Hepatitis Ebook

Alternative Hepatitis C Treatments

The therapeutic goals of Natural treatment for Hepatitis C are as follows: Decrease iral load Normalize liver enzyme levels. Enhance/regulate immune system function. Strengthen and promote healthy liver function. Protect the liver, prevent further damage. Virological response; i.e. viral clearance, viral reduction or elimination of the virus. Starve the virus by limiting levels of iron. Optimizing cellular levels of glutathione in the body, making detoxification of the liver possible and enhancing the immune system. Stimulate regeneration of the damaged liver cells. Use of antioxidants to combat the effects of free-radicals generated by the virus. Reduce inflammation. Slow viral replication. Replace all of the inflammation-damaged liver cells. Regulate immune function/prevent auto-immune problems. Cancer preventative measures. Reverse fibrosis to prevent and improve cirrhosis

Alternative Hepatitis C Treatments Summary


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Clinical Features of Sjogrens Syndrome Hepatitis C Virus Patients

Demographically, SS-HCV is characterized by a comparatively reduced female male ratio (4 1) and an older age at SS diagnosis.36 Clinically, SS-HCV patients have a similar percentage of altered diagnostic tests compared with primary SS patients, with a high rate of altered ocular tests (97 ), parotid scintigraphy (85 ), and salivary gland biopsies (74 ) (see Table 3). Although a similar prevalence of glandular features has been found, specific extraglandular manifestations, such as articular, vasculitic, and neuropathic involvement (the classic triad of the cryoglobulinemic syndrome), are Extrahepatic sites of hepatitis C virus infection more frequently observed in SS-HCV patients.36 This suggests that cryoglobulinemia may play a more important role in the extraglandular features observed in SS associated with HCVthan it does in primary SS. SS-HCV patients have a higher frequency of altered liver profile and also have a higher frequency of neoplasia compared with patients with primary...

Viral Hepatitis In Drug Abusers

In the mid-1990s, at least five types of disease-causing hepatitis viruses have been identified, and they are designated by the letters of the alphabet, A E. Table I summarizes some of their important characteristics. Of the five, hepatitis A and E are not particularly associated with injecting drug abuse but the other three very much are and they will be discussed in some detail in that context. Hepatitis B. This virus (which used to be called ''serum hepatitis ) is endemic to some parts of the world, such as Southeast Asia, where as much as 10 percent of the population may be infected. In the Western world, IDUs represent the greatest reservoir for hepatitis B virus. It is transmitted through a direct blood-borne route, such as The symptoms of hepatitis B infection vary. In its severest form, it can cause general unwellness, fever, jaundice, coma, and death. The majority of patients, even with marked jaundice and fever, do not die. Many infected people do not even have an overt...

Immunologic Profile of Sjogrens Syndrome Hepatitis C Virus

A study has found that nearly 70 of SS-HCV patients have positive ANA.36 Two-thirds of these ANA-positive patients had negative Ro La antibodies, an immunologic pattern (ANA positive, ENA negative) typically observed in chronic HCV infection.6 Although negative Ro La has been considered a typical immunologic feature of SS associated with HCV,18,19 the authors found a subset of 68 SS-HCV patients with positive ENA, representing 25 of the SS-HCV patients studied.36 This subset of SS-HCV-ENA-positive patients was predominantly female and had a higher prevalence of specific SS features and a lower frequency of liver involvement. This suggests that Ro La positivity may form part of the immunologic expression of some SS-HCV patients (although at a lower level than that observed in primary SS). A higher rate of anti-Ro La positivity has recently been reported in HCV-positive patients in whom subjective and objective sicca manifestations were more strictly selected and anti-Ro La positivity...

Cell Lymphoma in Hepatitis C Virus Patients

Although lymphoma has been closely linked with primary SS in the last 30 years, the evidence of a possible association between B-cell lymphoma and HCV has been recently suggested,16,37 although some studies have found no significant association.17,21,43 Recent studies have found a higher prevalence of lymphoproliferative disorders in HCV patients.44,45 Matsuo and colleagues46 performed an elegant meta-analysis of 23 epidemiologic studies on the association between HCV and NHL, including 4049 NHL patients. The summary odds ratio for NHL in HCV patients was 5.70, being 5.04 for B-cell and 2.51 for T-cell NHL.46 A similar meta-analysis was conducted by Dal Maso and Franceschi.47 This study was performed to evaluate the strength and the consistency of the association between HCV and NHL, and included only studies with greater than or equal to 100 age- and gender-adjusted cases. The pooled relative risk for all NHL in HCV-positive individuals was 2.5. Nieters and colleagues48 tested for...

Treatment of BCell Lymphoma in Sjogrens Syndrome Hepatitis C Virus Patients

The treatment of B-cell lymphoma in SS-HCV patients is a clinical challenge because of the confluence of various specific characteristics, including the age of the patients, other drug treatments, the concomitant autoimmune features, and the HCV-related liver disease. Unfortunately, no data are available for the therapeutic management of lymphoma in SS-HCV patients. In B-cell lymphomas, diverse therapeutic options have been used including conventional chemotherapy,61 monoclonal agents,69 antiviral70 or antimicrobial71 agents, and in some cases no specific therapy.12 In SS-HCV patients two therapeutic options should be highlighted as future options. The first is the use of monoclonal agents against B cells (rituximab), which have been successfully used to treat not only B-cell lymphomas72 but also cryoglobulinemic vasculitis,73 with the aim of controlling the marked B-cell hyperreactivity observed in SS-HCV patients. The second is the use of antiviral agents (interferon and ribavirin),...

Hivaids And Hepatitis C

The hepatitis C virus (HCV) has emerged as a problem of major significance, with many clinics reporting a prevalence upwards of 80 percent. Among those with HIV, coinfection with HCV is high. Inasmuch as 50 to 80 percent of new injectors become infected with HCV within 6 to 12 months, methadone maintenance will not reduce its spread as effectively as has occured with HIV. However, it does provide a structured system in which the patient can be monitored for good medical care, informed of emerging treatments, and educated about health practices to reduce the burden on the liver while more promising treatments are being developed.

Druginduced hepatitis

The liver plays a central role in the metabolism and excretion of drugs. At least 10 of all adverse reactions to drugs affect the liver. These reactions can range from asymptomatic to fulminant hepatic failure. Drugs can cause damage to hepatocytes, which is indistinguishable from viral hepatitis and cholestatsis. The mechanism of drug-induced damage includes direct toxicity to hepatocytes, the conversion of a drug into toxic metabolite and a drug-induced autoimmune reaction. Diagnosis of drug-induced hepatitis is made on the basis of a careful drug history, clinical signs and improvement if the patient stops the offending drug.

Lymphomagenesis in Hepatitis C Virus and Sjogrens Syndrome Patients

Lymphomagenesis in HCV patients might be initiated by the chronic stimulation of polyclonal B cells by the virus51 and the compartmentalization of HCV quasispecies in blood mononuclear cells,52 with the subsequent development of specific B-cell clonal expansions53,54 and procarcinogenic mutations.55,56 Vallat and colleagues54 suggested that B-cell clonality in the blood and liver may be a marker of lymphoma development in some HCV patients. Machida and colleagues55 reported that both acute and chronic HCV infection caused a 5- to 10-fold increase in mutation frequency in the Ig heavy chain, bcl-6, p53, and beta-catenin genes. Libra and colleagues56 detected bcl-2 rearrangement in mucosa-associated lymphoid tissue (MALT) lymphomas from HCV patients. Rosa and colleagues57 have recently proposed that CD81-mediated activation of B cells in vitro mimics the effects of HCV binding to B cell CD81 in vivo and that polyclonal proliferation of naive B lymphocytes is a key initiating factor for...

Characterization ofBCell Lymphoma in Sjogrens Syndrome Hepatitis C Virus Patients

A recent study60 has firstly described the disease characteristics of B-cell lymphoma in SS-HCV patients, its treatment, outcome, and survival prognosis. Compared with SS-HCV patients without lymphoma, those with lymphoma had a higher frequency of parotid enlargement and vasculitis.60 In primary SS, parotid enlargement is considered as a highly suggestive clinical sign of lymphoma,3,61 whereas vasculitic features are closely associated with cryoglobulinemia62 and lymphoma,61,63 with cryoglobulins being shown to be predictive factors for lymphoma development.64 This suggests a close association between cryoglobulinemic syndrome and lymphoma in SS-HCV patients, either in its asymptomatic (circulating cryoglobulins) or symptomatic (cryoglobulinemic vasculitis) form. Immunologically, nearly all SS-HCV patients who developed B-cell lymphoma had RF posivity.60 The secretion of RF by polyclonally activated B cells has been related to lymphoma development in both SS and HCV infection, but not...

