Malnutrition is prevalent in all forms of liver diseases. A number of factors contribute to malnutrition in patients with hepatic failure. Early diagnosis of malnutrition is essential to allow appropriate treatment, since malnutrition is an important predictor of complications of liver disease and mortality. Disease-specific nutritional therapy should be considered for acute liver failure, sepsis, transplantation, and encephalopathy. This article provides an overview of the nutritional management of acute and chronic liver disease and discusses the need for further intervention studies before appropriate rational treatment guidelines can be formulated.
{"title":"Nutritional management of acute and chronic liver disease","authors":"N. Saraf","doi":"10.4103/0972-9747.58810","DOIUrl":"https://doi.org/10.4103/0972-9747.58810","url":null,"abstract":"Malnutrition is prevalent in all forms of liver diseases. A number of factors contribute to malnutrition in patients with hepatic failure. Early diagnosis of malnutrition is essential to allow appropriate treatment, since malnutrition is an important predictor of complications of liver disease and mortality. Disease-specific nutritional therapy should be considered for acute liver failure, sepsis, transplantation, and encephalopathy. This article provides an overview of the nutritional management of acute and chronic liver disease and discusses the need for further intervention studies before appropriate rational treatment guidelines can be formulated.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117175646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatitis B virus (HBV) cross-infection during endoscopy is rare. Most of the reported cases have occurred when the endoscope reprocessing was inadequate. Standard reprocessing of endoscopes and accessories is sufficient to prevent HBV transmission.
{"title":"Hepatitis B virus transmission and reprocessing of endoscopes.","authors":"A. Dutta, A. Chacko","doi":"10.4103/0972-9747.76908","DOIUrl":"https://doi.org/10.4103/0972-9747.76908","url":null,"abstract":"Hepatitis B virus (HBV) cross-infection during endoscopy is rare. Most of the reported cases have occurred when the endoscope reprocessing was inadequate. Standard reprocessing of endoscopes and accessories is sufficient to prevent HBV transmission.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125829111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The anti-tumor necrosis factor (TNF) agents are a class of medications which have given clinicians a new level of control over inflammatory illnesses that was previously unattainable with older disease modifying agents. Though each medication has unique molecular differences, they all have as their specific target the proinflammatory cytokine TNF-α. With the great improvements provided by the anti-TNF agents though has come a new spectrum of side effects. On the basis of the importance of TNF-α in granuloma formation, neutralization of TNF-α has led to reactivation of latent infections, the most notable being Mycobacterium tuberculosis. Another infectious agent that can elude eradication and enter a latent state, reactivating when the immune system is depressed, is the hepatitis B virus (HBV). Inhibition of TNF-α could also lead to immune suppression and reactivation of the virus much like that experienced with the reactivation of TB. The purpose of this article is to review the current medical literature for cases where anti-TNF agents were used to treat an inflammatory illness such as rheumatoid arthritis or Crohn's disease in patients chronically infected with HBV. Additionally, the role of TNF-α in HBV infection is explored, the differences in the anti-TNF agents are examined, and guidelines regarding the screening for and prophylaxis of HBV are discussed.
{"title":"Safety of Anti-tumor necrosis factor ( Anti-TNF) therapy in patients with chronic Hepatitis B","authors":"M. Carroll, R. Holmes","doi":"10.4103/0972-9747.76907","DOIUrl":"https://doi.org/10.4103/0972-9747.76907","url":null,"abstract":"The anti-tumor necrosis factor (TNF) agents are a class of medications which have given clinicians a new level of control over inflammatory illnesses that was previously unattainable with older disease modifying agents. Though each medication has unique molecular differences, they all have as their specific target the proinflammatory cytokine TNF-α. With the great improvements provided by the anti-TNF agents though has come a new spectrum of side effects. On the basis of the importance of TNF-α in granuloma formation, neutralization of TNF-α has led to reactivation of latent infections, the most notable being Mycobacterium tuberculosis. Another infectious agent that can elude eradication and enter a latent state, reactivating when the immune system is depressed, is the hepatitis B virus (HBV). Inhibition of TNF-α could also lead to immune suppression and reactivation of the virus much like that experienced with the reactivation of TB. The purpose of this article is to review the current medical literature for cases where anti-TNF agents were used to treat an inflammatory illness such as rheumatoid arthritis or Crohn's disease in patients chronically infected with HBV. Additionally, the role of TNF-α in HBV infection is explored, the differences in the anti-TNF agents are examined, and guidelines regarding the screening for and prophylaxis of HBV are discussed.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127905854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatitis B virus is a microorganism formed in the excess of surface antigen which is devoid of nucleic acid. Surface antigen of HBV was from the beginning the natural candidate for the vaccine which was thus produced by isolation of plasma HBsAg and later substituted by recombinant protein(s). The Extended Program of Immunization was beneficial for the reduction of HBV incidence in the populations of many participating countries. It is further postulated that HCC incidence in the world was also reduced at least in the portion caused by hepatitis B virus. Persistence of anti-HBV immunity was first measured by quantitative anti-HBs assay determined at 1 month post vaccination cycle, and then at different time points, even up to 12-15 years. The frontier of 10 IU/L (mIU/ml) is a mark of sustained immunity. However, cellular immunity studies revealed that this kind of response is very important in the defense against the virus and may last longer than the detectable antibodies. It was shown that 'full' surface vaccines, i.e. preS+S, may give stronger immunity and are good even for neonates. The next generation vaccines are DNA-based and plant-based HBV vaccines. This last category raises many hopes and with sufficient immunogenicity could ensure the most comfortable route of administration.
