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Journal of Liver and Clinical Research

Hepatitis B and C in testing and Counselling Center – Current Aspects

Research Article | Open Access Volume 6 | Issue 1 |

  • 1. Medicine Student, FTC - Faculty of Technology and Science
  • 2. MD, SESAB - Governamental Health Secretary of Bahia State
  • 3. CEDAP - State Center Specialized in Diagnosis, Assistance and Research
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Corresponding Authors
Lara Fabiana Maia de Oliveira Medicine Student, FTC - Faculty of Technology and Science,Rua Comendador Alves Ferreira, 240. Garcia, Brazil Tel: 5571997241303
Abstract

Introduction: The World Health Organization 2017 report shows that 325 million people are infected by HBV or HCV. Therefore, Tests and Counseling Centers are already done screening tests and diagnosis of hepatitis, for places in which care is primarily for those who are at greater risk of infection and populations in situations of vulnerability.

Methodology: Observational, descriptive and analytical study using data from electronic and physical records of patients treated at CEDAP in 2017 diagnosed with Hepatitis B and / or C. Results: There were 124 HBV and 90 HCV carriers among 6,319 individuals. There was predominance of males with HBV. The transmission route for both was significant, being 76.1% by sex in HBV and 53.3% by way unknown in HCV. Coinfection with HIV was 47.6% with HBV and 35.5% with HCV. And drug use was higher in the HCV group (p <0.001).

Discussion: The prevalence was higher than in the population without increased risk, but it resembled that found in drug users and other CTAs. Epidemiological data, such as sex, age and ethnicity corroborate with that found in general populations.

Conclusion: The prevalence of B and C virus and the co-infection with HIV in CTA in 2017 were high, male, brown, and Salvador-Bahia origin predominated. Co-infection between HBV, HCV and HIV was significant, as was the use of drugs in these groups.

Keywords

Hepatitis B; Hepatitis C; Epidemiological surveillance.

CITATION

de Oliveira LFM, Gil Almeida DF (2020) Hepatitis B and C in testing and Counselling Center – Current Aspects. J Liver Clin Res 6(1): 1053.

INTRODUCTION

Viral hepatitis are infectious diseases caused by viruses with special tropism by the liver, generating necroinflammation. They have high morbidity and affect a high number of people, being considered a worldwide public health problem. The 2017 World Health Organization (WHO) report showed that 325 million people live with hepatitis B virus (HBV) or Hepatitis C (HCV) infection and most do not have access to tests and treatments [1]. In 2015 hepatitis B and C virus infections accounted for about 1.34 milliondeaths, higher than deaths caused by HIV [2].

The detection of HBV infection in Brazil in 2016 was 6.9 cases per 100,000 inhabitants. Since 1999, the year in which hepatitis was included in the compulsory notification list, a total of 212,000 cases have been confirmed.[3]HBV is the second leading cause of death among viral hepatitis, totaling 13,252 deaths from 2000 to 2015. 3On that note , it reveals the importance of prevention through the vaccine that had its first records dated 1980, being available for more than two decades[4,5].

In addition to this, there is the possibility of prophylaxis with immunoglobulin, if exposure, as with health workers[6,7]. Due to its silent evolution, usually oligosymptomatic, HBV is often discovered late, approximately 5 to 10% of the infected become chronic patients, when its consequences, such as cirrhosis and hepatocellular carcinoma (CHC), are already installed [8].

Currently, approximately 390,000 people die each year from Hepatitis C and even nowadays, there is no vaccine for this disease, even though 60 to 80% of those infected will evolve to a chronic form[9]. The number of deaths in 1990 was333,000 and in 2013, 704,000. This increase reflects the fact that HCV had not yet been fully discovered in the 1990s [10] HCV infection and consequences are the leading cause of death among viral hepatitis in Brazil, representing 25,000 deaths between 2000 and 2015. It is estimated that in 2015, worldwide, there were 1.75 million new infections. [2,3] Moreover, only half of the patients receive the new treatment, more effective and tolerated, which in addition to avoiding progression, also increases the quality of individual life [2,11].

