THE OFFICIAL PATIENT’S SOURCEBOOK
on
J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS
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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1
Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your physician. All matters regarding your health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before taking any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Patient’s Sourcebook on Hepatitis B: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83391-5 1. Hepatitis B-Popular works. I. Title.
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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.
Copyright Notice If a physician wishes to copy limited passages from this sourcebook for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail:
[email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.
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Dedication To the healthcare professionals dedicating their time and efforts to the study of hepatitis B.
Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to hepatitis B. All of the Official Patient’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.
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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Patient’s Sourcebook series published by ICON Health Publications.
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About ICON Health Publications In addition to hepatitis B, Official Patient’s Sourcebooks are available for the following related topics: ·
The Official Patient's Sourcebook on Appendicitis
·
The Official Patient's Sourcebook on Autoimmune Hepatitis
·
The Official Patient's Sourcebook on Bacteria and Foorborne Illness
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The Official Patient's Sourcebook on Barrett's Esophagus
·
The Official Patient's Sourcebook on Celiac Disease
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The Official Patient's Sourcebook on Cirrhosis of the Liver
·
The Official Patient's Sourcebook on Constipation
·
The Official Patient's Sourcebook on Crohn Disease
·
The Official Patient's Sourcebook on Cyclic Vomiting Syndrome
·
The Official Patient's Sourcebook on Diarrhea
·
The Official Patient's Sourcebook on Diverticular Disease
·
The Official Patient's Sourcebook on Fecal Incontinence
·
The Official Patient's Sourcebook on Gallstones
·
The Official Patient's Sourcebook on Gas
·
The Official Patient's Sourcebook on Gastritis
·
The Official Patient's Sourcebook on Gastroparesis
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The Official Patient's Sourcebook on Hemolytic Uremic Syndrome
·
The Official Patient's Sourcebook on Hemorrhoids
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The Official Patient's Sourcebook on Hepatitis A
·
The Official Patient's Sourcebook on Hepatitis C
·
The Official Patient's Sourcebook on Hiatal Hernia
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The Official Patient's Sourcebook on Hirschsprung
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The Official Patient's Sourcebook on Indigestion
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The Official Patient's Sourcebook on Inguinal Hernia
·
The Official Patient's Sourcebook on Intestinal Pseudo-obstruction
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The Official Patient's Sourcebook on Irritable Bowel Syndrome
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The Official Patient's Sourcebook on Lactose Intolerance
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The Official Patient's Sourcebook on Ménétrier
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The Official Patient's Sourcebook on Pancreatitis
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The Official Patient's Sourcebook on Peptic Ulcer
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The Official Patient's Sourcebook on Porphyria
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The Official Patient's Sourcebook on Primary Biliary Cirrhosis
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The Official Patient's Sourcebook on Primary Sclerosing Cholangitis
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The Official Patient's Sourcebook on Proctitis
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The Official Patient's Sourcebook on Rapid Gastric Emptying
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·
The Official Patient's Sourcebook on Short Bowel Syndrome
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The Official Patient's Sourcebook on Ulcerative Colitis
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The Official Patient's Sourcebook on Whipple Disease
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The Official Patient's Sourcebook on Wilson's Disease
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The Official Patient's Sourcebook on Zollinger-ellison Syndrome
To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health
Contents
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Table of Contents INTRODUCTION ................................................................................................................................. 1 Overview ....................................................................................................................................... 1 Organization ................................................................................................................................. 3 Scope.............................................................................................................................................. 3 Moving Forward............................................................................................................................ 4 PART I: THE ESSENTIALS ............................................................................................................. 7 CHAPTER 1. THE ESSENTIALS ON HEPATITIS B: GUIDELINES .......................................................... 9 Overview ....................................................................................................................................... 9 What Is Hepatitis B? ................................................................................................................... 11 What Causes Hepatitis B?........................................................................................................... 11 How Could I Get Hepatitis B? .................................................................................................... 11 What Are the Symptoms? ........................................................................................................... 12 What Are the Tests For Hepatitis B? .......................................................................................... 13 How Is Hepatitis B Treated? ....................................................................................................... 13 How Can I Protect Myself?......................................................................................................... 14 For More Information.................................................................................................................. 15 More Guideline Sources .............................................................................................................. 16 Vocabulary Builder...................................................................................................................... 30 CHAPTER 2. SEEKING GUIDANCE ................................................................................................... 33 Overview ..................................................................................................................................... 33 Associations and Hepatitis B....................................................................................................... 33 Finding More Associations ......................................................................................................... 41 Finding Doctors........................................................................................................................... 42 Selecting Your Doctor ................................................................................................................. 