Lineamientos técnicos para el control de las infecciones de transmisión sexual y hepatitis virales / Technical guidelines for the control of sexually transmitted infections and viral hepatitis

La prevención y el control de las infecciones de transmisión sexual (ITS) y hepatitis virales representan un desafío crucial en la agenda de la salud pública. Con el objetivo de reducir la incidencia y prevalencia de estas enfermedades, se establecen los siguientes lineamientos técnicos, delineando estrategias integrales de promoción, prevención y atención. Estos lineamientos definen las disposiciones técnicas necesarias para el control de las ITS y hepatitis virales, orientando las acciones del personal de salud en la promoción de la salud sexual, la identificación temprana de casos, el diagnóstico oportuno, el tratamiento adecuado y la atención integral de las personas afectadas a través de estrategias innovadoras y la provisión de servicios integrales de atención a la salud. Están diseñados para ser aplicados por el personal multidisciplinario en todos los establecimientos del Sistema Nacional Integrado de Salud (SNIS)

The prevention and control of sexually transmitted infections (STIs) and viral hepatitis represent a crucial challenge on the public health agenda. With the aim of reducing the incidence and prevalence of these diseases, the following technical guidelines are established, outlining comprehensive promotion, prevention and care strategies. These guidelines define the technical provisions necessary for the control of STIs and viral hepatitis, guiding the actions of health personnel in the promotion of sexual health, early identification of cases, timely diagnosis, adequate treatment and comprehensive care of affected people through innovative strategies and the provision of comprehensive health care services. They are designed to be applied by multidisciplinary staff in all establishments of the National Integrated Health System (SNIS)

Therapeutic mechanisms and beneficial effects of non-antidiabetic drugs in chronic liver diseases.

The global burden of chronic liver disease (CLD) is substantial. Due to the limited indication of and accessibility to antiviral therapy in viral hepatitis and lack of effective pharmacological treatment in nonalcoholic fatty liver disease, the beneficial effects of antidiabetics and non-antidiabetics in clinical practice have been continuously investigated in patients with CLD. In this narrative review, we focused on non-antidiabetic drugs, including ursodeoxycholic acid, silymarin, dimethyl4,4'-dimethoxy-5,6,5',6'-dimethylenedixoybiphenyl-2,2'-dicarboxylate, L-ornithine L-aspartate, branched chain amino acids, statin, probiotics, vitamin E, and aspirin, and summarized their beneficial effects in CLD. Based on the antioxidant, anti-inflammatory properties, and regulatory functions in glucose or lipid metabolism, several non-antidiabetic drugs have shown beneficial effects in improving liver histology, aminotransferase level, and metabolic parameters and reducing risks of hepatocellular carcinoma and mortality, without significant safety concerns, in patients with CLD. Although the effect as the centerpiece management in patients with CLD is not robust, the use of these non-antidiabetic drugs might be potentially beneficial as an adjuvant or combined treatment strategy.

Herbal medicine use among patients with viral and non-viral Hepatitis in Uganda: prevalence, patterns and related factors.

BACKGROUND: There is some evidence that patients with liver diseases commonly use complementary and alternative therapies to address general and liver-disease specific health concerns. The purpose of this study was to assess and describe prevalence, patterns and related factors of herbal medicine use among adults diagnosed with viral and non-viral hepatitis in Kampala, Uganda. METHODS: A cross-sectional study was conducted on 310 adult patients attending the gastrointestinal clinic in Mulago hospital referral hospital in Kampala. Data on prevalence, types and reasons for herbal medicine use was collected using standardized questionnaires and focus group discussions. Modified Poisson regression analyses were used to examine factors related to use. RESULTS: Usage of various herbal remedies within 12 months prior to April 2018 was reported by 46.1% (143/310) of patients with 27.3% (39/143) of these reporting having used conventional and herbal therapies concurrently. Herbal remedies were used to treat various health conditions including hepatitis. Patients with hepatitis C virus infection (PRR = 1.16, p = 0.02) compared to those with hepatitis B virus infection, and those who believed that it was safe to use herbal and conventional therapies concurrently (PRR = 1.23, p = 0.008) had higher prevalence odds of herbal medicine use. Conversely, patients who had been newly diagnosed with hepatitis (PRR = 0.69, p = 0.03) compared to those who had been diagnosed more than one-year prior, had lower prevalence odds of herbal medicine use. Various types of local herbs were reported as most commonly used however most patients did not know the ingredients of commercially prepared herbal therapies. CONCLUSION: A high prevalence of herbal medicine use was found among newly-diagnosed patients and patients with hepatitis C more likely to use herbal remedies after adjusting for other factors. Usage was influenced by the belief that herbal medicine is safe and effective. Health workers need to consistently elicit information about herbal remedy use. Research is needed on benefits, adverse effects and outcomes in patients who use herbal remedies to treat primary liver diseases in order to facilitate evidence of efficacy and product safety.