Developments for HBV and HCV have been so broad in the past decade that it is now possible to control HBV and cure HCV [12] However, both infections can evolve asymptomatically, thus only being confirmed with serological tests, such as AgHBs and anti HCV [13] Therefore, in 2004, serological screening and diagnosis of hepatitis were included in the Testing and Counseling Centers (CTAs). In these places, care is primarily focused on those who have the highest risk of infection, such as sex workers, men who have sex with other men (MSM), people deprived of liberty, those who use alcohol or other drugs, with special attention to injectable drugs, and transsexuals, as well as other populations framed in situations of vulnerability such as those exposed to violence, poverty and racism [14,15].

The struggle against the hepatitis B and C epidemic has already been delineated by the WHO until 2030, with goals such as the improvement and simplification of therapies for HBV and the intensification of the search for HCV vaccine [16] As a result, it is justified to expand the supply of epidemiological research lines for better development of prophylactic and curative actions, in addition to the propagation of current information from the hepatitis scenario of higher prevalence worldwide.

Therefore, the objective is to describe the epidemiological profile of patients diagnosed with Hepatitis B and C in 2017 at the State Center specialized in Diagnosis, Care and Research (CEDAP) in Salvador-BA, comparing the profile of individuals with HBV and HCV and their co-infections with HIV.

METHADOLOGY

This is an Observational , descretive, and Analytical study that used data from the medical records of patient treated at CEDAP, A centre of Excellence in HIV treatment, in infectious disease and sexually transmitted disease. About 40 to 60 people per day attend CTA.

Patients of both sexes, older than 18 years, who presented positive serological markers for Hepatitis B and/or C were included.

The variables of interest were gender, age, origin, ethnicity, HIV co-infection, current pregnancy, illicit drug use, blood transfusion, health care professional.

For data analysis, a data collection form was used and tabulated in Microsoft Excel. For descriptive statistics, frequency and percentage distribution tables were used for categorical variables, average, standard or median deviation and interquartile interval for numerical variables (according to data distribution), using the Graphpad Prism version 8 statistical analysis program. For the numerical variables, the t. E test was applied for the qualitative variables, the chi-square test. In both tests, the P<0.05 value was considered statistically significant.

This research was approved by the Research Ethics Committee (CEP) of SESAB with exemption from the TCLE because it is a retrospective study. The privacy and confidentiality of the recorded data are guaranteed, according to the guidelines of 466/2012 Resolution. Authorized in The Consubstantiated Opinion Number 3,152,859.

RESULTS

During 2017, 6,319 people were treated at CEDAP, 127 individuals tested positive for Hepatitis B, 35 (27.7%) AgHBs positive and 91 (72.2%) positive total antiHBC, with a prevalence total of 2%. Under Hepatitis C, there were 90 patients with positive HCV testing, which corresponds to 1.45% of the total tested.

In the sample, 96 (76.1%) with positive serology for HBV and 53 (58.8%) positive serology for HCV. The comparison between the genders of Hepatitis B and C showed statistical significance (p=0.006) that emphasizes a greater number of male individuals in the HBV group. The average age of those infected with Hepatitis B was 41.3± 14.3 years, while in Hepatitis C it was 42.7 ± 14.3 years. In the descriptionof the patients’ ethnicity, there was a greater number of cases amongbrown people, 83 (65.8%) with HBV and 48 (53.3%) HCV. When grouping by origin, almost totalitarian proceeded from Salvador-BA, totaling 97 (76.9%) among individuals with HBV and 69 (76.6%) HCV.

Comparing the transmissionroute, we found differences (p=0.001) between the proportions, among patients with Hepatitis B, the main transmissioncategory was by sexual route, with 96 (76.1%) followed by 15 (12%) unknown route and 6 (4.7%) by sharing sharp objects.

In Hepatitis C, 48 (53.3%) patients with unknown route, 21 (23.3%) patients through drugs and 13 (14.4%) by sharing sharp objects. Evaluating co-infection with HIV was positive in 60 (47.6%) patients with HBV and 32 (35.5%) HCV patients. Regarding the exposure of health professionals had positive results for HBV 5 (3%) people and HCV 7 (7%) people in the studied population. Pregnant patients were 2 (1.5%) Hepatitis B and 1 (1.1%) Hepatitis C. The prevalence of patients who reported illicit drug use was 18 (14.2%) with Hepatitis B and 29 (32.2%) with Hepatitis C, a statistically significant result (p<0.001), showing that drug use was higher in HCV patients (Table 1).

