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 Overview


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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...

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...

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),...

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....

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.

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...

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...

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...

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...

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.

Alcohol and Nutrition

The nutritional status of alcoholics is often impaired. Some of the pathophysiological changes seen in alcoholics are direct consequences of malnutrition. However, in the 1960s, Charles Lieber demonstrated that many alcohol-induced pathologies, including alcoholic hepatitis, cirrhosis, and myopathy, are reproducible in animals fed a nutritionally adequate diet. Consequently, the concept that all alcohol-induced pathologies are due to nutritional deficiencies is outdated and incorrect.

Body Weight and Energy Balance

The presence of alcoholic liver disease results in significant changes in body composition and energy balance. Although fatty liver is fully reversible, progression to alcoholic hepatitis can have profound effects on nutritional status. According to large multicenter studies, alcoholic hepatitis patients demonstrate universal evidence for protein calorie malnutrition, according to the physical findings of muscle wasting and edema, low levels of serum albumin and other visceral proteins, and decreased cell-mediated immunity, whereas their 6-month mortality is related in part to the severity of malnutrition. Anorexia is a major cause of weight loss in alcoholic liver disease, and may be caused by increased circulating levels of leptin. Furthermore, active alcoholic hepatitis contributes to increased resting energy expenditure as another cause of weight loss. On the other hand, resting energy expenditure is normal in stable alcoholic cirrhotics who are also typically underweight or...

Activities Indian Gum Arabic Tree

NAD) Fungicide (1 WO3) HCV-Protease Inhibitor (1 PR14 510) Hemostat (f DEP NAD) Hepa-totonic (f KAB) Hypertensive (1 X10594939) Hypoglycemic (1 ZUL) Hypotensive (f1 BOU ZUL X10594935) Lactagogue (f1 BIB UPW 15283686) Mastogenic (1 X15283686) Mollus-cicide (1 ZUL) Neurostimulant (f BIB UPW) p-Glycoprotein Inhibitor (1 X12748979) Plas-modicide (1 X10479756) Protease Inhibitor (1 X11054840) Protisticide (1 ZUL) Spasmogenic (1 X10594939) Stimulant (f BIB) Taenicide (1 ZUL) Teratologic (f ZUL) Tonic (f DEP SUW) Vasoconstrictor (1 X10594939).

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.

Precipitating factors for fatigue

There are a number of increasingly recognized acute triggers for the onset of CFS. Most widely studied are viral infections. Whilst there is no evidence that minor viral infections presenting to GPs are associated with subsequent chronic fatigue (Wessely et al. 1995), more severe illnesses such as glandular fever, hepatitis A, and viral meningitis probably are associated with a considerably increased risk of subsequent chronic fatigue (Berelowitz et al. 1995 Hotopf et al. 1996 White et al. 1998). The risk does not appear to be specifically associated with any one severe viral infection, but may be related to non-specific behavioural factors such as the duration of time the individual has off work following the illness (Hotopf et al. 1996). The risk is not associated solely with viral infections other acute physical insults such as surgical procedures and trauma are recognized as being associated with fatigue, even in the absence of an ongoing active disease process (Wessely et al....

Underlying Chronic Diseases Liver disease

Cirrhosis is a well-established risk factor for gallstones particularly in the more advanced stages.54,55 The overall prevalence is much higher than the general population at 25 to 30 .56 Increasing Child-Pugh score and obesity are more likely associated with gallstones. Most stones in cirrhosis are of the black pigment type.57 The biologic mechanism likely relates to altered pigment secretion, abnormal gallbladder motility, or increased estrogen levels.1 The threat of these stones becoming symptomatic seems higher in women, those more advanced in age, and patients with viral hepatitis compared with alcohol-related cirrhosis.58 Gallstone disease is also associated with hepatitis C virus (even when not yet cirrhotic)59 and nonalcoholic fatty liver disease, the connection being the metabolic syndrome and obesity.60