Intersectoral collaboration to end HIV, tuberculosis and viral hepatitis in Europe and central Asia: a framework for action to implement the United Nations Common Position

Many countries in the WHO European Region are facing significant challenges in ending the epidemics of HIV, tuberculosis (TB) and viral hepatitis. Addressing them demands a holistic approach, reaching beyond the health sector alone. In response to this, several United Nations agencies made a joint commitment to support Member States in scaling up cross-sectoral approaches to address the risk factors and determinants of these three diseases. The United Nations Common Position on Ending HIV, TB and ViralHepatitis through Intersectoral Collaboration was signed in May 2018; this included the recommendation to support countries inoperationalizing this approach. This first edition of the Framework for Action is intended to guide and support the country process of implementing intersectoral strategies to address the social, environmental, economic and other non-health determinants related to HIV, TB and viral hepatitis. This document builds on the respective regional action plans for the three diseases and the recommendations for intersectoral action contained therein. It is also intended to support countries in examining how various sectoral policies and legislation can help people live healthier lives, and more specifically reduce the risk of contracting HIV, TB and viral hepatitis and minimize the economic, social and health impacts for those affected by these diseases.

Modelo de Cascada de Atención para la co-infección de las hepatitis virales para el cuidado continuo en personas con VIH/Sida / Care Continuum Model for Coinfection of Viral Hepatitis for the Continuing Care in people living with HIV / AIDS

Introducción: las coinfecciones con hepatitis virales y el VIH representan un riesgo por su alta transmisibilidad y complicaciones. Es de vital importancia que se puedan identificar las barreras de acceso y manejo de las coinfecciones del VIH y la Hepatitis B y C. El propósito del estudio es describir la cascada de atención para la coinfección de las hepatitis virales en personas viviendo con VIH/SIDA. Métodos: se delimitaron los indicadores de manejo y seguimiento de los pacientes monitoreados actualmente en clínicas de primer nivel de atención en Santo Domingo y Santiago. Los datos recopilados fueron analizados a partir de los registros escritos de los pacientes en seguimiento, para evaluar los datos epidemiológicos y serológicos que se obtuvieron de los archivos clínicos. Resultados: se demostró que un 100 % de los pacientes fueron enrolados, 85.7 % se consideraron como retenidos en el manejo de la coinfección VIH/VHB y solamente 71.4 % recibieron TARV basado en Tenofovir. La cascada de atención para la coinfección VIH/VHC muestra un vínculo de 87.5 % de los pacientes, 75 % fueron retenidos y ninguno recibió tratamiento. Conclusión: la identificación de los factores de riesgo que influyen en las brechas de la cascada es fundamental para optimizar el manejo y monitoreo de los pacientes coinfectados, teniendo en cuenta que es preciso poder reconocer aquellos infectados para iniciar tratamiento de inmediato y así prever secuelas citopatológicas hepáticas

Introduction: Co-infections of viral hepatitis and HIV represent a risk due to their high transmissibility and complications. It is vitally important that barriers to access and management of HIV and Hepatitis B and C co-infections can be identified. The purpose of the study is to describe the cascade of attention for the preparation of viral hepatitis in people living with HIV/AIDS. Methods: The management and follow-up indicators of the patients currently monitored in first-level care clinics in Santo Domingo and Santiago were delimited. The data collected was analyzed from the written records of the patients in follow-up to evaluate the epidemiological and serological data that was obtained from the clinical files. Results: It was demonstrated that 100% of the patients were enrolled, 85.7% were considered as retained in care of HIV / HBV coinfection and only 71.4% received ARTbased on Tenofovir. The cascade of care for HIV / HCV coinfection shows a linkage to care of 87.5% of patients, 75% were retained and none received treatment. Conclusions: Identifying the risk factors that influence the gaps in the cascade of care is essential to optimize the management and monitoring of coinfected patients, with special interest in those that might receive immediate treatment to prevent liver cytopathological sequelae

