Chronic hepatitis in children can be caused by viral infections like hepatitis B and C, autoimmune disorders, drug reactions, and metabolic diseases. Hepatitis B often becomes chronic if contracted as a newborn. It progresses through immune tolerant, immune active, and inactive carrier phases. Hepatitis C poses a high risk of chronicity in children. Autoimmune hepatitis involves liver inflammation from a misdirected immune response. Common drugs that can cause chronic liver injury include anti-tubercular and anticonvulsant medications. Metabolic diseases such as Wilson's disease and nonalcoholic steatohepatitis account for a significant percentage of chronic liver disease in children. Treatment depends on the underlying cause and may include antiviral therapy,
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
Telegram: bmksupplier
signal: +85264872720
threema: TUD4A6YC
You can contact me on Telegram or Threema
Communicate promptly and reply
Free of customs clearance, Double Clearance 100% pass delivery to USA, Canada, Spain, Germany, Netherland, Poland, Italy, Sweden, UK, Czech Republic, Australia, Mexico, Russia, Ukraine, Kazakhstan.Door to door service
Hot Selling Organic intermediates
2. DEFINITION
Chronic hepatitis means ongoing
inflammation of the liver persisting for more
than six months that is detectable by
biochemical and histologic means.
4. 3.Drug-induced hepatitis
4.Metabolic disorders associated with chronic
liver disease
Wilson disease
Nonalcoholic steatohepatitis
α1-Antitrypsin deficiency
Tyrosinemia
Niemann-Pick disease type 2
Glycogen storage disease type iv
Cystic fibrosis
Galactosemia
Bile acid biosynthetic abnormalities
5.
6. Clinical presentation
Can present with acute decompensation
Asymptomatic
Signs of chronic liver disease/failure
7.
8. Hepatitis B
Chronic hepatitis : HBsAg positivity for >6 mo
Risk : >90% infected <1yr , 30% children &
2% of adults infected will become chronic
carriers.
Three phases of this chronic infection include
1. Immunotolerant phase - active viral
replication and minimal liver damage.HBsAg &
HBeAg are positive and anti Hbe is negative.
HBV DNA load is high. ALT normal
9. 2. Immuno active phase- host tries to resolve
infection HBsAg & HBeAg are positive and anti
Hbe is negative.
HBV DNA load is low. ALT high & with flares
3. Inactive carrier phase- HBsAg & anti Hbe are
positive and HBeAg is negative.
HBV DNA load is very low. ALT normal.
Sometimes may lead to resolution with HBsAg
being negative and Anti HBs positive.
10. Symptomatic Infection
Chronic Infection
Age at Infection
Chronic Infection (%)
SymptomaticInfection(%)
Birth 1-6 months 7-12 months 1-4 years Older Children
and Adults
0
20
40
60
80
100100
80
60
40
20
0
Outcome of Hepatitis B Virus Infection
by Age at Infection
ChronicInfection(%)
11. Sexual - sex workers and homosexuals are
particular at risk.
Parenteral - IVDA, Health Workers are at
increased risk.
Perinatal - Mothers who are HBeAg positive
are much more likely to transmit to their
offspring than those who are not. Perinatal
transmission is the main means of
transmission in high prevalence populations.
Hepatitis B Virus
Modes of Transmission
Keeffe EB, et al. Clin Gastroenterol Hepatol. 2006;4:936–962.
12. Diagnostic Interpretations of Hepatitis B
markers
HBsAg Non infectious component
of viral coat
Indicator of disease. If > 6
months: chronic HBV
Anti-HBs Antibody response to HBsAg Indicates recovery and/or
immunity
HBeAg Antigen that correlates with
replication and infectivity
High level of infectivity and
replication
Anti-HBe Antibody response to HBeAg Decreasing level of
replication
Remission/resolution
Anti-HBc IgM Non protective antibody to
the HBcAg
Recent HBV infection
Anti-HBc IgG As above Remote exposure to HBV
HBV DNA Replictative genetic
material of HBV; infectious
agent
Viral replication and
continues infection
13. Diagnostic Interpretations of Hepatitis B
markers
HBsAg Non infectious component
of viral coat
Indicator of disease. If > 6
months: chronic HBV
Anti-HBs Antibody response to HBsAg Indicates recovery and/or
immunity
HBeAg Antigen that correlates with
replication and infectivity
High level of infectivity and
replication
Anti-HBe Antibody response to HBeAg Decreasing level of
replication
Remission/resolution
Anti-HBc IgM Non protective antibody to
the HBcAg
Recent HBV infection
Anti-HBc IgG As above Acute or remote exposure
to HBV
HBV DNA Replictative genetic
material of HBV; infectious
agent
Viral replication and
continues infection
14. Symptoms
HBeAg anti-HBe
Total anti-HBc
IgM anti-HBc anti-HBsHBsAg
0 4 8 12 16 20 24 28 32 36 52 100
Acute Hepatitis B Virus Infection with
Recovery Typical SerologicCourse
Weeks after Exposure
Titre
15. IgM anti-HBc
Total anti-HBc
HBsAg
Acute
(6 months)
HBeAg
Chronic
(Years)
anti-HBe
0 4 8 12 16 20 24 28 32 36 52 Years
Weeks after
Titre
Progression to Chronic Hepatitis B Virus
Infection Typical Serologic Course
17. 17
Possible Outcomes of HBV Infection
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
Liver transplant
6-15% in 5 years 20-23% in 5 years
DeathDeath
18. Treatment
Only useful for immunoactive phase as it will
reduce risk of hepatic cancer and cirrhosis
Treatment for children is only by :
Interferon(IF alpha 2b,peg IF) AND lamivudine
after thorough investigations and classification
of stage of disease.
