This document provides consensus statements from guidelines on the management of hepatitis B virus (HBV) infection in India. It covers epidemiology, vaccination, diagnosis, treatment goals and monitoring, antiviral treatment strategies, special populations including children and healthcare workers, and pregnancy considerations. The guidelines were developed through an expert panel discussion and aim to standardize management of HBV in India based on available evidence.
- Autoimmune liver diseases involve an immunological attack against hepatocytes and/or the biliary epithelium, presenting variably from asymptomatic to acute/chronic. Diagnosis requires interpreting serological and histological markers alongside biliary imaging.
- Treatment aims to prevent end-stage liver disease and complications, but managing autoimmune liver disease can be challenging. For primary biliary cirrhosis (PBC), ursodeoxycholic acid (UDCA) is the first-line treatment and improves biochemistry and transplant-free survival.
- For autoimmune hepatitis (AIH), prednisolone alone or combined with azathioprine improves liver tests, histology, and survival, with combination
Management of chronic hepatitis c before and after liver transplantApollo Hospitals
Hepatitis C infection is the most common cause of cirrhosis worldwide. Management of chronic hepatitis C in peri-transplant period is challenging. Patients with compensated/Child's A cirrhosis due to hepatitis C virus (HCV) infection are treated like noncirrhotics, with peginterferon (PEG-IFN) and ribavirin, albeit with a higher incidence of complications. Treatment is not recommended for decompensated cirrhotics due to higher complication rate including the risk of death. After liver transplant, immunosuppression should be adjusted to prevent/delay recurrent HCV disease. Incidence and severity of recurrent HCV disease as well as patient and graft survival is similar between living donor and deceased donor liver transplants. It is currently recommended to treat established recurrent hepatitis C, that is raised alanine aminotransferase (ALT) with HAI >4 and/or F >1. Pre-emptive/prophylactic antiviral therapy is poorly tolerated and has low efficacy. Standard dose regimen (PEG-IFN 1.5 μg/Kg or 180 μg weekly + ribavirin 800–1200 mg/day) for 48 weeks irrespective of the genotype is the recommended treatment protocol. Therapy poses significant problems in the form of anemia, neutropenia, higher risk of rejection, and so on.
poster presentation Study of hematological parameters in sepsis patients and...RahulGupta1687
The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.
This document discusses long-term use of proton pump inhibitors (PPIs) and potential risks and conditions for use. It notes that long-term PPI use has been associated with chronic kidney disease (CKD) and dementia, though the relationships are uncertain. For conditions like GERD, NSAID use, and Barrett's esophagus, the benefits of PPIs usually outweigh the small and uncertain risks. The document provides guidance on what to tell patients about risk/benefit assessments and recommends the lowest effective dose and intermittent use when possible to reduce potential side effects.
This document summarizes information about hepatitis B and C co-infection with HIV. It notes that co-infection leads to faster progression of liver disease and higher rates of liver cancer and mortality. Treatment for both viruses is important, with newer regimens like tenofovir alafenamide having comparable efficacy to tenofovir disoproxil fumarate but being more tolerable with less bone and kidney toxicity. Achieving a sustained virologic response reduces complications of liver disease and improves overall health outcomes.
The document discusses the relationship between hepatitis C virus (HCV) infection and diabetes mellitus (DM). It notes that the liver plays an important role in glucose metabolism, which helps explain the association between cirrhosis and impaired glucose regulation. There is increasing evidence that HCV infection is linked to DM by mechanisms like pancreatic beta cell damage. DM can accelerate liver disease progression in HCV patients. Traditional antiviral therapy has been shown to improve DM outcomes and reduce risks of complications like heart attack and stroke. However, the impact of new direct-acting antiviral treatments on DM needs further research. Overall control of DM is important for good response to HCV treatment and reducing related complications.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
- Autoimmune liver diseases involve an immunological attack against hepatocytes and/or the biliary epithelium, presenting variably from asymptomatic to acute/chronic. Diagnosis requires interpreting serological and histological markers alongside biliary imaging.
- Treatment aims to prevent end-stage liver disease and complications, but managing autoimmune liver disease can be challenging. For primary biliary cirrhosis (PBC), ursodeoxycholic acid (UDCA) is the first-line treatment and improves biochemistry and transplant-free survival.
- For autoimmune hepatitis (AIH), prednisolone alone or combined with azathioprine improves liver tests, histology, and survival, with combination
Management of chronic hepatitis c before and after liver transplantApollo Hospitals
Hepatitis C infection is the most common cause of cirrhosis worldwide. Management of chronic hepatitis C in peri-transplant period is challenging. Patients with compensated/Child's A cirrhosis due to hepatitis C virus (HCV) infection are treated like noncirrhotics, with peginterferon (PEG-IFN) and ribavirin, albeit with a higher incidence of complications. Treatment is not recommended for decompensated cirrhotics due to higher complication rate including the risk of death. After liver transplant, immunosuppression should be adjusted to prevent/delay recurrent HCV disease. Incidence and severity of recurrent HCV disease as well as patient and graft survival is similar between living donor and deceased donor liver transplants. It is currently recommended to treat established recurrent hepatitis C, that is raised alanine aminotransferase (ALT) with HAI >4 and/or F >1. Pre-emptive/prophylactic antiviral therapy is poorly tolerated and has low efficacy. Standard dose regimen (PEG-IFN 1.5 μg/Kg or 180 μg weekly + ribavirin 800–1200 mg/day) for 48 weeks irrespective of the genotype is the recommended treatment protocol. Therapy poses significant problems in the form of anemia, neutropenia, higher risk of rejection, and so on.
poster presentation Study of hematological parameters in sepsis patients and...RahulGupta1687
The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.
This document discusses long-term use of proton pump inhibitors (PPIs) and potential risks and conditions for use. It notes that long-term PPI use has been associated with chronic kidney disease (CKD) and dementia, though the relationships are uncertain. For conditions like GERD, NSAID use, and Barrett's esophagus, the benefits of PPIs usually outweigh the small and uncertain risks. The document provides guidance on what to tell patients about risk/benefit assessments and recommends the lowest effective dose and intermittent use when possible to reduce potential side effects.
This document summarizes information about hepatitis B and C co-infection with HIV. It notes that co-infection leads to faster progression of liver disease and higher rates of liver cancer and mortality. Treatment for both viruses is important, with newer regimens like tenofovir alafenamide having comparable efficacy to tenofovir disoproxil fumarate but being more tolerable with less bone and kidney toxicity. Achieving a sustained virologic response reduces complications of liver disease and improves overall health outcomes.
The document discusses the relationship between hepatitis C virus (HCV) infection and diabetes mellitus (DM). It notes that the liver plays an important role in glucose metabolism, which helps explain the association between cirrhosis and impaired glucose regulation. There is increasing evidence that HCV infection is linked to DM by mechanisms like pancreatic beta cell damage. DM can accelerate liver disease progression in HCV patients. Traditional antiviral therapy has been shown to improve DM outcomes and reduce risks of complications like heart attack and stroke. However, the impact of new direct-acting antiviral treatments on DM needs further research. Overall control of DM is important for good response to HCV treatment and reducing related complications.
Background: The precise evaluation of hepatic fi brosis is crucial in the management of Chronic Hepatitis C (CHC). Multiple noninvasive serological scores and devices have been used in the accurate prediction of fibrosis however; early changes in non-invasive
biomarkers of liver fibrosis following antiviral therapy are widely unknown. We aim to evaluate changes of liver stiffness and 6 noninvasive serological fibrosis scores, easy to calculate particularly in poor areas, following sofosbuvir- based treatment.