Hepatocyte Injury Induced By Hcv Infection

During the course of a chronic HCV infection, hepatocytes are continuously damaged and replicated, and hepatic fibrosis appears to progress, whereas the frequencies of genetic alteration also probably increase. It is generally accepted that multiple genetic alteration, induced by mutations, is an important factor in carcinogenesis. Therefore, continuous cell death and replication and multiple genetic alteration may lead to the development of cirrhosis and HCC (Fig. 2). However, the mechanisms by which HCV induces liver injury and hepatocyte death remain, to a great extent, ambiguous. Cytotoxic T lymphocytes (CTLs) are not only thought to be a major host defense against viral infection, but have been implicated in immuno-pathogenesis as well. Two pathways, the perforin and Fas Fas ligand pathways, have been proposed to account for all cytolytic activity of CTLs (11), although tumor necrosis factor-a (TNF-a), a proinflammatory cytokine, is released by all HCV-specific CTL clones studied...

Hepatitis D Virus HDV

An uncommon version of the hepatitis virus in the United States, it infects about 15 million people around the world. In the United States, hepatitis D infection occurs more often among adults than children. However, children from underdeveloped countries where hepatitis D is endemic are more likely to contract the virus through breaks in the skin. Cause The virus requires the presence of hepatitis B virus to produce infection, so the frequency of hepatitis D closely parallels hepatitis B. Transmission from mother to child has not been documented in the United States. Hepatitis D is spread primarily through contaminated needles and exposure to blood products. Sexual transmission of hepatitis D is less efficient than for hepatitis B. Symptoms Hepatitis D cannot be distinguished from other causes of hepatitis. The development of a new episode of acute hepatitis in a patient with known chronic hepatitis B infection should prompt a search for evidence of a new hepatitis D infection....

Alcoholic Hepatitis and Enteral Nutrition

Seventy-one patients with severe alcoholic hepatitis were randomized to prednisone 40mg day or EN giving 2000kcal day for 28 days and then followed for 1 year or until death. The EN was a branched-chain-enriched diet and patients on steroid therapy were encouraged by dietitians to eat 2000 kcal day with 1 g kg day of protein. No patients from the steroid arm dropped out, whereas 8 35 patients from the EN arm did not receive EN for the entire period but were included in the analysis (intent to treat analysis). It is of interest that all patients in the steroid arm ate 80 of the prescribed diet. Using intent to treat analysis, there were no differences in mortality or complications in the hospital between groups. After discharge, even when confounding variables were adjusted, the EN group had a significantly better survival. Since both groups seemed to receive the same energy intake, the reason for better long-term survival with EN needs further study. Was it because of the use of...

Hepatitis B

Formerly known as serum hepatitis, this is the most common preventable infectious disease in the United States. The virus can destroy the liver and is 100 times more transmissible than the AIDS virus. It is believed that there are 300,000 cases a year, of which only about 15,000 are reported about 1.25 million Americans are carriers, which means they are infectious for the rest of their lives. Almost 6,000 Americans each year die from acute hepatitis B or complications of the infection around the world, the fatality rate is two million. It can be prevented by vaccine, but of the group who accounts for the most infections those aged 15 to 39 only about 5 percent ever get vaccinated. Cause The hepatitis B virus (HBV) is carried in the blood and is also found in saliva, semen, and other bodily fluids. It is transmitted much the same as the AIDS virus, but hepatitis B is even easier to catch. One drop of infected blood contains hundreds of thousands of virus one drop of blood with HIV...

Hepatitis C

The virus that causes hepatitis C was identified in 1988 and was first known as non-A, non-B hepatitis. In the United States, hepatitis C virus is linked to 20 percent of all clinical hepatitis cases and is the leading cause of chronic hepatitis. It causes liver cancer, kills up to 10,000 Americans a year, and causes almost half of all deaths from liver failure. More than half of all patients exposed to the virus become carriers, and up to 20 percent of these carriers develop cirrhosis, a severe liver disease. About five out of every 100 infants born to HCv-infected women become infected at the time of birth. There is no way to prevent this from happening. Most infants infected with hepatitis C at birth have no symptoms and do well during childhood scientists do not know if these children will have problems from the infection as they grow older. Cause Most children are infected at birth from infected mothers. There is no evidence that breastfeeding spreads hepatitis C, but infected...

Viral Hepatitis

Acute viral hepatitis is diagnosed primarily by clinical or serological examination cross-sectional imaging is not normally part of the primary diagnostic approach. Typical MR findings in acute viral hepatitis are hepatomegaly combined with edema of the liver capsule. In fulminant forms of acute viral hepatitis, diffuse or focal necrosis may be detected on MR images. In patients suffering from chronic hepatitis, cross-sectional imaging, especially MRI, is performed to determine the presence of cirrhosis or ascites and to screen for the presence of hepato-cellular carcinoma (HCC). A region of high SI surrounding the portal vein branches can frequently be found on T2-weighted images in patients suffering from acute or chronic active hepatitis, but is considered a non-specific sign 38 . In addition, diffuse or regional high signal areas can be identified on T2-weighted images 58,59 . Patients with viral hepatitis typically have enlarged lymph nodes at the liver hilum presenting as...


Hepatitis can be acute and short in duration or chronic and long-lasting. Liver cells are either inflamed and damaged or they die, leaving a malfunctioning liver. Viruses are the most common cause of hepatitis, indicated by alphabetical letters other causes are alcohol, exposure to industrial chemicals, fumes, and drugs, recreational or pharmaceutical, including acetaminophens like Tylenol. Symptoms include fatigue, fever, nausea, vomiting, loss of appetite, and possibly dark urine and a yellowing of the skin called jaundice. Hepatitis A can be transmitted by poor hygiene and through food. Hepatitis B and C are transmitted by sexual contact and blood.

Alcoholic hepatitis

This is inflammation of the liver caused by alcohol ingestion. Liver biopsy in patients with a history of alcohol abuse demonstrates liver cell degeneration, necrosis and fatty deposits. Symptoms of alcoholic hepatitis include right upper quadrant abdominal pain, fever, vomiting, anorexia and dark urine. Alcoholic hepatitis does not usually present with jaundice. Physical signs include hepatomegaly (enlarged liver), spenomegaly (enlarged spleen) and signs of cirrhosis. Treatment is based upon support care and abstinence from alcohol.

Hepatitis A

The most common type of hepatitis in children, hepatitis A is spread by eating food or drinking water contaminated with the hepatitis A virus that is shed in the stool. Formerly known as infectious hepatitis, hepatitis A tends to occur in cycles. In the United States, cases peaked from 1961 to 1971, declined, and then peaked again from 1983 to 1991 numbers dropped again after 1992. Food has been implicated in more than 30 outbreaks since 1983. It was implicated in 2004 in a large out break at a Pennsylvania Chichi's Restaurant, later traced to tainted scallions from Mexico. Hepatitis A belongs to the enterovirus group of the picornaviruses, which include polio virus, cox-sackie virus, echo virus, and rhinovirus. The virus enters through the mouth, multiplies in the body, and is passed in the feces it can then be carried on an infected child's hands and spread by direct contact, or by eating food or drink handled by that person. While anyone can get hepatitis A, it occurs most often...

TABLE 5 Extraglandular Manifestations in Primary SS

Autoimmune hepatitis primary biliary cirrhosis Diagnosis of SS also requires exclusion of other conditions that can mimic it. These include previous radiation therapy to the head and neck, amyloidosis, sarcoidosis, lymphoma, graft versus host disease, hepatitis C virus infection, HIV-diffuse infiltrative lymphocytosis syndrome, medication-induced dryness, and uncontrolled diabetes mellitus.

Juniperus chinensis L Cupressaceae Chinese Juniper

Traditional Medicinal Uses The leaves are used as a tonic to treat bleeding resulting from coughs. 12 It is also used for cold and haemorrhage. Liquor brewed from fresh leaves is used as a tonic and to treat hemoptysis. Others include treatment for convulsions, excessive sweating and hepatitis. 3 Its roots are used on burns, scalds and to promote hair growth on scars. 3

Areas Of Promising Research

The impact of comorbidities on cancer survival must be explored. The incidence of various comorbidities varies within different ethnic groups. Knowing which co-morbidities affect each group and developing interventions that target specifics groups will enhance survival for all cancer patients. Oncology health care providers must be cognizant of what issues affect each particular racial ethnic group. A prime example of this is the atypical cancer burden suffered by Asian Americans. As opposed to other racial ethnic groups, cancer rather than heart disease remains the leading cause of death in Asian Americans.34 Coupled with the fact that this group also has an increased incidence of cancer caused by infectious agents such as cervical cancer and HPV, hepatocellular cancer and hepatitis B infection, interventions targeted to this group should be focused to address these particular causes.

Small Vessel Vasculitis

Other forms of small vessel vasculitis seen in adolescents include hypersensitivity vasculitis (usually following drugs such as penicillin, antithyroid agents, retinoids) that is treated by removing the offending agent, and cryoglobulinaemic vasculitis that is rarely seen in the context of hepatitis C and intravenous drug abuse.

Paul Devenyi Revised by Ralph Myerson

Acute toxicity results in the impairment of behavior leading to other complications (e.g., trauma) and, in the case of some drugs, high doses can decrease breathing (respiratory depression) or change the rhythm of the heart, leading to accidental or intentional death. Chronic use can result in organ damage, which may lead to chronic illness or death (as with alcoholic cirrhosis of the liver). Persistent use of many classes of drugs also leads to TOLERANCE (an increased amount is required to produce the same effects) and physiologic (physical) dependence, so that a WITHDRAWAL syndrome is associated with sudden cessation of drug use. Drug users who employ hypodermic needles and syringes (injecting drug users IDUs ) are at risk for blood-borne diseases associated with the use of unsterile equipment, such as hepatitis and human immunodeficiency virus (HIV 1 and 2 the viruses responsible for AIDS see ACQUIRED IMMUNODEFICIENCY Syndrome).

