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INTRODUCTION: Hepatitis B virus (HBV) infection is associated with cirrhosis and hepatocellular carcinoma. Vaccination is one aspect of public health policy aimed at eliminating HBV infection. After the implementation of an HBV vaccination program for newborns in Thailand, the estimated residual infection rate was 3.5%. However, that study was conducted in only 5,964 participants in seven provinces and only 22 years after the start of the campaign. This study aimed to evaluate the HBV seroprevalence rate in Thailand in larger sample size and a longer duration after program implementation using HBV surveillance. METHODS: This was a surveillance study conducted in 20 provinces in northeast Thailand. The study period was between July 2010 and November 2019. Rates of HBV seroprevalence in each province and overall were calculated. Participants were divided into two groups: those vaccinated under the national campaign and those who were not. Participants aged 0-20 years were used as references, while other age groups (intervals of 10 years) were comparators. Residual HBV seroprevalence after the vaccination program was calculated with odds ratio for HBV seroprevalence in each age group. RESULTS: There were 31,855 subjects who participated in the project. Of those, 1,805 (5.7%) had HBV. The HBV seroprevalence rate in the national HBV vaccination group was significantly lower than that in those not vaccinated under the national program (1.0% vs 5.9%; p

A 63-year-old woman presented with jaundice and epigastric pain for 2 weeks. Physical examination revealed marked jaundice, and palpable gallbladder with right upper quadrant tenderness. Liver function test was remarkable for hepatocellular injury pattern. Antinuclear antibody and anti-smooth muscle antibody were positive with high titre and serum IgG was elevated more than upper normal range. Ultrasound and CT scan demonstrated mildly diffuse periportal oedema of liver parenchyma and markedly diffuse gallbladder wall thickening up to 2 cm. Liver histology showed focal interface hepatitis with prominent plasma cell infiltration and cluster formation, moderate lobular spotty necrosis and emperipolesis consistent with autoimmune hepatitis. The patient was treated with steroid and azathioprine. She had complete resolution of symptoms and normal biochemical laboratory results. Diffuse gallbladder thickening was seen in acute hepatitis from definite autoimmune hepatitis.

Background: Acute kidney injury (AKI) is frequently encountered around 40% in critically ill patients and associate with a high mortality particularly in AKI patients requiring renal replacement therapy (RRT). The objective of this study was to assess the clinical predictors for 28-day mortality in AKI patients requiring RRT.Methods: This is a retrospective cohort study from prospectively collected data over a year (2014-2015). AKI patients requiring RRT were included. We collected demographic and laboratory data of AKI patients requiring RRT within 24 hours before initiation of RRT. We excluded patients with pre-existing chronic kidney disease stage 5 and AKI patients requiring peritoneal dialysis. We compared clinical characteristics and analyzed the predictors of mortality of survivors and non-survivors according to 28-day mortality.Results: We included 122 AKI patients requiring RRT. Mortality rate at day 28 and 90 after AKI diagnosis were 59% (95% confidence interval [CI] 49.7-67.8) and 72.1% (95%CI 63.3-79.9). On multivariable analysis, clinical predictors for 28-day mortality were baseline serum creatinine (hazard ratio [HR] 0.57, 95% CI 0.36-0.90), SOFA score before initiation of RRT (HR 1.08, 95%CI 1.01-1.15), presence of vasopressors before initiation of RRT (HR 3.04, 95%CI 1.12-8.25), serum lactate > 4 mmol/L before initiation of RRT effect 4 mmol/L before initiation of RRT effect ≥10 days of survival time (HR 1.31, 95%CI 0.47-3.60).Conclusion: A lower baseline serum creatinine was associated with the mortality in AKI patients requiring RRT. SOFA score, presence of vasopressors, and a higher serum lactate before initiation of RRT are useful clinical predictors for the 28-day mortality.

A 29-year-old 11-week pregnant multigravida woman without previous medical history presentedwith sudden onset of hematemesis. This case illustrates the occurrence of a rare complication (rupture of pseudoaneurysm of right hepatic artery inside the biliary system), appearing as upper gastrointestinal bleeding in a pregnant woman. The cause of the rupture is presumably pregnancy-related. We would like to emphasize the presence of pseudoaneurysm of the hepatic artery as a rare cause of gastrointestinal bleeding in pregnancy. Figure 1 and 2 CTA showed a lobulated contour of saccular aneurysmal dilatation at proximal right hepatic artery, measured about 3.5x3.2x1.6 cm in size and 2.6 mm in neck width; pseudoaneurysm is likely. There is perianeurysmal heterogeneously hyperdense non-enhancing lesion which shows flip-flop phenomenon, measured about 5.5x6.1x5.5 cm in size; Partially thrombosed pseudoaneurysm at proximal right hepatic artery is likely. This lesion causes stretching of the common hepatic artery and portal vein. Hyperdenselesion with flip-flop phenomenon is also seen within dilated bilateral IHD, CHD, CBD and gallbladder; Contrast extravasation into CHD, CBD, 1st, 2nd, 3rd, 4th part of duodenum and jejunum is detected in portovenous phase. hemobilia is suggested.