Methods: This is a cohort study that included 155 CHC Egyptian patients. Transient elastography values were recorded as well
as Aspartate Aminotransferase-To-Platelet Ratio Index (APRI), FIB-4, Lok score, fibrosis index, King Score and fibro Q score were calculated at baseline and 12 weeks post-treatment.
This document summarizes the key guidelines from the 2008 Egyptian-Italian consensus meeting on the management of hepatitis C virus (HCV) infection. Some of the main points covered include:
1) Liver biopsy is still recommended before HCV treatment to assess fibrosis level.
2) Fibroscan and laboratory markers alone cannot replace liver biopsy.
3) Genotyping is only necessary for patients who travel abroad or are treatment failures.
4) There is no upper age limit for HCV treatment. Pegylated interferon can be used in children ages 5 years old.
5) Patients with persistently normal liver enzymes should be treated if fibrosis is F1 or above.
6) Patients with compens
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
When to dialyse a patient and with what modality of dialysis will be topic of discussion.The recent advances and debates surrounding the topic will be discussed in detail
- The patient is a 29-year-old Cambodian woman in her first trimester of pregnancy who was found to have chronic hepatitis B virus (HBV) infection. Her liver tests are normal. She is HBsAg+, HBeAg+ with an HBV DNA level of 50,000 IU/ml.
- It is recommended that the patient receive antiviral therapy during pregnancy to reduce the risk of mother-to-child transmission of HBV. Close monitoring of the infant after delivery for prophylaxis is also advised. Counseling on lifestyle modifications and vaccination of household members should be provided.
Effects of Da-Cheng-Qi decoction on enteroparalysis and serum inflammatory cy...LucyPi1
Abstract Objective: The objective of this study was to investigate the effects of Da-Cheng-Qi decoction (DCQD) on enteroparalysis and levels of the serum inflammatory cytokines C-C motif chemokine ligand 2 (CCL2) and interleukin-8 (IL-8) in patients with severe acute pancreatitis (SAP). Methods: A total of 48 patients diagnosed with SAP who hospitalized in First Affiliated Hospital of Henan Traditional Chinese Medicine University from May 1, 2016 to May 30, 2018 were randomly assigned to the control or treatment groups. Patients in the control group (n = 22) received conventional treatment and those in the treatment group (n = 26) received conventional treatment as well as additional DCQD for 10 days. The duration of abdominal pain and distension, the time when bowel sounds returned to normal, changes in the levels of serum amylase, lipase, C-reactive protein (CRP), CCL2 and IL-8, as well as acute physiology and chronic health evaluation (APACHE) II scores of patients on days 1 and 10 were recorded and compared. Results: The duration of abdominal pain and distension, the time when bowel sounds returned to normal, the levels of blood amylase, lipase and CRP, and APACHE II scores of patients in the treatment group decreased significantly compared with those of patients in the control group. Though there were no statistical differences in serum CCL2 and IL-8 concentrations on day 1 between patients in these two groups, the levels of serum CCL2 and IL-8 in the treatment group were lower than those in the control group on day 10. Conclusion: DCQD may decrease the levels of CCL2, CRP, and IL-8 in patients with SAP, quickly relieve enteroparalysis, and shorten hospitalization duration.
This document discusses common mistakes made in diagnosing celiac disease and how to avoid them. It outlines 10 specific mistakes: 1) Evaluating patients for celiac disease after they have already started a gluten-free diet, 2) Diagnosing based only on symptom resolution after starting a gluten-free diet, and 3) Taking an insufficient number of biopsy samples or lacking biopsy orientation. The document provides details on each mistake and recommendations for proper diagnosis.
This document discusses glucose control in renal transplant patients. It presents a case of new onset diabetes after transplant and reviews the pharmacology of immunosuppressants like calcineurin inhibitors that can cause glucose dysregulation. It also discusses the current recommendations for glucose control during and after transplant, including managing new onset diabetes after transplant through diagnosis and treatment approaches. Risk factors for developing new onset diabetes after transplant are examined, as well as the impacts of hyperglycemia on kidney transplant outcomes.
Cirrhosis is a dynamic disease with varying prognosis depending on clinical stage. It results from mechanisms leading to necroinflammation and fibrogenesis. Later stages are characterized by portal hypertension, ascites, encephalopathy, and risk of hepatocellular carcinoma. Treatment and prevention of complications, including screening and cause-specific therapies, can improve outcomes for patients with cirrhosis.
Acquired hemophilia is a rare disorder and if missed can cost lives. This presentation has been prepared keeping in view the non hematologist health care workers to broaden their index of suspicion and increase their awareness. The target people are medical residents those who work in ER and ICUs.
This document reports on 6 cases of new onset diabetes that appeared after kidney transplantation. It finds that 30% of kidney transplant patients in the studied population developed diabetes, with an average onset of 5 months post-transplant. Risk factors for developing diabetes included older age, family history, overweight status, and immunosuppressive medications. Treatment included insulin therapy, oral medications, and adjusting immunosuppression. Good glycemic control is important for transplant outcomes, but treatment must be carefully managed to avoid rejection.
Viral hepatitis is an infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs. Researchers have discovered several different viruses link that cause hepatitis, including hepatitis A, B, C, D, and E.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
Clinical Practice Guideline on management of patients with diabetes and chron...Ahmed Albeyaly
This document provides a summary of a clinical practice guideline on managing patients with diabetes and chronic kidney disease (CKD) stage 3b or higher. It outlines the composition of the guideline development group, which included nephrologists, endocrinologists, and epidemiologists from several European countries. The group aimed to provide guidance on evidence-based approaches to improve care for this patient population. The guideline's target audience is healthcare professionals treating adults with both diabetes and reduced kidney function (eGFR <45 mL/min). It focuses on developing standards of care for managing this complex patient group.
This document summarizes a study on the combined treatment of chronic viral hepatitis B, C, and mixed B and C with CitomixTM+Guna®-Liver+Interferon gamma 4C. Seventeen patients received this treatment combination for 3 months, while 16 control patients received no treatment. The combined treatment group showed clinical symptom improvement, decreased liver and spleen size, moderate decreases in liver enzyme levels, and seroconversion to anti-HBs antibodies in some patients. In contrast, the control group showed no clinical, biochemical, or immunological improvements.
- Rheumatoid arthritis (RA) is associated with a nearly two-fold increased risk of cardiovascular disease (CVD) due to chronic inflammation accelerating atherosclerosis.
- CVD risk assessment using algorithms like Framingham is recommended for RA patients, but these should be adapted by multiplying the risk score by 1.5 to account for RA-related risk.
- Lifestyle factors like smoking, physical inactivity, and comorbidities increase CVD risk in RA, so controlling disease activity, screening for risk factors, and treating modifiable risks are important for management according to EULAR guidelines.
GIT Kurdistan Board J club Functional heart burn16.Shaikhani.
- The patient has heartburn that does not respond to PPI therapy and has a normal endoscopy. Based on these findings, the most likely diagnosis is functional heartburn (FH). FH is diagnosed when there are typical reflux symptoms but normal acid exposure and no correlation between symptoms and reflux events.
- FH affects both men and women and is associated with visceral hypersensitivity, esophageal dysmotility, and traits seen in other functional gastrointestinal disorders. Diagnosis involves ruling out underlying reflux disease or motility issues through endoscopy, pH testing, and motility studies.