[Treatment of Fulminant Hepatic Failure - Myth and Facts]. / Die Therapie des akuten Leberversagens ­ alte Mythen und neue Trends.

Acute liver failure (ALF) refers to primary damage to a previously healthy liver. It is a rare disease with an incidence of about 200-500 cases/year in Germany. The liver can recover to restitutio ad integrum or lead to death in no time despite best medical treatment. Due to the rarity and potentially dramatic clinical course, patients with acute liver failure should be promptly referred to a special liver unit that can provide a liver transplantation as rescue treatment.The ALF should be strictly distinguished from "acute-on-chronic" liver failure (ACLF), which may show a similar clinical course but does not qualify for a high-urgency listing and transplantation.The reason for an ALF remains unknown in up to 20 % of cases. Hepatotropic virus (HAV, HBV and HEV) are the most common causative agents in Africa and Asia, while in North America and Northern and Central Europe, more drug-related liver failure is more frequent. Among drugs paracetamol and phenprocoumone are the leading cause for ALF. However, there are a couple of dietary supplements, herbs and mushroom poisoning that cause ALF.Other reasons are ischemic hepatitis and autoimmune hepatitis.

Aspects épidémiologiques, cliniques, étiologiques et évolutifs des hépatites aiguës au Centre Hospitalier National d'Enfants Albert Royer-Dakar

Introduction : l'hépatite aiguë est fréquente et représente un problème de santé publique dans les pays en développement. Les étiologies sont dominées par l'hépatite A en Afrique subsaharienne et en Asie du Sud-Est. Cependant, très peu d'études locales ont porté sur cette pathologie. Objectif : Étudier les aspects épidémiologiques, cliniques et évolutifs des hépatites aiguës chez les enfants hospitalisés au CHNEAR. Matériel et Méthodes : il s'agissait d'une étude rétrospective réalisée au CHNEAR de Dakar du 1er janvier 2007 au 31 décembre 2017. Étaient inclus les enfants hospitalisés pour une hépatite aiguë. Les données socio démographiques, cliniques, paracliniques et évolutives ont été recueillies. L'analyse des données uni et bivariée était faite grâce au logiciel R studio version 3.5.0. Résultats : au total, 35 000 enfants étaient hospitalisés durant la période d'étude parmi lesquels 71 patients avaient une hépatite aiguë déterminant une prévalence hospitalière de 0,2%. L'âge moyen à l'admission était de 65 mois avec un sex-ratio de 1,5. L'ictère cutanéo-muqueux était le principal signe physique (81,7%). La cytolyse était constante avec une moyenne des ALAT de 549UI/L. Une insuffisance hépatocellulaire était notée chez 24% des patients. L'étiologie était dans la grande majorité des cas indéterminée (66,2%). L'hépatite A représentait 15,5% et la phytothérapie (18,3%). L'évolution était favorable dans l'ensemble sans aucun cas de rechute. La létalité était de 16,9%. Conclusion : l'étiologie des hépatites demeurent encore indéterminées dans une large proportion au CHNEAR de Dakar. Le pronostic reste réservé pour les formes graves avec insuffisance hépatocellulaire

The life, times, and health care of Harry L Hopkins: Presidential advisor and perpetual patient.

Harry Hopkins was the most important nontitled allied leader in World War II. He was the advisor to President Roosevelt who managed the diplomacy between Roosevelt, Churchill, and Stalin from 1941 to 1946. Throughout these times, Hopkins was ill and required transfusions, admissions to the hospital, and nutritional supplementation to keep him well enough to travel the world and manage the allied war diplomacy. There has been no unifying theory to account for all his symptoms and his reported pathologic and autopsy findings. In this paper, we will review his political and medical history and a differential diagnosis of his illness.

