Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 71857

AbstractMaterial and MethodsResultsDiscussionConclusionAcknowledgementReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : June | Volume : 16 | Issue : 6 | Page : EC06 - EC09 Full Version

Hepatitis Activity Index and its Clinical and Biochemical Parameters in Liver Diseases- A Retrospective Study


Published: June 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55827.16485
Prema Devi Elangovan, Subashree Kannan, Rajesh Haridass, D Prathiba

1. Associate Professor, Department of Pathology, Sri Muthukumaran Medical College Hospital, Chennai, Tamil Nadu, India. 2. Associate Professor, Deparment of Pathology, Sri Venkateshwara Medical College, Puducherry, India. 3. Associate Professor, Department of Pathology, Tagore Medical College, Chennai, Tamil Nadu, India. 4. Professor, Department of Pathology, Sri Ramachandra Medical College, Chennai, Tamil Nadu, India.

Correspondence Address :
Dr. Prema Devi Elangovan,
Associate Professor, Department of Pathology, Sri Muthukumaran Medical College Hospital, Chennai, Tamil Nadu, India.
E-mail: premadevie@gmail.com

Abstract

Introduction: Hepatitis Activity Index (HAI) is a scoring system devised by Ishak K et al., for grading and staging chronic hepatitis. The HAI provides a numerical score that is both objective and reproducible, it may be useful as either an alternative or supplement to the use of conventional pathological terminology in the study and management of chronic hepatitis patients.

Aim: To assess the efficiency of HAI scoring in the non neoplastic liver diseases by relating it with the clinical and biochemical parameters.

Materials and Methods: This retrospective study was conducted in the Department of Pathology at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India, from 2010 to 2015. A total of 57 neoplastic cases and 41 non neoplastic cases were retrieved. The data was reassessed, HAI score and grade was noted and compared with the clinical and biochemical parameters. Chronic liver disease was classified as chronic viral hepatitis {Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)} or cirrhosis. Alkaline phosphatase levels, Serum Glutamic Oxaloacetic Transaminase (SGOT) levels, Serum Glutamic Pyruvic Transaminase (SGPT) levels were analysed. Descriptive analysis was done and the data was represented as frequency and percentage in Microsoft Excel.

Results: Among the non neoplastic cases, 21 (51.2%) belonged to hepatitis and cirrhosis and 20 (48.8%) belonged to others. In patients with high alkaline phosphatase levels, the predominant HAI score was 4. In cases with high SGOT levels, the predominant HAI score was 5 and 6. In cases with high SGPT levels, the HAI score was 5,6, and 7.

Conclusion: The HAI is useful in assessing the extent of active inflammation. It gives an objective guideline to the treating physician. The HAI score in combination with clinical and biochemical parameters offers a better insight into disease severity.

Keywords

Cirrhosis, Fibrosis, Ishak scoring, Inflammation, Management, Neoplastic

It is reported that around 400 million people are suffering from chronic Hepatitis B Virus (HBV) infection worldwide and in upto 40% of these cases cirrhosis has set in and the patients have progressed to end stage liver disease (1),(2).

Chronic Active Hepatitis (CAH) is a “necro-inflammatory lesion of the liver diagnosed by characteristic pathologic changes in the liver biopsy specimen.” In the early reports of these patients the clinical and biochemical alterations often accompanying this disease were emphasised; they described the poor prognosis associated with severe CAH, and also provided an outline of the treatment regimens; however, they were associated with significantly decreased mortality and morbidity (3),(4),(5),(6). Recent reports suggest that severe CAH patients represent only a small percentage of the total population whose liver biopsy specimens are interpreted as having CAH (7),(8). Many of these patients are completely free of any clinical symptoms and are reported to have only mild alterations in serum aminotransferases, y-globulin, and bilirubin. The natural history of asymptomatic CAH is yet to be understood totally and any guidelines for treatment have yet to be established.

