Hepatitis B virus (HBV) infection, a pan global health problem, has already effected one-third of the world popula- tion. India harbours around 40 million HBV carriers, thus account- ing for 10–15% share of total pool of HBV carriers of the world. Every year over 100,000 Indians die due to illnesses related to HBV infection
A Mathematical Model of the Dynamics of Hepatitis B Virus (HBV) Infection wit...ijtsrd
In this model we study the dynamics and control of hepatitis B virus (HBV) infection which is a major health problem worldwide by considering condom, vaccination and treatment as control measures. Initially we determined the basic reproduction number R_0 for the model and observe that once R_0 http://www.ijtsrd.com/mathemetics/other/18164/a-mathematical-model-of-the-dynamics-of-hepatitis-b-virus-hbv-infection-with-controls/titus-ifeanyi-chinebu
Hepatitis B virus HBV infection in detailsHassn Aljubory
Presentation
serological markers
Laboratory test
vaccinations
Chronic hepatitis B
Approach
Harrison
Davidsons
Step up medicine
Mksap
Notes & notes
Gastrointestinal disease
Hepatology
Risk group
Management
Hepatitis in pregnancy
The primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
A Mathematical Model of the Dynamics of Hepatitis B Virus (HBV) Infection wit...ijtsrd
In this model we study the dynamics and control of hepatitis B virus (HBV) infection which is a major health problem worldwide by considering condom, vaccination and treatment as control measures. Initially we determined the basic reproduction number R_0 for the model and observe that once R_0 http://www.ijtsrd.com/mathemetics/other/18164/a-mathematical-model-of-the-dynamics-of-hepatitis-b-virus-hbv-infection-with-controls/titus-ifeanyi-chinebu
Hepatitis B virus HBV infection in detailsHassn Aljubory
Presentation
serological markers
Laboratory test
vaccinations
Chronic hepatitis B
Approach
Harrison
Davidsons
Step up medicine
Mksap
Notes & notes
Gastrointestinal disease
Hepatology
Risk group
Management
Hepatitis in pregnancy
The primary treatment goals for patients with hepatitis B (HBV) infection are to prevent progression of the disease, particularly to cirrhosis, liver failure, and hepatocellular carcinoma (HCC).
Risk factors for progression of chronic HBV include the following :
Persistently elevated levels of HBV DNA and, in some patients, alanine aminotransferase (ALT), as well as the presence of core and precore mutations seen most commonly in HBV genotype C and D infections
Male sex
Older age
Family history of HCC
Alcohol use
Elevated alpha-fetoprotein (AFP)
Coinfection with hepatitis D (delta) virus (HDV), hepatitis C virus (HCV), or human immunodeficiency virus (HIV)
A synergistic approach of suppressing viral load and boosting the patient’s immune response with immunotherapeutic interventions is needed for the best prognosis. The prevention of HCC often includes the use of antiviral treatment using pegylated interferon (PEG-IFN) or nucleos(t)ide analogues.
HBV infection can be self-limited or chronic. No specific therapy is available for persons with acute hepatitis B; treatment is supportive.
Current managent of hepatitis B - Session 1NimzingLadep
This is the first of 3 sessions in the module covering a comprehensive overview of the management of hepatitis B virus infection. It discusses the introduction, presentation, symptoms and signs, as well as management of acute hepatitis B.
Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver .
The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation.
An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#HEPATITIS MADE EASY#HEPATITS B#HEPATITIS C#
Comprehending Hepatitis B: Origins, Signs, Preventive measures, and Managementkkaif2906
Hepatitis B is a viral infection that primarily affects the liver. It is caused by the Hepatitis B virus (HBV), which can be transmitted through contact with infected blood, semen, or other bodily fluids. Hepatitis B can manifest as an acute or chronic condition, with symptoms including fatigue, fever, nausea, abdominal pain, and jaundice. Chronic Hepatitis B can lead to serious liver complications such as cirrhosis and liver cancer. Prevention strategies include vaccination, practicing safe sex, avoiding needle sharing, and screening pregnant women for HBV. While there is no cure for Hepatitis B, antiviral medications can help manage the infection and reduce the risk of complications. Regular monitoring is essential for individuals with chronic Hepatitis B to assess disease progression and determine the need for treatment adjustments.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation
In the United States, an estimated 1.2 million Americans are living with chronic Hepatitis B and 3.2 are living with chronic Hepatitis C
Many do not know they are infected
Each year an estimated 21,000 persons become infected with Hepatitis A; 35,000 with Hepatitis B, and 17,000 with Hepatitis C
Hepatitis A – fecal/oral, contaminated food, vaccine available
Hepatitis B – blood, semen, vertical (mother-child), vaccine available
Hepatitis C – blood (IV drug use, transfusion, organ donation, unsterile injecting equipment, sexual intercourse)
Hepatitis D – survives only in cells co-infected with hepatitis B
Hepatitis E* – contaminated food or water, fecal/oral
*causes short-term disease and is not a chronic carrier state
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
Drug Repurposing: Recent Advancements, Challenges, and Future Therapeutics fo...JohnJulie1
Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
More Related Content
Similar to Epidemiological Profile and Clinical Spectrum of Hepatitis B-Ten Years Experience at Tertiary Care Centre of Northeren India
Current managent of hepatitis B - Session 1NimzingLadep
This is the first of 3 sessions in the module covering a comprehensive overview of the management of hepatitis B virus infection. It discusses the introduction, presentation, symptoms and signs, as well as management of acute hepatitis B.
Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver .
The most common types are Hepatitis A, Hepatitis B, and Hepatitis C.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation.
An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected
There are nearly 100 viruses of the herpes group that infect many different animal species.
Official name of herpesviruses that commonly infect human is Humans herpesvirus (HHV)
herpes simplex virus types 1 (HHV 1)
Herpes simplex virus type 2 (HHV 2)
Varicella-zoster virus (HHV 3)
Epstein-Barr virus, (HHV 4)
Cytomegalovirus (HHV 5)
Human herpesvirus 6 (HHV 6)
Human herpesvirus 7 (HHV 7)
Human herpesvirus 8 (HHV 8) (Kaposi's sarcoma-associated herpesvirus).
Herpes B virus of monkeys can also infect humans
hELMINTHS#corona virus#Aspergillosis#BUGANDO#CUHAS#CUHAS#CUHAS#HEPATITIS MADE EASY#HEPATITS B#HEPATITIS C#
Comprehending Hepatitis B: Origins, Signs, Preventive measures, and Managementkkaif2906
Hepatitis B is a viral infection that primarily affects the liver. It is caused by the Hepatitis B virus (HBV), which can be transmitted through contact with infected blood, semen, or other bodily fluids. Hepatitis B can manifest as an acute or chronic condition, with symptoms including fatigue, fever, nausea, abdominal pain, and jaundice. Chronic Hepatitis B can lead to serious liver complications such as cirrhosis and liver cancer. Prevention strategies include vaccination, practicing safe sex, avoiding needle sharing, and screening pregnant women for HBV. While there is no cure for Hepatitis B, antiviral medications can help manage the infection and reduce the risk of complications. Regular monitoring is essential for individuals with chronic Hepatitis B to assess disease progression and determine the need for treatment adjustments.
Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation
In the United States, an estimated 1.2 million Americans are living with chronic Hepatitis B and 3.2 are living with chronic Hepatitis C
Many do not know they are infected
Each year an estimated 21,000 persons become infected with Hepatitis A; 35,000 with Hepatitis B, and 17,000 with Hepatitis C
Hepatitis A – fecal/oral, contaminated food, vaccine available
Hepatitis B – blood, semen, vertical (mother-child), vaccine available
Hepatitis C – blood (IV drug use, transfusion, organ donation, unsterile injecting equipment, sexual intercourse)
Hepatitis D – survives only in cells co-infected with hepatitis B
Hepatitis E* – contaminated food or water, fecal/oral
*causes short-term disease and is not a chronic carrier state
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
The primary indication for an esophagectomy is esophageal cancer or Barrett’s esophagus with high-grade dysplasia. Patients undergoing esophagectomy often present with dysphagia, side effects from chemotherapy, decreased appetite, and weight loss. Esophagectomy may be an operation involving the abdomen, neck, and/or chest requiring 5 to 7 days of NPO status to permit healing of the anastomosis between the upper esophagus and new esophageal conduit (usually the stomach).
Need of Dual Antiviral Treatment in Chronic Hepatitis BJohnJulie1
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
Approximately one third of the world’s population has serological evidence of past or present infection with the hepatitis B virus (HBV). An estimated 350-400 million people are surface HBV antigen (HBsAg) carriers. India has 40 million HBV carriers i.e. 10–15% share of total pool of HBV carriers of the world. In India.
Anemia is a common condition of cancer patients. This is because cancers cause inflammation that decrease red blood cell production. In addition, many chemotherapies are myelosuppressive, meaning they slow down the production of new blood cells by the bone marrow.
Drug Repurposing: Recent Advancements, Challenges, and Future Therapeutics fo...JohnJulie1
Cancer is a prime public health burden that accounts for approximately 9.9 million deaths worldwide. Despite recent advances in treatment regimen and huge capital investment in the pharmaceutical sector, there has been little success in improving the chances of survival of cancer patients.
Abnormal Sodium and Chlorine Level Is Associated With Prognosis of Lung Cance...JohnJulie1
The imbalance of sodium and chloride ions occurs frequently in patients with lung cancer. However, the correlation between ion concentration change and patients prognosis have not been studied thoroughly. Our research will fill the gap, especially for high ion concentration.