- FH has a benign clinical course but can impact quality of life. Treatment focuses on reassurance and lifestyle changes rather than acid
This document summarizes guidelines for the management of hepatitis C virus (HCV) infection from the European Association for the Study of the Liver (EASL). Key points include:
- HCV infects an estimated 160 million people worldwide and is a major cause of chronic liver disease. New direct-acting antiviral drugs have improved treatment outcomes.
- The guidelines provide recommendations on diagnosing, assessing, and treating HCV infection. They address issues like determining liver disease severity, HCV genotyping, treatment goals and endpoints, and contraindications to therapy.
- For HCV genotype 1, the current standard of care is combination therapy with pegylated interferon, ribavirin, and one of two protease
This document discusses new-onset diabetes after transplantation (NODAT), which occurs in some patients after receiving a solid organ transplant. It defines NODAT and reviews its epidemiology and risk factors. The document outlines the pathogenesis and risk of NODAT associated with different immunosuppressive drugs. It also discusses the diagnosis, screening, and management of NODAT, including monitoring patients, treating hyperglycemia, and controlling cardiovascular risk factors. The document notes ongoing areas of uncertainty around preventing NODAT and determining the long-term impacts of improved glycemic control.
Post transplant diabetes patient education classawclarke
Post-transplant diabetes, also called new onset diabetes or post-transplant diabetes mellitus (PTDM), is a serious risk for organ transplant recipients that can lead to health complications if left uncontrolled. Risk factors include family history, obesity, certain ethnic backgrounds, immunosuppressant medications, and inactive lifestyle. Symptoms may include frequent urination, thirst, hunger, and tingling sensations. Early detection through blood glucose monitoring and treatment including insulin, medications, diet, and exercise changes can help reduce risks of long-term issues such as heart, eye, kidney, and nerve damage. Living well with diabetes requires ongoing self-management and support from one's healthcare team.
1. Chronic Hepatitis B (CHB) is caused by the HBV virus and can be either acute or chronic. It infects the liver and causes inflammation and necrosis.
2. Initial assessment of patients with CHB includes medical history, physical exam, liver disease markers and severity indicators, and testing of close contacts.
3. Treatment indications include elevated HBV DNA and ALT levels, cirrhosis, and family history of HCC. The preferred treatments are entecavir, tenofovir, and tenofovir alafenamide which have a high genetic barrier to resistance.
Recent guidelines in the management of chronic hepatitisShivshankar Badole
This document provides guidelines for the management of chronic hepatitis B (CHB) infection. It outlines the initial evaluation of HBsAg positive patients including laboratory tests and imaging/staging studies. It describes the phases of CHB infection and recommends treatment based on phase. Approved antiviral drugs are discussed along with monitoring on treatment. Treatment guidelines are provided for immune active CHB, immune tolerant CHB, HBeAg positive CHB that seroconvert, and HBeAg negative CHB. It also covers management of cirrhosis, viral breakthrough, pregnancy, and more.
This document summarizes the key guidelines from the 2008 Egyptian-Italian consensus meeting on the management of hepatitis C virus (HCV) infection. Some of the main points covered include:
1) Liver biopsy is still recommended before HCV treatment to assess fibrosis level.
2) Fibroscan and laboratory markers alone cannot replace liver biopsy.
3) Genotyping is only necessary for patients who travel abroad or are treatment failures.
4) There is no upper age limit for HCV treatment. Pegylated interferon can be used in children ages 5 years old.
5) Patients with persistently normal liver enzymes should be treated if fibrosis is F1 or above.
6) Patients with compens
Sydney Sexual Health Centre Journal Club presentation by Gwamaka E.M. on The Journal of Infectious Diseases Volume 214 Issue 10, published in November 2016.
The Journal of Infectious Diseases has been published continuously since 1904 and describes itself as "the premier global journal for original research on infectious diseases". Research published in the JID includes studies in microbiology, immunology, epidemiology, and related disciplines, on the pathogenesis, diagnosis, and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune responses. JID is an official publication of the Infectious Diseases Society of America.
The Sydney Sexual Health Centre Journal Club allows our team to stay up-to-date with what is being published in the field of sexual health. Staff members take turns to read, review and share the contents of an allocated journal. Journal Club encourages knowledge sharing and discussion about topics raised.
When to dialyse a patient and with what modality of dialysis will be topic of discussion.The recent advances and debates surrounding the topic will be discussed in detail
- The patient is a 29-year-old Cambodian woman in her first trimester of pregnancy who was found to have chronic hepatitis B virus (HBV) infection. Her liver tests are normal. She is HBsAg+, HBeAg+ with an HBV DNA level of 50,000 IU/ml.
- It is recommended that the patient receive antiviral therapy during pregnancy to reduce the risk of mother-to-child transmission of HBV. Close monitoring of the infant after delivery for prophylaxis is also advised. Counseling on lifestyle modifications and vaccination of household members should be provided.
Effects of Da-Cheng-Qi decoction on enteroparalysis and serum inflammatory cy...LucyPi1
Abstract Objective: The objective of this study was to investigate the effects of Da-Cheng-Qi decoction (DCQD) on enteroparalysis and levels of the serum inflammatory cytokines C-C motif chemokine ligand 2 (CCL2) and interleukin-8 (IL-8) in patients with severe acute pancreatitis (SAP). Methods: A total of 48 patients diagnosed with SAP who hospitalized in First Affiliated Hospital of Henan Traditional Chinese Medicine University from May 1, 2016 to May 30, 2018 were randomly assigned to the control or treatment groups. Patients in the control group (n = 22) received conventional treatment and those in the treatment group (n = 26) received conventional treatment as well as additional DCQD for 10 days. The duration of abdominal pain and distension, the time when bowel sounds returned to normal, changes in the levels of serum amylase, lipase, C-reactive protein (CRP), CCL2 and IL-8, as well as acute physiology and chronic health evaluation (APACHE) II scores of patients on days 1 and 10 were recorded and compared. Results: The duration of abdominal pain and distension, the time when bowel sounds returned to normal, the levels of blood amylase, lipase and CRP, and APACHE II scores of patients in the treatment group decreased significantly compared with those of patients in the control group. Though there were no statistical differences in serum CCL2 and IL-8 concentrations on day 1 between patients in these two groups, the levels of serum CCL2 and IL-8 in the treatment group were lower than those in the control group on day 10. Conclusion: DCQD may decrease the levels of CCL2, CRP, and IL-8 in patients with SAP, quickly relieve enteroparalysis, and shorten hospitalization duration.
This document discusses common mistakes made in diagnosing celiac disease and how to avoid them. It outlines 10 specific mistakes: 1) Evaluating patients for celiac disease after they have already started a gluten-free diet, 2) Diagnosing based only on symptom resolution after starting a gluten-free diet, and 3) Taking an insufficient number of biopsy samples or lacking biopsy orientation. The document provides details on each mistake and recommendations for proper diagnosis.
This document discusses glucose control in renal transplant patients. It presents a case of new onset diabetes after transplant and reviews the pharmacology of immunosuppressants like calcineurin inhibitors that can cause glucose dysregulation. It also discusses the current recommendations for glucose control during and after transplant, including managing new onset diabetes after transplant through diagnosis and treatment approaches. Risk factors for developing new onset diabetes after transplant are examined, as well as the impacts of hyperglycemia on kidney transplant outcomes.
Cirrhosis is a dynamic disease with varying prognosis depending on clinical stage. It results from mechanisms leading to necroinflammation and fibrogenesis. Later stages are characterized by portal hypertension, ascites, encephalopathy, and risk of hepatocellular carcinoma. Treatment and prevention of complications, including screening and cause-specific therapies, can improve outcomes for patients with cirrhosis.
