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  Most popular articles (Since October 20, 2006)

 
 
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REVIEW ARTICLE
Hepatitis B immunization: Is a booster necessary?
Chun-Yi Lu, Mei-Hwei Chang
January-December 2005, 2(1):56-73
  41,098 1,164 -
HBV and Indian medical and dental students
Shivaram Prasad Singh, Manorama Swain, Indu Bhusan Kar
January-December 2004, 1(1):229-239
  35,451 520 -
REVIEW ARTICLES
Hepatitis B virus serology: Use and interpretation
Sunil M Shah, Shivaram Prasad Singh
January-December 2007, 4(1):39-54
DOI:10.4103/0972-9747.45088  
Hepatitis B is a well-recognized global public health problem. It is estimated that nearly 2 billion people around the world have serologic evidence of past or present hepatitis B virus (HBV) infection, while 350 million people are chronically infected. This worldwide burden of hepatitis B mandates accurate and timely diagnosis of patients infected with HBV and the use of treatment strategies derived from evidence-based guidelines. HBV is a DNA virus that produces a series of viral protein products. Serologic and nucleic acid testing are critical to disease prevention and treatment objectives. Information from such testing helps determine patients' infectivity and immune status, appropriate monitoring strategies, and the efficacy of treatment, as well as providing data that contributes to a better understanding of the natural history and epidemiology of the disease. This article reviews the clinical use of serologic and nucleic acid tests as markers of disease activity.
  28,547 1,494 -
REVIEW ARTICLE
Hepatitis B Immunization: FAQs
Shivaram Prasad Singh
January-December 2004, 1(1):240-248
  27,146 655 -
REVIEW ARTICLES
Nutritional management of acute and chronic liver disease
Neeraj Saraf
January-December 2008, 5(1):117-133
DOI:10.4103/0972-9747.58810  
Malnutrition is prevalent in all forms of liver diseases. A number of factors contribute to malnutrition in patients with hepatic failure. Early diagnosis of malnutrition is essential to allow appropriate treatment, since malnutrition is an important predictor of complications of liver disease and mortality. Disease-specific nutritional therapy should be considered for acute liver failure, sepsis, transplantation, and encephalopathy. This article provides an overview of the nutritional management of acute and chronic liver disease and discusses the need for further intervention studies before appropriate rational treatment guidelines can be formulated.
  24,719 1,382 1
REVIEW ARTICLE
Extrahepatic manifestations of chronic hepatitis B
Michael Shim, Steven-Huy B Han
January-December 2006, 3(1):128-154
Hepatitis B virus (HBV) infection and its complications are global health problems. Approximately 400 million people are chronic HBV carriers worldwide. The spectrum of chronic HBV infection ranges from asymptomatic hepatitis B surface antigen (HBsAg) carrier state to chronic hepatitis with progression to cirrhosis and end-stage liver disease. It is estimated that 15% to 40% of people with chronic HBV will progress to cirrhosis. Several extrahepatic syndromes are associated with chronic HBV infection. These syndromes contribute significantly to morbidity and mortality. The mechanism of extrahepatic syndromes seen with chronic viral hepatitis appears to be immune-mediated. including deposition of circulating immune complexes, induction of local immune complex formation by viral antigens, reaction with tissue antigens by viral-induced autoantibodies, or a direct viral reaction to extrahepatic tissue sites. Polyarteritis nodosa (PAN) is a rare, but serious, systemic complication of chronic HBV infection affecting the small- and medium-sized vessels. PAN ultimately involves multiple organ systems, some with devastating consequences, though the hepatic manifestations are often more mild. HBV-associated glomerulonephritis (GN) occurs mainly in children, predominantly males, in HBV endemic areas of the world. In children, GN is usually self-limited with only rare progression to renal failure. In adults, course of GN may be more relentless, progressing slowly to renal failure. A serum-sickness like "arthritis-dermatitis" prodrome is also seen in some patients acquiring HBV infection. The joint and skin manifestations are varied, but the syndrome spontaneously resolves after the onset of clinical hepatitis without significant sequelae. Occasionally, the arthritis following the acute prodromal infection may persist; however, joint destruction is rare. The association between HBV and mixed essential cryoglobulinemia remains controversial. Finally, skin manifestations of HBV infection typically present as palpable purpura. Though papular acrodermatitis of childhood has been reported to be caused by chronic HBV, this association remains controversial.