Diagnostic Accuracy of Raised Platelet to Lymphocyte Ratio in Predicting Heli...JohnJulie1
Helicobacter Pylori (HP) infection is prevalent among patients with dyspepsia in developing countries with low socioeconomic status. The gold standard investigation is invasive method gastric biopsy through upper GI endoscopy, however non-invasive methods (stool for HP antigen) are not reliable up to the mark also need to wait for two weeks without symptomatic treatment. It is important to have a reliable, cost effective and easily accessible non-invasive marker to diagnose patients with H. pylori infection. Several non-invasive laboratory have been predicted in having the role in diagnosis of H.pylori infection. Therefore, the aim of our study was to determine the diagnostic accuracy of platelet to lymphocyte ratio in predicting H.Pylori infection in patients with dyspepsia.
IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...JohnJulie1
The IRF family of proteins involves in the tumor progression. However, but the functions of IRF5 in the tumorigenesis are largely unknown. Here, IRF5 was found to be up-regulated in hepatocellular carcinoma (HCC). Interfering with IRF5 inhibited the growth and tumorigenic ability of HCC cells.
•
Fibrous
•
Fibro glandular
•
Adipose (Fatty)
What is Tomosynthesis?
•
Is a 3 dimensional projection
•
Reduces overlapping tissue seen with 2D only
•
15 projections are taken with each combo exposure (7.5) (-7.5)
•
With an average breast (18*24) 3D dose is 1.34, combo is 2.56 Milligrey. (3 Milligrey FDA) (2D is 1.2
Alterations of Gut Microbiota From Colorectal Adenoma to CarcinomaJohnJulie1
Gut microbiota has been implicated as a critical role in the development of colorectal cancer (CRC) and colorectal adenoma (CRA). However, few basic research has revealed the association between gut microbiota and the development of CRA and CRC. We aim to compare the diversity and composition of intestinal flora in CRA and CRC patients, to reveal the changes of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis, and to explore potential biomarkers.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...JohnJulie1
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...JohnJulie1
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Combined Analysis of Micro RNA and Proteomic Profiles and Interactions in Pat...JohnJulie1
Liquid Chromatography Tandem Mass Spectrometry
The Liquid Mass System(LMS) includes an Easy nLC1000 (Thermo Fisher) coupled ultra-high resolution mass spectrometer Orbitrap Fusion Lumos (Thermo Fisher) with a Thermo Fisher electrospray source. Each injection is sent to a preset column (Acclaim PepMap C18, 100 μm x 2 cm, Thermo Scientific) for adsorption at a flow rate of 3 L/min. The sample is then sent to the analyzer column (Acclaim PepMap C18, 75 μm x 15 cm, Thermo Scientific) for separation.
Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Follow-Up Strategies in Focal Liver Lesions And Treatment MethodsJohnJulie1
Today, advances in cross-sectional imaging have led to the detection and early recognition of incidental/focal liver lesions (FCL). In approximately 17,000 cases of chest CT, incidental liver lesions were found in 6% [1]. In general, FCL consists of hepatocytes, biliary epithelium, mesenchymal tissue, connective tissue, or metastasized cells from distant sites. Most incidental lesions are benign, some may require careful management and treatment.
Contextual Factors Associated with Health-Related Quality of Life in Older Ad...JohnJulie1
The purpose of this study was to examine contextual factors associated with physical and mental health-related quality of life (HRQOL) in older adult cancer survivors.
Pancreatic Adenocarcinoma with Isolated Venous Involvement: Is Neoadjuvant Tr...JohnJulie1
Neoadjuvant Treatment (NAT) is indicated in locally advanced tumors and improves the results of subsequent surgery. In borderline tumors, the place of this preoperative treatment is more controversial, probably because borderline tumors are a heterogeneous group. We focused on the tumors with venous involvement without any arterial involvement and studied the results of neoadjuvant treatment in this particular group.
