Chronic viral hepatitis can be caused by hepatitis B virus (HBV), hepatitis C virus (HCV), or hepatitis D virus (HDV). HBV is responsible for 60-80% of hepatocellular carcinoma worldwide. HCV infection is the most common chronic blood-borne infection and a leading cause of cirrhosis and liver cancer. HDV requires HBV coinfection and can cause a more severe form of hepatitis. Treatment for chronic HBV and HCV infection involves antiviral medications like interferons, nucleoside analogs, and nucleotide analogs to achieve viral suppression and prevent disease progression.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
Explanation of what splenomegaly is in relation to its dimension deviation from normal spleen.Classification of splenomegaly according to it's size in adult and pediatric. The causes of splenomegaly along with the symptom that would manifest as a result of this anomaly. Lastly, diagnosis of splenomegaly
is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past.
scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS.
Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
2. Introduction
• Chronic hepatitis represents a series of liver
disorders of varying causes and severity in
which hepatic inflammation and necrosis
continue for at least 6 months.
• Milder forms are nonprogressive or only
slowly progressive, while more severe forms
may be associated with scarring and
architectural reorganization, which, when
advanced, lead ultimately to cirrhosis, etc.
4. Newer Classification
• The classification of chronic hepatitis is based
on
1. Cause
2. Histologic activity or grade
3. Stage or degree of progression
5. CAUSES OF CHRONIC HEPATITIS
• 1. Viral (HBV, HCV, HDV)
• 2. Drugs (alpha-methyldopa, isoniazid)
• 3. Alcoholic liver disease
• 4. Non-alcoholic steatohepatitis
• 5. Metabolic causes
– a. Primary biliary cirrhosis
– b. Sclerosing cholangitis
– c. Alpha-1-antitrypsin deficiency
– d. Wilson’s disease
– e. Haemochromatosis
• 6. Autoimmune hepatitis
– a. Type I (antiactin/lupoid)
– b. Type II (anti-liver kidney microsomal)
– c. Type III (anti-soluble liver antigen)
• 7. Cryptogenic
9. Hepatitis B Virus
• HBV is a DNA virus that belongs to the
hepadnavirus family.
• Eight genotypes of HBV have been identified and
labeled A through H.
• HBV (with or without cirrhosis) causes 60% to
80% of HCC worldwide.
• HBV-related mortality is estimated between
500,000 and 1,000,000 deaths worldwide per
year.
• HBV is an indication for l5% to 10% of the cases
of liver transplantation.
10. • Pathophysiology
HBV liver damage is immune mediated.
• Modes of transmission
Horizontal transmission
• Parenteral or percutaneous routes (e.g., needlestick
injury, injection drug use, hemodialysis, transfusions)
• Sexual contact (e.g., men who have sex with men,
sexual promiscuity, or intercourse with HBV-infected
partners)
• Vertical transmission: Mother to infant
11. • Chronic hepatitis B runs an indolent course,
sometimes for decades.
• Fatigue is a common symptom but frequently
overlooked because of its subjectivity. The
disease may only become clinically apparent
late in the natural course, with symptoms
typically associated with ESLD.
• Chronic HBV infection is a dynamic
process that occurs in different phases
12. Clinical course of HBV
Acute hepatitis B infection
Chronic HBV infection
3-5% of adult-acquired
infections
95% of infant-
acquired infections
Cirrhosis
Chronic hepatitis
12-25% in 5 years
Liver failureHepatocellular
carcinoma
6-15% in 5 years 20-23% in 5 years
13.
14.
15.
16. • Chronic hepatitis B immune tolerant patients
and
• chronic hepatitis B with low
replication should not be treated.
17. • Three main groups:
1. IFNs,
2. Nucleoside analogs (entecavir),
3. Nucleotide analogs (tenofovir).
18. • The ideal treatment outcome is HBsAg loss
with seroconversion, unfortunately this goal is
rarely achieved.
• Therefore, in patients who are HBeAg positive
at baseline, the expected outcome is loss of
HBeAg with anti-e seroconversion, clearance
of HBV DNA, and normalization of liver
enzymes.