Acquired hemophilia is a rare disorder and if missed can cost lives. This presentation has been prepared keeping in view the non hematologist health care workers to broaden their index of suspicion and increase their awareness. The target people are medical residents those who work in ER and ICUs.
This document reports on 6 cases of new onset diabetes that appeared after kidney transplantation. It finds that 30% of kidney transplant patients in the studied population developed diabetes, with an average onset of 5 months post-transplant. Risk factors for developing diabetes included older age, family history, overweight status, and immunosuppressive medications. Treatment included insulin therapy, oral medications, and adjusting immunosuppression. Good glycemic control is important for transplant outcomes, but treatment must be carefully managed to avoid rejection.
Viral hepatitis is an infection that causes liver inflammation and damage. Inflammation is swelling that occurs when tissues of the body become injured or infected. Inflammation can damage organs. Researchers have discovered several different viruses link that cause hepatitis, including hepatitis A, B, C, D, and E.
This document discusses guidelines for glycemic control in patients with diabetes and chronic kidney disease. It recommends monitoring HbA1c levels twice per year and targeting levels between 6.5-8%. Clinical trials showed that intensive glycemic control can reduce kidney disease progression but may increase mortality risk if targets are too low. The document also discusses guidelines for blood pressure control and the renoprotective effects of blocking the renin-angiotensin system with ACE inhibitors or ARBs. Combination therapy with an ACE inhibitor and ARB or adding an MRA may provide additional benefits but also increase risks like hyperkalemia.
Clinical Practice Guideline on management of patients with diabetes and chron...Ahmed Albeyaly
This document provides a summary of a clinical practice guideline on managing patients with diabetes and chronic kidney disease (CKD) stage 3b or higher. It outlines the composition of the guideline development group, which included nephrologists, endocrinologists, and epidemiologists from several European countries. The group aimed to provide guidance on evidence-based approaches to improve care for this patient population. The guideline's target audience is healthcare professionals treating adults with both diabetes and reduced kidney function (eGFR <45 mL/min). It focuses on developing standards of care for managing this complex patient group.
This document summarizes a study on the combined treatment of chronic viral hepatitis B, C, and mixed B and C with CitomixTM+Guna®-Liver+Interferon gamma 4C. Seventeen patients received this treatment combination for 3 months, while 16 control patients received no treatment. The combined treatment group showed clinical symptom improvement, decreased liver and spleen size, moderate decreases in liver enzyme levels, and seroconversion to anti-HBs antibodies in some patients. In contrast, the control group showed no clinical, biochemical, or immunological improvements.
- Rheumatoid arthritis (RA) is associated with a nearly two-fold increased risk of cardiovascular disease (CVD) due to chronic inflammation accelerating atherosclerosis.
- CVD risk assessment using algorithms like Framingham is recommended for RA patients, but these should be adapted by multiplying the risk score by 1.5 to account for RA-related risk.
- Lifestyle factors like smoking, physical inactivity, and comorbidities increase CVD risk in RA, so controlling disease activity, screening for risk factors, and treating modifiable risks are important for management according to EULAR guidelines.
GIT Kurdistan Board J club Functional heart burn16.Shaikhani.
- The patient has heartburn that does not respond to PPI therapy and has a normal endoscopy. Based on these findings, the most likely diagnosis is functional heartburn (FH). FH is diagnosed when there are typical reflux symptoms but normal acid exposure and no correlation between symptoms and reflux events.
- FH affects both men and women and is associated with visceral hypersensitivity, esophageal dysmotility, and traits seen in other functional gastrointestinal disorders. Diagnosis involves ruling out underlying reflux disease or motility issues through endoscopy, pH testing, and motility studies.
- FH has a benign clinical course but can impact quality of life. Treatment focuses on reassurance and lifestyle changes rather than acid
This document summarizes guidelines for the management of hepatitis C virus (HCV) infection from the European Association for the Study of the Liver (EASL). Key points include:
- HCV infects an estimated 160 million people worldwide and is a major cause of chronic liver disease. New direct-acting antiviral drugs have improved treatment outcomes.
- The guidelines provide recommendations on diagnosing, assessing, and treating HCV infection. They address issues like determining liver disease severity, HCV genotyping, treatment goals and endpoints, and contraindications to therapy.
- For HCV genotype 1, the current standard of care is combination therapy with pegylated interferon, ribavirin, and one of two protease
This document discusses new-onset diabetes after transplantation (NODAT), which occurs in some patients after receiving a solid organ transplant. It defines NODAT and reviews its epidemiology and risk factors. The document outlines the pathogenesis and risk of NODAT associated with different immunosuppressive drugs. It also discusses the diagnosis, screening, and management of NODAT, including monitoring patients, treating hyperglycemia, and controlling cardiovascular risk factors. The document notes ongoing areas of uncertainty around preventing NODAT and determining the long-term impacts of improved glycemic control.
Post transplant diabetes patient education classawclarke
Post-transplant diabetes, also called new onset diabetes or post-transplant diabetes mellitus (PTDM), is a serious risk for organ transplant recipients that can lead to health complications if left uncontrolled. Risk factors include family history, obesity, certain ethnic backgrounds, immunosuppressant medications, and inactive lifestyle. Symptoms may include frequent urination, thirst, hunger, and tingling sensations. Early detection through blood glucose monitoring and treatment including insulin, medications, diet, and exercise changes can help reduce risks of long-term issues such as heart, eye, kidney, and nerve damage. Living well with diabetes requires ongoing self-management and support from one's healthcare team.
1. Chronic Hepatitis B (CHB) is caused by the HBV virus and can be either acute or chronic. It infects the liver and causes inflammation and necrosis.
2. Initial assessment of patients with CHB includes medical history, physical exam, liver disease markers and severity indicators, and testing of close contacts.
3. Treatment indications include elevated HBV DNA and ALT levels, cirrhosis, and family history of HCC. The preferred treatments are entecavir, tenofovir, and tenofovir alafenamide which have a high genetic barrier to resistance.
Recent guidelines in the management of chronic hepatitisShivshankar Badole
This document provides guidelines for the management of chronic hepatitis B (CHB) infection. It outlines the initial evaluation of HBsAg positive patients including laboratory tests and imaging/staging studies. It describes the phases of CHB infection and recommends treatment based on phase. Approved antiviral drugs are discussed along with monitoring on treatment. Treatment guidelines are provided for immune active CHB, immune tolerant CHB, HBeAg positive CHB that seroconvert, and HBeAg negative CHB. It also covers management of cirrhosis, viral breakthrough, pregnancy, and more.
This document discusses recent advances in the diagnosis and management of hepatitis B and chronic hepatitis C. It covers the pathogenesis, diagnosis, and treatment of hepatitis B virus (HBV) infection including HBV genotypes, phases of chronic HBV infection, evaluation of HBsAg-positive patients, molecular diagnosis of HBV, screening for hepatocellular carcinoma, antiviral treatment options, and guidelines for treatment. It also discusses hepatitis C virus infection including acute and chronic hepatitis C, HCV genotypes and structures, evaluation of patients, and treatment recommendations.
Hepatitis B management involves treating over 400 million people with chronic hepatitis B infection globally. In Bangladesh, HBV is responsible for a significant proportion of liver disease cases. Treatment goals are to prevent disease progression, improve survival and quality of life, and prevent transmission. Treatment is indicated for those with elevated ALT/HBV DNA levels or cirrhosis. The main treatment options are pegylated interferon or nucleos(t)ide analogues like entecavir and tenofovir which have a high barrier to resistance. Treatment endpoints depend on HBeAg status and include sustained virological response off treatment or HBeAg seroconversion with consolidation therapy for HBeAg positive patients. Lifelong treatment is recommended
Work-up and management of chronic hepatitis B in non-pregnant adults, especially in a setting with limited resources such as Pakistan's healthcare system.