Predictive Value of Biomarkers Fibrinogen Like Protein-2 and A-Fetoprotein fo...JohnJulie1
Data concerning the utility of biomarkers for accurate early HCC detection in cirrhotic patients are lacking. 1.2. Methods: We evaluated 112 consecutive Caucasian cirrhotic patients with (n=28) or without (n=84) concomitant HCC at baseline for serum AFP and plasma fibrinogen like protein-2 (FGL-2) levels. Patients without confirmed HCC at baseline were further followed up every six months with ultrasound and serum AFP levels, according to HCC surveillance program. Imaging as well as histological confirmation of HCC was established in patients with new lesions.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
2. 2021, V5(13): 1-2
2
diagnostics are some of the challenges to scaling up management of
viral hepatitis B. Routine assessment of HbsAg-positive persons is
needed to guide HBV management and indicate the need for treat-
ment. This generally includes assessment of measuring aminotrans-
ferase levels to help determine liver inflammation and stage of liver
fibrosis by non-invasive tests (NITs) such as aspartate aminotransfer-
ase (AST) to-platelet ratio index (APRI). Serum HBV DNA levels/
viral load quantified by real-time polymerase chain reaction (PCR)
correlate with disease progression and are used for decisions to treat
and subsequent monitoring. Antiviral agents active against HBV are
available, and have been shown to suppress HBV replication, prevent
progression to cirrhosis, and reduce the risk of HCC and liver-relat-
ed deaths. However, currently available treatments fail to eradicate
the virus in most of those treated, necessitating potentially lifelong
treatment. Prevention strategies including needle exchange in people
who injects drugs (PWID), barrier contraception need to be promot-
ed in key affected populations, including persons who inject drugs,
men who have sex with men (MSM), and sex workers; prevention
of HBV transmission through immunization of health care workers
need to be ensured in health-care settings. Voluntary blood donation
and universal screening of blood and blood products for transfusion
will also help in prevention strategies.
3. Review of Literature
HBV infection prevalence in world ranges from 10% in some Asian
and Western Pacific countries to under 0.5% in the United States and
northern European countries. Most infections occur during infancy
or childhood particularly acquired from the carrier mothers at birth.
Since most infections in children are asymptomatic, there is little ev-
idence of acute disease related to HBV but the rates of chronic liver
disease and liver cancer in adults are high. The chronicity of infec-
tion depends upon age of acquering infection as more than 90% of
the adults infected with HBV successfully clear the acute infection
and become immune naturally. Approximately, 5-10% proceeds to
chronicity and become chronic carriers. Whereas around 98% babies
born to mothers with chronic HBV infection become infected and
around 95% of these will develop a persistent infection. The reason
behind this is that immune system of very young is less able to clear
the infected hepatocytes. All pregnant women with HBV should be
evaluated for the need of treatment for hepatitis B and any associat-
ed liver disease, and given advice about prevention of transmission.
Only a proportion of those with hepatitis B virus infection (preg-
nant or otherwise) need treatment. Hepatitis B in a pregnant woman
is not a reason for considering termination of pregnancy. Similarly,
the presence of HBV infection is not an indication for caesarean
delivery, which should be based on obstetric indications only. Ad-
ministration of hepatitis B vaccine to pregnant women with HBV
provides no benefit either to the mother or the baby. All infants born
to HBV positive women need to be immunized within 24 hours of
birth (Dose - 0) followed by 6, 10 & 14 weeks (dose – 10 µg IM)
and HBIG – (0.5 ml or 100 international units, intramuscular), this
should be done as soon after birth as possible (and within 12-24
hours) and in a limb other than the one in which hepatitis B vaccine
has been administered.
Figure 1: Showing Age Distribution of Hepatitis B patients.
3. 2021, V5(13): 1-3
3
Figure 2: Showing Clinical Stages of Hepatitis B patients.
Figure 3: Showing Sex Distribution of Hepatitis B patients
Chronic HBV infection is a dynamic process reflecting the interac-
tion between HBV replication, hepatocytes and the host’s immune
response. The natural history of chronic HBV infection has been
schematically divided into phases, taking into account the presence
of HbeAg, HBV DNA levels, alanine aminotransferase (ALT) values
and eventually the presence or absence of liver inflammation. The
risk of progression to cirrhosis and HCC is variable and is affected
by the host’s immune response. The natural history of HBV infec-
tion consists of five phases: the immunotolerant phase, the immune
reactive HBeAg positive phase, the inactive HBV carrier phase, the
HBeAg negative chronic hepatitis B phase and the HBsAg negative
phase or resolution phase (11). Patients with HBsAg positivity pre-
senting with jaundice may be due to acute HBV infection, superad-
ded infections like hepatitis A or E or due to reactivation of the HBV
virus. Cirrhosis, hepatocellular carcinoma and liver failure are major
long-term complications of chronic HBV infection that significantly
increases morbidity and mortality. In patients without cirrhosis, if
untreated, the incidence of liver related death is low and ranges from
0 to 1.06 per 100 person years. The mortality rate at 5 years is 16%
for those with compensated cirrhosis and is 65% to 86% for decom-
pensated cirrhosis [12, 13]. Various factors involving the host and
the virus may contribute to the development of hepatocellular car-
cinoma. HCC incidence is three to six times higher in males than in
females, suggesting a tumorigenic effect of androgens [14]. The old-
er age (>45 years), a first degree relative with HCC, the presence of
cirrhosis, and reversion activity are all thought to contribute to HCC
development [14]. Patients should be considered for treatment when
they have evidence of disease activity (serum ALT levels above the
upper limit of normal (ULN) and/or liver biopsy showing moderate
to severe active necroinflammation and/or at least moderate fibrosis
along with evidence of viral replication with HBV DNA levels above
2,000 IU/mL. Patients with cirrhosis or liver or obvious evidence of
active chronic hepatitis B with ALT above 2 times ULN and serum
HBV DNA above 20,000 IU/mL may start treatment even without
4. 2021, V5(13): 1-4
4
a liver biopsy. The risk of HBV infection may be higher in HIV-in-
fected adults, and therefore all persons newly diagnosed with HIV
should be screened for HbsAg and immunized if HbsAg is negative.
