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Management of chronic hepatitis B in children  [cached]
Liberek Anna,Luczak Graeyna,Gora-Gebka Magdalena,Landowski Piotr
Hepatitis B Annual , 2006,
Abstract: Chronic hepatitis B remains a major public health problem, affecting approximately about 350 million people globally. The number of hepatitis B virus (HBV) infected children has not been fully documented. The natural history of HBV infection reflects the dynamic host-virus interactions related to the condition of the host immune system; hence, the clinical course of HBV differs between children and adults. The immaturity of immune system in young children is responsible for the fact that nearly 90% of HBV infections acquired in infancy and 40-70% HBV infections before the age of 3 years result in chronic carrier state of the virus. Therefore a large population is in need of effective and save treatment of this disease. Significant advances have been made during the last decades in the treatment of chronic hepatitis B. The epidemiological situation of HBV infection, its natural history, clinical outcome with its serious long-term consequences and therapeutical approach in children are reviewed in the paper.
Development and Validation of an Online Program for Promoting Self-Management among Korean Patients with Chronic Hepatitis B  [PDF]
Jinhyang Yang
Nursing Research and Practice , 2013, DOI: 10.1155/2013/702079
Abstract: The hepatitis B virus is second only to tobacco as a known human carcinogen. However, chronic hepatitis B usually does not produce symptoms and people feel healthy even in the early stages of live cancer. Therefore, chronically infected people should perceive it as a serious health problem and move on to appropriate health behaviour. The purpose of this paper is to develop and validate an online program for promoting self-management among Korean patients with chronic hepatitis B. The online program was developed using a prototyping approach and system developing life cycle method, evaluated by users for their satisfaction with the website and experts for the quality of the site. To evaluate the application of the online program, knowledge and self-management compliance of the subjects were measured and compared before and after the application of the online program. There were statistically significant increases in knowledge and self-management compliance in the user group. An online program with high accessibility and applicability including information, motivation, and behavior skill factors can promote self-management of the patient with chronic hepatitis B. Findings from this study allow Korean patients with chronic hepatitis B to engage in proactive and effective health management in the community or clinical practice. 1. Introduction The hepatitis B virus is known as not only the second highest carcinogen after smoking, but also the cause of 75% of primary hepatocellular carcinoma [1]. A carrier of hepatitis B is 30–100 times more likely to have a risk of dying from liver disease than the average person [2]. Approximately 350 million people have hepatitis B worldwide, and, every year, about 620,000 die of liver diseases associated with hepatitis B [3, 4]. Hepatitis B is a disease that is more common in Asians than Westerners. Asian Americans have an infection rate of 5–15%, which is, approximately, more than 20 times higher than the hepatitis B infection rate of the entire population of the US [5]. Korea was ranked 5th in cancer incidence rate in 2010 for liver cancer, and is ranked second in cancer mortality [6]. The prevalence of hepatitis B in Korea was 4.0% of the population over the age of 30 [7]. Likewise, even today, hepatitis B remains a common disease among the average person, but there is a lack of management on disease monitoring and treatment compliance of hepatitis B virus carriers or patients [8]. Currently, a significant number of hepatitis B patients in Korea are caused by vertical infection from the mother during the perinatal
Practical approach to medical management of glaucoma  [cached]
Parikh Rajul,Parikh Shefali,Navin Shoba,Arun Ellen
Indian Journal of Ophthalmology , 2008,
Abstract: Primary open angle glaucoma (POAG) is usually a chronic, slowly progressive disease. At present, all resources are directed towards reduction of intraocular pressure (IOP), the only known causal and treatable risk factor for glaucoma, and medical management is frequently the first choice in most cases. With the introduction of innovative tools for early diagnosis and newer medications for treatment, decision-making in diagnosis and treatment of glaucoma has become more complex. The philosophy of glaucoma management is to preserve the visual function and quality of life (QOL) of the individual with minimum effects on QOL in terms of cost, side effects, treatment regime, follow-up schedules as well as socioeconomic burden. Our aim should be not to treat just the IOP, optic disc or visual field, but to treat the patient as a whole so as to provide maximum benefit with minimal side effects. In this article, we describe the scientific approach to medical management, mainly of POAG.