19. • In patients who are HBeAg negative at baseline,
the expected outcome is clearance of HBVDNA
and normalization of liver enzymes.
• In patients who are HBeAg positive at baseline,
treatment should be prolonged at
least 6 months after HBeAg loss/seroconversion.
• These patients should be monitored,
given the possibility of reactivation.
20. • In patients who are HBeAg negative at
baseline, treatment should be continued
indefinitely or until HBsAg loss/seroconversion
is achieved.
21. • Antiviral resistance is a phenomenon observed
with the use of nucleoside and nucleotide
analogs.
• Resistance should be considered in patients
with an HBV DNA level increase (.1 log10)
from the lowest level of suppression achieved
while on therapy.
22. • Tenofovir and entacavir have a high genetic
barrier for resistance (lowest susceptibility) when
compared to other nucleoside and nucleotide
analogs and are therefore the preferred oral
therapeutic agents
23. First Line
• Entecavir (ETV) oral nucleoside (guanosine)
analog Dose: 0.5 orally and 1 mg orally in case
of lamivudine resistance for 48 weeks.
• Tenofovir (TDF) oral nucleotide (acyclic)
analog Dose: 300 mg daily
24. INTERFERONS
• Antiviral, antiproliferative and
immunomodulatory effects.
• IFN-α and -β bind to the same receptor and have
predominantly antiviral effects.
• IFN-γ binds to a separate receptor and has more
marked immunoregulatory action but less potent
antiviral effects.
• Pegylation reduces rate of absorption,renal
clearance, decreases immunogenecity and
increases half life.
25. • IFN- α 2a and 2b—SC either 10 million units
thrice
• weekly or 5 million units daily for 4-6 months
or peginterferon α 2a 180 mcg weekly or 2b
100 mcg weekly for 48 weeks
26. Second Line
• Telbivudine (LdT) oral nucleoside (thymidine)
analog Dose: 600 mg daily
• Adefovir (ADV) oral nucleotide (adenosine)
analog Dose: 10 mg daily orally for 48 weeks
• Lamivudine oral nucleoside (dideoxy-3¢-
thiacytidine) analog Dose: 100 mg daily orally
for 48 weeks
27. Hepatitis C
• Classification
• HCV is an RNA virus that belongs to the
flavivirus family.
• There are six HCV genotypes with multiple
subtypes
28. • Epidemiology
• HCV is a global health problem with
approximately 180 million carriers
worldwide.
• The incidence of hepatitis C has declined in
the last 30 years.
29. • HCV infection is the most common chronic
blood-borne infection
• Transmission by transfusion of blood products
(and their derivatives) and organ
transplantation has been reduced to near zero
in developed countries due to sensitive
screening methods.
30. • Genotype 1 accounts for 75% and
genotypes 2 and 3 account for 20% of HCV
infections in the United States.
31. • 70% of cases of chronic hepatitis, 40% of cases
of ESLD, 60% of cases of HCC,
and 40% of liver transplantations.
32. • Pathophysiology
• The liver damage that ensues after HCV infection
is immune mediated.
• Modes of transmission include:
• Parenteral (e.g., transfusion, injection drug use,
body piercing, needlestick injury)
• Sexual (high-risk sexual practices) and from
mother to offspring (vertical transmission),
although at a much lower frequency than HBV
33. • Clinical Presentation
• The incubation period varies from 15 to 150
days.
• Acute hepatitis can be silent, especially in
children and young adults.
34. • Symptoms
may also vary from mild illness to ALF. Malaise, fatigue,
pruritus, headache abdominal pain, myalgias,
arthralgias, nausea, vomiting, anorexia, and fever are
common but nonspecific symptoms.
• Chronic hepatitis runs an indolent course, sometimes
for decades.
• Fatigue is a common symptom. The disease may only
become clinically apparent late in the natural course,
when symptoms are associated with advanced liver
disease.
37. Diagnostic Testing
• Antibodies against HCV (anti-HCV) may be undetectable for
the first 8 weeks after infection. These antibodies are
detected by enzyme immunoassay (EIA).