[Efficacy and safety of Kuhuang injection in treating viral hepatitis： systematic review and Meta-analysis of randomized controlled trials].

To systematically evaluate the effectiveness and safety of Kuhuang injection in treating viral hepatitis. Eight electronic databases and clinic trials were searched to collect randomized controlled trials for the effect of Kuhuang injection in the treatment of viral hepatitis. According to the Cochrane Handbook 5.1, two independent reviewers screened out the literatures, extracted data and assessed the quality of thestudies included. RevMan5.3 software was used for the data analysis. A total of 32 articles were included, involving 3 188 patients, including male 1 951 cases (61.2%), female 859 cases (26.9%), and 378 cases of unknown sex (11.9%). All the clinical studies showed a low quality. Due to the complication of diseases and difficulty in intervention measures, most trails were classified by the condition of diseases, and then a descriptive analysis was made. The results showed that the test group was better than the control group in total efficiency of treating severe icteric viral hepatitis, and the test group was advantageous over the control group in jaundice removal and liver function recovery rate in treating icteric hepatitis. In the Meta-analysis on the RCTs for icteric viral hepatitis, the total efficiency of Kuhuang injection + comprehensive treatment group was higher than that of the comprehensive treatment group （RR=1.35, 95%CI=[1.10,1.66], P=0.61）. In addition, when Kuhuang injection was dripped too fast, patients had such adverse reactionsas dizziness, palpitation, nausea, vomiting and skin rash, which could be relieved at a lower dripping speed.Based on the existing evidences, Kuhuang injection had a certain effect in treating viral hepatitis. Most clinic trails did not include viral hepatitis etiology, clinical classification and diversified intervention measures, which resulted in a high clinical heterogeneity and poor comparability between trails. Besides, most trials had a low methodological quality, which affected the authenticity of the results. Therefore, more high-quality, multi-center, large-sample, randomized double-blind controlled trialsarerequired to prove the evidences.

Drug-induced Liver Injury: The Hepatic Pathologist's Approach.

The evaluation of liver biopsies in suspected drug-induced liver injury (DILI) can be complex. The biopsy may be approached systematically, by identification of histologic lesions and then identification of the overall pattern of injury. Potential DILI must be separated from concomitant non-DILI liver disease. The findings can be analyzed with respect to the various prescription and nonprescription medications and dietary supplements under suspicion to provide a complete interpretation of the findings. The pathologic findings, the histologic differential diagnosis, and expert interpretation are part of a complete biopsy assessment and provide information that is of greatest value in patient management.

Hepatoprotective effect of quercetin: From chemistry to medicine.

Liver diseases caused by viral hepatitis infections have a negative impact on global health. Approximately 30 million people in the USA and 29 million people in the European Union suffer from chronic liver disease. There are many kinds of diseases of the liver, caused by viruses, such as hepatitis A, hepatitis B and hepatitis C, or by certain drugs and poisons including excessive alcohol consumption. Many herbal medicines are used in traditional medicine for their protective and therapeutic properties against liver diseases. Among their bioactive components, flavonoids have been found to be active against liver dysfunction and damage caused by liver diseases. Extensive evidences report that quercetin (QE), a major flavonol commonly found in apple, berries, onion, citrus fruits, cruciferous vegetables, tea, pepper, tomato, whole gain, cocoa and red wine, displays a wide range of healthy properties, including anti-oxidative, anti-inflammatory, anti-apoptotic and hepatoprotective activities against various hepatic ailments. This review aims to critically analyze the available literature regarding the hepatoprotective effects of QE with special emphasis on its mechanisms of actions. To provide a complete picture of QE, its distribution, chemistry, biosynthesis and bioavailability are reported. Overall, data in literature shows that QE appears to be a promising hepatoprotective compound.

Supportive therapies for prevention of hepatocellular carcinoma recurrence and preservation of liver function.