Management of chronic hepatitis B in pregnancy  [cached]
Guo-Rong Han,Chuan-Lu Xu,Wei Zhao,Yong-Feng Yang
World Journal of Gastroenterology , 2012, DOI: 10.3748/wjg.v18.i33.4517
Abstract: Pregnancy associated with chronic hepatitis B (CHB) is a common and important problem with unique challenges. Pregnant women infected with CHB are different from the general population, and their special problems need to be considered: such as the effect of hepatitis B virus (HBV) infection on the mother and fetus, the effect of pregnancy on replication of the HBV, whether mothers should take HBV antiviral therapy during pregnancy, the effect of these treatments on the mother and fetus, how to carry out immunization of neonates, whether it can induce hepatitis activity after delivery and other serious issues. At present, there are about 350 million individuals with HBV infection worldwide, of which 50% were infected during the perinatal or neonatal period, especially in HBV-endemic countries. Currently, the rate of HBV infection in the child-bearing age group is still at a high level, and the infection rate is as high as 8.16%. Effective prevention of mother-to-child transmission is an important means of reducing the global burden of chronic HBV infection. Even after adopting the combined immunization measures, there are still 5%-10% of babies born with HBV infection in hepatitis B e antigen positive pregnant women. As HBV perinatal transmission is the main cause of chronic HBV infection, we must consider how to prevent this transmission to reduce the burden of HBV infection. In this population of chronic HBV infected women of childbearing age, specific detection, intervention and follow-up measures are particularly worthy of attention and discussion.
Therapeutic approach of chronic Hepatitis C  [PDF]
Nikolaos V. Fotos
To Vima tou Asklipiou , 2007,
Abstract: Chronic infection from the hepatitis C virus (HCV) is one of the most common infectious diseases worldwide. It is estimated that more than 170 million people worldwide are infected by HCV. HCV is responsible for the 70% of cases of chronic hepatitis, the 60% of cases of hepatocellular cancer and the 30% of liver transplantations. Therapy of chronic infection from the HCV aims to the: a) eradication of the virus from liver and blood and sustenance of undetectable serum HCV-RNA after the end of the treatment and b) stabilization or improvement of liver histological status. In 80' physicians treated chronic hepatitis C by using interferon alpha (IFN-α), whereas few years later they added ribavirin to the treatment. The combination therapy of IFN-α and ribavirin had had better results, but many patients left untreated. In 90' IFN-α was replaced by pegylated interferon alpha (PEG-IFN-α), with or without the use of ribavirin. In this study the following questions are answered: a) which patients should be treated? b) what are the appropriate clinical and laboratory tests before treatment? c) which is the most effective therapeutic scheme and which is its duration? and d) which is the appropriate surveillance of the patients, especially after the end of the treatment? Additionally, there are mentioned the most common adverse effects of interferon and ribavirin treatment, which are in many cases the cause of altering the treatment.
Management overview of chronic hepatitis B with established therapies  [cached]
Amarapurkar Deepak
Hepatitis B Annual , 2007,
Abstract: Currently available options for the treatment of chronic hepatitis B virus (HBV) infection include standard and pegylated interferon alfa and Thymosin alpha, four oral antiviral agents (lamivudine, adefovir, entecavir, and telbivudine), two agents Tenofovir and emtricitabine approved in the HIV HBV co-infection are likely to be approved for HBV infection in immediate future. These treatment strategies are either therapies of finite duration that aim to achieve sustained off-therapy responses, or long-term treatments that aim to maintain on-therapy remission. Most agents designed to target hepatitis B are hindered by the development of resistance, poor tolerability or limited efficacy; therefore, new agents and treatment strategies are needed. Although therapy of hepatitis B is evolving, which between single and/or combined agents are most effective, how long therapy should last, which criteria should be used to start or continue and switch or stop therapy are to be defined. This paper provides a review of management with the available treatment options for HBV associated liver diseases.