Those already infected with HBV (HbsAg positive) do not benefit
from HBV vaccine.
4. Aim of Study
To study the Epidemiological profile and Spectrum of patients with
Hepatitis B virus infection.
5. Material and Methods
This was prospective study done at Department of Medical Gastro-
enterology, PGIMS, Rohtak over a period of ten years i.e. 01.09.2010
to 31.08.2020,of patients who were found to be HbsAg positive on
outdoor or indoor basis and were admitted in various wards of our
hospital.
5.1. Inclusion Criteria
Patients who were found HbsAg positive on rapid card test or En-
zyme linked immunoassay test and confirmed on Polymerase Chain
test for HBV DNA quantitative test.
5.2. Exclusion Criteria
Patients who refused to give consent for enrollment in the study.
5.3. Methodology
In this prospective study, HBV patients who visited the Medical Gas-
troenterology Department in last ten years, and consented for enroll-
ment in the study, their records were collected regarding their epide-
miological profile and clinical spectrum. At inclusion time, detailed
history of the patient was recorded like age, gender , residence, when
hepatitis B detected , past history of any blood transfusion, surgery,
needle stick injury, dental procedure, tattooing, acupuncture, unpro-
tected intercourse with multiple sexual partners, intravenous drug
abuse, history of previous upper GI bleed, hepatic encephalopathy,
melena, history of other co morbidities like diabetes, hypertension,
HIV, hepatitis C, chronic kidney disease, thyroid dysfunction. After
that detailed clinical examination was done which included measur-
ment of height, weight, BMI , complete general examination , tattoo,
needle or puncture marks, icterus, stigmata of liver disease, organo-
megaly, ascites and systemic examination was done. The laborato-
ry investigations were done like HBV DNA Quantitative, HBsAg,
HBeAg, anti HBc IgM and IgG, anti HBeAg, anti HIV antibody, anti
HCV antibody, complete blood counts, liver function tests , kidney
function tests, serum electrolytes, coagulation parameters (PT, INR),
blood sugar, ultrasonogram abdomen, chest x ray PA view ,ascitic
fluid - TLC, DLC, cultures, SAAG, Upper GI endoscopy , CECT
abdomen or Triple phase CT scan of abdomen and Fibro scan.
6. Stastical Analysis
Statistical analysis was performed by the SPSS program version
25.0. Continuous variables were presented as mean ± SD or median
(range), and categorical variables were presented as absolute num-
bers and percentage. Data was checked for normality before statisti-
cal analysis using Shaipro Wilk test. Normally distributed continuous
variables were compared using Student’s t test or ANOVA with ap-
propriate post hoc tests. Categorical variables were analyzed using
the chi square test. For all statistical tests, a p value less than 0.05 was
considered to be significant.
7. Observation
The age distribution varied between 1-100 yrs of age and charac-
terstically showed predominance of patients between 20-50 yrs of
age group (65% of total patient pool) with highest peak in 20-30yrs
of age ( 1468 patients i.e.30%). The number of patients were fewer
in number at extremes of ages like from 0-10 yrs of age, only 39
patients i.e. 1%, from 10-20 yrs of age, 580 patients i.e. 12%, 80-90
yrs of age, 12 patients i.e.0.002% & 91-100 yrs of age, 4 patients
i.e. 0.0008% contributed to total pool of 4828 hepatitis B patients.
8. Discussion
India is in intermediate zone of HBV prevalence and thus it is a ma-
jor public health problem in India. About 40 million asymptomatic
hepatitis B virus (HBV) carriers are present in India. There are no
large-scale population studies of the prevalence of HBV in India.
The smaller studies done show wide geographic variations due to
differences in socio-economic status or cultural practices in different
regions. The overall rate of HBsAg positivity has been reported to
range between 2% and 8% in most studies [15-17]. The same fact has
been confirmed in study by Malhotra etal, 2020 in which retrospec-
tive analysis of five years, the yearly prevalence of HbsAg ranged
between 3.16%- 8.1% with mean of 5.23% [18]. The widely quoted
figure of a carrier rate in India of 4.7% with an estimated carrier
population of 56.5 million.