44 Working with Your Doctor ......................................................................................................... 44 Broader Health-Related Resources .............................................................................................. 46 Vocabulary Builder...................................................................................................................... 46 CHAPTER 3. CLINICAL TRIALS AND HEPATITIS B .......................................................................... 47 Overview ..................................................................................................................................... 47 Recent Trials on Hepatitis B........................................................................................................ 50 Benefits and Risks........................................................................................................................ 63 Keeping Current on Clinical Trials ............................................................................................. 66 General References....................................................................................................................... 67 Vocabulary Builder...................................................................................................................... 68 PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL ........................... 73 CHAPTER 4. STUDIES ON HEPATITIS B ........................................................................................... 75 Overview ..................................................................................................................................... 75 The Combined Health Information Database .............................................................................. 75 Federally-Funded Research on Hepatitis B ................................................................................. 81 E-Journals: PubMed Central ....................................................................................................... 94 The National Library of Medicine: PubMed.............................................................................. 110 Vocabulary Builder.................................................................................................................... 120 CHAPTER 5. PATENTS ON HEPATITIS B ........................................................................................ 127 Overview ................................................................................................................................... 127 Patents on Hepatitis B............................................................................................................... 128 Patent Applications on Hepatitis B ........................................................................................... 142 Keeping Current ........................................................................................................................ 147 Vocabulary Builder.................................................................................................................... 148 CHAPTER 6. BOOKS ON HEPATITIS B............................................................................................ 151
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Contents Overview ................................................................................................................................... 151 Book Summaries: Federal Agencies ........................................................................................... 151 Book Summaries: Online Booksellers ........................................................................................ 155 The National Library of Medicine Book Index........................................................................... 158 Chapters on Hepatitis B............................................................................................................. 162 General Home References .......................................................................................................... 170 Vocabulary Builder.................................................................................................................... 171 CHAPTER 7. MULTIMEDIA ON HEPATITIS B ................................................................................. 173 Overview ................................................................................................................................... 173 Video Recordings....................................................................................................................... 173 Audio Recordings ...................................................................................................................... 179 Bibliography: Multimedia on Hepatitis B ................................................................................. 180 CHAPTER 8. PERIODICALS AND NEWS ON HEPATITIS B .............................................................. 185 Overview ................................................................................................................................... 185 News Services & Press Releases ................................................................................................ 185 Newsletters on Hepatitis B........................................................................................................ 193 Newsletter Articles .................................................................................................................... 194 Academic Periodicals covering Hepatitis B ............................................................................... 198 Vocabulary Builder.................................................................................................................... 199 CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES .............................................................. 201 Overview ................................................................................................................................... 201 NIH Guidelines ......................................................................................................................... 201 NIH Databases .......................................................................................................................... 202 Other Commercial Databases .................................................................................................... 215 The Genome Project and Hepatitis B......................................................................................... 215 Specialized References ............................................................................................................... 220 Vocabulary Builder.................................................................................................................... 220 CHAPTER 10. DISSERTATIONS ON HEPATITIS B ........................................................................... 221 Overview ................................................................................................................................... 221 Dissertations on Hepatitis B ..................................................................................................... 221 Keeping Current ........................................................................................................................ 223
