Hepatitis
Some selected abstract: |
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Azad N, Rojanasakul Y. Vaccine delivery--current trends and future. Curr Drug Deliv. 2006 Apr;3(2):137-46. Review.
West Virginia University,
School of Pharmacy, Department of Pharmaceutical Sciences, Morgantown, WV
26506, USA.Since its discovery in 1796 by Edward Jenner, vaccines have been
an integral aspect of therapeutics, combating a number of infectious
diseases with remarkable success. In recent years, due to rapid advances in
proteomics, genomics, biotechnology and immunology and the plethora of
knowledge amassed in related fields, it is fair to expect vaccine
development to progress at an exponential pace. However, as we march on into
the 21st century, we are still struggling in our efforts to eradicate fatal
diseases such as AIDS, malaria and hepatitis C due, in part, to the absence
of effective vaccines against these diseases. Vaccine development faces
major challenges both technologically and economically. Newer vaccines that
are stable, economical, require fewer doses and can be administered using
needle free systems are a worldwide priority. An ideal theoretical vaccine
may not be cogent unless formulated and delivered aptly. Delivery of
vaccines via oral, intranasal, transcutaneous and intradermal routes will
decrease the risk of needle-borne diseases and may eliminate the need for
trained personnel and sterile equipment. Crucial to the success of a vaccine
is the delivery strategy that is to be employed. Currently, various
techniques involving DNA vaccines, adjuvants, microparticles and transgenic
plants are being developed and evaluated. Although, no major breakthrough is
in prospect, these systems have potential and will take immunization to a
new technological level. This review will focus on the current development
of some novel vaccine delivery systems and will explore the non-parenteral
routes of vaccine administration. |
2 |
Brent RL. Risks and benefits of immunizing pregnant women: the risk of doing nothing. Reprod Toxicol. 2006 May;21(4):383-9. Laboratory of Clinical and Environmental Teratology, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE 19899, USA. rbrent@nemours.org
The medical, social and legal risks of
immunizing pregnant women are obstacles preventing the initiation of
programs to immunize women for their protection and for their infant's
protection. Recent projects devoted to vaccine development have focused on
protecting newborns and infants. But there are many other reasons for
developing or utilizing vaccines before or during pregnancy, beyond the
protection of the newborn. Besides the usual reasons for utilizing
immunizations to protect the mother and the neonate, the threat of
bio-terrorism adds a new dimension to the necessity for addressing this
issue. The potential advantages for thinking about vaccinating pregnant
women include an array of possible programs associated with risks and
benefits. The immunization of pregnant women or women of reproductive age
has multiple purposes: to protect the mother, to protect the newborn and
infant and to prevent diseases and complications of pregnancy. (1)
Preparation of vaccines against infectious agents that are known to result
in reproductive pathology and congenital malformation if the infection of
the mother occurs during pregnancy. (2) To utilize vaccines used routinely
to protect the non-pregnant population, for administration during pregnancy,
i.e., influenza, tetanus and other vaccines. Should these vaccines and other
routinely used vaccines for children and non-pregnant adults be administered
to women during pregnancy if they are medically indicated? (3) Utilization
of vaccines to protect women from diseases to which they are susceptible
because of pregnancy (poliomyelitis, hepatitis). (4) Utilization of vaccines
for use before or during pregnancy, primarily to protect the newborn and
infant via maternal transplacental antibodies, i.e., GBD (group B
streptococcus). (5) The prevention of intrauterine infection that has been
alleged to initiate premature labor. (6) The preparation of a vaccine for
use before or during pregnancy to protect both the mother and the neonate,
i.e., botulism toxin vaccine. The regulatory agencies and the vaccine
producers will need a great deal of objective scientific advice and support
and it is the scientific community's responsibility to provide that support.
If the scientific and medical community ignores the opportunity to develop
vaccines that could reduce the occurrence of reproductive and developmental
problems, then we can be accused of acquiescing to the "risk of doing
nothing." |
3 |
Chattopadhyay S, Das BC, Gupta RK, Kar P. Presence of TT virus infection in chronic hepatitis patients from a hospital in New Delhi, India. Indian J med Res 2005, 122(1), 29-33. PCR-Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
BACKGROUND & OBJECTIVE:
The recent discovery of a novel parenterally transmitted, unenveloped,
single-stranded DNA virus called TT virus (TTV) in chronic hepatitis
patients with unclear pathogenesis throughout the world led us to
investigate, its presence in chronic hepatitis patients attending a hospital
in New Delhi, India, and to evaluate its role in liver disease. METHODS: TT
virus DNA was investigated in serum samples of 70 patients with various
types of chronic hepatitis, and 100 healthy subjects from New Delhi, India by nested PCR using the primers
that belonged to UTR (A) region of the genome. RESULTS: TTV DNA was detected
in 6 of 23 patients (26%) with type B chronic hepatitis, 3 of 20 patients
(15%) with type C chronic hepatitis, and 12 of 100 subjects (12%) from
healthy control group with normal liver function profile tests. None of the
27 non-B, non-C chronic hepatitis patients had TTV DNA positivity. The
prevalence of TTV was significantly higher in type-B chronic hepatitis
patients as compared to normal subjects (P< 0.05) but comparable to type C
chronic hepatitis patients. The clinical course and biochemical profiles of
type B, or type C chronic hepatitis patients co-infected with TTV did not
differ significantly from those without TTV infection. INTERPRETATION &
CONCLUSION: Interestingly, in chronic hepatitis patients, TTV was always
associated with either hepatitis B or C virus indicating a likely parenteral
route of transmission. All TTV-positive subjects in healthy control group
showed normal clinical and biochemical profiles. Thus, the presence of TTV
infection is unlikely to influence the course of chronic hepatitis related
to hepatitis B virus (HBV) or hepatitis C virus (HCV) or cause liver
diseases in healthy subjects. |
4 |
Dunser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006 Apr;34(4):1234-42. Review. Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria.