Most of the available data is based on blood bank screening which
does not truly reflect the national prevalence, as shown by Malhotra
etal , 2020, in which blood bank data revealed prevalence rates of
HBsAg and anti-HCV antibody positivity of 0.80% and 0.81%, re-
spectively, whereas the rates of the same derived from passive screen-
ing data were 5.23% and 5.18%, respectively [19]. Many of the blood
banks show HBsAg prevalence was 0.2–4%, most of which have
prevalence much lower than that of the commonly quoted preva-
lence data [20]. This fact is also confirmed in our study, as out of
total 4828 patients, only 148 patients (3.06% ) were detected during
blood donation.
A large study involving 8575 pregnant women from Northern India,
documented HBsAg carrier rate in antenatal mothers to be 3.7%,
HBeAg carrier rate 7.8% and vertical transmission was observed in
18.6% [21]. However, a recent study by Dwivedi et al [22] has shown
a lower prevalence rate of 0.9 In two different studies, Malhotra etal
showed seroprevalence of HbsAg to be 0.34% in pregnant women
[23, 24]. In our present study out of total pool of 4828 patients, 70
pregnant females were found positive for HbsAg.
5. 2021, V5(13): 1-5
5
The peaking of infection rates in adulthood in Indian population also
suggests a close relationship of acquisition of infection in the adults
[25]. The prevalence of HbsAg was 2.97% in study conducted by
Chaudhary A,2004 and there was a peak of prevalence after the sec-
ond decade of life [26]. In our study also, the age distribution varied
between 1-100 yrs of age and characterstically showed predominance
of patients between 20-50 yrs of age group (65% of total patient
pool) with highest peak in 20-30yrs of age ( 1468 patients i.e. 30%).
In an earlier study, frequent exposure to percutaneous injuries, re-
peated use of Parenteral injections for trivial illnesses and the un-
trained para-medical personnel, lacking in knowledge about modes
of sterilization in primary care centers have been found to be the
major factors that facilitate transmission of HBV, as well as other
viruses in this population [25]. In our study also, 40% (1931) patients
gave history of Parenteral injections, dental or any other surgical
interventions & tattooing which reemphasizes the significant con-
tribution of unsafe injection practices in spreading transmission of
hepatitis B in the community. Moreover, 70% (3380 patients) of pa-
tients in our group of study came from rural background with low-
er socioeconomic status and as expected circumstantially they were
exposed maximum to unsafe needle practices. Apart from exposure
from extraneous sources, interfamilial aggregation of HBV infected
persons in a family has been well documented in India [27]. HbsAg
contamination of surfaces is wide spread in homes of chronically
infected persons [28] which may explain the non-sexual interpersonal
spread of HBV such as among household contacts. Household con-
tacts of subjects with chronic HBV infection are known to be at high
risk of acquiring infection through multiple modes [29].
One thing which was characteristically observed in our study group
was regarding certain districts of our Haryana state like Jind, Kaithal,
Panipat, Karnal, Sonepat were found to be hotspots for hepatitis B,
as maximum number of patients belonged to these districts. Surpris-
ingly, all these districts are also hotspots for Chronic Hepatitis C, as
reported by Malhotra etal in 2016 [30]. The reason can be that both
hepatitis B & C are having common route of transmission i.e. blood
borne and non-availability of proper health infrastructure thus lead-
ing to unsafe needle practices can be significant contributory factor
for making these districts hotspots for both hepatitis B & C.
Adult patients with HBeAg-positive chronic hepatitis usually pres-
ent in the third or fourth decade of life and are more frequently
males [31]. In our study also there was male predominance strikingly
3224 patients (67%) were males and only 1604 patients (33%) were
females. The spectrum of liver damage ranges from mild (approxi-
mately 20 to 40%) to moderate or severe chronic hepatitis (approxi-
mately 40 to 60%) or active cirrhosis (approximately 10 to 25%) [32].
In about two-thirds of the disease burden in India, it is represented
by hepatitis e−ve disease, with low or undetectable viral load which
naturally mitigates the disease severity to some extent [33]. In an an-
other study, a significant number of patients were in the inactive/
immunotolerant phase not requiring treatment [34]. The same find-
ings were observed in our study as maximum number of hepatitis B
patients were chronic hepatitis B but in inactive carrier state i.e. 3646
patients (76%) who did not require any treatment. In total 700 pa-
tients (14%) of chronic hepatitis B were found to be in active phase
or cirrhotics and were started on treatment. In total pool of 4828
patients, only 71 patients (1.46%) were found to be cirrhotic and
we analyze in treatment group, then out of total 700 patients which
required treatment, the contribution of these 71 patients is around
10.14% only. This is positive outcome of early detection of hepatitis
B infection by various inetiatives like screening camps in hotspots,
screening before surgical interventions, dialysis, thalassemiacs, preg-
nancy etc. and early treatment if indicated, leading to less chances
of progression to cirrhotic stage. In only 10 patients (0.20%) out of
total 4828 patients developed hepatocellular carcinoma (H.C.C). Out
of these ten patients, eight had cirrhosis and two were non-cirrhotic
which emphasizes the fact that hepatitis B virus can directly proceed
to H.C.C without passing through cirrhotic stage but in very limited
number of patients. The acute hepatitis B state was seen in 482 pa-
tients i.e. 10% of total patients of hepatitis B.
