Viral Hepatitis: Manifestations and Management Strategy

Hematology ◽  
2006 ◽  
Vol 2006 (1) ◽  
pp. 375-380 ◽  
Author(s):  
Roberto J. Firpi ◽  
David R. Nelson
Keyword(s):  
Hepatitis B ◽  
Viral Hepatitis ◽  
Management Strategies ◽  
Clinical Manifestations ◽  
Disease Recurrence ◽  
Hcv Infection ◽  
Morbidity And Mortality ◽  
Viral Reactivation ◽  
Virus Reactivation ◽  
Significant Morbidity

AbstractViral hepatitis is the third most common cause of liver disease in allogeneic transplant recipients and causes significant morbidity and mortality. When treating patients with hematological malignancies, an emphasis should be placed on identification of patients at risk for viral hepatitis with appropriate screening. Initial screening serology should include anti-HCV, HBsAg, anti-HBs, and anti-HBc testing. When hepatitis B exposure has been documented, prophylaxis of viral reactivation for all HBsAg-positive patients with a nucleoside analogue should be implemented. HCV infection appears to have little short-term impact on survival after bone marrow transplantation, but is a risk factor for veno-occlusive disease (VOD) and graft-versus-host disease (GVHD). In the long-term survivor, HCV infection can lead to significant morbidity and mortality due to the development of cirrhosis, decompensation, and liver cancer. Since effective antiviral therapies are available for both hepatitis B and C, routine screening and selected intervention is recommended once reactivation and disease recurrence is documented. In this chapter we will highlight the mechanisms of virus reactivation, clinical manifestations, and management strategies to minimize acute and chronic morbidity in this population.

scholarly journals Psychotic disorders in late life: a narrative review

2019 ◽  
Vol 9 ◽  
pp. 204512531988279 ◽  
Author(s):  
Rajesh R. Tampi ◽  
Juan Young ◽  
Rakin Hoq ◽  
Kyle Resnick ◽  
Deena J. Tampi
Keyword(s):  
Psychotic Disorders ◽  
Adult Population ◽  
Management Strategies ◽  
Late Life ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Antipsychotic Medications ◽  
Clinical Presentations ◽  
Older Adult Population ◽  
Work Up

Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.

Disseminated intravascular coagulation in paediatrics

2016 ◽  
Vol 102 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Revathi Rajagopal ◽  
Jecko Thachil ◽  
Paul Monagle
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Diagnostic Tests ◽  
Early Life ◽  
Clinical Manifestations ◽  
Review Article ◽  
Morbidity And Mortality ◽  
Significant Morbidity ◽  
Intravascular Coagulation ◽  
Management Algorithm ◽  
Recent Advances

Disseminated intravascular coagulation (DIC) in paediatrics is associated with significant morbidity and mortality. Although there have been several recent advances in the pathophysiology of DIC, most of these studies were done in adults. Since the haemostatic system is very different in early life and changes dramatically with age, creating a variety of challenges for the clinician, delay in the diagnosis of DIC can happen until overt DIC is evident. In this review article, we report the aetiology, pathophysiology, clinical manifestations, diagnostic tests and a management algorithm to guide paediatricians when treating patients with DIC.

scholarly journals Acute viral hepatitis B in infants: a clinical case

2021 ◽  
Vol 20 (1) ◽  
pp. 65-68
Author(s):  
A. V. Vasyunin ◽  
G. S. Karpovich ◽  
E. I. Krasnova ◽  
I. V. Kuimova ◽  
N. I. Gavrilova ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Viral Hepatitis ◽  
Clinical Case ◽  
Clinical Observation ◽  
Acute Viral Hepatitis ◽  
Morbidity And Mortality ◽  
Routine Vaccination ◽  
Viral Hepatitis B

Routine vaccination against viral hepatitis B (HBV) has significantly reduced morbidity and mortality from this infection. The development of acute HBV in children is currently a rarity, but there is still the possibility of developing a similar scenario in children from family foci of HBV, aswell as in children with no specific prophylaxis. A clinical observation of the development of acute HBV in aninfant is presented, and the difficulties of managing such patients are demonstrated.

scholarly journals Hematological Malignancies and HBV Reactivation Risk: Suggestions for Clinical Management

Viruses ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 858 ◽  
Author(s):  
Alessandra Zannella ◽  
Massimo Marignani ◽  
Paola Begini
Keyword(s):  
Hematological Malignancies ◽  
Management Strategies ◽  
Clinical History ◽  
Immunosuppressive Drugs ◽  
Viral Reactivation ◽  
Current Evidence ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Effective Prevention ◽  
Clinical Consequences