Complications And Prognosis

Splenomegaly, palatal petechiae, and hepatomegaly develop in another 10 of infected patients. The main serious complication is enlarged spleen and its possible rupture. Less common complications include hemolytic anemia, thrombocytope-nia, aplastic anemia, myocarditis, hepatitis, rash, and neurologic complications, such as Guillain-Barre syndrome, encephalitis, and meningitis.

Immunizations for health care professionals

Include the HEPATITIS B vaccine (Recombivax or EngerixB) in a three-dose series INFLUENZA vaccine every fall MMR (measles-mumps-rubella) vaccine unless there is proof of immunity and Td. See also IMMUNIZATION VACCINE. immunizations for homosexual males heterosexuals with multiple partners Anyone with this sexual history should receive the HEPATITIS B vaccine in a three-dose series, plus routine vaccines recommended for adults. See also IMMUNIZATION VACCINE.

General features and trends of compromising illnesses

One of the challenges of pregnancy is that half the child's genetic traits are from the mother and half are from the father, generating a fetus that is antigenically different from the mother. In order to prevent fetal rejection by the mother, the cell-mediated immune system response is decreased through progesterone production. Unfortunately, the decreased cell-mediated immunity leads to increased vulnerability to a variety of infectious pathogens, such as Brucella, Listeria monocytogenes, Salmonella, Shigella, Yersinia, Hepatitis A and E, Coxiella burnetti, and Toxoplasma gondiae (Smith, 1999). Later in this chapter, Listeria monocytogenes infections will be discussed in more detail.

Sclerosing Cholangitis

Typical findings with MRI are diffusely distributed regions of biliary dilatation and areas of periportal inflammation. These features are best distinguished on heavily T2-weighted images when the biliary dilatation presents as areas showing a fluid-equivalent signal localized along branches of the portal veins. On the other hand, periportal inflammation shows decreased SI on T1-weighted images, while a signal intermediate between that of liver tissue and bile is seen on T2-weighted images. These imaging findings are typically localized in the liver hilum and accompany the intra-hepatic portal tracts surrounding the portal vein branches, but not the hepatic veins, which are unaffected by the disease. For the differential diagnosis of sclerosing cholangitis, periportal inflammation, biliary obstruction, hepatitis and periportal neoplasm all have to be taken into consideration.

Other Medical Complications

Opioid addicts frequently develop viral hepatitis (types A, B, and C). In addition, addicts who are also heavy drinkers have a high incidence of cirrhosis and other disorders of liver function. Pregnancy and Lactation. Infants of opioid-addicted mothers are born physically dependent on the drug, because both heroin and methadone cross the placental barrier. They may also acquire HIV infection or hepatitis from an infected mother. Pregnant addicts should be encouraged to enter a methadone maintenance program rather than attempt complete withdrawal, because withdrawal in the last trimester of pregnancy may cause early labor. Mothers on methadone maintenance can nurse infants without harm to the child, because breast milk will not contain large amounts of the methadone.

Harry K Wexler Revised by Richard Dembo

PRISONS AND JAILS DRUG USE AND HIV AIDS IN From the beginning of the epidemic in the early 1980s, HIV AIDS has seriously affected correctional inmate populations. The first AIDS cases among inmates were reported in New York State in 1983. As the overall face of the epidemic has changed, with the virus first infecting mostly white homosexuals, to increasing predominance among African American and Hispanic intravenous drug users and their sexual partners, prisons and jails have become epicenters for HIV AIDS, STDs, tuberculosis, and hepatitis. Nevertheless, the prevalence of HIV among inmates, although disproportionate to rates found in the total

Diagnosis of human infections

Hepatitis A is diagnosed in individuals by detection of anti-hepatitis A virus IgM antibodies in the serum of recently or acutely ill patients.33 Nucleic acid amplification is not generally used for diagnostic purposes, though hepatitis A virus RNA can be detected in stools and blood of most acutely infected persons.

Foods associated with outbreaks of viral gastroenteritis

Bivalve molluscan shellfish (particularly cockles, mussels, and oysters) are an important source of foodborne viral infections because these filter feeders can concentrate hepatitis A and noroviruses in their tissue and retain them for some time. These shellfish are commonly harvested from locations close to shore where water may be contaminated with viruses from sewage effluents. Because shellfish become contaminated by sewage, shellfish outbreaks often involve multiple virus strains. Shellfish also tend to cause multi-state or multi-country outbreaks. Various regulations may prohibit harvesting of shellfish from

Transmission routes of viral contamination

For foodborne viruses, all virus transmission occurs through a fecal-oral transmission route (Fig. 14.1). Environmental transit times between hosts may be prolonged or brief. Long-distance transmission may take place through water, air, and transported food. Long-distance transmission is also accompanied by exposure to the environment and dilution. Since enteric viruses cannot replicate outside their hosts, viral levels theoretically should decrease during transport and storage. Both hepatitis A virus and norovirus counteract these effects by inducing shedding high numbers of virus from the host and by being particularly resistant to environmental exposure including low pH, high temperature, drying, and various disinfectants (Table 14.2). Table 14.2 Effect of various inactivation approaches for noroviruses and hepatitis A viruses on foods and surfaces Hepatitis A

Fecaloral transmission route

Both norovirus and hepatitis A virus are transmitted from person to person via fecal contamination of the environment. Therefore, foodborne transmission of these viruses is merely a subset of the fecal-oral transmission route, and food has a privileged niche because it is easily introduced into the body, has widespread distribution through trade, and is of economic importance.2 A simplified model of the fecal-oral transmission route is illustrated in Fig. 14.1. This figure includes documented and suspected transmission routes for norovirus and hepatitis A virus. Vomitus is grouped with feces because it may be the origin of viral contamination into the environment and foods. Each box is connected by multiple lines because contamination of food can occur through multiple routes. Each line represents a potential transmission route that could be a potential site for a public health intervention. Public health interventions can be divided into two categories primary and secondary...

Food contamination during food processing

Both noroviruses and hepatitis A virus are persistent in the environment and easily transferred from surfaces to hands to other surfaces. Foods are rarely contaminated with viruses during food processing, although products served raw or only lightly cooked would be at greater risk of transmitting viruses arising from either pre- or postharvest sources. Furthermore, processing of some products, such as shellfish, may not inactivate viruses. For example, since viruses are sequestered in the gut of the mollusk, viruses may be protected due to inadequate heat.70,71 Some NoV outbreaks have been associated with cooked oysters.72 The effect of temperature on hepatitis A and norovirus is described in Table 14.2.

Case study 142 Cake frosting causes outbreak in Georgia USA

Both norovirus and hepatitis A viruses are resistant to multiple common disinfectants listed in Table 14.2. The methods that are most effective at reducing virus levels include UV light, ozone, thermal inactivation, chlorine, and hypochlorite (bleach). However, the efficacy of these disinfectants may be inhibited by the food matrix. For example, shellfish protect hepatitis A virus from thermal inactivation.70'71 Although UV is a good virucidal agent, it does not penetrate foods and can be used only for surface inactivation. Some virucidal agents may not be used on certain foods because they may affect their form or taste, or introduce toxic substances. Several groups have also determined that high hydrostatic pressure processing, a novel way to decontaminate shellfish, may be effective at reducing levels of hepatitis A virus on shellfish.78,79 High hydrostatic pressure processing is also effective at reducing levels of feline calicivirus, a commonly used surrogate for norovirus.78 The...

Mechanisms of host cell invasion

Infection replication of other tissues organs resulting in non-enteric illnesses such as aseptic meningitis, mild paralytic disease, acute hemorrhagic conjunctivitis or poliomyelitis (poliovirus).238 This is in contrast to the primarily systemic infection and illness (e.g. hepatitis) observed following hepatic infection with hepatitis A virus.150 As with non-enteric viral diseases, illnesses caused by an enteric viral infection may be due to a direct and or immunolo-pathologic consequence of virus replication in the infected tissue organ.

Adverse Effects And Reactions Allergies And Toxicity

No reports are available on allergies and toxicity resulting from purple wheat products. However, it can be speculated that adverse effects and reactions associated with common wheat may also be applicable to purple wheat. Indeed, the peptides derived from gluten proteins present in wheat are known to be responsible for celiac disease, an intestinal disorder caused by T-cell responses to these peptides (Spaenij-Dekking et al., 2005). Secondary intolerances including viral hepatitis and intestinal infections may also occur in predisposed individuals. However, there is potential for selection of non-toxic varieties for celiac-disease patients. High levels of wheat-specific immunoglobulin E (IgE) have been reported in patients with anaphylaxis (Pourpak et al., 2004).