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

Abuse Of Tranquilizers

Only a few patients prescribed benzodiazepines push the dose up above recommended levels. If this happens, the user may become intoxicated, with slurred speech and incoordination. Some people with alcohol problems also abuse benzodiazepines. Intravenous (IV) injection of benzodiazepines and hypnotics has become an increasing problem and has led to controls on these drugs concerning manufacture and prescription in various countries, including the United States and the U.K. Some addicts abuse benzodiazepines alone others combine it with heroin-type drugs. Injection of benzodiazepines can result in clotting of the veins. It also carries the risk of getting infectious diseases from sharing dirty syringes, such as hepatitis and the human immunodeficiency virus (HIV or the AIDS virus).

Platelet transfusions

As with other blood products, platelets are capable of transmitting infections hepatitis, cytomegalovirus, and HIV (the virus that causes AIDS). The chance of contracting these infections, although small, is the reason that platelet transfusions are also given only when absolutely necessary. Because uncontrollable bleeding can be life threatening, prevention is paramount. Platelet transfusions usually take less than an hour.

Electroencephalographs Studies of Chronic Substance Abusers

Hepatitis, cardiovascular disorders, diabetes, HIV AIDS, malnutrition), licit and illicit medication use, head injuries, seizures, and epilepsy (Lowinson et al., 1992). In addition, substance dependent patients exhibit low levels of compliance motivation, below average IQ scores, and higher-than-normal rates of childhood psychopathology. Other complicating factors include dysfunctional environmental or genetic histories, and educational, social, or cultural factors (e.g., reading disability or illiteracy, language barriers, a below-average level of educational achievement that is overestimated by educational attainment) all of which predate their substance abuse careers. The simple demonstration of a difference in EEG EP ERP (or other neuroimag-ing) indices between a group of patients and a group of healthy volunteers is therefore insufficient for inferring causation, unless the researchers have either matched the groups on all of these potential confounds, excluded all patients with...

Historical Cultivation And Usage

Garcinia kola seed plays a very important role in African ethno-medicine. The seed is employed as a general tonic, and is believed to cure impotence. Traditionally, the seeds are used in the treatment of inflammatory disorders and liver disease. Extracts of the seeds led to remarkable improvement of liver function in patients with chronic hepatitis and cholangitis after treatment for 14 days at a Nigerian herbal home (Iwu, 1982). Other medicinal uses include as a purgative, an antiparasitic, an antimicrobial, and an antiviral. The seeds are used in the treatment of bronchitis and throat infections, and to prevent and relieve colic, cure head or chest colds, and relieve coughs (Figure 26.2). Constituents include xanthones and benzophenones. The antimicrobial properties of this plant are attributed to the benzophenone flavanones, while the hepatoprotective properties have been linked to the biflavonoid constituents of the plant. Specifically, a de-fatted fraction of an alcoholic extract...

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).

Clinical Manifestations

Oral hairy leukoplakia, a collection of hairy or corrugated white lesions located on the lateral surface of the tongue, is common. Sometimes splenomegaly or mild hepatitis may develop. Uncommon manifestations include heart problems, jaundice, pneumonitis, blood dyscrasia, and cerebritis (2). In patients with HIV infection, infection of epithelial cells by EBV is often represented by oral hairy leukoplakia.

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.

Salmonella Typhimurium As Carrier System

An alternative approach to improve vaccination against the neuroblastoma described above was chosen by the same group. Only partial protection against subcutaneous tumors had been observed in this model and no effect was detected against metastases (50,55). The original construct encoding tyrosine hydroxylase fused with ubiquitin was modified to include the posttranscriptional regulatory acting RNA element (PRE) sequence of the woodchuck hepatitis B virus (WPRE). This sequence is known to improve gene expression posttran-scriptionally by a still undetermined mechanism. Salmonella-mediated DNA vaccination using this construct was very efficient in protecting mice from metastases. Control animals had

Therapeutic Applications Of G Lucidum

A randomized, placebo-controlled trial examined the effect of mixture of G. lucidum with 34 other Chinese herbs on HIV-1-infected individuals (n 68) with CD4 cell count < 0.5 x 109 L. No improvement in clinical manifestation, plasma viral load, CD4 cell count, or quality of life was seen (117). In another small, uncontrolled clinical trial (46), four patients with hepatitis B were given 6 g day of G. lucidum commercial extract for 3 months, after which the patients were HbsAg-negative and their liver enzymes (AST, ALT, ALP) had returned to normal. This is the usual course of recovery following acute hepatitis B, however, and whether G. lucidum contributed to the recovery was not demonstrated.