Aasld guidelines for diagnosis & treatment of chronic hepatitis bsreejith246
- The AASLD guidelines provide recommendations for the diagnosis and treatment of chronic hepatitis B in adults and children. They analyzed literature using a GRADE approach to determine the quality of evidence and strength of recommendations.
- The guidelines address whom to treat, how long to treat, preferred antiviral regimens, management of treatment failure or resistance, and special populations like pregnancy and cirrhosis. Key recommendations include treating immune active CHB with antivirals and considering indefinite treatment for HBeAg-negative or cirrhotic patients.
The document discusses the prevention of hepatitis B and C infections in hemodialysis patients, noting that bloodborne virus transmission was recognized as a hazard in renal units in the 1960s. It recommends screening and surveillance of patients and staff, segregation and immunization of infected patients, implementation of universal precautions including hand hygiene and personal protective equipment, and disinfection of equipment to prevent the spread of hepatitis B and C viruses in hemodialysis settings.
This document provides guidelines for treating hepatitis B virus (HBV) infection. It discusses the epidemiology of HBV, noting that 240 million people have chronic HBV worldwide. The guidelines recommend entecavir or tenofovir as first-line therapy for chronic HBV. Special populations like pregnant women, cirrhotic patients, and those with renal disease require adjusted treatment approaches. Monitoring of viral load and liver enzymes is important both on and off treatment. Vaccination is recommended for at-risk groups to prevent the spread of HBV.
This document summarizes information about hepatitis B virus (HBV) genotypes, pathogenesis, transmission routes, clinical phases of acute and chronic HBV infection, treatment options, vaccination schedules, and post-exposure prophylaxis. It discusses that HBV genotype C is associated with more severe liver disease outcomes compared to genotype B. It recommends entecavir or tenofovir as preferred treatments for immune-active chronic hepatitis B and outlines vaccination schedules, treatment in pregnancy/cirrhosis, and a new drug called Myrcludex B that is under clinical trial.
1) Hepatitis C virus genotype 4 is predominant in Egypt, with a prevalence of around 9%.
2) New direct-acting antiviral agents have improved treatment outcomes, but the virus's ability to mutate rapidly can lead to resistance.
3) The document provides treatment recommendations and regimens using direct-acting antivirals like sofosbuvir and daclatasvir to treat hepatitis C genotype 4, including for different patient populations and treatment experiences. It establishes guidelines for Egyptian treatment protocols.
Hepatitis C genotypes determine treatment response and disease severity. In India, Genotype 3 is most prevalent and associated with hepatic steatosis and fibrosis. Treatment options for Hepatitis B include PEG IFN-α and nucleoside analogs. For Hepatitis C, the standard of care is dual therapy with PEG IFN-α and ribavirin for either 6 or 12 months depending on genotype and viral load. Sustained virological response can cure 40-80% of patients.
1) Hepatitis B is a viral infection that can cause both acute and chronic liver disease. An estimated 296 million people globally have chronic hepatitis B infection.
2) In Uganda, the prevalence of hepatitis B is estimated to be 4.3% among adults, with the highest rates in the northern region. Screening indicates that 9 out of 10 Ugandans do not know their hepatitis B status.
3) Hepatitis B can be transmitted vertically from mother to child or horizontally through contact with infected bodily fluids. Chronic hepatitis B can lead to cirrhosis, liver cancer, and death if left untreated.
This document discusses the treatment of chronic hepatitis B (CHB) infection. It outlines the different phases of CHB infection and approved antiviral drugs. Pegylated interferon and nucleoside/nucleotide analogs are first-line therapies for immune active CHB. Entecavir or tenofovir are preferred first-line options. Treatment duration depends on cirrhosis status and HBeAg seroconversion. Lifelong antiviral therapy is recommended for cirrhosis. Special considerations for pregnancy, immune tolerant CHB, and HIV coinfection are also covered.
1) Hepatitis B virus (HBV) infection is a global health problem affecting approximately 350-400 million people worldwide and is a leading cause of death from liver disease and cancer.
2) HBV is a DNA virus that can cause both acute and chronic infection. Chronic infection, defined as persistence of the virus for more than 6 months, puts people at risk for progressive liver disease and liver cancer.
3) Management of HBV involves antiviral therapy to suppress viral replication and prevent progression of liver disease. First line oral antiviral agents with high potency and low resistance include entecavir and tenofovir.
1) Hepatitis B virus (HBV) infection is a global health problem affecting approximately 350-400 million people worldwide and is a leading cause of death from liver disease and cancer.
2) HBV is a DNA virus that can cause both acute and chronic infection. Chronic infection, defined as persistence of the virus for more than 6 months, puts people at risk for progressive liver disease and liver cancer.
3) Management of HBV involves antiviral therapy to suppress viral replication and prevent progression of liver disease. First line oral antiviral agents with high genetic barriers to resistance like entecavir and tenofovir are recommended. Lifelong monitoring is needed due to risk of reactivation and liver cancer development
Diagnosis and management of chronic hepatitis b infection(word)Himanshu Rana
- The document discusses guidelines for screening, assessing, treating, and managing chronic hepatitis B infection. It outlines populations that should be screened, goals and definitions of treatment response, first and second line therapies including tenofovir and entecavir, management of antiviral resistance, and screening for hepatocellular carcinoma.
- Key points covered include screening high-risk populations, treating to suppress HBV DNA and improve liver disease, using pegylated interferon as initial treatment in eligible patients, and treating coinfections like hepatitis C and D.
- Monitoring for treatment response and resistance is important, involving regular HBV DNA testing and considering resistance testing if virologic breakthrough occurs on therapy.
Chair, Paul Kwo, MD, AGAF, FACG, FAASLD, prepared useful Practice Aids pertaining to hepatitis B for this CME/MOC activity titled “HBV Is Primary! Your Role in the ‘Call to Action’ to Eliminate Viral Hepatitis By 2030.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3EYVafQ. CME/MOC credit will be available until March 21, 2024.
Systemic treatment in advanced hepatocellular carcinoma (HCC) refers to the use of medications or therapies that are administered throughout the body to target cancer cells beyond the liver. HCC is the most common type of liver cancer and often presents at an advanced stage, making systemic therapies crucial in managing the disease.
One of the main categories of systemic treatment for advanced HCC is targeted therapies. Targeted therapies are designed to selectively inhibit specific molecules or pathways involved in tumor growth, thereby blocking the signals that support cancer cell survival and proliferation. Sorafenib and lenvatinib are examples of targeted therapies that have been approved for the first-line treatment of advanced HCC. They target vascular endothelial growth factor (VEGF) receptors, which play a key role in promoting the growth of new blood vessels necessary for tumor growth. By inhibiting these receptors, these drugs can help slow down tumor growth and improve patient outcomes.
In addition to sorafenib and lenvatinib, other targeted therapies have shown promising results in the treatment of advanced HCC. Regorafenib, for instance, is a multi-kinase inhibitor that targets several pathways involved in tumor angiogenesis, cell proliferation, and survival. Cabozantinib is another multi-kinase inhibitor that has been approved as a second-line treatment option for patients who have progressed on or are intolerant to prior systemic therapy. These targeted therapies have demonstrated efficacy in improving overall survival and delaying disease progression in patients with advanced HCC.