{"title":"Recent advances in Hepatitis B vaccination","authors":"K. Madaliński","doi":"10.4103/0972-9747.58805","DOIUrl":"https://doi.org/10.4103/0972-9747.58805","url":null,"abstract":"Hepatitis B virus is a microorganism formed in the excess of surface antigen which is devoid of nucleic acid. Surface antigen of HBV was from the beginning the natural candidate for the vaccine which was thus produced by isolation of plasma HBsAg and later substituted by recombinant protein(s). The Extended Program of Immunization was beneficial for the reduction of HBV incidence in the populations of many participating countries. It is further postulated that HCC incidence in the world was also reduced at least in the portion caused by hepatitis B virus. Persistence of anti-HBV immunity was first measured by quantitative anti-HBs assay determined at 1 month post vaccination cycle, and then at different time points, even up to 12-15 years. The frontier of 10 IU/L (mIU/ml) is a mark of sustained immunity. However, cellular immunity studies revealed that this kind of response is very important in the defense against the virus and may last longer than the detectable antibodies. It was shown that 'full' surface vaccines, i.e. preS+S, may give stronger immunity and are good even for neonates. The next generation vaccines are DNA-based and plant-based HBV vaccines. This last category raises many hopes and with sufficient immunogenicity could ensure the most comfortable route of administration.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128437672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.193291
L. Ali
{"title":"HBV: Your help needed please....","authors":"L. Ali","doi":"10.4103/0972-9747.193291","DOIUrl":"https://doi.org/10.4103/0972-9747.193291","url":null,"abstract":"","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131918913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine). These treatment strategies are either therapies of finite duration which aim to achieve sustained off-therapy responses or long term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Pegylated interferon alfa may offer higher sustained off-therapy responses after one year, but most patients do not respond. Oral antivirals are the only candidates for long term treatment of patients with chronic HBV infection. Viral suppression has favorable effects on outcome outcome and modifies the natural history of the disease. The oral nucleos(t)ide analogues are generally better tolerated than interferon. This article attempts to provide an overview of the data available on the two new drugs entecavir and telbivudine.
{"title":"Comparison of entecavir and telbivudine in management of chronic Hepatitis B","authors":"S. Singh","doi":"10.4103/0972-9747.58811","DOIUrl":"https://doi.org/10.4103/0972-9747.58811","url":null,"abstract":"The currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine). These treatment strategies are either therapies of finite duration which aim to achieve sustained off-therapy responses or long term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Pegylated interferon alfa may offer higher sustained off-therapy responses after one year, but most patients do not respond. Oral antivirals are the only candidates for long term treatment of patients with chronic HBV infection. Viral suppression has favorable effects on outcome outcome and modifies the natural history of the disease. The oral nucleos(t)ide analogues are generally better tolerated than interferon. This article attempts to provide an overview of the data available on the two new drugs entecavir and telbivudine.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121926578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.190079
R. Goyal, S. Acharya
Hepatitis B virus (HBV) is the most important cause of chronic liver disease and hepatocellular carcinoma in India. During the past three decades, considerable advances in the diagnosis and treatment of HBV infection have been achieved. However, despite the remarkable improvements, medical management for HBV induced cirrhosis, and liver cancer remains unsatisfactory. In fact, it is becoming increasingly clear that as of now, there is no cure for hepatitis B infection. Management of chronic hepatitis B has changed considerably; currently, emphasis is in identifying and treating patients at high risk of disease progression since effective antiviral therapy arrests disease progression, reduces complications and can potentially reverse liver damage if given for sufficient duration. The treatment should be initiated with drugs that have high potency and high genetic barrier to resistance, and compliance should be ensured once decision to treat is initiated. Resistant patients are difficult to treat and preferably combination treatment with high potency and high genetic barrier drugs should be used to avoid treatment failure. Close monitoring of both treated and untreated patients for disease progression should be done, and early intervention is required to prevent complications in those who show progression over time.
