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Hepatitis

Hepatitis

Hepatitis can be caused by many different things including viral infections, parasites, bacteria, chemicals, autoimmunity, drugs or alcohol. Of these, viral infection is the most common cause of chronic (long-term) hepatitis, which can lead to severe liver damage including cirrhosis and liver cancer.

Hepatitis B and C viruses (HBV and HCV) are among the world’s most common infectious pathogens. It is estimated that 500 million people – 1 in 12 of the global population – are chronically infected with one or both of these viruses.1,2  The majority of these people live in the developing world and many of them are unaware that they are infected. Chronically infected patients are at increased risk of developing cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC), which together account for more than 1 million deaths annually.3

The hepatitis B virus is a resilient virus present in all bodily fluids of infected individuals. It is resistant to breakdown and able to survive outside the body. It can be transmitted effectively through contact with infected bodily fluids in the same way as HIV. However, HBV is 50–100 times more infectious than HIV.

Screening for HBV and HCV infection is crucial, not only to detect patients who may require treatment to reduce the risk of progression to severe sequelae, but also to reduce transmission rates.

The primary objective of therapy for chronic HBV is to achieve control of viral replication and halt disease progression/improve liver histology. This will decrease pathogenicity and infectivity and thereby stop or reduce hepatic necroinflammation.

Chronic hepatitis C infection may result in severe liver damage leading to liver failure, HCC and death. As a consequence, therapeutic intervention can arrest, and perhaps even reverse, the disease before irreversible liver damage occurs. 

Enter the Hepatitis B and C Knowledge Centre


References

1. World Health Organization. World Health Organization Hepatitis B Fact Sheet. 1998.
2. World Hepatitis Alliance. www.aminumber12.org
3. Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet 2003;362:2089–94

Men's Health

Men's Health

As a disease topic Men's Health covers a broad set of issues affecting men of all ages. Some of the issues requiring greater focus and more thorough dissemination of information amongst the healthcare community, are those that have the potential to go undetected in the early stages. Diseases where early detection and more regular health checks not only improve prognosis and efficacy of treatment outcomes, but also quality of life.

These include:

Erectile Dysfunction (ED)

Erectile dysfunction is characterized by the regular or repeated inability to obtain or maintain an erection. Although not considered a part of the aging process, it is associated with certain physiologic and psychological changes related to age. ED is most common in men between 40-70 years of age. However incidence is also higher amongst men with certain medical conditions which include, diabetes, heart disease, and hypertension. ED can also be a warning sign/symptom of these underlying conditions. 1

Hypogonadism (low testosterone)

Testosterone is an essential male hormone produced in the testes that plays a crucial role in the health and well being of male bodies. It is responsible for typical male sexual characteristics and is required by all men for a healthy life physically and psychologically.

Low testosterone, clinically known as hypogonadism, consists of decreased functional activity of the testes with diminished production and action of testosterone.  Although there is a progressive decline in testosterone levels as men age, hypogonadism can occur in men of any age.

Men with low testosterone are also at increased risk of cardiovascular disease, diabetes and metabolic syndrome and osteoporosis.

For your information, the Mens Health knowledge centre concentrates on the understanding, management and treatment of erectile dysfunction and hypogonadism.  The website also provides extensive details on up-coming conferences as well as an extensive library of useful resource. You can also access the knowledge centre via www.menshealthfocus.com.

Enter the Men's Health Knowledge Centre


References

1. McVary, Kevin T. Erectile. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL et al., editors. Harrison's Internal Medicine. 16th ed. New York: McGraw-Hill; 2005. p. 272-274

Clinical Case Studies

Cryptococcal Disease in HIV

Infection: HIV Infection

Neil D. Ritchie, Clinical Lecturer in Infectious Diseases, Medical Faculty, University of Glasgow, Glasgow, UK

Case History
A 43-year-old Zimbabwean woman presented with headache and meningism of several weeks' duration.