Box 2 Identifiers of complexity

Care by the origin of their illness (eg, hepatitis C due to high risk behavior), symptoms (eg, unexplained physical complaints), or the complexity of the required treatment and the related distress produced (eg, transplantation). A list of possible identifiers of complexity is provided in Box 2. As mentioned in the Preface to this issue, identification of complexity must be followed by an adequate assessment that provides useful clinical information required for an integrated treatment plan. Only a few instruments have been designed to detect or assess complexity. The INTERMED method, discussed in detail in the article by Stiefel and colleagues in this issue, is such an instrument 6,7 . It is empirically based and has been evaluated with regard to reliability, validity, and predictive validity. The INTERMED method is based on the communi-metric approach (see the article by Lyons in this issue). It contains 16 health risks, such as whether a patient has a chronic disease, has had...

Recombinant Dna Technology Monoclonal Antibodies

For hundreds of years mankind has utilised micro-organisms to produce a whole range of natural products which we can use (e.g. ethanol, organic acids, dextrans, antibiotics). Micro-organisms are extremely easy to cultivate and large scale culture results in high yields of the product required which can then be purified and utilized. Natural products can also be extracted from plant tissue. Biologically active compounds from animals can be isolated from the appropriate organ or tissue but as these are extremely potent compounds, they are normally only present in small quantities and large amounts of the appropriate tissue are required to obtain useful quantities of the product. This is a particular problem with compounds of human origin due to lack of cadavers and to the possibility of contamination of the resulting product with human viruses such as hepatitis and the AIDS virus.

Historical Aspects Of The Use Of Nuts And Seeds For Health In Pakistan

Chicken pox (Ahmad etal., 2006), Respiratory tract ailments, aphrodisiac, and spermatopoetic (Rizvi etal., 2007 Hussain et al., 2007) Nausea, and stomach ache (Ahmad et al., 2006) Antifebrile, stomachic, gastrointestinal disorders, molluscicidal, menstruation problems, expectorant, antibacterial, and antidote to opium (Ali etal., 2003 Sabeen & Ahmad, 2009) Gastritis, antifebrile, constipation, and diabetes mellitus (Kabirudin & Khan, 2003) Asthma, cough, wounds, jaundice, bronchitis, menstrual problems, for the removal of umbilical cord, and to ease labor (Rizvi et al., 2007 Hayat et al., 2008) Antifebrile, jaundice, and hepatitis (Kabirudin & Khan, 2003), Gastrointestinal disorders, anthelmintic, and purgative (Shinwari & Khan, 2000 Qureshi etal., 2009) Hepatitis, gastritis, constipation, antifebrile,

Static Biochemical Tests

Iron status is assessed in relation to three stages of development of iron-deficiency anemia. In the first stage, to evaluate the size of body iron stores, serum or plasma ferritin can be measured by radiometric methods or using ELISA. Commercial kits are available. Confounding effects of infection, liver and malignant diseases, acute leukemia, Hodgkin's disease, rheumatoid arthritis, thalasse-mia major, alcohol consumption, age, and sex are reported. In the second stage, to determine the adequacy of iron supply to the erythroid marrow, serum iron (measured by the colorimetric method, available as commercial kits AAS is not recommended because it gives higher values), plasma or serum total iron binding capacity (TIBC by colo-rimetric or radioactive methods available as commercial kits), erythrocyte protoporphyrin (by specific hematofluorometer), and serum transferrin receptor (by ELISA using developed monoclonal antibodies) are measured. The percentage of trans-ferrin saturation is...

Techniques for Liver MR Imaging

Normal Mri Liver

Valuable for sensitive evaluation of the acute and chronic changes of hepatitis, including cirrhosis. Dynamic perfusion analysis is obtained by the acquisition of a series of scans at multiple times (see Chapt. 3). No other imaging technique can provide the comprehensive evaluation of liver disease possible on MRI. Use of contrast-enhanced CT for multiphase examinations is associated with an ionizing radiation burden that is proportional to the number of scans obtained during the study. There are increasing concerns regarding the risks of radiation and the iodinated contrast agents associated with CT imaging of the abdomen. For example, the National Academy of Science has released BEIR VII, the seventh in a series of consensus reports on radiation risks, which includes a section on radiation from diagnostic CT. In brief, assuming the demographic distribution of the U.S. population, a single dose of 100 mSv is associated with an estimated lifetime attributable risk (LAR) for developing...

Condylomata acuminata

Not all communicable diseases must be reported, since they are not all considered to be a danger to society. Some diseases which must be reported include bacterial meningitis, aids, food poisoning, measles, hepatitis, rabies, lyme disease, syphilis, malaria, and tuberculosis. The infant is also vulnerable to maternal infection while passing through the birth canal. At this time, any active infection in the mother's genital area can have serious repercussions to her child. Conditions acquired in this way include conjunctivitis, genital herpes, or chlamydial infection. Staph, or strep infections, meningitis, hepatitis b, or listeriosis may also be passed on. contagious disease Any communicable disease. (Previously, the term referred to any disease transmitted by direct physical contact.) Some of the contagious diseases are actinomycosis, amebiasis, candidiasis, chicken pox, cholera, colds, conjunctivitis, diphtheria, gastroenteritis, giardiasis, hepatitis, herpes, influenza, meningitis,...

Parenchymal Pseudolesions

Fat Attenuation

Fatty liver infiltration is a common, metabolic complication of a variety of toxic, ischemic and infectious insults to the liver, such as obesity, diabetes mellitus, alcoholic liver disease, malnutrition, and chemotherapy. Other causes include hy-peralimentation, inherited metabolic disturbance, inflammatory bowel disease, severe hepatitis, endogenous and exogenous steroid use, and pregnancy 1 . Generally, fat is deposited in response to different metabolic changes, such as increased hepatic synthesis of fatty acids (ethanol), decreased hepatic oxidation or utilization of fatty acids (carbon tetrachloride, tetracycline), impaired release of hepatic lipoproteins (steroids), or excessive mobilization of fatty acids from adipose tissue (alcohol, steroids). The prevalence of focal fatty infiltration of the liver increases significantly with advancing age whereas it is uncommon in infants and young children, it is present in roughly 10 of the adult population 23 .

Personal hygiene practices of consumers

Personal hygiene includes cleanliness of the hands, hair, clothing, and body in general. Hand washing is most frequently the sentinel behavior for assessment of personal hygiene in consumer food safety studies. From a Hazard Analysis and Critical Control Point (HACCP) perspective, the critical control point for ensuring the safety of foods that are prepared to be served without heating is personal hygiene. Controlling the transfer of pathogens from the hands to food is important for almost all foodborne illnesses, but especially (1) raw vegetables and fruits (2) some types of desserts (3) raw or undercooked foods exposed to polluted water and (4) previously cooked foods handled by consumers and served without additional heating. It is estimated that 5 of Hepatitis A cases are foodborne, 20 of Shigella cases, and 40 of Norovirus cases are estimated as being foodborne (Mead et al., 1999). Thus, hands contaminated with fecal pathogens can be the source of pathogens in foods (Feachem,...

Hantavirus pulmonary syndrome

Symptoms Hantavirus pulmonary syndrome begins as a flulike illness with fever and chills, muscle aches, and cough it can be easily misdiagnosed as HEPATITIS or an inflamed pancreas. The virus goes on to damage the kidneys and lungs, causing an accumulation of fluid that can drown the victim. The disease is fatal in almost half of all cases. hepatitis The description for any inflammation of the liver. It is generally caused by a virus, but alcoholism or certain drugs can also damage the liver and lead to hepatitis. When the liver is damaged, it can't excrete the blood breakdown substance called bilirubin, which then builds up in the blood. This causes a yellow tinge to skin and eyes (called jaundice). The appearance of jaundice is more or less a warning sign that the liver is no longer able to cleanse the blood. In severe cases of hepatitis, the liver fails altogether, resulting in death unless a liver transplant is done. Hippocrates was the first to mention epidemics of jaundice, and...

Clinical Presentation

Hypothesized that polyps either mechanically disrupt the formation of stones or that polyps are harder to diagnose radiographically when stones are present. Patients with congenital polyposis syndromes such as Peutz-Jeghers and Gardner syndrome can also develop gallbladder polyps.15'16 A recent large retrospective analysis of risk factors for gallbladder polyps in the Chinese population identified chronic hepatitis B as a risk factor.17 Proposed patient risk factors for malignant gallbladder polyps include age greater than 60, presence of gallstones, and primary sclerosing cholangitis. Polyp risk characteristics include a size greater than 6 mm, solitary, and sessile.

Drugs Used to Treat Infectious Diseases

Combining interferon with either acyclovir or vidarabine is useful in treating various versions of hepatitis. Thanks to recombinant DNA technology, interferon is now available in large enough quantities from bacterial cells and many studies around the country are currently under way.

Antibacterial and Antiviral Activities

These promising in vitro results have begun to promote various in vivo studies of certain viruses in mice. These include LP-BMS murine immunodeficiency viruses, murine cytomegalovirus (MCMV), Sindbis virus, Friend virus, and Ranscher leukemia virus (75-77). Hypericin has also shown in vitro activity against influenza and herpes viruses (78), vesiculostomatitis and Sendai viruses (73), and duck hepatitis B virus (79). Hypericin impacts other viruses. It completely inactivated bovine diarrhea virus (BVDV) in vitro in the presence of light (82). BVDV, a pestivirus, has structural similarities to hepatitis C virus (HCV) (83,84). Jacobson et al. (85) examined the effects of hypericin on HCV, and found that in the doses studied, hypericin demonstrated no detectable anti-HCV activity. Plasma HCV levels were not lowered in HCV-infected patients nor was any effect seen on improving serum liver enzyme levels in the patients studied (85). These results provide significant evidence that, in the...