PART III. APPENDICES .............................................................................................................. 225 APPENDIX A. RESEARCHING YOUR MEDICATIONS ..................................................................... 227 Overview ................................................................................................................................... 227 Your Medications: The Basics ................................................................................................... 228 Learning More about Your Medications ................................................................................... 229 Commercial Databases............................................................................................................... 232 Contraindications and Interactions (Hidden Dangers)............................................................. 234 A Final Warning ....................................................................................................................... 235 General References..................................................................................................................... 236 Vocabulary Builder.................................................................................................................... 236 APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ............................................................... 239 Overview ................................................................................................................................... 239 What Is CAM? .......................................................................................................................... 239 What Are the Domains of Alternative Medicine? ..................................................................... 240 Can Alternatives Affect My Treatment?................................................................................... 243 Finding CAM References on Hepatitis B .................................................................................. 244 Additional Web Resources......................................................................................................... 256 General References..................................................................................................................... 262 Vocabulary Builder.................................................................................................................... 263 APPENDIX C. RESEARCHING NUTRITION..................................................................................... 265 Overview ................................................................................................................................... 265 Food and Nutrition: General Principles .................................................................................... 266
Contents
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Finding Studies on Hepatitis B ................................................................................................. 270 Federal Resources on Nutrition................................................................................................. 273 Additional Web Resources......................................................................................................... 273 Vocabulary Builder.................................................................................................................... 276 APPENDIX D. FINDING MEDICAL LIBRARIES ............................................................................... 279 Overview ................................................................................................................................... 279 Preparation ................................................................................................................................ 279 Finding a Local Medical Library ............................................................................................... 280 Medical Libraries Open to the Public ........................................................................................ 280 APPENDIX E. YOUR RIGHTS AND INSURANCE ............................................................................. 287 Overview ................................................................................................................................... 287 Your Rights as a Patient............................................................................................................ 287 Patient Responsibilities ............................................................................................................. 291 Choosing an Insurance Plan...................................................................................................... 292 Medicare and Medicaid ............................................................................................................. 294 NORD’s Medication Assistance Programs............................................................................... 297 Additional Resources................................................................................................................. 298 Vocabulary Builder.................................................................................................................... 299 ONLINE GLOSSARIES ............................................................................................................... 301 Online Dictionary Directories................................................................................................... 306 HEPATITIS B GLOSSARY.......................................................................................................... 307 General Dictionaries and Glossaries ......................................................................................... 326 INDEX.............................................................................................................................................. 328
Introduction
1
INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that every patient incorporate education into the treatment process. According to the AHRQ: Finding out more about your condition is a good place to start. By contacting groups that support your condition, visiting your local library, and searching on the Internet, you can find good information to help guide your treatment decisions. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist patients in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3
Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2
2
Hepatitis B
Since the late 1990s, physicians have seen a general increase in patient Internet usage rates. Patients frequently enter their doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding patients through sound therapies. The Official Patient’s Sourcebook on Hepatitis B has been created for patients who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to hepatitis B, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on hepatitis B. Given patients’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on hepatitis B should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your best option. This sourcebook is no exception. Each patient is unique. Deciding on appropriate
Introduction
3
options is always up to the patient in consultation with their physician and healthcare providers.
Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching hepatitis B (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other patient networks dedicated to hepatitis B. It also gives you sources of information that can help you find a doctor in your local area specializing in treating hepatitis B. Collectively, the material presented in Part I is a complete primer on basic research topics for patients with hepatitis B. Part II moves on to advanced research dedicated to hepatitis B. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on hepatitis B. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading for all patients with hepatitis B or related disorders. The appendices are dedicated to more pragmatic issues faced by many patients with hepatitis B. Accessing materials via medical libraries may be the only option for some readers, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing patients with hepatitis B.
Scope While this sourcebook covers hepatitis B, your doctor, research publications, and specialists may refer to your condition using a variety of terms. Therefore, you should understand that hepatitis B is often considered a synonym or a condition closely related to the following: ·
Diffuse Hepatocellular Inflammatory Disease
·
Serum Hepatitis
4
Hepatitis B
In addition to synonyms and related conditions, physicians may refer to hepatitis B using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for hepatitis B:4 ·
070.2 viral hepatitis b with hepatic coma
·
070.3 hepatitis b
·
070.3 viral hepatitis b without mention of hepatic coma
For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to hepatitis B. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.
Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by patients or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? All too often, patients diagnosed with hepatitis B will log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. These patients are left to wonder where the relevant information is, and how to obtain it. 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”
Introduction
5
Since only the smallest fraction of information dealing with hepatitis B is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of hepatitis B, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find peer groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you the most options available in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your treatment plan. The Editors
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PART I: THE ESSENTIALS
ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on hepatitis B. The essentials of a disease typically include the definition or description of the disease, a discussion of who it affects, the signs or symptoms associated with the disease, tests or diagnostic procedures that might be specific to the disease, and treatments for the disease. Your doctor or healthcare provider may have already explained the essentials of hepatitis B to you or even given you a pamphlet or brochure describing hepatitis B. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what your doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.
Guidelines
CHAPTER 1. GUIDELINES
THE
ESSENTIALS
ON
HEPATITIS
9
B:
Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on hepatitis B. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the patient in mind. Since new guidelines on hepatitis B can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.
The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current patient guidelines and fact sheets on hepatitis B. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.
5
Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.
10 Hepatitis B
There is no guarantee that any one Institute will have a guideline on a specific disease, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare diseases. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with hepatitis B and associated conditions: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
·
National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html
·
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
Among these, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is particularly noteworthy. The NIDDK’s mission is to conduct and support research on many of the most serious diseases affecting public health.6 The Institute supports much of the clinical research on the diseases of internal medicine and related subspecialty fields as well as many basic science disciplines. The NIDDK’s Division of Intramural Research encompasses the broad spectrum of metabolic diseases such as diabetes, inborn errors of metabolism, endocrine disorders, mineral metabolism, digestive diseases, nutrition, urology and renal disease, and hematology. Basic research studies include biochemistry, nutrition, pathology, histochemistry, chemistry, physical, chemical, and molecular biology, pharmacology, and toxicology. NIDDK extramural research is organized into divisions of program areas: ·
Division of Diabetes, Endocrinology, and Metabolic Diseases
·
Division of Digestive Diseases and Nutrition
·
Division of Kidney, Urologic, and Hematologic Diseases
The Division of Extramural Activities provides administrative support and overall coordination. A fifth division, the Division of Nutrition Research Coordination, coordinates government nutrition research efforts. The Institute supports basic and clinical research through investigator-initiated This paragraph has been adapted from the NIDDK: http://www.niddk.nih.gov/welcome/mission.htm. “Adapted” signifies that a passage is reproduced exactly or slightly edited for this book. 6
Guidelines 11
grants, program project and center grants, and career development and training awards. The Institute also supports research and development projects and large-scale clinical trials through contracts. The following patient guideline was recently published by the NIDDK on hepatitis B.
What Is Hepatitis B?7 Hepatitis B is a liver disease. Hepatitis (HEP-ah-TY-tis) makes your liver swell and stops it from working right. You need a healthy liver. The liver does many things to keep you alive. The liver fights infections and stops bleeding. It removes drugs and other poisons from your blood. The liver also stores energy for when you need it.
What Causes Hepatitis B? Hepatitis B is caused by a virus. A virus is a germ that causes sickness. (For example, the flu is caused by a virus.) People can pass viruses to each other. The virus that causes hepatitis B is called the hepatitis B virus.
How Could I Get Hepatitis B? Hepatitis B spreads by contact with an infected person’s blood, semen, or other body fluid. You could get hepatitis B by: Adapted from The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): http://www.niddk.nih.gov/health/digest/pubs/hep/hepb/hepb.htm. 7
12 Hepatitis B
·
Having sex with an infected person without using a condom
·
Sharing drug needles
·
Getting a tattoo or body piercing with dirty tools that were used on someone else
·
Getting pricked with a needle that has infected blood on it (health care workers can get hepatitis B this way)
·
Sharing a toothbrush or razor with an infected person
An infected woman can give hepatitis B to her baby at birth or through her breast milk. You cannot get hepatitis B by ·
Shaking hands with an infected person
·
Hugging an infected person
·
Sitting next to an infected person
What Are the Symptoms? Hepatitis B can make you feel like you have the flu. You might: ·
Feel tired
·
Feel sick to your stomach
·
Have a fever
·
Not want to eat
·
Have stomach pain
·
Have diarrhea
Some people have: ·
Dark yellow urine
·
Light-colored stools
·
Yellowish eyes and skin
Some people don’t have any symptoms.