OBJECTIVE: To give
critical care clinicians in Western nations a general overview of intensive
care medicine in less developed countries and to stimulate institutional or
personal initiatives to improve critical care services in the least
developed countries. DATA SOURCE: In-depth PubMed search and personal
experience of the authors. DATA SYNTHESIS: In view of the eminent burden of
disease, prevalence of critically ill patients in the least developed
countries is disproportionately high. Despite fundamental logistic (water,
electricity, oxygen supply, medical technical equipment, drugs) and
financial limitations, intensive care medicine has become a discipline of
its own in most nations. Today, many district and regional hospitals have
units where severely ill patients are separately cared for, although major
intensive care units are only found in large hospitals of urban or
metropolitan areas. High workload, low wages, and a high risk of
occupational infections with either the human immunodeficiency virus or a
hepatitis virus explain burnout syndromes and low motivation in some health
care workers. The four most common admission criteria to intensive care
units in least developed countries are postsurgical treatment, infectious
diseases, trauma, and peripartum maternal or neonatal complications.
Logistic and financial limitations, as well as insufficiencies of supporting
disciplines (e.g., laboratories, radiology, surgery), poor general health
status of patients, and in many cases delayed presentation of severely sick
patients to the intensive care unit, contribute to comparably high mortality
rates. CONCLUSION: More studies on the current state of intensive care
medicine in least developed countries are needed to provide reasonable aid
to improve care of the most severely ill patients in the poorest countries
of the world. |
5 |
Romero-Gomez M, Otero MA, Sanchez-Munoz D, Ramirez-Arcos M, Larraona JL, Suarez Garcia E, Vargas-Romero J. Acute hepatitis due to Mycoplasma pneumoniae infection without lung involvement in adult patients. J Hepatol. 2006 Apr;44(4):827-8. Digestive Diseases Unit, Hospital Universitario de Valme, Ctra Cadiz s/n 41014, Sevilla, Spain. mromerog@supercable.es
Mycoplasma pneumoniae has
been associated with cholestatic hepatitis in children, while in adults, the
lack of liver involvement has been considered as a typical feature of M.
pneumoniae infection. Controversial data have been reported about the
possibility of liver involvement with M. pneumoniae community-acquired
pneumonia. We present two cases of acute hepatitis associated with M.
pneumoniae infection without lung involvement. |
6 |
Shinefield H, Black S, Thear M, Coury D, Reisinger K, Rothstein E, Xu J, Hartzel J, Evans B, Digilio L, Schodel F, Brown ML, Kuter B; The 013 Study Group for ProQuad. Safety and immunogenicity of a measles, mumps, rubella and varicella vaccine given with combined Haemophilus influenzae type b conjugate/hepatitis B vaccines and combined diphtheria-tetanus-acellular pertussis vaccines. Pediatr Infect Dis J. 2006 Apr;25(4):287-92. University of California School of Medicine, San Francisco, USA.
BACKGROUND: A study was
conducted to assess administration of a combination measles, mumps, rubella
and varicella vaccine (MMRV) with other childhood vaccines. METHODS: In this
open, multicenter trial, 1915 healthy children ages 12-15 months were
randomized into 3 groups: group 1, MMRV, combined Haemophilus influenzae
type b conjugate-hepatitis B vaccines (Hib/HepB) and combined
diphtheria-tetanus-acellular pertussis vaccines (DTaP) concomitantly; group
2, MMRV followed by Hib/HepB and DTaP 42 days later; group 3, MMR and
varicella vaccine followed by Hib/HepB and DTaP 42 days later. RESULTS:
Antibody responses to measles, mumps, rubella, varicella, Hib, HepB,
diphtheria and tetanus were similar between groups 1 and 2 (all >95%, except
varicella, 89.7% in group 1 and 90.9% in group 2). Pertussis toxin and
filamentous hemagglutinin responses were significantly lower in group 1 than
in group 2 (group 1, 74.1 and 67.1%; group 2, 90.4 and 86.8%, respectively).