Another significant advancement in systemic treatment for advanced HCC is the use of immune checkpoint inhibitors. Immunotherapy has revolutionized cancer treatment in recent years, including for HCC. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, work by blocking proteins that act as checkpoints on immune cells, such as programmed cell death protein 1 (PD-1) or its ligand (PD-L1). By doing so, these drugs help restore and enhance the immune system's ability to recognize and eliminate cancer cells. Checkpoint inhibitors have shown promising results, with some patients experiencing durable responses and improved overall survival.
Introduction to chronic Hepatitis B Infection in Malaysia, epidemiology and common treatment. Phases of chronic Hepatitis B Infection, clinical presentation and complications.
This document summarizes guidelines from the IAP/APA on the clinical management of acute pancreatitis. It includes 38 recommendations across 12 topics, including diagnosis, severity prediction, imaging, fluid therapy, intensive care management, nutritional support, and biliary tract management. The recommendations are based on systematic reviews of evidence and provide strength ratings. Key points include use of CT or MR imaging 72-96 hours after onset, goal-directed IV fluid resuscitation, enteral nutrition as primary therapy for severe cases, and selective use of ERCP depending on presence of cholangitis.
This document provides information on non-alcoholic fatty liver disease (NAFLD). It defines NAFLD and discusses its spectrum, including steatosis and non-alcoholic steatohepatitis (NASH). Risk factors, epidemiology, pathogenesis, diagnosis and treatment options are summarized. Liver biopsy remains the gold standard for diagnosing NASH, but transient elastography and biomarkers can help identify patients at risk of advanced fibrosis who may require biopsy. Lifestyle modifications targeting weight loss and insulin resistance are the primary treatment approach.
1) Acute liver failure (ALF) is characterized by sudden loss of liver function within 24 weeks without pre-existing liver disease, often caused by viral hepatitis, drug overdose, or unknown etiology.
2) Patients present with coagulopathy, encephalopathy, and multi-organ failure affecting the brain, cardiovascular, respiratory, and renal systems. Prognosis is poor without a liver transplant.
3) Management involves supportive care, treating complications, investigating the cause, and considering a liver transplant for eligible patients within 7 days to prevent death from hepatic encephalopathy and multi-organ dysfunction.
IgG4-related disease is a chronic fibroinflammatory condition characterized by tumefactive lesions rich in IgG4-positive plasma cells and storiform fibrosis. It commonly involves the pancreas, salivary glands, lacrimal glands, and retroperitoneum. Diagnosis involves elevated serum IgG4 levels, histopathological examination showing lymphoplasmacytic infiltrate and fibrosis, and often fulfilling clinical diagnostic criteria. Differential diagnosis includes cancers, infections and other diseases. Treatment involves glucocorticoids as first line with potential use of immunosuppressants. Relapse is common requiring glucocorticoid tapers or maintenance therapy.
Drug induced liver injury Dr Suresh GorkaSuresh Gorka
Drug-induced liver injury (DILI) can present in various forms from asymptomatic elevation of liver enzymes to jaundice and acute liver failure. DILI is most commonly caused by antimicrobials worldwide and antituberculosis drugs in India. The mechanisms of DILI include intrinsic toxicity, idiosyncratic reactions, mitochondrial toxicity, and defects in bile transport. Diagnosing DILI requires excluding other causes of hepatitis since it is a diagnosis of exclusion. A liver biopsy may be considered to help identify chronic DILI or autoimmune features.
1) Acute liver failure (ALF) is characterized by sudden loss of liver function within 24 weeks without pre-existing liver disease, often caused by viral hepatitis, drug overdose, or unknown etiology.
2) Patients present with coagulopathy, encephalopathy, and multi-organ failure affecting the brain, cardiovascular, respiratory, and renal systems. Prognosis is poor without a liver transplant.
3) Management involves supportive care, treating complications, investigating the cause, and considering a liver transplant depending on the type and progression of liver dysfunction and encephalopathy. The overall mortality of ALF remains high without transplantation.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
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2. Introduction
• This is the first guidelines on HBV being published
from India.
• A 2 day round table discussion was held on 11th and
12th February 2017 at Port Blair, Andaman & Nicobar
Islands, to discuss, debate, and finalize the consensus
statements.
• The strength of recommendations (strong: 1, weak:
2) thus reflects the quality (grade) of underlying
evidence (A, B, C, D)
4. EPIDEMIOLOGY OF HBV IN INDIA
• Consensus Statements
• The prevalence of chronic hepatitis B in general
population India is between 1.4% and 2.7%. (A)
• Predominant mode of transmission is horizontal,
however, vertical transmission is also common in
India. (B)
• Most HBV infections in India are due to genotype A
and D. (A)
5. PREVENTION OF HBV INFECTION THROUGH
VACCINATION
• Consensus Statements
• Universal hepatitis B vaccination is recommended for all
infants, and the first dose should be given as soon as possible
after birth. (A1)
• HBV vaccination is also recommended in people with risk
factors for acquiring HBV infection, such as those who
frequently require blood or blood products, dialysis patients,
recipients of solid organ transplantations, injecting drug
users, household and sexual contacts of people with chronic
HBV infection, people with multiple sexual partners, as well as
health-care workers and others who may be exposed to blood
and blood products through their work. (A1)
6. • HBV vaccination is advisable for all children and adults who
are not previously vaccinated. (C2)
• There is no evidence to support the need for a booster dose
of hepatitis B vaccine. (A1)
• For immunosuppressed population higher vaccine doses or
increased number of doses are required. The anti-HBs
response of such persons should be tested after they are
vaccinated, and those who have not responded should be
revaccinated with 1–3 additional doses. (B1)
7. DIAGNOSIS AND INITIAL EVALUATION
• Consensus Statements
• During initial evaluation of HBsAg positive persons, special
emphasis should be on possible mode of acquisition, current
phase and staging, need for antiviral treatment, presence of
additional risk factors such as co-morbidities, co-infections,
alcohol use, and family history of cirrhosis and liver cancer.
(A1)
• Laboratory tests should include assessment of liver function
(AST, ALT, GGT, alkaline phosphatase, bilirubin, serum
albumin, serum globulins, CBC and INR),
8. • Markers of HBV replication (HBeAg, anti-HBe, quantitative
HBV DNA), and tests for co-infection with HCV and HIV. An
ultrasound examination of the liver is recommended in all
patients. (A1)
• Till more data on normal ALT levels from India are available,
an ALT 40 U/L should be considered normal for Indian
patients. (B1)
• A liver biopsy or non-invasive test should be performed to
determine disease stage and need for antiviral treatment in
cases where biochemical tests and ultrasonography reveal
inconclusive results. (A1)
9. • Abstinence from alcohol and smoking should be strongly
advised during initial evaluation of patients with chronic
HBV infection. (A1)
• Barrier method of contraception is advised to patients with
HBV infection with detectable HBV DNA levels, if the partner
is unvaccinated or not fully vaccinated. (A1)
• Because tenofovir and possibly also entecavir monotherapy
can cause HIV resistance mutations, all HBsAg-positive
patients should be screened for HIV before these drugs are
used in the treatment of HBV infection.