Table 1 - Epidemiological and comparative profile of Hepatitis B and C.

 

HEPATITIS B

HEPATITIS C

PVALUE

GENDER?

     

Male

96, (76,19%)

53, (58,89%)

0.006

Female

30, (23,81%)

37, (41,11%)

 

AGE¥

41,33, (14,35)

42,74, (14,28)

0.232

ORIGIN?

   

0.641

Salvador

97, (76,98%)

69, (76,67%)

 

Other

29, (23,02%)

20, (23,33%)

 

ETHNICITY?

   

0.211

Black

29, (23,02%)

32, (35,56%)

 

White

7, (5,56%)

6, (6,67%)

 

Yellow

2, (1,59%)

2, (2,22%)

 

Brown

83, (65,87%)

48, (53,33%)

 

Non registered

0, (0%)

1, (1,11%)

 

TRANSMISSION?

   

0.001

Vertical

1, (0,79%)

0, (0%)

 

Sexual

96, (76,19%)

2, (2,22%)

 

Sharing sharp objects

6, (4,76%)

13, (14,44%)

 

Drug use

1, (0,79%)

21, (23,3%)

 

Blood transfusion

2, (1,59%)

0, (0%)

 

Tattoo

5, (3,97%)

6, (6,67%)

 

Unknown

15, (11,9%)

48, (53,33%)

 

HIV?

   

0.077

Positive

60, (47,62%)

32, (35,56%)

 

Negative

66, (52,38%)

58, (64,44%)

 

PREGNANT?

   

0.768

Yes

2, (1,59%)

1, (1,11%)

 

No

124, (98,41%)

89, (98,89%)

 

DRUG USE?

   

0.001

Yes

18, (14,29%)

29, (32,22%)

 

No

108, (85,71%)

61, (67,78%)

 

HEALTH PROFESSIONAL ?

   

0.228

Yes

5, (3,97%)

7, (7,78%)

 

No

121, (96,03%)

83, (92,22%)

 

Source: Author’s data base.

?, Chi Square Test

¥, Student T Test

We stratified HBV patients between the profile of HIV positive and negative patients. A higher frequency was found in males, both in HIV-positive patients, 81.6%, and in HIV-negative, 71.2%. The average age of patients with HIV and HBV was 39 ± 13.3 years, in those with only HBV it was 42.7 ± 15.9 years. Both groups had a higher origin prevalence in Salvador-BA, 46 (76.6%) HIV-positive patients and 51 (77.27%) HIV-negative patients.

Mixed ethnicity prevailed in both groups with 34 (56.67%) co-infected patients with HIV and 49 (74.24%) only with HBV. Sexual transmission was significant, with higher transmission by sexual route in those with HIV positive, total of 86.6%.

Regarding pregnancy, 2 (3%)patients were HIV negative. Drug use prevailed in those with HIV and HBV co-infection, representing 21.7%, given with statistical significance (p=0.024). About health professionals 3(5%) had HIV-positive result (Table 2).

Table 2 - Description Coinfection Hepatitis B and HIV.

HEPATITIS B

HIV +

HIV -

PVALUE

GENDER ?

 

 

 

Male

49, (81,67%)

47, (71,21%)

0.168

Female

11, (18,33%)

19, (28,79%)

 

AGE¥

39,82, (13,33)

42,7, (15,9)

0.247

ORIGIN ?

     

Salvador

46, (76,67%)

51, (77,27%)

0.663

Other

14, (23,33%)

15, (22,73%)

 

ETHNICITY ?

     

Black

19, (31,67%)

10, (15,15%)

0.153

White

3, (5%)

4, (6,06%)

 

Yellow

1, (1,67%)

1, (1,52%)

 

Brown

34, (56,67%)

49, (74,24%)

 

TRANSMISSION ?

     

Vertical

1, (1,67%)

0, (0%)

0.011

Sexual

52, (86,67%)

44, (66,67%)

 

Sharing sharp objects

2, (3,33%)

4, (6,06%)

 

Drug use

0, (0%)

1, (1,52%)

 

Blood transfusion

2, (3,33%)

0, (0%)

 

Tattoo

2, (3,33%)

3, (4,55%)

 

Unknown

1, (1,67%)

14, (21,21%)

 

PREGNANT?