An exploratory analysis suggested that the difference in and pertussis toxin
and filamentous hemagglutinin responses was likely the result of study
design rather than interference among vaccine components because the groups
differed in age of receipt of DTaP (group 1, approximately 12 months; group
2, approximately 13.5 months). When the groups were matched for age, sample
size was sufficient for comparison only in children > or =13.5 months old.
Pertussis toxin and filamentous hemagglutinin responses were similar in
these children. The safety profiles for each vaccination regimen were
comparable. CONCLUSIONS: The immunogenicity data support concomitant
administration of MMRV with Hib/HepB. Limited data from an exploratory
analysis indicate that MMRV can be administered concomitantly with DTaP.
Concomitant administration of MMRV, Hib/HepB and DTaP is well-tolerated. |
7 |
Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect. 2006 Apr;12(4):309-14. Review. Digestive Diseases Unit, Hospital Universitario de Valme, Ctra Cadiz s/n 41014, Sevilla, Spain. mromerog@supercable.es
Mycoplasma pneumoniae has been associated
with cholestatic hepatitis in children, while in adults, the lack of liver
involvement has been considered as a typical feature of M. pneumoniae
infection. Controversial data have been reported about the possibility of
liver involvement with M. pneumoniae community-acquired pneumonia. We
present two cases of acute hepatitis associated with M. pneumoniae infection
without lung involvement. |
8 |
Tam DH, Farber HW. Pulmonary hypertension and beta-thalassemia major: report of a case, its treatment, and a review of the literature. Am J Hematol. 2006 Jun;81(6):443-7. Evans Medical Foundation, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Pulmonary hypertension is
a common complication of beta-thalassemia major. We report a case of
successful treatment of pulmonary hypertension in a patient with beta-thalassemia
major and review the literature on pulmonary hypertension and beta-thalassemia
major. A 28-year-old man with beta-thalassemia major, splenectomy, hepatitis
C, and hemosiderosis who presented with increasing dyspnea on exertion was
diagnosed with pulmonary hypertension. After receiving continuous
epoprostenol infusion and desferoxamine, his functional capacity and
hemodynamic status improved. To our knowledge, this is the first case of
pulmonary hypertension associated with beta-thalassemia treated with
continuous epoprostenol infusion and desferoxamine. Epoprostenol, beneficial
in the treatment of other types of pulmonary hypertension, may ameliorate
the morbidity and mortality of pulmonary hypertension associated with
thalassemia. |
9 |
Vogiatzi MG, Macklin EA, Fung EB, Vichinsky E, Olivieri N, Kwiatkowski J, Cohen A, Neufeld E, Giardina PJ. Prevalence of fractures among the Thalassemia syndromes in North America. Bone. 2006 Apr;38(4):571-5. Pediatrics, Weill Medical College of Cornell University, New York, NY, USA.
Historically, fractures
are cited as a frequent problem in patients with Thalassemia prior to
optimization of transfusion and chelation regimens. The aim of this study
was to determine the prevalence of fractures in a contemporary sample of
North American patients with Thalassemia. The North American Thalassemia
Clinical Research Network (TCRN) database registry was used to gather
historical data on 702 patients with common alpha and beta-Thalassemia
diagnoses including Thalassemia Major (TM), Intermedia (TI), E/Beta,
homozygous alpha Thalassemia (AT), Hemoglobin H disease (HbH) and HbH with
Constant Spring (HbH/CS), who consented to a medical record chart review.
Bone mineral density (BMD) measurements by DXA were available for review in
a subgroup of patients (n = 312). The overall fracture prevalence among all
Thalassemia syndromes was 12.1%, equally distributed between females (11.5%)
and males (12.7%). Fractures occurred more frequently in TM (16.6%) and TI
(12.2%) compared to E/Beta (7.4%) and alpha (2.3%). Prevalence increased
with age (2.5% ages 0-10 years, 7.4% ages 11-19 years, 23.2% ages >20 years)
and with use of sex hormone replacement therapy (SHRT) (P < 0.01). On
average, BMD Z and T scores were 0.85 SD lower among patients with a history
of fractures (mean Z/T score -2.78 vs. -1.93, 95% CI for the difference
-0.49 to -1.22 SD, P = 0.02). Presence of other endocrinopathies (i.e.
hypothyroidism, hypoparathyroidism and diabetes mellitus), anthropometric
parameters, heart disease or hepatitis C were not significant independent
predictors of fractures. These data indicate that fractures remain a
frequent complication among the aging patients with both TM and TI beta-Thalassemia.
However, the fracture prevalence has improved compared to published reports
from the 1960s to 1970s. In addition, children with Thalassemia appear to
have low fracture rates compared to the general population. |
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