  24,144 1,467 -
Management of chronic hepatitis B infection in patients with end-stage renal disease and dialysis
Ping-Nam Wong, Siu-Ka Mak, Andrew Kui-Man Wong
January-December 2006, 3(1):76-105
Chronic hepatitis B virus (HBV) infection is an important issue among dialysis patients. It could result in nosocomial transmission and infection outbreaks in dialysis units. Vaccination, in addition to universal precautions, regular virologic screening and segregation policy, appear to be of paramount importance in the effective control of HBV infection in a hemodialysis unit, especially in view of the recent discovery of occult hepatitis B infection. Apart from infection control considerations, chronic HBV infection also poses particular problems to dialysis patients in terms of diagnosis and treatment of hepatic complications and pre-transplant management. This review summarizes the recent knowledge and understanding regarding the natural history, clinical presentation and outcome of chronic hepatitis infection in uremic patients and limitations of various existing diagnostic measures in the management of hepatic complications. It seems that chronic HBV infection is associated with high risk of hepatic complications in uremic individuals. Biochemical markers and HBV DNA are, however, inconclusive and liver biopsy remains the only definitive means to establish the activity of liver disease in dialysis patients. In this review, we propose an algorithm for approaching this group of patients and discuss the indications of liver biopsy, options of anti-viral therapy and pre-transplant workup in dialysis patients with chronic hepatitis B infection.
  23,675 1,434 -
Management of hepatitis B viral infection with normal ALT
Deepak Amarapurkar
January-December 2006, 3(1):155-164
Alanine transaminase (ALT) levels have been routinely used in assessment of patients with chronic HBV infection for making the treatment decisions. ALT is traditionally considered to be marker of hepatocellular injury. Various studies using interferon, peg interferon, Lamivudine, Adefovir have shown the importance of elevated ALT levels in predicting the response rate to therapy. Various guidelines have recommended treating the patients of chronic hepatitis B with elevated transaminases and suggested that patients with normal ALT should not be treated. This approach needs a reappraisal. Information available to us in last decade compels to us reevaluate importance of ALT in management of chronic hepatitis B infection. With the help of available information it is reasonable to conclude that the ALT levels have poor predictability for progression of liver disease and planning treatment in patients with CHB. To conclude, patients with CHB infection with normal ALT should be considered for treatment based on the HBV DNA levels assessed by sensitive real time PCR and histological activity. Patients age and family history of liver cancer are two important parameters in considering aggressive approach in these patients.
  19,332 1,329 -
Approach to the management of an incidentally detected HBsAg carrier
Yogesh Kumar Chawla
January-December 2004, 1(1):210-216
  17,823 995 -
REVIEW ARTICLES
Incidentally detected asymptomatic HBsAg positive subjects
Vinod Kumar Dixit, Sushant Kumar Jena
January-December 2008, 5(1):95-101
DOI:10.4103/0972-9747.58808  
Hepatitis B virus [HBV] affects almost five per cent of the total population worldwide and majority of the affected population are detected incidentally without any symptoms. This mammoth pool of Hepatitis B virus infected population needs to be properly assessed and followed up to minimize morbidity and mortality in them. This article reviews literature related to this subset of HBV patients and attempts to provide a rational guideline to approach and manage them.
  18,076 556 -
HBeAg negative chronic Hepatitis B: An overview
Mamun-Al-Mahtab , SM Fazle Akbar
January-December 2009, 6(1):131-140
DOI:10.4103/0972-9747.76910  
Over 350 million people worldwide are infected with hepatitis B virus (HBV), and patients with HBeAg-negative chronic hepatitis B constitute a major proportion of this population. Mutant varieties of HBV resulting from mutations in the precore or core promoter region of the viral genome give rise to HBeAg-negative CHB, and these cases must be differentiated from the inactive carrier state. These patients with HBeAg-negative CHB must be managed judiciously and in certain situations kept under close follow-up instead of rushing to treatment. However, this does not mean advocating adoption of a too conservative approach, allowing many to proceed to irreversible and progressive liver disease. This article provides an overview of the management of HBeAg-negative chronic hepatitis B.
  17,723 577 -
REVIEW ARTICLE
Hepatitis B associated hepatocellular carcinoma: Epidemiology, diagnosis and treatment
KM Mohandas
January-December 2004, 1(1):140-152
  16,982 1,282 -
Epidemiology of hepatitis B virus infection in India
Abhijit Chowdhury
January-December 2004, 1(1):17-24
  15,287 1,615 -
Occult hepatitis B virus infection
Jean-Pierre Allain
January-December 2005, 2(1):14-30
  14,861 1,710 -
Entecavir : A review
Chee-Kiat Tan
January-December 2006, 3(1):35-53
Entecavir is the newest and most potent nucleoside analog to be licensed worldwide for the treatment of chronic hepatitis B infection. It has been shown to be more effective than lamivudine and adefovir in direct head-to-head comparison trials. It is also useful in the treatment of lamivudine-refractory patients. Entecavir is safe with no significant difference in adverse effects compared to lamivudine and adefovir. Available data for up to 2 years of continuous therapy showed no development of viral resistance in nucleos(t)ide-naοve patients. Resistance to entecavir occurs only in patients previously exposed to lamivudine and occurs at a rate of 9% after 2 years of continuous therapy with entecavir.