Guidelines 13
If you have symptoms, or think you might have hepatitis B, go to a doctor.
The doctor will take some blood to check for hepatitis B.
What Are the Tests For Hepatitis B? To check for hepatitis B, the doctor will test your blood. These tests show if you have hepatitis B and how serious it is. The doctor may also do a liver biopsy. Biopsy (BYE-op-see) is a simple test. The doctor removes a tiny piece of your liver through a needle. The doctor checks the piece of liver for signs of hepatitis B and liver damage.
How Is Hepatitis B Treated?
Hepatitis B is treated through shots of medicine.
Treatment for hepatitis B may involve: ·
A drug called interferon (in-ter-FEAR-on). It is given through shots. Most people are treated for 4 months.
14 Hepatitis B
·
A drug called lamivudine (la-MIV-you-deen). You take it by mouth once a day. Treatment is usually for one year. Sometimes lamivudine is combined with interferon.
·
Surgery. Over time, hepatitis B may cause your liver to stop working. If that happens, you will need a new liver. The surgery is called a liver transplant. It involves taking out the old, damaged liver and putting in a new, healthy one from a donor.
How Can I Protect Myself?
You can get the hepatitis B vaccine. Vaccines protect you from getting hepatitis B. A vaccine is a drug that you take when you are healthy that keeps you from getting sick. Vaccines teach your body to attack certain viruses, like the hepatitis B virus. The hepatitis B vaccine is given through three shots. All babies should get the vaccine. Infants get the first shot within 12 hours after birth. They get the second shot at age 1 to 2 months and the third shot between ages 6 and 18 months. Older children and adults can get the vaccine, too. They get three shots over 6 months. Children who have not had the vaccine should get it. You need all of the shots to be protected. If you miss a shot, call your doctor or clinic right away to set up a new appointment.
Guidelines 15
People who touch blood at work should wear gloves to protect themselves from hepatitis B.
You can also protect yourself and others from hepatitis B if you ·
Use a condom when you have sex
·
Don’t share drug needles with anyone
·
Wear gloves if you have to touch anyone’s blood
·
Don’t use an infected person’s toothbrush, razor, or anything else that could have blood on it
·
Also, if you get a tattoo or body piercing, make sure it is done with clean tools
For More Information You can also get information about hepatitis B from these groups: American Liver Foundation 75 Maiden Lane, Suite 603 New York, NY 10038 Phone: 1-800-465-4837 (This is a free call.) Email:
[email protected] Internet: www.liverfoundation.org
16 Hepatitis B
Hepatitis Foundation International 30 Sunrise Terrace Cedar Grove, NJ 07009-1423 Phone: 1-800-891-0707 (This is a free call.) Email:
[email protected] Internet: www.hepfi.org
More Guideline Sources The guideline above on hepatitis B is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to hepatitis B. Many of the guidelines listed below address topics that may be of particular relevance to your specific situation or of special interest to only some patients with hepatitis B. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly.
Topic Pages: MEDLINEplus For patients wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and patientoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search.
