4%) decompensated. There were no significant differences in the pre-treatment HBV-DNA level among HBeAg (+ve) and HBeAg-ve group, with a mean± SD log 10 of 7.9±5.4 and 7.4±5.0 respectively. (P= 0.237). There was a significant viral load reduction after 6 months Entecavir therapy that was more in the HBeAg –ve compared to HBeAg +ve group. In HBeAg +ve, 19 (82.61%) had HBV-DNA suppression after a median of 7 months, compared to 100% in HBeAg –ve with a median of 5 months (P <0.05). In the HBeAg-ve group; one (2.13%) had HBsAg loss at 45 months compared to none in HBeAg (+ve) group (P <0.001), while in the HBeAg (+ve) group; 5 (21.74%) showed HBeAg clearance after a median of 16 months. Multivariate analysis identified HBeAg negative status, as the only independent factor affecting viral suppression. The drug showed 100% safety. None showed hepatic decompensation, HCC or reported death. Conclusions: In real-life data; long term Entecavir treatment effectively sup-pressed HBV.  Entecavir is considered an effective and safe treatment for CHB patients compared to 82% in HBeAg (+ve) group. Entecavir is considered an effective and safe choice on long term use for treatment CHB patients.

https://scumj.journals.ekb.eg/article_116298_4bca11b245f12b510920cb4910e141b1.pdf

A Retrospective- Prospective Study for the Efficacy and Safety of Entecavir in a Cohort of West Asian with Chronic HBV Infection

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Asthma in Children in Relation to Pre-term Birth and Fetal Growth Restriction

Retrospective-Prospective Study on Efficacy & Safety of Entecavir in ChronicHepatitis B West Asian Patients with Genotype D

A Retrospective- Prospective Study for the Efficacy and Safety of Entecavir in a Cohort of West Asian with Chronic HBV Infection