Chronic hepatitis needs to be graded, based on the degree of inflammation and hepatocellular injury; this condition may lead to the fibrosis stage. The end stage of chronic hepatitis is cirrhosis with clinical decompensation (9),(10).

Hepatitis Activity Index (HAI) grading and staging are two vital scores that determine the mild, moderate or the severe nature of the disease (11). Though several scoring systems have been developed and are in use Ishak scoring system is more popular (12). Conventional clinical and pathological descriptions of histology of serial liver biopsy specimens do not readily provide definitive endpoints for statistical analysis. The HAI provides a numerical score that is both objective and reproducible, it may be useful as either an alternative or supplement to the use of conventional pathological terminology in the study and management of chronic hepatitis patients in whom histological changes in serial liver biopsy specimens may be the only prognostic indicator available for evaluation.

Hence, this study was performed to assess the efficiency of HAI scoring in the non neoplastic liver diseases by relating it with the clinical and biochemical parameters.

Material and Methods

A retrospective study was performed with the liver biopsy data reported in the Department of Pathology over a period of 5 years from 2010 to 2015. This study was conducted at Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India. The Institutional Ethical Committee approved the conduct of the study (Ref: CSP-MED/13/JUN/07/35).

Inclusion and Exclusion criteria: The non neoplastic cases of hepatitis and cirrhosis were identified, reassessed, HAI score and grade noted as per Ishak scoring system (12), and compared with the clinical and biochemical parameters. All non neoplastic cases were identified and included in the study. All neoplastic cases were excluded from the study.

Procedure

Liver biopsy samples were embedded in paraffin. Sections were stained with Haematoxylin and Eosin (H&E), Perls, and Reticulin stain. As half of the liver sample is frozen for virologic studies, the mean sizes of the initial and final biopsy specimens were 15.6±7.5 mm and 17±6.5 mm. Chronic liver disease was classified as chronic viral hepatitis {Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV)} or cirrhosis. The cirrhosis cases were further confirmed using the special stain- Massons Trichome (Table/Fig 1). Necro inflammatory activity and fibrosis were semi-quantitatively assessed according to the HAI score. Histologic analyses were performed by the same pathologist using current technical conditions.

• Clinical parameters such as age, gender, aetiology of hepatitis were recorded.

• Biochemical parameters such as alkaline phosphatase levels, Serum Glutamic Oxaloacetic Transaminase (SGOT) levels, Serum Glutamic Pyruvic Transaminase (SGPT) levels were recorded.

• Hepatitis Activity Index (HAI) grading and staging are two vital scores that determine the mild, moderate or severe nature of the disease (11). Though several scoring systems have been developed and are in use but Ishak K et al., scoring system is more popular (12).

STATISTICAL ANALYSIS

Hepatitis activity index score was considered as outcome variable of interest. The descriptive analysis was done and the data was represented as frequency and percentage. Microsoft Excel was used for statistical analysis.

Results

The mean age of the study population was 42.1 years. Among the 98 evaluated cases of liver biopsy, 57 cases were neoplastic (58.16%) and 41 cases were non neoplastic (41.84%). Among the non neoplastic cases, chronic liver diseases like hepatitis and cirrhosis in which HAI scoring was done were 21 cases (51.2%) and cases with infectious aetiology, vascular lesions, and storage disorders constituted the other 20 (48.7%) cases (Table/Fig 2). In the chronic liver diseases, majority of the cases (n=6) were due to alcohol intake, followed by three cases of Hepatitis B, two cases of biliary cirrhosis, and one case of Hepatitis C.