In hepatitis B virus (HBV) or hepatitis C virus (HCV) endemic
countries, patients are exposed to the risk of being co-infected with
both viruses. Parenteral viral transmission could also lead to HCV/
HBV co-infection. In patients infected with both HCV and HBV,
the risk of developing liver cirrhosis (LC) and hepatocellularcarcino-
ma (HCC) is usually highert han those with mono-infectionof either
virus [35-37]. Therefore, patients co-infected with hepatitis C and
B require regular monitoring and aggressive antiviral treatment. In
our study, out of total 4828 patients, HBV & HCV co-nfection was
seen only in 68 patients (1.40%) whereas HBV & HIV co-infection
was seen only in 19 patients (0.39%). The characterstic point was
that majority of patients of co-infection belonged to hotspots which
can be due to common mode of transmission i.e. blood borne. The
very minimal percentage of co-infection in such a large group of
4828 patients can be explained on basis of one virus not allowing
the survival of another virus in human body which is already well
documented in literature.
9. Results
Hepatitis B is a major health issue in India with non-uniform distri-
bution and certain geographical areas are hotspots like Haryana. The
young males belonging to rural background are most vulnerable. The
unsafe needle & injection practices along with vertical transmission
are major reason for transmission of this disease. We cannot rely on
blood bank data for determining the prevalence of it but screening
of high risk population in atleast hotspots will reflect true picture.
Moreover,it will lead to early detection of cases and thus will sub-
stantially decrease the development of long term complications like
cirrhosis and hepatocellular carcinoma, as shown in our this study.
6. 2021, V5(13): 1-6
6
References
1. World Health Organization (2012). Hepatitis B. World Health Organi-
zation Fact Sheet 204 (Revised August 2008). [online] Available from
http://who.int/inf-fs/en/fact204.html. [Accessed Sep 2012].
2. Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment,
and current and emerging prevention and control measures. J Viral
Hepat. 2004; 11: 97-107.
3. Lok AS. Chronic hepatitis B. N Engl J Med. 2002; 346: 1682-3.
4. Goldstein ST, Zhou F, Hadler SC. A mathematical model to estimate
global hepatitis B disease burden and vaccination impact. Int J Epide-
miol. 2005; 34: 1329-39.
5. Te HS, Jensen DM. Epidemiology of hepatitis B and C viruses: a global
overview. Clin Liver Dis. 2010; 14: 1-21.
6. Dutta S. An overview of molecular epidemiology of hepatitis B virus
(HBV) in India. Virol J. 2008; 5: 156.
7. World Health Organization (2012). Introducing Hepatitis B Vaccine in
Universal Immunization Programe in India. A Brief Scenario. [online].
Available from http://www.whoindia.org/en/section6/section8.htm.
[Accessed Sep 2012].
8. Abraham P. Viral Hepatitis in India. Clin Lab Med. 2012; 32: 159-74.
9. Thyagarajan SP, Jayaram S, Mohanavalli B. Prevalence of HBV in gen-
eral population in India. In: Sarin SK, Singal AK, (Eds). Hepatitis B
in India: problems and prevention. New Delhi: CBS; 1996. pp. 5-16.
10. Lok AS. Natural history and control of perinatally acquired hepatitis B
virus infection. Dig Dis 1992; 10: 46-52.
11. Zaidi AKM, Awasthi S, deSilva HJ. Burden of infectious diseases in
South Asia. BMJ. 2004; 328: 811-5.
12. de Jongh FE, Janssen HL, de Man RA. Survival and prognostic indica-
tors in hepatitis B surface antigen-positive cirrhosis of liver. Gastroen-
terology 1992; 103: 1630-5.
13. Fattovich G, Giustina G, Schalm SW. Occurrence of hepatocellular
carcinoma and decompensation in western European patients with cir-
rhosis type B. Hepatology. 1995; 21: 77-82.
14. Beasley RP. Hepatitis B virus. The major etiology of hepatocellular
carcinoma. Cancer 1988; 61: 1942-56.
15. Abraham P. Viral hepatitis in India. Clin Lab Med. 2012; 32: 159–174.
16. Thyagarajan S.P., Jayaram S., Mohanavalli B. Prevalence of HBV in
general population of India. In: Sarin S.K., Singal A.K., editors. Hepa-
titis B in India: Problems and Prevention. CBS Publishers and Distrib-
utors; New Delhi: 1996. pp. 5–16.
17. Prevention of Hepatitis B in India – AnOverview. World HealthOrga-
nization South-East Asia Regional Office; New Delhi: 2002.