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.

Optimization Of Cationic Liposome Formulations For Use In Vivo

In summary, in vivo nucleic acid-liposome complexes that produce efficacy in animal models of disease have extended half-life in the circulation, are stable in serum, have broad biodistribution, efficiently encapsulate various sizes of nucleic acids, are targetable to specific organs and cell types, penetrate across tight barriers in several organs, penetrate evenly throughout the target tissue, are optimized for nucleic acid lipid ratio and colloidal suspension in vivo, can be size fractionated to produce a totally homogenous population of complexes prior to injection, and can be repeatedly administered. Recently, we demonstrated efficacy of a robust liposomal delivery system in small and large animal models for lung (15), breast (17), head and neck (Hung and Templeton, 2002), and pancreatic cancers (16), and for hepatitis B and C (Clawson and Templeton, 2000). Based on efficacy in these animal studies, this liposomal delivery system will be used in upcoming clinical trials to treat...

Pharmacological Profile A Hepatoprotective Effects

1 mmol kg, respectively, for 3 days also reduced the extent of hepatic injury induced by tacrine bis-tacrine or menadione (23,24). In addition, mice pre-treated with Sch B at an oral daily dose of 1 mmol kg for 3 days showed protective effect against galactosamine endotoxin-induced toxicity (25). One point worth noting is that since lignans can cause irreversible inhibition on hepatic GPT (26), the inability of DDB to protect against CCl4 hepatotox-icity, though decreasing plasma GPT activity, was evidenced by the negative histological assessment on hepatic damage (27). Paradoxically, DDB has been shown to improve liver functions of patients suffering from chronic hepatitis (28). The hepatoprotective effect of DDB may therefore be limited to certain kinds of liver injury, probably not that produced by CCl4. The effect of Gom A treatment on immunologically induced liver injuries has been investigated (32-34). Gom A pretreatment (5-50 mg kg, p.o., for 4 weeks) reduced the mortality in...

Infant botulism See botulism

Eases are a large and important group of conditions they remain the major cause of death throughout the world. According to the World Health Organization, the 1997 world's deadliest diseases are all infectious. In order, they are pneumonia, diarrhea, tuberculosis, malaria, hepatitis b, aids, measles, tetanus, whooping cough, and roundworm.

Effects On The Newborn

A pregnant drug-dependent woman puts her developing fetus at risk for a number of diseases, including hepatitis, ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS), tuberculosis, and sexually transmitted diseases (STDs). A number of these diseases may be acquired through needle sharing. Mothers who are infected with these diseases are likely to deliver prematurely.

Aflatoxin and Human Cancer

In the early 1990s, nested case-control studies conducted in Shanghai utilized these biomarkers to establish a significant association between afla-toxin exposure and HCC. They showed that the risk of HCC increased dramatically (60-fold) in individuals who had been exposed to aflatoxin and had chronic hepatitis infection compared to those with neither the chemical nor viral exposures. Additional studies in Qidong and Taiwan have confirmed this striking chemical-viral interaction. The underlying mechanism for this interaction remains poorly understood.

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.