Hepatocellular carcinoma (HCC) is one of the deadliest cancers in the world and is associated with a high risk of recurrence. The development of a wide range of new therapies is therefore essential. In this study, from the perspective of supportive therapy for the prevention of HCC recurrence and preservation of liver function in HCC patients, we surveyed a variety of different therapeutic agents. We show that branched chain amino acids (BCAA) supplementation and late evening snack with BCAA, strategies that address issues of protein-energy malnutrition, are important for liver cirrhotic patients with HCC. For chemoprevention of HCC recurrence, we show that viral control after radical treatment is important. We also reviewed the therapeutic potential of antiviral drugs, sorafenib, peretinoin, iron chelators. Sorafenib is a kinase inhibitor and a standard therapy in the treatment of advanced HCC. Peretinoin is a vitamin A-like molecule that targets the retinoid nuclear receptor to induce apoptosis and inhibit tumor growth in HCC cells. Iron chelators, such as deferoxamine and deferasirox, act to prevent cancer cell growth. These chelators may have potential as combination therapies in conjunction with peretinoin. Finally, we review the potential inhibitory effect of bone marrow cells on hepatocarcinogenesis.

The Honolulu Liver Disease Cluster at the Medical Center: Its Mysteries and Challenges.

In 2013, physicians at the Honolulu Queen's Medical Center (QMC) noticed that seven liver disease patients reported the use of OxyELITE Pro (OEP), a widely consumed dietary supplement (DS). Assuming a temporal association between OEP use and disease, they argued that OEP was the cause of this mysterious cluster. Subsequent reexamination, however, has revealed that this QMC cohort is heterogeneous and not a cluster with a single agent causing a single disease. It is heterogeneous because patients used multiple DS's and drugs and because patients appeared to have suffered from multiple liver diseases: liver cirrhosis, liver failure by acetaminophen, hepatotoxicity by non-steroidal antiinflammatory drugs (NSAIDs), resolving acute viral hepatitis by hepatitis B virus (HBV), herpes simplex virus (HSV), and varicella zoster virus (VZV), and suspected hepatitis E virus (HEV). Failing to exclude these confounders and to consider more viable diagnoses, the QMC physicians may have missed specific treatment options in some of their patients. The QMC physicians unjustifiably upgraded their Roussel Uclaf Causality Assessment Method (RUCAM) causality scores so that all patients would appear to be "probable" for OEP. However, subsequent RUCAM reassessments by our group demonstrated a lack of causality for OEP in the evaluated QMC cases. The QMC's questionable approaches explain the extraordinary accumulation of suspected OEP cases at the QMC in Hawaii as single place, whereas similar cohorts were not published by any larger US liver center, substantiating that the problem is with the QMC. In this review article, we present and discuss new case data and critically evaluate upcoming developments of problematic regulatory assessments by the US Centers for Disease Control and Prevention (CDC), the Hawaii Department of Health (HDOH), and the Food and Drug Administration (FDA), as based on invalid QMC conclusions, clarifying now also basic facts and facilitating constructive discussions.

Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New?

Patients with inflammatory bowel disease (IBD) do not receive routine preventative care at the same rate as general medical patients. This patient population is at increased risk of vaccine preventable illness such as influenza and pneumococcal pneumonia. This review will discuss health maintenance needs and preventative care issues in patients with IBD.

[[ENDOTHELIAL DYSFUNCTION AND ITS LOW-LEVEL LASER THERAPY CORRECTION IN PATIENTS WITH CHRONIC VIRAL HEPATITIS].

UNLABELLED: The aim of the work to study the influence of the low-intensive laser therapy on the endothelium function in chronic virus hepatitis patients. RESEARCH METHODS: All patients have been divided into three groups: In the first (control) group (30 persons) the traditiona medicamentous therapy was used only, the patients of the experimental 11 group (45 person) alongside with complex medicamentous therapy received the course of intravenous laser therapy and Ill group of patients (45 person) received a rate complex medicamental and laser (cutaneous) therapy. RESULTS: Medicamentous therapy of patients chronic virus hepatites is not accompanied by authentic improvement of the maintenance in plasma of blood NOx, and inclusion in a complex of medical actions of laser therapy promotes authentic improvement of parameters in plasma of blood NOx. THE CONCLUSION: Various methods of laser therapy improve NO--producing function endothelium, improve a functionacondition of vascular endothelium.