Cough management: a practical approach
Francesco De Blasio, Johann C Virchow, Mario Polverino, Alessandro Zanasi, Panagiotis K Behrakis, Gunsely Kilin?, Rossella Balsamo, Gianluca De Danieli, Luigi Lanata
Cough , 2011, DOI: 10.1186/1745-9974-7-7
Abstract: In addition to being an airway defence mechanism, coughing is a very common symptom observed in many diseases other than those affecting the respiratory system. To recognize its cause is not always an easy task. Where possible, the clinician should avoid treatment based on symptoms only which often only serves the purpose to reassure the patient or the parents (in the case of a paediatric patient). On the other hand it is worth mentioning that internal medicine physicians are frequently overwhelmed by requests for help by patients who report coughing, alone or together with other non-specific symptoms such as malaise, pharyngodynia, and a mild temperature. In such cases, treatment of symptoms alone appears justified as a therapeutic approach. However, it must be emphasized that a high level of suspicion needs to be maintained, especially when coughing persists which would require a thorough investigation of other possible causes.This review summarises the effectiveness of symptomatic cough remedies including two specific drugs (levodropropizine and moguisteine) which have been tested in the symptomatic treatment of cough, and have received Grade A evidence in the treatment of cough due to either acute or chronic bronchitis. In addition we identify missing pieces of evidence regarding the efficacy of symptomatic cough treatments as well as associated side effects. Moreover, clear treatment algorhythms still need to be established for acute and chronic coughA thorough systematic literature search was conducted in the main international search databases (Pubmed, Embase, Biosis) of all articles (both original clinical trials and reviews) published in the period from 1950 up to now. For this search, all keywords related to cough (acute, sub acute and chronic), cough mechanism and pathogenesis, cough treatment (cough suppressants, anti-tussives and other drugs with anti-tussive activity) were used.Authors' recommendations were based on this clinical evidence and on availa
Practical Approach for Master Data Management  [cached]
Chandra Sekhar Bhagi
World of Computer Science and Information Technology Journal , 2011,
Abstract: Any organization typically has data on Customers, Financials (Chart of accounts, profits, Cost), Products, Business Partners (Suppliers, Distributors), Employees, Locations, Sales Contacts, Physical assets, Claims or Policies (Insurance). These data items or business entities are referred as Master Data. The process and technology involved in acquiring Master Data from multiple domains across enterprise and thereby maintaining a single consistent view is Master Data Management (MDM). MDM is getting popularity in Health & Life sciences, Medical Device Manufacturing, Financial Services, Insurance, Manufacturing & Technology, Retail, Consumer Packaged Goods, Telecommunications, Information services & Media, Aerospace, Defense and Government. The current article illustrates the technical solution to implement enterprise Master Data Management in domain specific companies.
Inpatient management of alcohol withdrawal: a practical approach
Signa Vitae , 2008,
Abstract: Alcohol intake contributes directly or indirectly to 15 to 20% of medical problems in primary care or an inpatient setting. It is estimated that approximately 500,000 episodes of withdrawal will be severe enough to require pharmacologic intervention. The total cost to the United States economy from alcohol abuse was estimated to be $185 billion for 1998. This review attempts to put forth a practical and evidence based approach towards the inpatient management of alcohol withdrawal. Various agents and their pharmacology are described. Strength of evidence regards to efficacy and shorter inpatient stays is examined.
Management of liver cirrhosis between primary care and specialists  [cached]
Ignazio Grattagliano,Enzo Ubaldi,Leonilde Bonfrate,Piero Portincasa
World Journal of Gastroenterology , 2011, DOI: 10.3748/wjg.v17.i18.2273
Abstract: This article discusses a practical, evidence-based approach to the diagnosis and management of liver cirrhosis by focusing on etiology, severity, presence of complications, and potential home-managed treatments. Relevant literature from 1985 to 2010 (PubMed) was reviewed. The search criteria were peer-reviewed full papers published in English using the following MESH headings alone or in combination: “ascites”, “liver fibrosis”, “cirrhosis”, “chronic hepatitis”, “chronic liver disease”, “decompensated cirrhosis”, “hepatic encephalopathy”, “hypertransaminasemia”, “liver transplantation” and “portal hypertension”. Forty-nine papers were selected based on the highest quality of evidence for each section and type (original, randomized controlled trial, guideline, and review article), with respect to specialist setting (Gastroenterology, Hepatology, and Internal Medicine) and primary care. Liver cirrhosis from any cause represents an emerging health issue due to the increasing prevalence of the disease and its complications worldwide. Primary care physicians play a key role in early identification of risk factors, in the management of patients for improving quality and length of life, and for preventing complications. Specialists, by contrast, should guide specific treatments, especially in the case of complications and for selecting patient candidates for liver transplantation. An integrated approach between specialists and primary care physicians is essential for providing better outcomes and appropriate home care for patients with liver cirrhosis.
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