The Effects Of Alcohol On Bodily Systems

Acute hepatitis) may also contribute to this neurologic impairment. Computerized tomography (CT) scans reveal that many alcoholics have cerebral atrophy this consists of decreased brain weight, an increase in spaces (sulci) between various regions of the brain, and an increase in size of ventricles (spaces filled with cerebrospinal fluid). In a minority of cases, these structural changes are reversible with abstinence. Seizures are associated with heavy alcohol consumption and usually occur in association with alcohol withdrawal. Abstinence from alcohol is usually the only treatment needed for this type of seizure. The hallucinations that are mostly associated with alcohol withdrawal are usually treated with drugs benzodiazepines and phe-nothiazines. Liver. Alcoholic liver disease is a major cause of morbidity and mortality in the United States in 1986, cirrhosis of the liver was the ninth leading cause of death. Alcohol causes three progressive pathological (abnormal) changes in the...

Chronic Recurrent Multifocal Osteomyelitis and Synovitis Acne Pustulosis Hyperostosis and Osteitis Syndromes

Parvovirus B19, HIV, hepatitis B arthritis or arthralgia and less commonly EBV, CMV, coxsackie B, adenovirus 7, herpes simplex, varicella zoster, and echoviruses) Small- and large-joint arthritis Reactive arthritis can occur after viral infections or after vaccinations. Joint symptoms occur more frequently in adolescence compared to childhood following rubella and mumps infections. Small- and large-joint involvement occurs. A variety of musculoskeletal presentations are recognized in up to 75 of patients with HIV, including a mild polyarticular arthralgia, incomplete Reiter's syndrome, mono-articular or oligo-articular arthritis. Following hepatitis B infection, a disease resembling serum sickness can be seen in up to 20 adults with a polyarthritis and rash. Another 40 can get arthralgia.

Inflammatory Mediators

In patients with hepatitis C infection (HCV), the severity of depressive symptoms is IFN-a administration is commonly associated with a spectrum of neuropsychologic effects, including fatigue, vegetative symptoms (sleep disorder, psychomotor slowing, and anorexia), and affective disorders (anxiety and depression), in addition to cognitive effects and profound cerebral dysfunction. In cancer patients undergoing IFN-a therapy, a well described syndrome of IFN-mediated fatigue followed by depression occurs and progresses to coma if INF-a therapy is continued.116 A similar syndrome of fatigue, cognitive dysfunction, and depression is associated with IFN-a therapy of chronic hepatitis C liver disease.117 Evidence linking IFN-a with neuropsychiatry symptoms in cancer and HCV suggests a potential role for interferon inducible inflammatory cytokines in mediating the cognitive and affective disorders in medically ill patients, particularly persons with rheumatic disorders however, the data...

Acute Cholecystitis

Cholecystitis Patient

Patients with suspected cholecystitis should be imaged for 2 major reasons. First, most patients (60 -85 ) referred to exclude cholecystitis have other causes of right upper quadrant pain, including peptic ulcer disease, pancreatitis, hepatitis, appendicitis, hepatic congestion from right-sided heart failure, perihepatitis from pelvic inflammatory disease (Fitz-Hugh-Curtis syndrome), right lower lobe pneumonia, right-sided pyelonephritis, or nephroureterolithiasis. If the patient does not have acute cholecystitis, the clinical workup can be redirected before the patient's clinical condition deteriorates. Secondly, imaging can diagnose severe complications such as emphy-sematous cholecystitis and perforation, which require immediate surgery.37

Blood Coagulation System And Immune Complement System

Needling is used effectively for acute inflammation of soft tissues caused by injury from accidents, sports, and all kinds of pathologic conditions (e.g., tonsillitis inflammation of the parotid gland, lymphatic vessels, and nodes appendicitis pancreatitis postoperational infections bacterial dysentery hepatitis B nephritis and other hypoimmune reactions). ISDN is also used for improving hyperimmune response in cases of chronic inflammation such as hyperthyroidism, Hashimoto thyroiditis, sinusitis, asthma, allergy, urticaria, gastritis, rheumatoid arthritis, diabetes, and low leukocyte count during chemotherapy. ISDN is a safe and beneficial adjunct therapy for all these conditions.

Shellfish poisoning 243

Throughout the 1970s and early 1980s, most STD patients could expect to be cured with antibiotics. But about the same time, doctors began to realize that new infections such as the chronic disease herpes and the occasionally fatal illness hepatitis B could not be cured by drugs. With the spread of AIDS in 1982, doctors realized that STDs were again a serious risk to life, and now consider promiscuous sex to be a high-risk venture. Most cases of shellfish poisoning have occurred when people ate raw or undercooked shellfish in fact, raw shellfish have been linked to nearly 1,000 cases of hepatitis a year. For this reason, doctors recommend that no one eat raw shellfish. It's also possible to contract hepatitis a from eating raw shellfish harvested from sewage-contaminated waters. Even though federal regulations and posting of contaminated waters offer some protection, there is still a risk of contracting viruses when eating raw shellfish.

Ruta graveolens L Rutaceae Herb of Grace Common

Induration Insect Bites

Traditional Medicinal Uses It is frequently used to treat worm and parasitic infection. 6 It has been commonly used for the treatment of psoriasis and vitiligo due to the psoralens and methoxypsoralens present. 7 It is also used to relieve muscle spasms, as carminative, emmenagogue, haemostat, uter-onic, vermifuge, to treat hepatitis, dyspepsia, diarrhoea, bug bite, cancer, cold, fever, snakebite, earache, toothache and as an antidote especially in malarial poisoning. 3,4,8 It is also used as an abortifacient to terminate pregnancy. The plant has been used for pain relief in Mexico. 10

Gallbladder Carcinoma

Gallbladder Findings

Two factors interfere with the sonographic recognition of carcinoma as the cause of gallbladder wall thickening (1) Changes of early gallbladder carcinoma may be only subtle mucosal irregularity or mural thickening. (2) Gallbladder wall thickening is a nonspecific finding that can also be caused by acute or chronic cholecystitis hyperalimentation portal hypertension adenomyomatosis inadequate gallbladder distention hypoalbuminemia hepatitis or hepatic, cardiac, or renal failure. Sometimes the echo architecture of the wall can help narrow the differential diagnosis.2,3,11,86 Although CT is inferior to ultrasonography in evaluating the gallbladder wall for mucosal irregularity, mural thickening, and cholelithiasis, it is superior in evaluating the thickness of portions of the gallbladder wall that are obscured by interposed gallstones or mural calcifications on ultrasonograph. On CT scans, focal malignant wall thickening (Fig. 16C) usually enhances after administration of intravenous...

Cytopathic effect CPE

Wild-type hepatitis A virus infection in culture does not produce CPE despite replication, assembly, and spread of infectious virus. While the clinical symptoms and pathology of infectious hepatitis are attributed to a T cell mediated destruction of infected cells,64'319'320 the contribution of virus replication per se to hepatic cell destruction remains unclear. There is currently no information regarding the development of either CPE or necrosis in cell culture by human NoV owing to the lack of a cell culture system for this virus. Human volunteer studies reveal upper small intestinal histopathologic lesions and mononuclear cell infiltration of the lamina propria, suggesting virus particle binding to epithelia cells (stomach) and enterocytes (small intestine).105 While animal rotaviruses can be grown in cell culture quite easily, the culture of human rotaviruses often requires additional methods such as pretreatment and or incorporation of trypsin in the culture medium possibly...

Alcoholic Liver Diseases

Alcoholic Cirrhosis Liver Uss

This is a potentially more serious form of alcoholic liver disease. A certain proportion of alcoholics, in addition to accumulating fats in their livers when drinking, will develop inflammation (hepatitis means liver in-flammation)-consisting of an accumulation of white blood cells, the death (necrosis) of some of the liver cells, and the presence of some very char- Alcoholic Hepatitis Alcoholic Hepatitis The clinical picture of alcoholic hepatitis can be very variable. At one extreme is the person who feels perfectly well and only the biopsy could tell that something is wrong. At the other extreme is the patient with a swollen and painful liver, yellow jaundice (a yellowing of the entire body from bile pigment leaking into the blood), fever, and disturbed consciousness who dies. Between these extremes are people with varying degrees of seriousness of the illness for example, with or without some jaundice, with or without pain and fever, etc. The blood's white...