Autoimmune Liver Diseases

Autoimmune chronic active hepatitis (CAH) and PBC are autoimmune liver diseases frequently thought to be associated with Sjogren's syndrome. Again, older publications on this association are difficult to interpret because of the inconsistent definition of Sjogren's syndrome. In 1994, we found PBC in 9 and CAH in 4 of our primary Sjogren's syndrome patients.34 However, the definition of Sjogren's syndrome according to the Copenhagen criteria35 does not allow differentiation between sicca syndrome due to PBC or CAH and primary Sjogren's syndrome associated with these disorders. A new survey in 2008 revealed only 2 cases of PBC and 1 case of CAH among 109 consecutive primary Sjogren's syndrome patients, while another 2 patients with PBC had severe sicca syndrome without fulfilling the AECC criteria for primary Sjogren's syndrome (unpublished observation). These data are in concordance with Lazarus and Isenberg's publication of additional autoimmune diseases in primary Sjogren's syndrome,...

Needle And Syringe Exchanges

AND HIV AIDS The first syringe exchange (SE) program was begun in 1984 in Amsterdam, the NETHERLANDS, out of concern for the spread of hepatitis B among INJECTING DRUG USERS (IDUs). While the hepatitis B virus, hepatitis C virus, and human T cell lymphotropic virus can all cause fatal illness and are all spread through multiperson use (sharing) of drug-injection equipment, the threat of human immunodeficiency virus (HIV) has clearly become the dominant force in implementing needle- and syringe-exchange programs throughout the world.

Respiratory Mucosal Immunity Neuronal Innervation and Its Stress Related Perturbations

Since stress is such a potent modulator of the immune response and its effector mechanisms (Elenkov et al. 2000), it follows that it may be a contributor to the success of immunization, a mainstay strategy in the prevention of respiratory infections such as influenza and pneumococcal disease. In a recent trial involving young adults receiving the hepatitis B vaccine, those subjects experiencing psychological distress had significantly lower specific antibody responsiveness (Marsland et al. 2006). Drummond and Hewson-Bower (1997) found a correlation between lower serum IgA albumin ratio and stress in children with recurrent upper respiratory tract infections. Another study concluded that a healthy individual's increased sociability decreased the risk of viral upper respiratory tract infection (Cohen et al. 2003).

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.

Specific Dietary Interventions

Dietary nucleotides build blocks of RNA, DNA, ATP, and therefore a supplemented formula may improve growth and immunity, optimize the maturation, recovery and function of rapidly dividing tissue, such as the gastrointestinal tract mucosa. Infant studies have shown that the addition of nucleotides decreases the incidence of diarrhea and upper (but not lower) respiratory tract infections, affects NK cell activity, increases serum IgA, T cell maturation and antibody level after Haemophilus influenzae type B (but not hepatitis B) vaccination 27, 28 . 'Most' dietary nucleotides are rapidly metabolized and excreted. However, 'some' are incorporated in tissue, probably depending on many factors such as age at supplementation. In infants with severe intrauterine growth retardation nucleotides enhance catch-up growth. The supplementation of nucleotides in infant feeding can be regarded as very safe therefore the cost benefit ratio is of major importance. As a consequence, the addition of...

Effects Of Shosaikoto On Hepatic Fibrosis

In investigating the mechanism by which Sho-saiko-to inactivates HSCs, Kakumu et al. showed that Sho-saiko-to enhanced the in vitro production of interferon (IFN)-g and antibodies to the hepatitis B core and e antigens, produced by peripheral blood mononuclear cells from patients with chronic hepatitis (41). IFN-g is a potent cytokine with immunomodu-

Effects Of Shosaikoto On Hepatic Carcinogenesis

HCC is, worldwide, one of the most common malignancies, especially in Southeast Asia. Based on clinical information, as a causative agent, HCV is more common than HBV in both Japan and Western countries. The incidence of HCC has been shown to be higher in patients with chronic HCV infection than for those with chronic HBV infection (79). In chronic hepatitis B, a resolution of the disease can frequently be seen after the inactivation of viral replication (4), which probably contributes to a lower incidence of HCC. In contrast, HCV multiplication is sustained throughout the course of a typical infection (80,81). When hepatocytes are continuously damaged and replicated, as is the case for HCV-infected patients with cirrhosis, the frequencies of genetic alteration also probably increase along with hepatic fibrosis, leading to the development of cirrhosis and HCC (Fig. 2). It is generally accepted that multiple genetic alteration is important in carcinogenesis. The HCC occurrence rate in...