  15,863 633 -
Hepatitis B virus infection in pregnancy
Narendra Prasad Bohidar
January-December 2004, 1(1):199-209
  15,443 978 -
REVIEW ARTICLES
Hepatitis B vaccine induced HBsAg positivity
Shivaram Prasad Singh
January-December 2007, 4(1):55-60
DOI:10.4103/0972-9747.45089  
Hepatitis B vaccine can induce transient hepatitis B surface antigen positivity not only in adult hemodialysis patients but also in normal adults and children. Hence hepatitis B vaccinees may be mistaken for confirmed hepatitis B surface antigen-positive carrier. Hence blood donors should not donate blood in this early post-vaccination period and renal dialysis patients should not be screened for hepatitis B surface antigen for at least 21 to 28 days after hepatitis B vaccination. These guidelines could prevent individuals in the early post-inoculation period from being erroneously labeled as having hepatitis B viral infection.
  15,551 619 1
REVIEW ARTICLE
Hepatitis B virus infection in children in India
Malathi Sathiyasekaran, VS Sankaranarayanan
January-December 2004, 1(1):72-91
  13,811 852 -
REVIEW ARTICLES
Prophylaxis and treatment of Hepatitis B in immunocompromised patients
Alfredo Marzano, Andrea Marengo, Pietro Lampertico
January-December 2008, 5(1):23-50
DOI:10.4103/0972-9747.58804  
The literature on hepatitis B virus (HBV) in immunocompromised patients is heterogeneous and refers mainly to the pre-antivirals era. Today a rational approach to the problem of hepatitis B in these patients provides for: a) the evaluation of HBV markers and of liver condition in all subjects starting immunosuppressive therapies (baseline), b) the treatment with antivirals (therapy) of active carriers, c) the pre-emptive use of antivirals (prophylaxis) in inactive carriers, especially if they are undergoing immunosuppressive therapies judged to be at high risk, d) the biochemical and HBsAg monitoring (or universal prophylaxis, in case of high risk immunosuppression) in subjects with markers of previous contact with HBV (HBsAg-negative and antiHBc-positive), in order to prevent reverse seroconversion. Moreover it is suggested a strict adherence to the criteria of allocation based on the virological characteristics of both recipients and donors in the general setting of transplants, and in liver transplantation the universal prophylaxis with nucleos(t)ides analogues (frequently combined with specific anti-HBV immunoglobulins) in HBsAg-positive candidates and in HBsAg-negative recipients of antiHBc-positive grafts should be adopted.
  12,615 907 1
Complementary and alternative therapies in the treatment of chronic hepatitis B
Jia-Ming Chang, Kai-Ling Huang
January-December 2007, 4(1):72-106
DOI:10.4103/0972-9747.45091  
Hepatitis B virus (HBV) infects approximately more than 350 million people worldwide, especially in Asia, Africa, southern Europe and Latin America. Except for interferon-α, most anti-HBV drugs are derived from the anti-herpes and anti-HIV drugs. Because of the high cost of hepatitis B medications, herbs-also called 'complementary and alternative therapies' in modern Western science-are widely used for treatment of chronic hepatitis B in developing countries. Herbals confer their activities not only by inhibiting HBV secretion but also by building up immunity against viruses. After studying the anti-HBV mechanism of herbs, scientists were encouraged to find that novel anti-HBV drugs target viral secretion, whereas nucleoside analogues target viral polymerase. The complementary and alternative anti-HBV therapies published in scientific peer-reviewed journals are reviewed and discussed in this article.