Hepatocellular Carcinoma

Hepatocellular Carcinoma And Mri

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and one of the most prevalent visceral malignances worldwide 21 . HCC usually occurs in the setting of cirrhosis with a known cause, such as chronic viral hepatitis or alcoholism. Regarding alcoholism as a cause of cirrhosis, it is thought that alcoholism promotes hepatic malignancies indirectly via its immuno-suppressive effects. These effects facilitate the development of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections. Furthermore, alcoholic cirrhosis is triggered by the well-known oxidative effects that deplete the anti-oxidative defense system 35 . Whereas in Asia HCC occurs almost exclusively in patients with chronic liver damage from hepatitis, in North America many patients develop HCC without cirrhosis or known risk factors 74 . In these latter patients it is possible that steroid hormones may play a role in carcinogene-

Applications To Health Promotion And Disease Prevention

Other uses as folk remedies are for the treatment of liver disorders (antihepatotoxic activity), hepatitis, laryngitis, bronchitis, and gonorrhoea (Okojie et al., 2009). Iwu (1993) has also reported the antidiabetic potential of GK seed. Some studies have shown that GK seed extract exhibits a dilatory effect on the alveolar ducts and sacs, and alveoli, thus improving respiratory activity (see Okojie et al., 2009, for a review). The extract also enhances the functionality of the gall bladder, indicating that it has detoxification and cleansing properties. Other therapeutic uses are in the management of tuberculosis and diarrhea, and the treatment of measles and mumps in children.

Plate V Skin Alterations Related To Vascularization Paleness Hyperemia Telangiectasia

Reticular Telangiectasia

Plate VA Linear telangiectasia on the right upper concha, delimiting a hypertrophic area of the root of the helix, in a 65-year-old female with chronic persisting hepatitis. Plate VA Linear telangiectasia on the right upper concha, delimiting a hypertrophic area of the root of the helix, in a 65-year-old female with chronic persisting hepatitis.

Blood poisoning See septicemia

The blood used at most hospitals is from volunteer donors who are not paid for giving blood or blood products. Each blood donor must answer medical history questions and be given a limited physical examination before being accepted as a donor. All donated blood is tested for hepatitis, syphilis, and antibodies to immunodeficiency viruses including the aids virus. These tests decrease the chances of transfusion-related infections. Most transfusions do not cause any problems, but mild side effects may include symptoms of an allergic reaction such as headache, fever, itching, increased breathing effort, or rash. This type of reaction can usually be treated with medication if the child needs more transfusions in the future. Serious reactions are rare. The most common serious side effect is serum hepatitis, an infection of the liver.

Drug Addicts Hemophiliacs and Children

Bill Gates Workin

Many scientists felt that the infections seen in intravenous drug users suggested that GRID could be spread through the blood as well as through sexual contact, and that it was more likely to have a viral cause. Since intravenous drug users often shared needles, they were exposed to the blood of other drug users. This means of disease transmission was well known. The blood contact spread diseases such as hepatitis B, which was caused by a virus.

Thalassemia Macroscopic Image

Fatty Infiltration Liver

Dysplastic focus is defined as congeries of hepato-cytes, measuring less than 1 mm in diameter, which show dysplasia but no histological signs of malignancy. Dysplastic foci generally occur in cirrhosis of any origin and are extremely rare in non-cirrhotic livers. In addition, patients suffering from a-1-antitrypsin deficiency, tyrosinemia or chronic viral hepatitis B or C demonstrate a comparatively high prevalence of dysplastic foci. Usually, serum a-fetoprotein is normal or minimally increased. However, in patients with tyrosinemia, high levels of serum a-fetoprotein can be found even before nodules are macroscopically visible 12,181 . In Europe and North America the incidence of HCC is generally below 3 100,000 inhabitants, while in parts of Asia and Africa it is about thirty times higher. The endemic occurrence of chronic hepatitis B and exposure to Aflatoxin B1 seem to be primary reasons for this 8 . In Europe and Japan the leading cause of HCC is chronic hepatitis C with...

Antioxidant Properties

More recently, S. maxima has been shown to prevent fatty liver formation in male and female mice with alloxan-induced diabetes. The administration of S. maxima to these animals reduced the levels of thiobarbi-turic acid-reactive substances in serum and liver as well as triglyceride and LDL and VLDL levels (40). Spirulina has also been shown to prevent liver fibrosis (41) and arrest the progress of chronic hepatitis into hepatocirrhosis (42).

Mucous Membrane Pemphigoid

Crack Cocaine Effects Teeth

FIGURE 30 Lichenoid stomatitis in chronic hepatitis C. This red and white lesion at a high-risk site like the lateral border of the tongue was sensitive to spicy food and was highly suspicious for a premalignancy. A biopsy showed a liche-noid mucositis without dysplasia. Note the central erythematous area surrounded by white, radiating striae, the typical lichenoid clinical appearance. Source Courtesy of Stacy Mullins, DDS. FIGURE 30 Lichenoid stomatitis in chronic hepatitis C. This red and white lesion at a high-risk site like the lateral border of the tongue was sensitive to spicy food and was highly suspicious for a premalignancy. A biopsy showed a liche-noid mucositis without dysplasia. Note the central erythematous area surrounded by white, radiating striae, the typical lichenoid clinical appearance. Source Courtesy of Stacy Mullins, DDS.

HDAC Inhibitors in Models of Inflammatory Diseases 321 Models of Lupus Erythematosus

3.2.4 Hepatitis Induced by Intravenous Con A The in vivo model of ConA-induced hepatic injury, a model that is TNFa- and IL-18-dependent, is a model of activated CD4+ T cells that may represent autoimmune hepatitis and possibly most cytokine-mediated hepatic injury (Faggioni et al. 2000 Fantuzzi et al. 2003). In this model, a single dose of 50 mg kg SAHA given orally reduced the injury by more than 70 as determined by a reduction in circulating levels of ALT by (Leoni et al. 2002).

Pyridoxine Deficiency

Pyridoxine (vitamin B6) is required for transamination reactions, including the elimination of homo-cysteine. Pyridoxine deficiency in chronic alcoholism is caused by poor diet, whereas displacement of pyridoxal phosphate from circulating albumin by the alcohol metabolite acetaldehyde increases its urinary excretion. Low serum levels of pyridoxal phosphate are common in chronic alcoholics, and pyridoxine deficiency is manifest by peripheral neuropathy and sideroblastic anemia. In alcoholic hepatitis, the serum level of alanine transaminase (ALT) is disproportionately low compared to aspartate

Learning a pregnant womans health history

Probable Signs Pregnancy Pictures

This chapter suggests questions to ask each woman so you can learn more about her. You probably have some questions of your own that you want to ask but that we do not include here. For example, if there is hepatitis B in your community, you may want to ask the woman if she has hepatitis B or tell her how to prevent it. Think about the information you need to know in order to give her good care. What questions do you usually ask a pregnant woman

Tissue Specific Expression

The liver represents one of the primary targets for gene therapeutic treatment of numerous metabolic diseases, cancers, hepatitis, and other pathologies. Although recombinant viral vectors have been widely used to introduce new genes into the liver, their usefulness may be mitigated by side effects and potential safety concerns (60-63). Plasmid delivered to hepatic vasculature (64), by hydrodynamic methods (65,66), or by electropora-tion constitutes an alternative method to deliver transgenes to the liver. Mechanistic studies to characterize electric field dis

Stevensjohnson syndrome

Stevens Syndrome Disease

SJS is characterized by the presence of widely distributed purpuric macules and blisters that predominate on the trunk and face. The lesions may be preceded one to three days by fever and influenza-like symptoms. The rash can spread within hours and is usually maximal within four days. About 90 of patients have painful erosions or crusts on mucous membranes. Widespread mucosal erosions result in impaired alimentation, photophobia, and painful micturition. Gastrointestinal epithelia can be involved, resulting in profuse diarrhea. Diffuse interstitial pneumonitis and tracheobronchial epithelial involvement can occur, resulting in respiratory distress. About 85 of patients have conjunctival lesions, ranging from hyperemia to pseudomembrane formation. Mild elevation of hepatic enzymes may occur, with overt hepatitis in 10 of cases (34).

Prevention of Bacterial Food Poisoning

All foods entering the kitchen should be considered to be potentially hazardous. In any investigation, it is important not to assume that a food cannot be the cause just because it is unlikely or not known to have caused FP in the past. Salads and other vegetables or fruit eaten raw may be contaminated, and outbreaks have been caused by lettuce (S. sonnei and E. coli VTEC 0157), raspberries and strawberries (Cyclospora cayetanensis and hepatitis A), alfalfa sprouts (S. enteritidis), and radish sprouts grown hydroponically (E. coli VTEC 0157). Some of these foods were contaminated at the source by water or sewage, others during processing by infected food handlers (NLV and hepatitis A), and others by food handlers during preparation. It is difficult to avoid or prevent such infections in the kitchen short of cooking everything, and more stringent codes for hygiene at the growing farms and processing plants are required. Cooking food, especially meat, thoroughly will destroy vegetative...

Kava Kava Piper Methysticum

A number of concerns have recently been raised about the safety of kava. In most studies, the number of adverse effects were similar to that of placebo (91). Undesired effects have usually consist of mild gastrointestinal upset and allergic skin reactions. Eye irritation and a yellow, scaly dry rash (kawaism) has been described with heavy, chronic use (87). Reports of extrapyramidal effects and exacerbation of Parkinson's disease do exist in the literature (93). The greatest concern regarding adverse effects has been over liver toxicity. Although rare, 25 cases of liver toxicity including hepatitis, cirrhosis, and fulminant hepatic failure have been reported in Europe (94). This has prompted the government of Switzerland to ban the sale of kava. The Food and Drug Administration is currently considering such actions in the United States.