     
 

0, (0%)

2, (3,03%)

0.174

DRUG USE ?

     

Yes

13, (21,67%)

5, (7,58%)

0.024

No

47, (78,33%)

61, (92,42%)

 

HEALTH PROFESSIONAL ?

     
 

3, (5%)

2, (3,03%)

0.571

Source: Author’s database.

?, Chi Square Test

¥, Student T Test

The stratification of Hepatitis C and co-infection with HIV showed a higher number of male patients in both groups, 19 (59.3%) and 34 (58.6%), respectively. The average age remained near to 45.13 ± (11.85) in patients with HCV and HIV and 41.43 ± (15.4) in those monoinfected with HCV. The most prevalent origin was from Salvador-BA and 26 (81.2%) patients with HIV and 43 (74.1%) patients without HIV. The most prevalent ethnicity was brown, 18 (56.2%) HIV-positive patients and 30 (51.7%) HIV negative patients. There was 1 (1.7%) ongoing pregnancy in HIV-negative patients.

Comparing the proportions of the transmission route between the HIV-positive and negative groups, statistical significance was found (p=0.0261). The HIV-negative group had high transmission by unknown route, with 37.7% and sharing sharp objects, with 12.3%.

Regarding drug use, it showed that HIV-positive patients use more drugs, 17 (53.1%) statistically significant data (p<0.05). And in health professionals, co-infection was lower: 2 (6.2%) HIV-positive (Table 3).

Table 3: Description of Hepatitis C and HIV co-infection.

HEPATITIS C

HIV +

HIV -

PVALUE

GENDER ?

 

 

 

Male

19, (59,38%)

34, (58,62%)

0.944

Female

13, (40,63%)

24, (41,38%)

 

AGE¥

45,13, (11,85)

41,43, (15,4)

0.242

?

     

Salvador

26, (81,25%)

43, (74,14%)

0.320th

Other

6, (18,75%)

14, (25,86%)

 

ETHNICITY?

     

Black

10, (11,11%)

22, (37,93%)

0.574

White

3, (3,33%)

3, (5,17%)

 

Yellow

0, (0%)

2, (3,45%)

 

Brown

18, (20%)

30, (51,72%)

 

Not registered

1, (1,11%)

0, (0%)

 

TRANSMISSION ?

     

Sexual

1, (1,11%)

1, (1,11%)

0.026

Sharing sharp objects

1, (1,11%)

12, (13,33%)

 

Drug use

13, (14.44%)

8, (8.89%)

 

Tattoo

3, (3,33%)

3, (3,33%)

 

Unknown

14, (15,56%)

34, (37,78%)

 

PREGNANT ?

     
 

0, (0%)

1, (1,72%)

0.454th

DRUG USE ?

     

Yes

17, (53,13%)

12, (20,69%)

0.001

No

15, (46,88%)

46, (79,31%)

 

HEALTH PROFESSIONAL

     
 

2, (6,25%)

5, (8,62%)

0.687

Source: Author’s Database.

?, Chi Square Test

¥, Student T Test

DISCUSSION

The prevalence of viral hepatitis in Latin America is heterogeneous due to population factors. [17] Moreover, it was remarkable to maintain the high prevalence of HBV infection, even with the vaccine, created in 1981, being offered to children under 02 years old in Brazil since 1992. [2] It is known that vaccination has a great impact on infections in this decade, since the countries that succeeded in their vaccination campaigns drastically reduced the prevalence, [18,19] However, it is likely that the group tested in this sample did not benefit from this coverage, due to the average age found in the 5th decade.

However, several national studies since 2000 show prevalence below 1% in all regions of Brazil, in individuals without additional infectionrisk, meaning a downward trend compared to the historical series.[20] Based on this, we see that at-risk populations keep the prevalence as in scenarios of the past decade, which makes it necessary to maintain prophylactic and curative measures in these groups that are constantly reintroducing into society.