Presentday Cultivation And Usage

Milk thistle is indigenous to Kashmir, Southern Europe, Southern Russia, North Africa, and Asia Minor. It was introduced to most areas of Europe, North and South America, and Southern Australia, and is cultivated mainly in the dry rocky soils of European countries, Australia, Canada, China, North and South America as a medicinal plant. It is also grown as ornamental plant for its attractive foliage. The seeds are collected when ripe, during late summer. Presently, milk thistle seed, its purified extracts and its active constituents are mainly used in liver diseases. It is the most widely used hepatoprotective agent in chronic inflammatory hepatic disorders, including hepatitis, jaundice, alcohol abuse, fibrosis, cirrhosis, and fatty infiltration and in hepatotoxicity by mushroom poisoning and by industrial pollutants. It is also widely used as nutraceutical agent. In homoeopathy, the seed tincture is used in liver disorders, jaundice, gall stones, peritonitis, hemorrhage, bronchitis,...

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.

Importance Of Vaccines

Vaccination is a deliberate introduction of materials in humans to elicit immune protection against diseases (1). For example, some Indian Buddhists drank snake venom to protect themselves from snake bites (1). During the 9th century in China, The Correct Treatment of Small Pox was written by a Buddhist nun. The manuscript recommended a mixture of ground dried smallpox scabs and herb to be blown into the nostrils of children. Even with such a long history, immunization was not widely used until Edward Jenner deliberately injected cowpox virus into humans to protect them from ravages of smallpox. Since that time, wide use of vaccines against pathogenic microorganisms has become the most important advance in the history of medicine. Vaccines have not only provided protection from smallpox, but also from poliomyelitis, measles, mumps, rubella, yellow fever, pertussis (whooping cough), hepatitis A, hepatitis B, and varicella, as well as others. These vaccines have dramatically reduced...

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

Case study 141 Multistate outbreaks caused by oysters from Louisiana USA

Viral foodborne illness can be linked to produce and salads. Produce and salads refer to both fruit and vegetables. Salads are more commonly implicated in outbreaks than are individual produce items. Both produce and salads are commonly handled immediately before serving, are eaten raw, and are frequently eaten without peeling. These practices increase their risk for viral contamination. Contamination may occur at any point in the food path preharvest, postharvest, processing, food preparation, and table where produce or salad is to be eaten. Produce that are contaminated during production or harvest tend to cause multi-state or multi-country outbreaks. Unfortunately washing of produce is often not effective at eliminating viral contaminants (Table 14.2).56 In the vast majority of cases, when this type of food is associated with an outbreak, an infected food handler is suggested as the source. Unfortunately, this causal relationship is rarely confirmed. Produce can become contaminated...

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.

Chronology of Problems

Arthritis, diabetes, high blood pressure, heart disease, osteoporosis, alcoholism, ulcers, kidney disease, liver disease, migraine, tuberculosis, stroke, psychiatric problems, epilepsy, lung disease, venereal disease, sciatica, drug dependency, thyroid disease, hepatitis, skin disorders, AIDS, fractures, multiple sclerosis, endometriosis, lupus, cancer, heart attack, carpal tunnel, breast implants, irritable bowel, Sjogren's, asthma, posttraumatic stress, sinusitis, vasculitis

Water contaminated 297

Water, contaminated Water can be a source of infection if it contains infective or parasitic organisms and is drunk, swum in, or comes into contact with food. Throughout the world, tainted water is a major source of the spread of infectious disease, including viral HEPATITIS A, DIARRHEA, TYPHOID FEVER, CHOLERA, AMEBIASIS, and some types of worm infestation. Water can become contaminated by feces (either human or animal) that contain infective material in rivers, lakes, reservoirs, or wells. Contamination can also occur via untreated sewage or leakage between sewage and water supplies.