{"title":"Management of chronic hepatitis B","authors":"R. Goyal, S. Acharya","doi":"10.4103/0972-9747.190079","DOIUrl":"https://doi.org/10.4103/0972-9747.190079","url":null,"abstract":"Hepatitis B virus (HBV) is the most important cause of chronic liver disease and hepatocellular carcinoma in India. During the past three decades, considerable advances in the diagnosis and treatment of HBV infection have been achieved. However, despite the remarkable improvements, medical management for HBV induced cirrhosis, and liver cancer remains unsatisfactory. In fact, it is becoming increasingly clear that as of now, there is no cure for hepatitis B infection. Management of chronic hepatitis B has changed considerably; currently, emphasis is in identifying and treating patients at high risk of disease progression since effective antiviral therapy arrests disease progression, reduces complications and can potentially reverse liver damage if given for sufficient duration. The treatment should be initiated with drugs that have high potency and high genetic barrier to resistance, and compliance should be ensured once decision to treat is initiated. Resistant patients are difficult to treat and preferably combination treatment with high potency and high genetic barrier drugs should be used to avoid treatment failure. Close monitoring of both treated and untreated patients for disease progression should be done, and early intervention is required to prevent complications in those who show progression over time.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"96 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122111925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of chronic Hepatitis B: Problems galore","authors":"S. Singh, Y. Chawla","doi":"10.4103/0972-9747.58802","DOIUrl":"https://doi.org/10.4103/0972-9747.58802","url":null,"abstract":"","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127804261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1900-01-01DOI: 10.4103/0972-9747.162158
G. Choudhuri
Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Besides, the information and evidence which is generated by a proper interaction and communication, to individualize and tailor the treatment for each patient of Hepatitis B, the way patients' perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in doctor-shopping and malpractice litigations. It has now been established that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. Improvement in the care of hepatitis B patients, it is essential that patient physician interaction is optimal in view of the prolonged duration of therapy and uncertainty of outcome of therapy in these cases. This unique essay sheds light on the strategies which the physicians need to adopt to improve patient physician interaction.
{"title":"Patient physician interaction","authors":"G. Choudhuri","doi":"10.4103/0972-9747.162158","DOIUrl":"https://doi.org/10.4103/0972-9747.162158","url":null,"abstract":"Effective interaction and communication between doctor and patient is a central clinical function that cannot be delegated. Besides, the information and evidence which is generated by a proper interaction and communication, to individualize and tailor the treatment for each patient of Hepatitis B, the way patients' perceive their connection with their physician significantly influences their sense of satisfaction and level of concern about their health. A good effective, empathic physician-patient communication leads to improved patient compliance, better clinical outcomes and reduction in doctor-shopping and malpractice litigations. It has now been established that problems in doctor-patient interaction and communication are extremely common and adversely affect patient management. It has been repeatedly shown that the clinical skills needed to improve these problems can be taught and that the subsequent benefits to medical practice are demonstrable, feasible on a routine basis, and enduring. Improvement in the care of hepatitis B patients, it is essential that patient physician interaction is optimal in view of the prolonged duration of therapy and uncertainty of outcome of therapy in these cases. This unique essay sheds light on the strategies which the physicians need to adopt to improve patient physician interaction.","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"255 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132189855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"I wish I had AIDS","authors":"S. Singh","doi":"10.4103/0972-9747.58813","DOIUrl":"https://doi.org/10.4103/0972-9747.58813","url":null,"abstract":"","PeriodicalId":345516,"journal":{"name":"Hepatitis B Annual","volume":"23 7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"1900-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"113975553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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