• Antibodies do not confer immunity. The test has a
sensitivity of 95% to 99% and a lower specificity.
• A false-positive test (anti-HCV positive with HCV RNA
negative) may be detected in the setting of autoimmune
hepatitis (AIH) or hypergammaglobulinemia.
• A false-negative test (anti-HCV negative with HCV RNA
positive) may be seen in immunosuppressed individuals
and in patients on hemodialysis.
38. • HCV RNA can be detected by PCR in serum as
early as 1 to 2 weeks after infection
(qualitative and quantitative assays).
• It is expressed in international units
per milliliter (IU/mL), with lower limits of
detection approaching 10 IU/mL.
• HCV RNA determination is useful for both
diagnosis and treatment purposes.
39. • HCV genotypes and subtypes can be detected by
commercially available serologic and molecular
assays. HCV genotype influences the duration,
dosage, and response to treatment.
• Liver biopsy is useful to score the degree of
inflammation (grade) and fibrosis (stage) in the
liver of chronically infected patients.
• It is useful to grade the amount of liver steatosis
and guides treatment decisions.
40. Treatment
Goals Endpoints
• Viral eradication
• Prevention of disease
progression
Sustained loss of HCV
RNA in serum (3-6
months post-Tx)
Normalization of liver
enzymes
Improved liver
histology
Improved quality of
life
41. Treatment outcome in HCV is determined by a number of
pretreatment and ontreatment factors
Pretreatment factors
• Viral genotype, IL-28B
genotype (CC allele), viral
load, treatment naïve or
previous treatment failure,
advanced liver disease
(amount of liver fibrosis),
metabolism
• (obesity, steatosis, and
insulin resistance),
race/ethnicity
On-treatment factors
• Adherence to the
prescribed regimen,
• dose and duration of
ribavirin, pIFN-a, and
protease inhibitors
boceprevir and telaprevir
• Rapidity of viral clearance
42. Treatment
• In patients with genotype 1 (all subtypes), the standard
of care is to use triple therapy including pIFN, ribavirin,
and a direct antiviral agent (DAA).
• DAAs currently approved are boceprevir and
telaprevir.
• The chosen treatment regimen takes into consideration
prior exposure and response to pIFN and ribavirin,
presence of cirrhosis, and selected DAA
• Side effects of IFN-based therapy include flu-like
symptoms, neuropsychiatric disorders, endocrine
dysfunction, and bone marrow suppression.
43.
44.
45. HEPATITIS D
• Classification
• HDV is a circular RNA virus and is the only
member of the genus Delta virus.
• Originally, it was considered a subviral particle
resembling plant pathogens, viroids, and
virusoids.
46. • Epidemiology
• It is found throughout the world and is endemic
to the Mediterranean basin, the
Middle East, and portions of South America.
• Outside these areas, infections occur
primarily in individuals who have received
transfusions or in injection drug users.
• HDV requires the presence of HBV for infection
and replication.
47. • Pathophysiology
• HDV infection clinically presents as a
coinfection (acute hepatitis B and D),
• as a superinfection (chronic hepatitis B with
acute hepatitis D) that may progresses to
chronic infection and cirrhosis, or as a latent
infection (i.e., in the liver transplantation
setting).
48. • Risk Factors
• High-risk groups are similar to HBV (see
Epidemiology under Hepatitis B Virus
section).
• Prevention
• Although there is no vaccine to prevent HDV in
carriers of HBV, both infections
can be prevented by timely administration of the
HBV vaccine.
49. • Clinical Presentation
• In patients with coinfection, the course is
transient and self-limited.
• The rate of progression to chronicity is similar
to the one reported for acute HBV.
• In superinfection, the HBV carriers may
present with a severe acute hepatitis
exacerbation with frequent progression to
chronic HDV.
50. • Diagnostic Testing
• Diagnosis is made by finding HDV RNA or HDV
antigen in serum or liver and
by detecting antibody to the HDV antigen in
the setting of acute or chronic HBV.
• TREATMENT
• IFN-a is the treatment of choice for chronic
hepatitis D.