Bone Marrow Stimulation During Chemotherapy

CHRONIC ACTIVE HEPATITIS (IN COMBINATION WITH OTHER HERBS) In a double-blind, multicentre clinical study of 222 patients with chronic active hepatitis, Sho-saiko-to was found to significantly decrease AST and ALT values compared with placebo. The difference between the treatment and placebo groups in the mean value was significant after 12 weeks. In patients with chronic active type B hepatitis, a tendency towards a decrease of HBeAg and an increase of anti-HBe antibodies was also observed. No remarkable side effects were noticed (Hirayama et al 1989).

Catching Fibromyalgia

From hepatitis B or hepatitis C Fibromyalgia may be triggered by an infection with hepatitis B (a viral infection transmitted by body fluids that attacks the liver) or by hepatitis C (a less common bloodborne infection that also attacks the liver). According to the Centers for Disease Control and Prevention (CDC), there were 5,494 reported active cases of hepatitis B in the United States in 2005, compared to 671 cases of hepatitis C. A study of the frequency of fibromyalgia among carriers of hepatitis B, reported in a 2005 issue of the Journal of Clinical Rheumatology, suggested that chronic hepatitis B apparently increased the risk for the incidence of fibromyalgia. Among 50 hepatitis B carriers, 26 percent met the criteria for FMS, compared to 4 percent among the control group of subjects who didn't have hepatitis B. The patients with hepatitis B also had a much greater level of fatigue (40 percent) compared to the control group (12 percent) and sleep disorders (36 percent in the...

Muscle Enzymes Creatine Kinase and Aldolase

Aldolase is another muscle enzyme that may be elevated in children with muscle damage. In general, the aldolase is less sensitive to muscle inflammation than the CK, but there are children with dermatomyositis who have elevated aldolase levels and a normal CK. Aldolase can also be increased in children with liver inflammation secondary to infectious mononucleosis or viral hepatitis.

Fulfillment of the Sjogrens Syndrome Classification Criteria

There is a considerable overlap between European diagnostic criteria for SS and some extrahepatic features of HCV infection.39 Extrapolating from the main studies with large series of HCV patients,6 xerostomia was observed in 158 (18 ) of 859 patients xerophthalmia in 129 (17 ) of 769 positive ocular tests in 83 (38 ) of 216 positive salivary gland biopsy (grades 3-4 of Chisholm-Mason classification) in 64 (25 ) of 251 positive ANA in 481 (18 ) of 2641 and positive RF in 357 (40 ) of 1117 HCV patients. In contrast, positive anti-Ro SS-A antibodies were described in only 30 (4 ) of 765 HCV patients and anti-La SS-B in 27 (3 ) of 765 (Table 4).10 These percentages suggest that a diagnosis of SS could be easily made in HCV patients presenting with sicca syndrome, positive ANA, or RF. The SS diagnosed in these HCV patients may be considered as one of the extrahepatic manifestations of chronic HCV infection. Although some SS-HCV patients fulfilled all six European classification criteria...

Bile pigments in the gastrointestinal tract

Other common causes of jaundice include decreased uptake of bilirubin into hepatocytes, defective intracellular coagulation, or disturbed secretion into the bile canaliculi. Jaundice is most often seen in acute hepatitis and is known as intracellular or hepatocellular jaundice.

Therapeutic Applications Of Transcleaving And Transsplicing Ribozymes

Coloring Worksheets About Worry

Inhibition of Hepatitis C Virus by Ribozymes In addition to its use as an anti-HIV-1 antiviral, hammerhead ribozymes are also being used to target hepatitis C virus (HCV) infection (94). Fifteen different hammerhead ribo-zymes were designed to target different sites in the conserved 5' untranslated region (UTR) present in all HCV RNAs, and tested for their ability to reduce expression of a luciferase reporter gene downstream of the HCV 5' UTR. Cotransfection of OST7 cells with target and ribozyme plasmids resulted in a 40 to 80 reduction in luciferase activity. In a more realistic setting, inhibition of polio viral replication in HeLa cells was ascertained by a chimeric construct that contains the HCV 5'UTR fused to the polio virus. Several HCV 5' UTR targeted ribozymes inhibited the chimeric HCV-PV replication by 90 , suggesting that hammerhead ribozymes may be useful in reducing viral burden in HCV infection. Trans-splicing ribozymes have recently been employed to deliver new gene...

Immunizations for kidney disease patients

Anyone undergoing hemodialysis or who has had a kidney transplant should receive the three-dose series of HEPATITIS B, an INFLUENZA vaccine each fall, and the PNEUMOCOCCAL VACCINE. See also IMMUNIZATION VACCINE. immunizations for pregnant women Pregnant women who are not immune to MEASLES, MUMPS, or rubella should receive these live virus VACCINES right after delivery. Otherwise, pregnant women should receive a booster dose of tetanus (Td) if more than 10 years have passed since the last vaccine, together with a HEPATITIS B vaccine if the woman is at risk of exposure because of lifestyle or contact with a carrier. She should receive an INFLUENZA vaccine if she has medical conditions that warrant this. She should only receive YELLOW FEVER and polio vaccines if she is traveling to an area where there is a high risk of exposure, and travel can't be put off until after delivery. See also IMMUNIZATION. Several immunizations are suggested for anyone who works in the public safety field....

Chemical Components A Lipid Soluble Components


Consequence of severe liver damage that occurs in many patients with chronic liver diseases, such as persistent infection with hepatitis C and B viruses, as well as alcoholic liver disease and bile duct obstruction (12). Liver stellate cells are regarded as the primary target cells for inflammatory stimuli (13). It has been shown that activation of hepatic stellate cells in injured livers leads to their proliferation and transformation into myofibroblast-like cells. The transformed cells synthesize large quantities of the major components of the ECM, including collagen types I, III, and IV, fibronectin, laminin, and proteoglycans, leading to fibrosis. In addition to experimental studies, some preliminary clinical trials have been carried out to evaluate the effect of SM in treating common liver diseases, such as chronic hepatitis (48) and portal vein hypertension (49). Although results

Evidence for the association between Mfvmfrvs and prostate cancer 41 The Interferon IFN pathway

Img162 Imagetwist Com

Could the ADAR activity induced by Interferon (ADAR-1) be responsible for important antiviral effects in human and other cells Although the question is still open and there are also examples of opposite regulation as previously mentioned -for example in Hepatitis Delta Virus (HDV) 70 -, important inhibitory effects were documented, with Measles Virus 76 77 and with Influenza Virus in mouse cells 78 . Furthermore, a specific gene of the Adenovirus genome is responsible for counteracting the RNA-editing activity of ADAR the VAI gene 79 . In the case of Reoviridae, little is still known but there is at least one animal model in which ADAR was induced by both artificial dsRNA and reoviridae genome

Child care centers and infectious disease since

The common cold, fifth disease, influenza, meningitis, and tuberculosis. Germs can be transmitted by direct contact to cause cold sores, cytomegalovirus, head lice, scabies, and streptococcal infections. Germs can be spread via the fecal-oral route to cause diarrheal diseases or hepatitis a.

Lilium Tigrinum For Balanitis Treatment

See also Chamaelirium luteum hemlock see Conium maculatum hemlock spruce see Abies canadensis hemorrhoids 35, 70, 238-39 hemp dogbane see Apocynum cannabinum henbane see Hyoscyamus niger Hepar sulphuris calcareum (Hepar sulph.) 84, 294 boils 240-41 croup 84, 250-51 earaches 222-23 mild acne 240-41 sinusitis 226-27 tonsillitis 250-51 hepatitis 35, 47

Case study 143 Gastroenteritis at a university in Texas USA

Because contamination of foods by hands is the common denominator for many cases of foodborne viral contamination, we describe it in its own section. Hand contamination may be addressed by regular hand-washing practices, but hand disinfectants may also help. Several studies have examined the effect of hand disinfectants on the inactivation of enteric viruses (reviewed in Richards,6 and D'Souza et al.46). In general, alcohol and chlorhexidine gluconate-based hand disinfectants are not effective at reducing the levels of foodborne viruses.80 Hand-washing with soap reduces levels of viruses but does not always eliminate them. A survey of several soaps found that soaps with Triclosan, a chlorophenol, were most effective at reducing hepatitis A virus levels.80 Additional work is needed in this area to identify effective hand sanitizers against hepatitis A virus, norovirus, and other foodborne viruses. An example of an outbreak caused by contamination by hands is provided in Case study 14.3.

Food contamination during preparation

RTE foods are the main cause of foodborne illness. RTE foods are often contaminated by food handlers. Food handlers play an important role in transmission of foodborne viruses a recent review suggested they were the most common source of viral contamination of food.73 Food handlers generally cause single strain outbreaks. Food handlers may themselves be infected and contaminate food or may be uninfected but have contaminated hands (e.g. contact with sick relatives, working with contaminated surfaces) and go on to contaminate food. Both hepatitis A virus and norovirus may induce an asymptomatic infection with variable amounts of viral shedding. Viral shedding may occur over days and weeks for both viruses. For these reasons, it is important to prevent sick and infected food handlers from working with food for a predetermined period of time (usually 2-3 days). It is also important to institute appropriate hygiene practices and sanitary conditions when working with food (e.g. frequent...