It is well known that hepatitis B virus reactivation (HBVr) can occur among patients undergoing treatment for hematological malignancies (HM). The evaluation of HBVr risk in patients undergoing immunosuppressive treatments is a multidimensional process, which includes conducting an accurate clinical history and physical examination, consideration of the virological categories, of the medication chosen to treat these hematological malignancies and the degree of immunosuppression induced. Once the risk of reactivation has been defined, it is crucial to adopt adequate management strategies (should reactivation occur). The purpose of treatment is to prevent dire clinical consequences of HBVr such as acute/fulminant hepatitis, and liver failure. Treatment will be instituted according to the indications and evidence provided by current international recommendations and to prevent interruption of lifesaving anti-neoplastic treatments. In this paper, we will present the available data regarding the risk of HBVr in this special population of immunosuppressed patients and explore the relevance of effective prevention and management of this potentially life-threatening event. A computerized literature search was performed using appropriate terms to discover relevant articles. Current evidence supports the policy of universal HBV testing of patients scheduled to undergo treatment for hematological malignancies, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and classes of immunosuppressive drugs.

scholarly journals Hematological Malignancies and HBV Reactivation: Suggestions for Clinical Management

2019 ◽  
Author(s):  
Alessandra Zannella ◽  
Massimo Marignani ◽  
Paola Begini
Keyword(s):  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Hematological Malignancies ◽  
Immunosuppressive Drugs ◽  
Viral Reactivation ◽  
Hbv Reactivation ◽  
Virus Reactivation ◽  
Hepatitis B Virus Reactivation ◽  
B Virus ◽  
Clinical Consequences

It is well known that the event of hepatitis B virus reactivation can occur among patients undergoing treatment for hematological malignancies. In this paper we will present the available data regarding the risk of hepatitis B virus reactivation in this special population of immunosuppressed patients and explore the relevance of an accurate prevention and management of this condition. A computerized literature search was performed using appropriate terms arrangement, including English-written literature only or additional relevant articles. The evaluation of hepatitis B reactivation risk is a multidimensional process, which includes conducting an accurate clinical and physical history, considering the virological categories, the knowledge of the medication chosen to treat these hematological malignancies and the induced grade of immunosuppression. Adopting adequate preventive strategies and surveillance according to the current international recommendations is crucial to prevent HBVr and its dire clinical consequences (hepatitis, liver failure, interruption of lifesaving anti-neoplastic treatments). Universal HBV screening of patients scheduled to undergo treatment for hematological malignancies should be the chosen policy, and clinicians should be aware of the inherent risk of viral reactivation among the different virological categories and the classes of immunosuppressive drugs.

Prevalence of parenteral viral hepatitis as a professional disease in medical workers in the Northwestern Federal District

2021 ◽  
Vol 61 (5) ◽  
pp. 324-329
Author(s):  
Nikolay N. Petrukhin ◽  
Oleg N. Andreenko ◽  
Ivan V. Boyko
Keyword(s):  
Hepatitis B ◽  
Viral Hepatitis ◽  
Occupational Diseases ◽  
Health Workers ◽  
Federal District ◽  
Medical Personnel ◽  
Hcv Infection ◽  
Biological Factor ◽  
Leningrad Region ◽  
Risk Of Infection

Currently, the problem of parenteral viral hepatitis HBV and HCV has become extremely urgent due to an increase in morbidity, an increase in the number of patients with chronic forms of infection, and high mortality rates from complications. The aim of the study consists in considering the level of prevalence of the incidence of hepatitis viruses HBV and HCV among medical personnel in the Northwestern Federal District (NWFD), assessing the potential risk of infecting this group of workers while performing their professional duties. Analyzed the reporting forms of the FBUZ «Center for Hygiene and Epidemiology in the Leningrad Region» on the frequency of detection of the surface antigen of the hepatitis B virus (HBsAg) and antibodies to viral hepatitis C (anti-HCV) among various population groups in 2009-2017; form No. 60/u FBUZ Center for Hygiene and Epidemiology in the city of St. Petersburg on the registration of primary cases of hepatitis among the population of St. Petersburg for 2007-2017. Retrospective analysis of a sample from the medical history of 227 patients with established occupational diseases (PD) from the influence of a biological factor. As a result of the study, it was found that out of 227 health workers in the Northwestern Federal District, viral hepatitis B and C were officially diagnosed in 4 patients, which is 1.7% of all established cases of occupational diseases (3 doctors and 1 nurse). In the Leningrad region for the period from 2009 to 2015, the incidence of the hepatitis virus HBV among medical personnel varied in the range of 0.1-0.3 per 10,000 people. The morbidity rate of hospital patients was significantly higher, which created a certain risk of infection of health workers in the process of work. But at the same time, over 6 years, the incidence of HCV infection among medical personnel has halved from (0.2 in 2009 to 0.1 in 2015). The incidence of MR in the NWFD with viral hepatitis HBV and HCV is not high among the entire population as a whole and in a number of individual groups of the population (pregnant women and patients admitted to the hospital for planned surgical interventions), but and at the current level of disease, the registration of all 4 patients with an officially established diagnosis of occupational hepatitis over 17 years suggests the presence of significant shortcomings in the system of investigating the causes of hepatitis MR virus HBV and HCV infection. In particular, it seems expedient when registering a case of blood contact hepatitis in MR, to record in the reporting documents not only his profession and place of work, but also his specialty with an indication of the risk of infection that existed in the process of work when in contact with the blood of patients.