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...

Epidemiologic factors

Hepatitis A virus Hepatitis A virus is present worldwide and may cause sporadic and epidemic disease. Different rates of prevalence and endemicity are observed in various world regions. In the United States, one-third of the general population has serologic evidence of prior hepatitis A infection while in some parts of southeast Asia, over 90 of the general population has serologic evidence of infection.33 In developing countries, hepatitis A is endemic, and most individuals are infected in early childhood without symptoms. A single hepatitis A infection renders immunity to the virus. Because of this, in developing countries, most adults are usually immune, and epidemics of hepatitis A are uncommon. As socioeconomic or sanitation conditions improve, the prevalence of hepatitis A infections decreases, and the average age of reported cases increases because people are more likely to be exposed later in life and have symptomatic infections. In industrialized countries, transmission is...

Implications and future studies 1461 Implications for prevention

Contamination of foods by enteric viruses usually occurs through fecal-oral transmission routes. Within the fecal-oral transmission routes, the manual handling of foods is the most significant contributor to foodborne disease. Therefore, the most straightforward measures to reduce the probability of food contamination and resulting outbreaks are to implement strict sanitation and hygiene protocols (e.g. emphasize hand-washing), agree on rules for the furloughing of sick food handlers and agricultural workers, provide education on viral transmission and appropriate reporting to health facilities, vaccinate all food handlers against hepatitis A virus, and enforce appropriate barriers of protection from foods (e.g. gloves and hair nets). Nonetheless, for a variety of reasons, these measures are difficult to implement, and lack of compliance remains an important issue. At a national and international level, foodborne disease outbreak surveillance systems have been implemented in both the...

General Immune Enhancement

The largest was a 3-year study of 20,847 people that showed that substituting conventional table salt with table salt fortified with sodium selenite significantly reduced the incidence of viral hepatitis compared with controls provided with normal table salt (Yu et al 1989).

Factors contributing to the pathogenicity of viral foodborne diseases

Led.101'234'323 A genetic component for susceptibility to human norovirus (NoV) infection is also suggested by the recent finding of cell surface receptors for this virus.157'199 The role of the JAK-STAT pathway of interferon signaling during the replication of rotavirus' hepatitis A virus (HAV) and mouse norovirus (MNV) also point to the critical role played by the genetic background of the Most foodborne viruses belong to the picornavirus' calicivirus' and reovirus families (Table 15.1). The total number of illnesses caused by these viruses has been estimated to be upwards of 30 million cases per year in the United States. However' most estimates indicate foods as a primary source of infection in only 5-6 of the incidences.75'186'221 For reasons to be discussed in Section 15.6' direct demonstration of the presence of viruses in foods implicated in foodborne outbreaks have been achieved only in a few instances.125'182'195 In terms of sheer numbers' Norwalk virus (NV) within the genus...

Jonathan Fryer Indications

Liver transplantation is indicated in circumstances where a life-threatening pathological process that involves the liver cannot be overcome, without replacing the entire liver. Most commonly, this occurs when end-stage liver disease (ESLD) has developed in a cirrhotic liver. Other situations where liver transplantation may be needed when cirrhosis is not present include acute liver failure, nonmetastatic tumors that are otherwise unresectable, polycystic liver disease, severe hepatic trauma, or acute failure of a transplanted liver. Disease entities that commonly cause cirrhosis in adults include hepatitis B and C, alcohol abuse, nonalcoholic steatohepatitis (NASH), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). In children common causes of cirrhosis include biliary atresia and metabolic liver diseases like Wilson's or alpha 1 antitrypsin deficiency. Other conditions, like acute liver failure and inborn errors of metabolism, may also necessitate...