Psychological Stress the Stress Response and the Impact on Immunity

Research in the field of PNI has amply demonstrated that stressful periods are associated with exacerbations of a variety of different diseases. For example, it has been demonstrated that individuals reporting higher levels of stress in their daily lives are more likely to develop clinical symptoms during experimental respiratory viral infection (Cohen 2005). To determine if these effects are due to stressor-induced immunosuppression, many researchers have studied the immune response to vaccination during stressful situations, and have found that stressors influence antibody and T-cell responses to vaccines. For example, it was demonstrated in medical students that responsiveness to hepatitis B vaccination was significantly reduced during final exams, an effect found to be associated with stress perception and feelings of loneliness (Glaser et al. 1992 Jabaaij et al. 1996). Likewise, the chronic stress associated with caring for a spouse with Alzheimer's disease (AD) resulted in lower...

Clinical Targets For Cancer Gene Therapy

Multiple liver metastases are also targets for immunologi-cal gene therapy strategies. In this respect, the CEA is one of the most promising candidates under investigation. In 2 clinical studies of recombinant vaccinia virus-CEA immunization, T-cell responses were demonstrated (298,299). In a recently published clinical trial of a dual-expression, plasmid-encod-ing, carcinoembryonic antigen (CEA) and hepatitis B surface antigen (HBsAg) in 17 patients with metastatic colorectal carcinoma, 4 patients developed lymphoproliferative responses to CEA after vaccination, although no objective clinical responses to the DNA vaccine were observed (300). In addition, significant tumor growth inhibition of xenografts from colon tumor cells in established animal models has also been accomplished using different approaches. These include vaccinia virus-mediated transfer of B7-1 and IL-12 (301) adenovirus-mediated transfer of IL-12 (294) liposomal transfer of MHC class I molecules (302) or the...

Using helpful alternative remedies

JflNG In late 2001, the Food and Drug Administration (FDA) issued a warning that some people in Europe who've used kava kava have experienced severe liver toxicity (damage to the liver, a crucial organ that you can't live without), suffering from such problems as hepatitis, cirrhosis, and even liver failure. In addition, the FDA also received reports on Americans experiencing liver problems with taking kava kava.

Effects of Alcohol on Liver Function

Progression to alcoholic hepatitis involves invasion of the liver by neutrophils with hepatocyte necrosis. Giant mitochondria are visible and dense cytoplasmic lesions (Mallory bodies) are seen. Alcoholic hepatitis can be asymptomatic but usually presents with abdominal pain, fever, and jaundice, or, depending on the severity of disease, patients may have encephalopathy, ascites, and ankle oedema.

Liver in Specific Hepatobiliary Disorders Hepatocellular Diseases

Table 1 summarizes the five published controlled trials of the effect of oral or enteral nutritional supplements on patients with alcoholic hepatitis. In most, nitrogen balance and or protein synthesis improved, although no effect on mortality was shown, perhaps because of the small number of patients studied and or the duration of follow-up. In the largest study, at 1-year follow-up, the experimental group had a significantly better survival 2 24 (8 ) died compared to 10 27 (37 ) of the controls. In general, the effects of parenteral nutrition in alcoholic liver disease are similar to those noted the studies of enteral nutritional supplements. A variety of international associations have made nutritional recommendations for patients with various types of alcoholic liver disease. The primary recommendation is of course abstinence, which may be all that is needed in patients with fatty liver. Patients with alcoholic hepatitis should take 40kcal kg, 1.5-2.0 g protein kg, 4-5g kg of...

Food Borne Infections during Pregnancy

For many years it has been recognized that food-borne antenatal infections may cause death or serious fetal damage. Women may be more susceptible to the effects of infection during pregnancy because of immunological changes leading to suppression of the immune system (most commonly cell-mediated immunity), probably as a result of increases in pregnancy-associated sex steroids, such as oestradiol or progesterone. Among the most common causes of diarrhea during pregnancy are several food- or water-borne pathogens (bacteria, protozoa, or viruses), including salmonella species, Helicobacter pylori, Shigella, Escherichia coli, and cryptospori-dium. Hepatitis A is also a food- or water-borne pathogen of concern, particularly in countries where sanitation is poor. In pregnant women, severe vomiting and diarrhea may negatively affect the availability of important nutrients to the growing fetus. For example, impairment of the supply of folate (or the synthetic form, folic acid) during a...

The risk factors paradigm

It is estimated that approximately 15 of all cancers can be attributed to viral infections. The oncogenic role of at least six viruses has strongly been established, including Epstein-Barr virus (EBV), Hepatitis B virus (HBV), Hepatitis C virus (HCV), several Human Papillomavirus (HPV) types, Human T-cell Lymphotropic Virus type I (HTLV-I) and Human Immunodeficiency Virus type I (HIV-I) (Boccardo & Villa, 2011). Cells infected by these viruses may turn towards oncogenesis after many years of infection latency,

Chronic Fatigue and Immune Dysfunction Syndrome CFIDS

Overlap between the two shows that 35 to 70 percent of those with CFIDS have FM, whereas 20 to 70 percent of those with FM report an additional diagnosis of CFIDS. Earlier terms for CFIDS included yuppie flu or chronic Epstein-Barr Syndrome. CFIDS is defined by the Centers for Disease Control as a medically unexplained, persistent, or relapsing fatigue that is not substantially alleviated by rest and which is associated with significant functional impairment, including fatigue that occurs concurrently with four of more of the following cognitive dysfunction, sore throat, tender lymph nodes, muscle pain, joint pain without swelling, headaches, lightheadedness, unrefreshing sleep, and postexertional malaise lasting for at least twenty-four hours. These symptoms must persist at least six consecutive months to be diagnosed as CFIDS. As there is no simple test to confirm CFIDS, diagnosis is based on history and physical exam. Tests are often done to rule out other diseases that might mimic...

Saw Palmetto Serenoa Repens

Side effects reported with the use of saw palmetto have been mild and rare. Gastrointestinal symptoms seem to be the most commonly reported complaint, occurring in less than 2 of patients (97). A case of hepatitis has been reported with the use of an herbal blend containing saw palmetto (99). A concern over bleeding and the potential for interactions with anticoagulants has also been raised owing to a single case report of intraoperative hemorrhage and animal data that suggest its role as a cyclooxygenase inhibitor (100).

Cordyceps Restores Liver Function

Cordyceps could be used for the treatment of chronic hepatitis and related disease conditions (54). The protective effect of Cordyceps on bacille Calmette Guerin (BCG)- and lipopolysaccharide-induced liver injury was determined in mice Cordyceps markedly inhibited the activities of serum alanine and aspartate aminotransferases, decreased the liver- and spleen-enlarged index, reduced the level of lipid peroxide in serum and hepatic tissue in mice, and reduced the level of serum TNF-a (55). In the same liver injury model, the polysaccharides enriched with Cordyceps increased the activities of serum transaminase and liver superoxide dismutase. In addition, the concentration of liver malondialdehyde, the weighting index of liver, and the liver pathology were significantly improved by treatment with Cordyceps (56).

Hepatoprotective Activity

Preadministration of acteoside at 10 or 50 mg kg subcutaneously at 12 and 1 hr prior to D-galactosamine and lipopolysaccharide (D-GalN LPS) intoxication significantly inhibited hepatic apoptosis, hepatitis, and lethality. Tumor necrosis factor-a (TNF-a) secreted from LPS-stimulated macrophages is an important mediator for apoptosis in this model. Acteoside showed no apparent effect on the marked elevation of serum TNF-a, but it partly prevented in vitro TNF-a-induced cell death in D-GalN-sensitized hepatocytes at the concentrations of 50, 100, and 200 M. These results indicate that D-GalN LPS-induced hepatic apoptosis could be blocked by an exogenous antioxidant, suggesting the involvement of reactive oxygen intermediates (ROIs) in TNF-a-dependent hepatic apoptosis (43).

Oral Immunosuppressive Agents

Azathioprine has been used widely to suppress allograft rejection and to treat a variety of autoimmune disorders, including systemic lupus erythematosis (SLE), RA, and autoimmune hepatitis. The NZB NZW F1 hybrid mouse, often used as model of systemic lupus erythematosus, also develops lymphocytic infiltrates in the salivary and lacrimal glands similar to that seen in SS. Yeoman and Franklin15 studied the responsiveness of lymphocytic sialadenitis developing in NZB NZW mice to treatment with azathioprine early in the course of disease (14 weeks of age) and late in the disease course (26 weeks of age). A dosage equivalent to 2 to 2.5 mg kg per day in humans was used.

Ephedra Ephedra SiNiCA

Reported side effects have included hypertension, nephrolithiasis, hepatitis, insomnia, arrythmias, myocardial infarction, and stroke. Cases of death and permanent disability have also been reported (46). Concomitant use of ephedra and other stimulant medications should be avoided to protect from potentiation of toxicity.