Review of Albanian studies suggests the need for further efforts to counteract significant hepatitis B virus prevalence

BACKGROUND Hepatitis B virus(HBV)is categorized as one of the smallest enveloped DNA viruses and is the prototypical virus of the Hepatoviridae family.It is usually transmitted through body fluids such as blood,semen,and vaginal secretions.The majority(more than 95%)of immunocompetent adults infected with HBV spontaneously clear the infection.In the context of the high prevalence of HBV infection in Albania,the research gap is characterized by the lack of studies aimed at advancing the current understanding and improving the prevailing situation.The main objective of this study was to address the low rate of HBV diagnosis and the lack of a comprehensive national program to facilitate widespread diagnosis.AIM To analyze the prevalence of HBV infection in Albania and elucidate the persistently high prevalence despite efforts and measures implemented.METHODS Using a systematic literature review,we collected existing research on the epidemiology of HBV in Albania from PubMed,Cochrane Library,Google Scholar,and Albanian Medical Journals,focusing on studies published after the 1980s and conducted solely in the Albanian population.RESULTS The findings reveal a dynamic shift in HBV prevalence in Albania over several decades.Initially high,the prevalence gradually declined following the implementation of screening and vaccination programs.However,the prevalence rates have remained notably high,exceeding 8%in recent years.Contributing factors include vertical transmission,inadequate healthcare infrastructure,and challenges in screening and diagnosis.Studies among Albanian refugees in neighboring countries also reported high prevalence rates,emphasizing the need for transnational interventions.Despite advancements in screening,vaccination,and healthcare infrastructure,Albania continues to face a substantial burden of HBV infection.CONCLUSION The persistence of high prevalence underscores the complexity of the issue,requiring ongoing efforts to ensure a comprehensive understanding and effective mitigation.Addressing gaps in vaccination coverage,improving access to screening and diagnosis,and enhancing public awareness are crucial steps toward reducing HBV prevalence in Albania.

Sequence of events leading to primary biliary cholangitis

Primary biliary cholangitis(PBC)is a chronic cholestatic liver disease that is observed more frequently in middle-aged women.This disorder is considered an autoimmune disease,since liver injury is sustained by the presence of selfdirected antimitochondrial antibodies targeting the bile duct cells.The prognosis may vary depending on an early diagnosis and response to therapy.However,nearly a third of patients can progress to liver cirrhosis,thus requiring a liver transplant.Traditional immunosuppressive therapies,commonly employed for other autoimmune diseases,have limited effects on PBC.In fact,dramatic functional changes that occur in the biliary epithelium in the course of inflammation play a major role in perpetuating the injury.In this minireview,after a background on the disease and possible predisposing factors,the sequential cooperation of cellular/molecular events leading to end-stage PBC is discussed in detail.The rise and maintenance of the autoimmune process,as well as the response of the biliary epithelia during inflammatory injury,are key factors in the progression of the disease.The so-called“ductular reaction(DR)”,intended as a reactive expansion of cells with biliary phenotype,is a process frequently observed in PBC and partially understood.However,recent findings suggest a strict relationship between this pathological picture and the progression to liver fibrosis,cell senescence,and loss of biliary ducts.All these issues(onset of chronic inflammation,changes in secretive and proliferative biliary functions,DR,and its relationship with other pathological events)are discussed in this manuscript in an attempt to provide a snapshot,for clinicians and researchers,of the most relevant and sequential contributors to the progression of this human cholestatic disease.We believe that interpreting this disorder as a multistep process may help identify possible therapeutic targets to prevent evolution to severe disease.