Viral genes and pathogenicity

Synthesis from viral mRNA in a cap-independent manner. > > > > Panel A of Fig. 15.2 shows the IRESs identified for picornaviruses are located in their 5' UTR. Based on their conserved RNA sequences and secondary structures, most picornavirus IRESs can be divided into two groups, Type I and Type II. Type I IRESs are present in enteroviruses and human rhinovirus while Type II IRESs are present in other picornaviruses such as cardioviruses and aphthoviruses. A possible third Type III IRES has been identified in hepatitis A virus. A representative IRES structure is shown in panel A to illustrate the highly ordered secondary structures present in IRESs.24,216,271 Panel B shows the mechanism of cap-independent translation of picornaviral genomic RNA (via the IRES structure). It is believed that 40S ribosomal subunit recognition of an IRES and subsequent translation factor assembly is facilitated in part by RNA-protein interactions translation efficiency is further augmented though...

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...

YY1 as a transcription factor

HCV core, p300 and B23 itself are involved Another example of YYl-activated oncogene expression is its regulation of the protein B23. B23 is involved in nuclear export of ribosomes and chaperone activity and stimulates repression of multiple tumor suppressors. YY1 activates B23 in the presence of a viral gene product, the hepatitis C virus (HCV) core, which plays a pivotal role in liver oncogenesis 12 . The HCV core leads to YYl-mediated recruitment of p300 and B23 to the B23 promoter, activating its gene expression. In the absence of the HCV core, YY1 recruits HDAC1 to the B23 promoter to act as a transcriptional repressor. Thus, B23, like E1A, switches YY1 from a transcriptional repressor to an activator 43 . Other YYl-activated oncogenes include proliferating cell nuclear antigen (PCNA) and HER2 17, 40, 44 .

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.

Toxicological Effects In Humans

Acute aflatoxicosis is characterized by severe, acute hepatotoxicity with early symptoms including anorexia, malaise, and low-grade fever. Moreover, acute high-level exposure can lead to death by hepatitis, with vomiting, abdominal pain, jaundice, and fulminate hepatic failure (Strosnider et al., 2006). Epidemiological studies in humans have shown that exposure to aflatoxins is one of the major risk factors in the multifactorial etiology of hepatocellular carcinoma (HCC) in Africa, the Philippines, and China. The contribution of AFB1 to HCC is affected by several factors, such as infection by hepatitis B or hepatitis C virus, the nutritional state and age of the individual, as well as the exposure level to AFB1 (Wang et al., 1996).

Differential diagnosis

Pregnancy can, for a short while, be a mysterious cause of nausea and vomiting. Likewise, hepatitis during its prodrome, can be misleading, but the appearance of jaundice makes all clear. Even rarer are various metabolic diseases usually diagnosed in different contexts such as diabetic ketoacidosis, renal tubular acidosis, and adrenocortical insufficiency which may all present with anorexia, nausea, vomiting, and obscure abdominal pain.

Problem 1 The Product Is Toxic

Several problems have arisen with various herbal products that induce hepatotoxicity. Herbal teas from germander (Teucrium chamaedrys) have been widely used throughout antiquity, but several cases of germander-induced hepatitis with periportal inflammation and centrilobular necrosis associated with consumption of capsules containing germander extract led to the banning of all germander products in France (14). Jin bu huan (JBH) has been used in TCM as a sedative, analgesic, and decongestant, but chronic consumption of some products can cause hepatotoxicity (14). One problem is that a variety of herbs are marketed as JBH, although the offending one was labeled as an extract of Polygala chinensis (14). Indeed it is common in TCM for one name to apply to a group of botanically unrelated materials. Other

Preclinical Studies A Genetic Immunization

Using particle bombardment, a polyclonal immune response against various pathogens such as Ebola virus (60), hepatitis B and C (61-64), herpes simplex (65,66), malaria (51,67), mycoplasma (58,68), papillomavirus (69), prions (70), rotavirus (71), and tuberculosis (72,73) has been reported. Two diseases with a major impact on socioeconomic health served as a model influenza and HIV. Pioneering work has been performed by Johnston et al. and Liu et al., who

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

Hyperechoic Lobular Liver

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 Mri

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

Gall Bladder Lesions Ultrasound

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

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 (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.