The worldwide prevalence of HCV represents 1% of the population, according to the WHO, showing that the population studied even in its vulnerability scenario had a slight increase in prevalence. In contrast, in Brazil in 2016 the prevalence was 0.7%. [21] In the European Union the prevalence of HCV varies widely, especially in groups at higher risk of infection. [22 ] Therefore, it is believed that the population of this study has an increased infectionrisk, since the use of drugs, the main route of transmission, is more prevalent in relation to the population ingeneral. In addition, there is healthcare to the public of MSM, sex workers, who have a higher chance of transmission through sexual means, as already demonstrated. [11,23]

Although evaluating anat-riskpopulation, Hepatitis B and Cepidemiological data, such as age and gender, are close to that observed in general populations, which corroborates that detection has been more prevalent in men and aged around 45 years old [3] The brown ethnic group was the one with the greatest declaration, which is demonstrated in another epidemiological study in CTA in Bahia. 24 However, in the study developed at the CTA in northern Bahia, there was a higher prevalence of women in reproductive age. The distinction for the present study can be explained by the CTA studied having attended more men that year. And in relation to ethnicity that was higher in brown people, it is justified by the origin that have been higher in Salvador-BA, because it is the place where the CTA is located and in this locality the populationmiscegenation is intense.

Nevertheless, there is no differentiation of the sexual orientation and diversity of partners, as well as co-infection with other sexually transmitted infections, because in the medical records there were not enough recordsof thesedata, which were well scored and broughtin previous studies. [24] Thus, itis undeniable the importance of the information about these factors for better development of exposed populationcounseling strategies.

Regarding the greater detection of individuals with HBV infection through total AntiHBC, similarly seen in a study developed at the CTA in the state of Ceará, making evident the importance of this serological test as the most frequent screening marker [26]

Increased co-infection of HBV and HIV was found, an association already found that increases the mortality of HIV patients, including a higher risk of progression to hepatocellular carcinoma (HCC), even in patients who are under treatment. [27] A significant sexual procedure transmission was found, especially in the HIV co-infected group, demonstrating once again that it is a well-known and frequent transmission route of both infections. [28]

Drug use showed a great deal of significance, also drawing attention to HIV-infected drugs, this linkage of illicit drug use and higher prevalence of HBV has already been demonstrated in a CTA in Pará, which showed a higher risk of HBV infection 1.7 in long-term non-injecting drug users.[28,29]

In the context of Hepatitis C, the high prevalence of transmission by drug use and the statistical significance of drug use in the group within HIV were noted, as also found in the study by Rahman M. et all, conducted in a Bangladesh CTA.[30]

HIV/HCV co-infection has a variance of 3.3 to 82.4%, in Brazil.31 However, HCV/HIV co-infection in this study was superior to the population that does not expose to the risk, thus, it is very close to what was found in drug users in Pará.[32] It is known that HIV/HCV co-infection makes prognosis worse and can interfere in a negative treatment, increasing the morbidity and mortality rate. [33,34] Therefore, hepatitis is considered as an opportunistic disease of HIV and before the above, the need to approach Hepatitis B and C is emphasized whenever an HIV positive patient comes, even if asymptomatic.

As evidenced in an European Union study, which has already led to a decrease in risk groups, the elimination of these hepatitis is not only a public health issue, but also a human rights issue. [22] Therefore, it is essential to trace risk groups in a well-defined way, since these individuals are in constantly resocializing, to minimize the proliferation of new infections, which are at the mercy of the lack of prevention and treatment policies that include it.

Therefore, it is concluded that the epidemiological profile of Hepatitis B and C found in the CTA, followed the pattern of diagnoses in the population not considered at risk, being more prevalent in males, aged between 40 and 45 years old, brown, from Salvador-BA. In addition, there was a high co-infection of both hepatitis with HIV. Hepatitis B and HIV share the highest prevalence of sexual transmission and significant drug use in this group and Hepatitis C had a higher prevalence of co-infection with HIV in the drug user group, corroborating that this is its main route of transmission.

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de Oliveira LFM, Gil Almeida DF (2020) Hepatitis B and C in testing and Counselling Center – Current Aspects. J Liver Clin Res 6(1): 1053.

Received : 01 Sep 2020
Accepted : 14 Oct 2020
Published : 14 Oct 2020
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ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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