10. TREATMENT GOALS
• Consensus Statements
• The ultimate long-term treatment goal in patients with
hepatitis B is to decrease mortality rate by preventing the
development of, or preventing the progression of, liver
cirrhosis and/ or HCC. This may be achieved by:
HBsAg clearance, or Long-term maintenance of an
undetectable HBV DNA level. (A1)
• The short-term treatment goals in patients with HBeAg-
positive hepatitis are normalization of the ALT level,
undetectable HBV DNA level, and the clearance or
seroconversion of HBsAg and HBeAg. In patients with HBeAg-
negative hepatitis the treatment goals are normalization of
the ALT level, and an undetectable HBV DNA level. (B1)
14. DRUGS USED FOR ANTIVIRAL TREATMENT
• Consensus Statements
• Following drugs should be used for treatment:
Tenofovir disoproxil fumarate (TDF), Tenofovir alafenamide
(TAF), Entecavir (ETV), and Pegylated interferon alpha
(PegIFN-a). (A1)
• All the drugs should be used as monotherapy. Combination
therapy or sequential therapy of NA and PegIFN-a is not
recommended at present. (B1)
• Following drugs should not be used for treatment:
Lamivudine, Adefovir, and Telbivudine. (A1)
15. • In patients with cirrhosis:
Oral antiviral therapy with Tenofovir or Entecavir is preferred.
(A1)
• PegIFN-a may be used with careful monitoring of liver
function and side effects in patients with compensated liver
cirrhosis with preserved liver function. (B2)
• The use of PegIFN-a is contraindicated in patients with
decompensated cirrhosis due to the risk of serious
complications, such as hepatic failure. (A1)
16. MONITORING OF PATIENTS CURRENTLY
NOT ON ANTIVIRALS
• Consensus Statements
• Patients who do not fulfill any of the above treatment
indications should be followed as follows:
Patients with HBV DNA >2000 IU/ml: should have ALT
determinations at least every 3–6 months, HBV DNA
determinations every 6–12 months and assessment of liver
fibrosis every 12 months.
Patients with HBV DNA <2000 IU/ml: should have
ALT determinations every 6–12 months and periodical
HBV DNA and liver fibrosis assessments, every 2–3
years. (B1)
17. MONITORING OF PATIENTS ON ANTIVIRAL
TREATMENT
• Consensus Statements
• During antiviral therapy, close monitoring for side effects of
each drug is mandatory. (A1)
• Monitoring of drug compliance of patient is of paramount
importance as poor adherence to antiviral treatment may lead
to increased risk of drug resistance and treatment failure. (B1)
• All patients treated with NA:
Should be followed with periodical assessment of ALT and
serum HBV DNA. (A1)
18. • Following patients should undergo periodical renal monitoring
at least including estimated glomerular filtration rate
(eGFR) and serum phosphate levels:
- Patients at risk of renal disease treated with any NA
- All patients regardless of renal risk treated with TDF
• Patients on TDF at risk of development and/or with underlying
renal or bone disease should be considered for a switch
to ETV or TAF.
• All patients treated with PegIFN-a
Should be monitored with periodic assessment of CBC,
ALT, TSH, HBeAg, anti-HBe, serum HBV DNA and HBsAg
levels. (A1)
19. • Patients of decompensated cirrhosis should be closely
monitored for tolerability of the drugs and the development
of rare side effects like lactic acidosis or kidney dysfunction.
(B1)
• HCC surveillance is mandatory for all patients with cirrhosis
as well as those with medium or high HCC risk scores at the
onset of therapy. (B1)
22. • Consensus Statements
• Treatment failure is considered when there is primary
virological non-response (PVNR), partial virological response
(PVR) or virological breakthrough. (A1)
• Compliance to therapy should be checked in all cases of
treatment failure. (A1)
• Treatment adaptation should be performed as soon as
treatment failure under NAs is confirmed and should be based
on NAs cross-resistance data:
23. • For patients treated with a drug with a high genetic barrier
to resistance, treatment could either be switched to another
drug with a high genetic barrier to resistance or be continued
with monitoring for a virologic response at 3–6-months
intervals. (C1)
• For patients treated with a drug with a low genetic barrier to
resistance, treatment should be switched to a drug with a
higher genetic barrier to resistance. (B1)
24. • An antiviral resistance test should be performed when
virologic breakthrough occurs, especially in cases with good
compliance. (A1)
• Rescue antiviral therapy should be started as soon as possible
upon emergence of resistant variants, especially when viral
breakthrough is detected and genotypic resistance is
confirmed. (A1)
26. • Consensus Statements
• In HBeAg-positive CHB patients:
• At 12 weeks of PegIFN-a therapy:
HBsAg levels >20,000 IU/ml for genotype B and C, or no
decline of HBsAg levels for genotype A and D, are associated
with a very low probability of subsequent HBeAg sero-
conversion and can be used as PegIFN-a stopping rules. (B2)
• At 24 weeks of PegIFN-a therapy:
- HBsAg levels >20,000 IU/ml for any genotype, is associated
with a very low probability of subsequent HBeAg sero-
conversion and can be used as PegIFN-a stopping rules. (B2)
27. • In HBeAg-negative CHB patients:
At 12 weeks of PegIFN-a therapy:
- No decrease in HBsAg levels and <2 log10 IU/ml reduction
in serum HBV DNA levels predicts no response and should
be used as PegIFN-a stopping rules. (B1)
28. CESSATION OF ANTIVIRAL TREATMENT
• Consensus Statements
• PegIFN-a the treatment should be stopped at 48 weeks or at
12 or 24 weeks, if stopping rules are met. (A1)
• In patients receiving NA, the treatment should be stopped if:
HBsAg loss is achieved, with or without anti-HBs seroconversion
For HBeAg-positive patients at least 12 months after serum
HBV DNA is undetectable and HBeAg seroclearance or
seroconversion is attained.