18. Prevalence of hepatitis B and Hepatitis C in Tertiary Care Centre of
Northern India. Malhotra P, Malhotra V, Pushkar, Gupta U, Sanwariya
Y. Adv Res Gastro enterol Hepatol 2020; 15: 55918.
19. Malhotra P, Malhotra V, Gupta U, Gill PS, Pushkar, Sanwariya Y, The
Prevalence of Hepatitis B and C among the Passively Screened Popu-
lation and Blood Donors in Haryana, India: A Retrospective Analysis.
Gastroenterol Hepatol Lett. 2020; 2: 1-5.
20. Singh K., Bhat S., Shastry S. Trend in seroprevalence of hepatitis B vi-
rus infection among blood donors of coastal Karnataka, India. J Infect
Dev Ctries. 2009; 3: 376–379.
21. Nayak NC, Panda SK, Bhan MK, Guha DK, Zuckerman AJ. Dynam-
ics and impact of perinatal transmission of hepatitis B virus in North
India. J Med Virol. 1987; 21: 137-145.
22. Dwivedi M, Misra SP, Misra V. Seroprevalence of hepatitis B infection
during pregnancy and risk of perinatal transmission. Indian J Gastro-
enterol. 2011; 30: 66–71.
23. Hepatitis B Infection in Pregnancy – Experience at a Tertiary Care
Centre of North India. Malhotra V, Malhotra P, Bhuria V, Pahuja I,
Nanda S, Chauhan M, Sangwan N. Jour of Hematology Research 2017;
4: 35-7.
24. Prevalence of HIV, Hepatitis B, Hepatitis C in Pregnancy at Tertiary
care center of Northern India. Malhotra P, Malhotra N, Malhotra V,
Nanda S, Chauhan M, Chugh A et al. Adv Res Gastroenterol Hepatol.
2016; 1: 555568.
25. Chowdhury A, Santra A, Chakravorty R, Banerji A, Pal S, Dhali GK
et al. Community-based epidemiology of hepatitis B virus infection
in West Bengal, India: prevalence of hepatitis B e antigen-negative in-
fection and associated viral variants. J Gastroenterol Hepatol. 2005;
20: 1712-20.
26. Chowdhury A Epidemiology of Hepatitis B Virus Infection in India.
Hepatitis B Annual. 2004; 17-24.
27. Chakravarty R, Chowdhury A, Chaudhuri S, Santra A, Neogi M, Raen-
dran K, Panda CK et al. Hepatitis B infection in Eastern Indian fam-
ilies: Need for screening of adult siblings and mothers of adult index
cases. Public Health. 2005, 119: 647-54.
28. Petersen NJ, Barrett DH, Bond WW, Berquist KR, Favero MS, Bend-
er TR et al. Hepatitis B surface antigen in saliva, impetiginous
lesions, and the environment in two remote Alaskan villages. Appl
Environ Microbiol. 1976, 32: 572-4.
29. Maddrey WC: Hepatitis B: an important public health issue. J Med
Virol. 2000, 61: 362-6.
30. Malhotra P, Malhotra N, Malhotra V, Chugh A, Chaturvedi A, Chan-
drika P et al. Haryana in Grip of Hepatitis C. International Invention
Journal of Medicine and Medical Sciences (ISSN: 2408-7246) 2016;
3: 6-13.
31. Fattovich G. Natural history and prognosis of hepatitis B. Semin Liver
Dis. 2003; 23: 47-58.
32. Giovanna Fattovich, Irene Zagni, Chiara Scattolini. Natural History of
Hepatitis B and Prognostic Factors of Disease Progression. Manage-
ment of Patients with Viral Hepatitis, Paris, 2004.
33. Ray G. Current Scenario of Hepatitis B and Its Treatment in India.
Journal of Clinical and Translational Hepatology 2017; 5: 277-96.
34. Balasubramanian S, Velusamy A, Krishnan A, Venkatraman J. Spec-
trum of hepatitis B infection in Southern India: A cross-sectional anal-
ysis. Hepatitis B Annual. 2012; 9: 4-15.
7. 2021, V5(13): 1-7
7
35. Liu CJ, Liou JM, Chen DS, Chen PJ. Natural course and treatment of
dual hepatitis B virus and hepatitis C virus infections. J. Formos. Med.
Assoc. 2005; 104: 783–91.
36. Chen DS, Kuo GC, Sung JL, Lai MY, Sheu JC, Chen PJ et al. Hep-
atitis C virus infection in an area hyper endemic for hepatitis B and
chronic liver disease: The Taiwan experience. J. Infect. Dis. 1990; 162:
817–822.
37. Liu CJ, Chen PJ, Shau WY, Kao JH, Lai MY, Chen DS et al. Clinical
aspects and outcomes of volunteer blood donors testing positive for
Hepatitis-C virus infection in Taiwan: A prospective study. Liver Int.
2003; 23: 148–155.