Biochemical markers: Alkaline phosphatase levels were less than 200 in 14 cases and more than 300 in four cases. Serum Glutamic Oxaloacetic Transaminase (SGOT) levels were below 100 in 14 cases and ≥100 in seven cases. Serum Glutamic Pyruvic Transaminase (SGPT) levels were less than 100 in 17 cases and ≥100 in four cases (Table/Fig 3). In cases with high alkaline phosphatase levels (n=6) the predominant HAI score was 4. In cases with high SGOT levels (n=6) the predominant HAI score was 5 and 6. In cases with high SGPT levels (n=3) the HAI score was 5,6, and 7. The predominant HAI scores were score 2 and 3 and the predominant HAI stage was stage 4. The total HAI score was 2 and 3 among 19.05% respectively. Based on HAI staging, 47.6% of the participants had stage 4 i.e. cirrhosis (Table/Fig 4). The management of the patients based on the HAI scoring has been mentioned in (Table/Fig 5).

Discussion

This study evaluated liver biopsy specimens using HAI scoring system. The study’s findings proved that HAI scoring system can aid in assessing the severity of the disease and in the diagnosis and management. In this current study, 21 out of the total 98 liver biopsy showed hepatic cirrhosis. Among the 21 samples, 42.86% aetiology was not identified, followed by 28.57% alcoholic aetiology and 14.29% had hepatitis B viral aetiology. Among them, 66.67% had alkaline phosphatase levels less that 200 and SGOT less than 100 respectively. The SGPT was less than 100 in 80.95% of the specimens.

In most forms of chronic liver diseases, the pathologists are expected to assign a grade and stage as part of the evaluation of the liver biopsy as it will help in predicting the patient outcome (13). There are many simple grading systems like International Association for the Study of the Liver (IASL), metavir activity score,and Batts-Ludwig score but the information conveyed to the clinician from these systems are limited and hence in the present study authors have used the Ishak hepatitis activity index (HAI) score as it provides more information than the other scoring systems (14),(15),(16).

The HAI scoring is done based on four major histopathological parameters. First, periportal of interface hepatitis graded as absent, mild (focal, few), moderate and severe with scores ranging from 0 to 4. Second, confluent necrosis (Table/Fig 6) graded as absent, focal, zone 3 necrosis in some area, necrosis in most area, necrosis with occasional portal central bridging, necrosis with multiple bridging and panacinar necrosis with scores from 0 to 4. Third, Focal lytic necrosis graded as one focus, two foci, five to ten and more than ten foci in 10 power objectives with score range 0 to 4. Lastly, portal inflammation as mild, moderate, sever and marked with scores 0 to 4. Based on this scoring and grading in this current study, periportal or periseptal interface hepatitis (Table/Fig 7) was seen in majority of cases (42.86%) with score 1, the confluent necrosis in majority of the cases (80.96%) was score 0, the focal lytic necrosis, apoptosis and focal inflammation in majority of cases (61.90%) was score 0 and portal inflammation in majority of cases (38.10%) was score 1. The predominant HAI score in the present study was score 2 and 3 and the predominant stage in this study was stage 4 (10 cases).

This current study related the HAI score with the biochemical markers. In cases with high alkaline phosphatase levels six cases the predominant HAI score was 4. In cases with high SGOT levels (six cases) the predominant HAI score was 5 and 6. In cases with high SGPT levels (three cases) the HAI score was 5,6 and 7. Highest HAI score in patients with elevated liver enzymes was 7. Highest HAI score in patients with cirrhosis was 9.5. Cirrhosis cases had low serum enzyme levels. Eleven patients with low serum enzymes had HAI score ≥2.

The management in the current study was done based on the HAI scoring system. Patients in stage 0 was advised for follow-up, stage 1 and 2 patients were managed with medical intervention, stage 3 patients with both medical and surgical intervention and stage 4 with surgical intervention. Hence, the management of the condition can be done based on this scoring.

Previous studies in literature have insisted on the need for using a histopathological scoring system in diagnosing chronic hepatitis and cirrhosis (12),(13),(14). The scoring can also aid in determining the prognosis of the patients. Patients with initial high scores were observed to have guarded prognosis (17). The HAI score should be related with the aetiology of the disease and the biochemical parameters.