For HBeAg-negative patients if long-term (>3 years) virological
suppression is achieved and close post-NA monitoring can be
guaranteed. (B1)
• Antiviral treatment should not be stopped in cirrhotics. (A1)
29. MONITORING AFTER CESSATION OF
ANTIVIRAL TREATMENT
• Consensus Statements
• During the first year after the cessation of antiviral treatment,
liver function should be monitored and serum HBV DNA
should be measured every 3 months, and HBeAg and antiHBe
should be checked at 6-month intervals. (B1)
• Beyond 1 year after the cessation of antiviral treatment, liver
function and serum HBV DNA should be tested every 6
months to detect viral relapse. (C1)
• HCC surveillance is mandatory for all patients with cirrhosis
as well as those with moderate or high HCC risk scores even
after stoppage of antiviral treatment. (A1)
30. PREVENTION OF HBV RECURRENCE AFTER
LIVER TRANSPLANTATION
• Consensus Statements
• Pre-transplant therapy with a NA is recommended for all
HBsAg-positive patients undergoing liver transplantation to
achieve the lowest possible level of HBV DNA (preferably
undetectable HBV DNA level) before transplantation. (A1)
• Patients who are at a high risk for HBV recurrence, namely
those who are HBV DNA positive at the time of liver
transplantation, who are HBeAg-positive, have HCC, and HDV
or HIV co-infected should receive lifelong combination
therapy with NA plus HBIG. (B1)
31. • Patients with a low risk of recurrence can discontinue HBIG
but need continued mono-prophylaxis with a potent NA. In
selected patients HBIG-free regimen from start may also be
considered. (B2)
• HBsAg-negative patients receiving livers from donors with
evidence of past HBV infection (anti-HBc positive) are at risk
of HBV infection and should receive antiviral prophylaxis with
a NA indefinitely. (B1)
32. HIV CO-INFECTED PATIENTS
• Consensus Statements
• All HIV-positive patients with HBV co-infection should
start antiretroviral therapy (ART) irrespective of CD4 cell
count. (B1)
• HIV-HBV co-infected patients should be treated with a TDF or
TAF-based ART regimen. (A/B1)
33. HDV CO-INFECTED PATIENTS
• Consensus Statements
• PegIFN-a for at least 48 weeks is the current treatment of
choice in HDV-HBV co-infected patients with compensated
liver disease. (A1)
• In HDV-HBV co-infected patients with ongoing HBV DNA
replication, NA therapy should be considered. (B1)
• PegIFN-a treatment can be continued until week 48 irrespective of
on-treatment response pattern if well tolerated. (B2)
34. HCV CO-INFECTED PATIENTS
• Consensus Statements
• Treatment of HCV with direct-acting antivirals (DAAs) may
cause reactivation of HBV. Patients fulfilling the standard
criteria for HBV treatment should receive NA treatment. (B1)
• HBsAg-positive patients undergoing DAA therapy but not
fulfilling the HBV treatment criteria should be considered
for concomitant NA prophylaxis until week 12 after DAA,
and monitored closely. (B2)
• HBsAg-negative, anti-HBc positive patients undergoing DAA
should be monitored and tested for HBV reactivation in case
of ALT elevation. (B1)
35. ACUTE HEPATITIS B, ACUTE LIVER
FAILURE, SEVERE ACUTE REACTIVATION,
ACUTE ON CHRONIC LIVER FAILURE
• Consensus Statements
• Most adults with uncomplicated acute HBV hepatitis do not
require antiviral treatment because they will fully recover
spontaneously. (B1)
• Patients with protracted severe disease (bilirubin >5 mg/dl
plus INR >1.5, for >4 weeks) have either ‘severe acute
hepatitis B’ or severe acute reactivation of CHB. These
patients are at risk of liver failure (ALF or ACLF) and thus merit
antiviral treatment with NA. (C1)
• Patients with acute liver failure or acute-on-chronic liver
failure due to HBV should immediately be started with NA,
and should be considered for liver transplantation. (A1)
37. • Consensus Statements
• In children, antiviral treatment should be considered for
following patients:
HBeAg-positive children with an HBV DNA level
>20,000 IU/ml, when the ALT level is >80 U/L,
HBeAg-negative children with an HBV DNA level
>2000 IU/ml,
- when the ALT level is >80 U/L, or
- when liver biopsy shows moderate-to-severe necro-inflammation or
periportal fibrosis
Children with cirrhosis. (B1)
38. • Antiviral therapy is not indicated for children in
immunetolerant phase (HBeAg positive, HBV DNA >20,000
IU/ml, normal ALT). (A1)
• In children or adolescents who meet treatment criteria, ETV,
TDF, TAF, and PegIFN-a can be used. (B2)
• Entecavir is considered the first-line therapy in children older
than 2 years and tenofovir in those older than 12 years
39. HEALTHCARE WORKERS
• Consensus Statements
• Unvaccinated or incompletely vaccinated healthcare workers
with reasonably anticipated risk for blood or body fluid
exposure should receive hepatitis B vaccination. (A1)
• Vaccinated healthcare workers should receive post-
vaccination serologic testing (anti-HBs) 1–2 months after the
final dose of vaccine is administered. (B1)
• HBV infection alone should not disqualify infected persons
from the practice or study of surgery, dentistry, medicine, or
allied health fields. (C1)
40. • Healthcare workers performing exposure prone procedures
with serum HBV DNA >200 IU/ml may be treated with NA
to reduce transmission risk to patients. (B2)
41. PREGNANCY
• Consensus Statements
• All HBV positive women of childbearing age should be
counseled about implications of pregnancy, the risk of
mother-to child transmission of HBV, and safety of HBV drugs
during pregnancy and lactation. (A1)
• A CHB woman of childbearing age, who plans pregnancy in
the near future, should be treated with antiviral agents that
belong to pregnancy category B drugs (preferably TDF), or be
advised to delay therapy until the child is born. (B2)
• PegIFN-a has an advantage in female patients who are
planning pregnancy due to its finite treatment duration. (C1)
42. • However, the side effects pertaining to fetal malformations
make PegIFN-a treatment contraindicated during pregnancy,
and it should be recommended only in combination with
contraception. (A1)
• Screening for HBsAg in the first trimester of pregnancy is
strongly recommended. (A1)
• In pregnant women already on NA therapy, TDF should
be continued while ETV or other NA should be switched to
TDF. (B1)
43. • In all pregnant women with high HBV DNA levels
(>200,000 IU/ml) or HBsAg levels >4 log10 IU/ml, antiviral
prophylaxis with TDF should start at week 24–28 of gestation
and continue for up to 12 weeks after delivery. (A1)
• Newborns of HBV-infected mothers should receive HBIG and
hepatitis B vaccine at delivery and complete the
recommended vaccination series. (A1)
• Breastfeeding is not contraindicated in HBsAg-positive
untreated women or on TDF-based treatment or prophylaxis.
(C2)
44. PATIENTS UNDERGOING IMMUNOSUPPRESSIVE
THERAPY OR CHEMOTHERAPY
• Consensus Statements
• Prior to initiation of immunosuppressive treatment or
chemotherapy screening for HBsAg and IgG anti-HBc is
recommended. If either is positive, serum HBV DNA should be
tested. (A1)
• Patients without evidence of HBV infection should be vaccinated.
(B1)
• Consider preventive antiviral therapy with ETV, TDF, or
TAF simultaneously with the initiation of immunosuppressive
treatment/chemotherapy if HBsAg or HBV DNA is positive. (A1)
45. • If IgG anti-HBc is positive without HBsAg or HBV DNA,
irrespective of anti-HBs titers, serum HBV DNA and HBsAg
should be tested regularly and pre-emptive antiviral therapy
should be considered if either reappears during
immunosuppressive treatment/chemotherapy. (A1)
• Pre-emptive antiviral therapy in patients with isolated anti-
HBc can be initiated in high-risk groups such as patients with
lymphoma under a rituximab-containing regimen or those
with leukemia who undergo hematopoietic stem cell
transplantation. (B2)
46. • Serum HBV DNA should be monitored periodically (3-6mt)
during and after preventive antiviral therapy. (A1)
• Preventive antiviral therapy should be maintained for at least
12 months (18 months for rituximab-based regimens) after
the termination of immunosuppressive treatment/
chemotherapy. (C1)
47. DIALYSIS AND RENAL TRANSPLANT
PATIENTS
• Consensus Statements
• All dialysis and renal transplant recipients should be screened
for HBV markers (B1).
• Vaccination is recommended for patients under dialysis
negative for HBsAg and anti-HBs. (A1)
• Oral NAs such as Entecavir and Tenofovir (TDF or TAF) are
preferable to interferon therapy in patients under dialysis.
(B1)
• NAs should be dose-adjusted according to residual renal
function. (A1)
48. • ETV, TDF or TAF can be used, however; doses of NAs should be
adjusted according to eGFR values in patients with eGFR <50
ml/min, except for TAF, which does not require dose
adjustment if eGFR is >15 ml/min.
• All HBsAg-positive renal transplant recipients should receive
ETV or TAF as prophylaxis or treatment. (B1)
• HBsAg-negative, anti-HBc positive subjects should be
monitored for HBV infection after renal transplantation. (C1)
49. EXTRAHEPATIC MANIFESTATIONS
• Consensus Statements
• Patients with extrahepatic manifestations should receive
antiviral treatment with NA. (B1)
• PegIFN-a should not be administered in patients with
immune-related extrahepatic manifestations. (C1)