HIV and Syphilis in Pregnancy

Infection: Genitourinary Infection

Nneka Nwokolo, Consultant in Genitourinary Medicine, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK

Case History
A 35-year-old Ethiopian woman was referred from the antenatal clinic with the following results from her booking blood tests: human immunodeficiency virus type 1 (HIV-1) antibody-positive, venereal disease research laboratory (VDRL) test 1:64, syphilis immunoglobulin G/immunoglobulin M positive, Treponema pallidum particle agglutination (TPPA) positive. She was 20 weeks pregnant with her fourth child.

Medical Videos

The Risk Factors Associated With Sexually Transmitted Diseases
The Risk Factors Associated With Sexually Transmitted Diseases

Recent Drug Updates

Medical Images

HIV-1 genome
HIV-1 genome
Pneumocystis jirovecii pneumonia
Pneumocystis jirovecii pneumonia
Key events leading up to the era of HAART
Key events leading up to the era of HAART
HIV-1 group M subtypes and CRFs
HIV-1 group M subtypes and CRFs
gp120 and the CCR5 co-receptor
 gp120 and the CCR5 co-receptor
HIV envelope glycoprotein
HIV envelope glycoprotein

Clinical Guidelines

British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (Updated November 2013)

Nov 2013

The overall purpose of these guidelines is to provide guidance on best clinical practice in the..

... treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults.

Guidelines on the management of erectile dysfunction

Sep 2013

The objective of this guideline is to provide healthcare professionals with recommandations on the..

... management of patients with erectile dysfunction.

Online CME

Antimicrobial-resistant gonorrhoea

This article discusses the recent problem of drug-resistant strains of gonorrhoea and how management methods have been adapted to combat this.

e-LfH eHIV-STI

eHIV-STI is an engaging and extensive e-learning programme supporting specialist training in Sexual Health & HIV. It has been developed by the British Association for Sexual Health and HIV (BASHH)...

Chlamydia infection: diagnosis and management

After completing this module you should know: the symptoms of chlamydia infections, how to test for and treat chlamydia infections, and how to manage sexual contacts of people with chlamydia...

Clinical Trials

Correlation of Pain, Obesity and Fertility Potential.

18-06-2014

The overall aim of the study is to investigate if patients with musculoskeletal chronic pain would show reduced semen quality in comparison with age matched healthy controls. Further the aim is to investigate whether overweight with or without chronic pain are related to reduced semen quality. We will investigate..

... semen quality in obese chronic pain patients, normal weight chronic pain patients and in obese and normal weight healthy controls.

Effects of Probiotics on Microbial Translocation and Immune Activation Markers in HIV-positive Patients on Combined Antiretroviral Therapy (PROBIO-HIV)

11-06-2014

Combined antiretroviral therapy (cART)-treated patients have increased mortality and morbidity compared to age-matched seronegative individuals. This increased mortality and morbidity has been associated to immune activation that persists also in patients under cART even with undetectable levels of HIV-RNA in blood...

... Indeed, HIV-infected patients, irrespective of cART treatment, show higher levels of activated T cells, inflammatory monocytes and proinflammatory cytokines than seronegative individuals. Several putative causes of this residual inflammation have been proposed and include ongoing HIV replication at low levels, the presence of coinfections such as cytomegalovirus, and microbial translocation.

None of these causes are mutually exclusive and understanding the degree to which of these three cause residual inflammation in cART-treated individuals will require novel therapeutic interventions aimed at alleviated each putative cause.

In this longitudinal study we aim:

  1. to reduce microbial translocation induced inflammation in cART-treated individuals with supplementation of cART with the probiotics.
  2. to investigate the potential benefits of 24 weeks of probiotics supplementation on immune function and on immune activation status

Indeed, the early stage of HIV infection is associated with dysbiosis of the GI tract microbiome with reducted levels of bifidobacteria and lactobacillus species with increased levels of potentially pathogenic proteobacteria species.

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