Limitation(s)

The limitation of the current study is its retrospective nature, hence clinical follow-up of the patients was not possible. Large prospective studies with clinical and biochemical correlation is recommended in further.

Conclusion

Based on this study findings, HAI score in combination with the clinical and biochemical parameters can give more information for the therapeutic intervention and management of patients. Hence, utilisation of HAI score in routine reporting of liver biopsy is recommended.

Acknowledgement

Authors would like to acknowledge the department staffs.

References

1] Koziel MJ, Siddiqui A. Hepatitis B virus and hepatitis D virus. In: Mandell GL, Bennett JE, Dolin E, editors. Principles and practice of infectious diseases. 6th ed. Philadelphia: Churchill Livingstone; 2005. pp. 1864-90.

2.
Hassanjani MR, Taheri H. Frequency of chronic active hepatitis in asymptomatic HBV carriers in Babol, Iran. Arch Iran Med. 2002;5:97-99.
3.
Fiel MI. Pathology of chronic hepatitis B and chronic hepatitis C. Clinics in liver disease. 2010;14(4):555-75. [crossref] [PubMed]
4.
Marcellin P, Kutala BK. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver International. 2018;38:02-06. [crossref] [PubMed]
5.
Giannakopoulos G, Verbaan H, Friis-Liby IL, Sangfelt P, Nyhlin N, Almer S, et al. Mycophenolate mofetil treatment in patients with autoimmune hepatitis failing standard therapy with prednisolone and azathioprine. Digestive and Liver Disease. 2019;51(2):253-57. [crossref] [PubMed]
6.
Pape S, Schramm C, Gevers TJ. Clinical management of autoimmune hepatitis. United European Gastroenterol J. 2019;7(9):1156-63. [crossref] [crossref]
7.
Terrault NA, Lok AS, McMahon BJ, Chang KM, Hwang JP, Jonas MM, et al. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-99. [crossref] [PubMed]
8.
Knodell RG, Conrad ME, Ishak KG. Development of chronic liver disease after acute non-A, non-B posttransfusion hepatitis. Gastroenterology. 1977;72:902-09. [crossref]
9.
Goodman ZD, Ishak KG. Hepatic histopathology. In: Schiff ER, Sorrell MF, Maddrey WC, editors. Schiff’s diseases of the Liver. 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2003. pp. 69-134.
10.
Bedossa P, Dargère D, Paradis V. Sampling variability of liver fibrosis in chronic hepatitis C. Hepatology. 2003;38:1449-57. [crossref] [PubMed]
11.
Desmet VJ. Liver: Non-neoplastic diseases. In: Rosai J, editor. Rosai and Ackerman’s Surgical Pathology. Philadelphia: Mosby, Elsevier Inc; 2004. pp. 917-91.
12.
Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, et al. Histological grading and staging of chronic hepatitis. J Hepatol. 1995;22:696-99. [crossref]
13.
Goodman ZD. Grading and staging systems for inflammation and fibrosis in chronic liver diseases. J Hepatol. 2007;47(4):598-607. [crossref] [PubMed]
14.
Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, et al. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology. 1981;1(5):431-35. [crossref] [PubMed]
15.
Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ. Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology. 1994;19(6):1513-20. [crossref] [PubMed]
16.
Batts KP, Ludwig J. Chronic hepatitis. An update on terminology and reporting. Am J Surg Pathol. 1995;19(12):1409-17. [crossref] [PubMed]
17.
Fontaine H, Nalpas B, Poulet B, Carnot F, Zylberberg H, Brechot C, et al. Hepatitis activity index is a key factor in determining the natural history of chronic hepatitis C. Human pathology. 2001;32(9):904-09. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2022/55827.16485

Date of Submission: Feb 21, 2022
Date of Peer Review: Mar 31, 2022
Date of Acceptance: Apr 21, 2022
Date of Publishing: Jun 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 24, 2022
• Manual Googling: Mar 03, 2022
• iThenticate Software: Apr 19, 2022 (8%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com