  11,992 1,459 -
ORIGINAL ARTICLE
Study on awareness about Hepatitis B viral infection in coastal Eastern India
Bijay Misra, Chittaranjan Panda, Haribhakti Seba Das, Kinshuk Chandra Nayak, Shivaram Prasad Singh
January-December 2009, 6(1):19-28
DOI:10.4103/0972-9747.76902  
Background: Hepatitis B is a major health problem in India. To prevent transmission and progression of the disease in the community, proper community awareness about the disease, including prevention, is necessary. Our objective was to study the awareness amongst the general population about hepatitis B virus, including knowledge regarding vaccine. Materials and Methods: The study was conducted in Department of Gastroenterology of SCB Medical College. The patients attending the OPD and their attendants were subjected to a questionnaire about different aspects of hepatitis B. Binary logistic regression analysis (SPSS 16) was employed to assess the statistical importance of the observations. Results: In all, 682 individuals (65% patients, 35% non-patients) were studied; 78% were males while 22% were females. Majority were in the age group of 31-40 years. 65% hailed from rural area; 65% were poor. About half of the subjects attended state run medical centers for medical attention; only 17% preferred medical colleges. Awareness about the disease and the vaccine among the subjects was 38% and 32%, respectively. 50% of those who were aware had no knowledge about route of transmission, infectivity, or importance of vaccination. Educated individuals were more aware about hepatitis B vaccine (P < 0.05). Those who read newspaper and listened to radio were more aware about hepatitis B (P < 0.05), and its vaccine (P < 0.05). The percentage of vaccination was 20% among study subjects, but in 30%, their children were vaccinated. The common reason for non-vaccination was lack of awareness (50%); of them, 60% blamed government/doctors/media for their ignorance. Majority (56%) received the vaccine from government hospitals or health centers. Only (10%) obtained vaccination from private centers. Reasons cited for non-vaccination included ignorance (50%), carelessness (12%), high cost (10%), and nonavailability (6%). Source of information regarding hepatitis B included television (75%), newspapers (55%), and radio (26%). Conclusions: Only about one-third of the population in coastal Eastern India are aware about hepatitis B and its vaccine. Less than a third of the population are vaccinated for hepatitis B. The educated, especially those who read newspapers and listened to radio, were more aware about the disease/vaccine. The government health agencies and physicians should work together to educate the masses about hepatitis B and its vaccine.
  12,073 1,274 1
REVIEW ARTICLE
Pathogenesis, prevention and treatment of hepatitis B associated hepatocellular carcinoma
W Thomas London, William S Mason, Minhhuyen Nguyen
January-December 2005, 2(1):154-185
  11,818 691 -
Long-term management of patients with chronic hepatitis B virus infection
Anna SF Lok
January-December 2005, 2(1):127-153
  11,777 620 -
REVIEW ARTICLES
Recent advances in Hepatitis B vaccination
Kazimierz Madalinski
January-December 2008, 5(1):51-65
DOI:10.4103/0972-9747.58805  
Hepatitis B virus is a microorganism formed in the excess of surface antigen which is devoid of nucleic acid. Surface antigen of HBV was from the beginning the natural candidate for the vaccine which was thus produced by isolation of plasma HBsAg and later substituted by recombinant protein(s). The Extended Program of Immunization was beneficial for the reduction of HBV incidence in the populations of many participating countries. It is further postulated that HCC incidence in the world was also reduced at least in the portion caused by hepatitis B virus. Persistence of anti-HBV immunity was first measured by quantitative anti-HBs assay determined at 1 month post vaccination cycle, and then at different time points, even up to 12-15 years. The frontier of 10 IU/L (mIU/ml) is a mark of sustained immunity. However, cellular immunity studies revealed that this kind of response is very important in the defense against the virus and may last longer than the detectable antibodies. It was shown that 'full' surface vaccines, i.e. preS+S, may give stronger immunity and are good even for neonates. The next generation vaccines are DNA-based and plant-based HBV vaccines. This last category raises many hopes and with sufficient immunogenicity could ensure the most comfortable route of administration.
  10,368 1,572 2
Safety of Anti-tumor necrosis factor ( Anti-TNF) therapy in patients with chronic Hepatitis B
Matthew B Carroll, Robert Holmes
January-December 2009, 6(1):89-109
DOI:10.4103/0972-9747.76907  
The anti-tumor necrosis factor (TNF) agents are a class of medications which have given clinicians a new level of control over inflammatory illnesses that was previously unattainable with older disease modifying agents. Though each medication has unique molecular differences, they all have as their specific target the proinflammatory cytokine TNF-α. With the great improvements provided by the anti-TNF agents though has come a new spectrum of side effects. On the basis of the importance of TNF-α in granuloma formation, neutralization of TNF-α has led to reactivation of latent infections, the most notable being Mycobacterium tuberculosis. Another infectious agent that can elude eradication and enter a latent state, reactivating when the immune system is depressed, is the hepatitis B virus (HBV). Inhibition of TNF-α could also lead to immune suppression and reactivation of the virus much like that experienced with the reactivation of TB. The purpose of this article is to review the current medical literature for cases where anti-TNF agents were used to treat an inflammatory illness such as rheumatoid arthritis or Crohn's disease in patients chronically infected with HBV. Additionally, the role of TNF-α in HBV infection is explored, the differences in the anti-TNF agents are examined, and guidelines regarding the screening for and prophylaxis of HBV are discussed.
  10,445 566 -
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