Management of skin cancer in recipients of solid organ transplants

2019 ◽  
Vol 80 (6) ◽  
pp. 331-336
Author(s):  
Amr Salam ◽  
Emilia Peleva ◽  
E Mary Wain
Keyword(s):  
Skin Cancer ◽  
Life Expectancy ◽  
Malignant Disease ◽  
Management Strategies ◽  
Morbidity And Mortality ◽  
Solid Organ ◽  
Organ Transplants ◽  
Significant Morbidity ◽  
Post Transplant ◽  
Skin Cancers

Recent improvements in post-transplant care have led to an increased life expectancy for recipients of organ transplants. These patients require lifelong immunosuppression, which is associated with an increased incidence of malignant disease. Skin cancers are the most common malignancies seen in recipients of organ transplants and are associated with significant morbidity and mortality. This review describes factors pertaining to the development and prognosis of skin cancers in recipients of organ transplants, as well as outlining prevention and management strategies in this cohort.

scholarly journals Pediatric Stroke: A Review

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Daniel S. Tsze ◽  
Jonathan H. Valente
Keyword(s):  
Risk Factors ◽  
Clinical Presentation ◽  
Management Strategies ◽  
Morbidity And Mortality ◽  
Pediatric Stroke ◽  
Significant Morbidity ◽  
Short Term ◽  
Delay In Diagnosis

Stroke is relatively rare in children, but can lead to significant morbidity and mortality. Understanding that children with strokes present differently than adults and often present with unique risk factors will optimize outcomes in children. Despite an increased incidence of pediatric stroke, there is often a delay in diagnosis, and cases may still remain under- or misdiagnosed. Clinical presentation will vary based on the child's age, and children will have risk factors for stroke that are less common than in adults. Management strategies in children are extrapolated primarily from adult studies, but with different considerations regarding short-term anticoagulation and guarded recommendations regarding thrombolytics. Although most recommendations for management are extrapolated from adult populations, they still remain useful, in conjunction with pediatric-specific considerations.

scholarly journals Single Nucleotide Polymorphisms of Cytotoxic T-lymphocyte Antigen 4 (CTLA-4) and Susceptibility to Chronic Viral Hepatitis B and C Infections

2018 ◽  
Vol 2 (1) ◽  
pp. 10-17 ◽  
Author(s):  
Moisés Enciso-Vargas ◽  
Bertha Ruíz-Madrigal ◽  
Zamira Helena Hernández-Nazara ◽  
Montserrat Maldonado-González
Keyword(s):  
Hepatitis C ◽  
Hepatitis B ◽  
Single Nucleotide Polymorphisms ◽  
Viral Hepatitis ◽  
T Lymphocyte ◽  
Cytotoxic T Lymphocyte ◽  
Hcv Infection ◽  
Nucleotide Polymorphisms ◽  
Single Nucleotide ◽  
Lymphocyte Antigen

The cytotoxic T-lymphocyte antigen 4 (CTLA-4) gene is a negative regulator of T lymphocyte activation and proliferation. Single nucleotide polymorphisms (SNPs) occurring on the CTLA-4 gene can modify the ability to control the proliferation of T lymphocytes, thereby impacting the clearance of hepatitis B (HBV) and hepatitis C (HCV) virus infections. The -319C/T and +49A/G SNPs of CTLA-4 gene have been associated with autoimmune disorders and liver infections. Studies show that the +49G allele confers susceptibility to HBV and HCV infection in chronic disease (without cirrhosis), associates with the risk of chronic HCV infection in males, confers protective effect against the development of hepatocellular carcinoma, and favors viral elimination. Furthermore, the +49G allele alone or in haplotype with the -319C favors chronic infection with genotype 3 HCV; has an inverse association with HCV genotype 1; and decreases viral load in chronic hepatitis C associated with sustained viral response (SVR). These findings support an important role of the SNPs of CTLA-4 gene in viral hepatitis; however, the mechanisms by which they influence immune response against viral infections is not fully understood. This review gives an overview of the current understanding of the association between CTLA4 SNPs and HBV/HCV infections.

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