Adefovir ,entecavir and tenofovir are used in
older children(>12 years)
19. Chronic hepatitis C
Prevalence low in children
Risk of perinatal transmission:5%
Increases to 20% if mother coinfected with HIV
Poses 85 % risk of developing chronicity but
no good evidence in children
20. Mostly asymptomatic with fluctuating /normal
transaminases levels
Slow progression to fibrosis/cirrhosis/CLD
Associated with extrahepatic manifestations
21. Natural History of Hepatitis C
Exposure
No infection
Acute
Chronic
Spontaneous
clearance
(early)
•Cirrhosis
(20-40%)
•HCC
(1-4%/year)
<75%
>20%
22. Diagnosis: HCV RNA and genotype , liver
biopsy
Treatment:
PEG INTERFERON ALPHA 2b and
RIBAVIRIN
(in > 3yrs of age) for 2 year duration
23. Autoimmune liver disease
Autoimmune liver disease is a clinical
constellation that suggests an immune-
mediated process characterized by :
hypergammaglobulinemia,
circulating autoimmune antibodies,
necro inflammatory histology &
responsive to immunosuppressive therapy .
They include autoimmune hepatitis,
autoimmune sclerosing cholangitis & de
novo hepatitis.
24. Pathophysiology
Triggering factors : molecular mimicry,
infections, drugs, environment (toxins) in a
genetically susceptible host
Inflammatory cells invades the surrounding
parenchyma.
HLA DR3, DR4, and DR7 isoforms confer
susceptibility to autoimmune hepatitis
25.
26. Clinical manifestations
Acute viral hepatitis like picture(40%) can
progress to ALF esp in Type 2
Insidious onset of liver disease with fatigue,
relapsing or prolonged jaundice.
Chronic liver disease and its complications
Extrahepatic manifestations: arthritis,
vasculitis, nephritis, throiditis, anemia, rash
27. Management
Diagnosis is done by:
elevated transaminases, positive auto
antibodies , raised gammaglobulins and IgG
levels, liver biopsy, absence of known etiology
and response to immunosuppressive drugs.
Steroids, Azathioprine are first line drugs
Cyclosporine and mycophenolate mofetil are
second line drugs
Liver transplantation as and when required.
28. Drug induced liver disease
Drugs commonly used in children that can
cause chronic liver injury include isoniazid,
methyldopa, pemoline, nitrofurantoin,
dantrolene, minocycline, pemoline, and the
sulfonamides.
Anti tubercular and anticonvulsant drugs are
major causes
Can be chemical hepatotoxicity/idiosyncratic
heapatotoxicity
29. They can mimic any form of liver
disease(acute &chronic hepatitis, ALF, portal
hypertension)
Good history taking and high index of
suspicion is required
Treatment is by withdrawal of drug and
supportive care
30. Metabolic causes
Can account for 15-20% of liver diseases in
India
Most common is Wilsons disease.
Most symptoms are due o hepatocyte injury or
secondary to hypoglycemia or
hyperammonemia
Treatment is cause specific.
31. Wilsons disease
a/k/a hepatolenticular degeneration
Toxic accumulation of copper in
liver,brain,cornea and other tissues
Due to abnormal gene, ATP 7B in
chromosome 13
32. Clinical features
Various forms of hepatic disease:
Asymptomatic hepatomegaly
subacute/chronic hepatitis
Acute hepatic failure with/without hemolytic
anemia
Others: neuropsychiatric disease, KF
Ring,sunflower cataract , coombs negative
hemolytic anemia, arthritis, pancreatitis,
nephrolithiasis, cardiomyopathy
,endocrinopathies
35. Nonalcoholic steatohepatitis
Usually associated with obesity and insulin
resistance
Most children are asymptomatic
May have vague abdominal pain.
o/e: hepatomegaly , features of insulin
resistance like striae, acanthosis nigricans
obesity and hepatomegaly.
It can progress to cirrhosis.
36. Diagnosis is usually clinicopathological
correlation . Other causes to be excluded
Treatment is by weight reduction and dietary
modifications.
Ursodeoxycholic acid and vitamin E have
promising results