Guidelines 17
The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on hepatitis B and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·
Stay Free from Hepatitis B Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 7 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.05 each; plus shipping and handling; quantity discounts available. Order number 40428 for English version; 40527 for Spanish version. Summary: Written in nontechnical language, this patient education booklet reviews hepatitis B, a liver disease caused by a virus in the blood. Hepatitis B virus (HBV) is usually transmitted by having vaginal, anal or oral sex without a condom, by sharing needles for drug abuse, or tattooing or body piercing. Many people do not realize that they have hepatitis B; although they remain without symptoms, they can still pass the infection to others. Early signs of hepatitis B may include flulike symptoms, jaundice (yellow skin), dark urine, and lack of appetite. A blood test is the only sure way to know if a person has HBV. Most people recover in a few months, but some people with HBV become carriers and can experience lasting liver problems and liver cancer. Babies with HBV have a high risk of becoming carriers. The section on drug use reminds readers that quitting is safest, but notes that drug works should not be shared with anyone else. The telephone numbers of the CDC AIDS Hotline are provided, through which readers can also find out about needle exchange programs. The brochure describes how to disinfect needles and syringes with bleach. The next section of the brochure explains how sexual activities (oral, vaginal, or anal) can result in transmission of hepatitis B; readers are encouraged to use latex condoms for every sexual encounter. The hepatitis B vaccine, given in a series of 3 doses over 4 to 6 months, can protect against the disease. The booklet is illustrated with line drawings.
18 Hepatitis B
·
Learn the Facts About Hepatitis C Source: South Deerfield, MA: Channing L. Bete Co., Inc. 2000. 15 p. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.05 each plus shipping and handling; quantity discounts available. Order number 75447. Summary: This booklet offers basic information about hepatitis C, a viral infection that causes liver disease. Most people who get hepatitis C virus (HCV) become chronic carriers of the disease and must be careful to protect their own health and that of others (in order to avoid transmitting the disease). HCV is spread mainly through blood; risk factors for transmission of the virus include sharing needles or other equipment to inject drugs, having had a blood transfusion before 1992, exposure to blood on the job (e.g., health care workers), sharing personal care items, and sexual contact (a less frequent mode of transmission). HCV is not spread through casual contact or by food or water. The symptoms of HCV infection can resemble the flu and include fatigue, nausea, vomiting and abdominal pain, loss of appetite (anorexia) and weight loss, mild fever, and headaches; hepatitis C sometimes causes jaundice, dark urine, and light colored bowel movements. Most people with HCV have no symptoms, but they can still infect others and have liver damage resulting from their infection. Diagnosis of HCV is based on medical history, physical examination, and blood tests. Patients with chronic HCV are advised to get follow up tests, take medication as prescribed, avoid alcohol, get vaccinated against hepatitis A and hepatitis B, avoid or limit certain medications, and live a healthy lifestyle with a positive outlook. One section of the booklet encourages readers to help stop the spread of HCV and other viruses by never sharing needles or personal care items; abstaining from sex; using a latex condom for each act of vaginal, anal, or oral sex; and taking extra precautions if HCV infection is present. Detailed information on cleaning drug works (equipment) and on using condoms is provided. The booklet concludes with resources that can give readers additional assistance. The booklet is illustrated with simple line drawings.
·
Hepatitis Basics Source: Kalamazoo, MI: Hope Publications. 200x. [4 p.]. Contact: Available from Hope Publications. 350 East Michigan Avenue, Suite 301, Kalamazoo, MI 49007-3851. (616) 343-0770. Website: hithope.com. Price: $0.59 each for 10-100 copies.
Guidelines 19
Summary: This brochure, written in nontechnical language, offers a basic overview of human viral hepatitis, a disease that attacks the liver. The brochure describes the three main types: hepatitis A, hepatitis B, and hepatitis C. Hepatitis A infection is usually brief and causes no long term problems. However, hepatitis B and hepatitis C can lead to serious illness, including chronic (lifelong) infection, cirrhosis of the liver, liver cancer, liver failure, and death. The brochure emphasizes that the best way to deal with all three types of hepatitis is prevention. For each type, the brochure discusses risk factors, transmission, symptoms, and prevention strategies. Hepatitis A is transmitted through human feces, that is, in food or water that has been contaminated with feces. Raw foods such as fruits and vegetables pose the greatest risk (cooking kills the virus); but cooked foods can spread the disease if they're touched by contaminated hands after cooking. Hepatitis B is spread primarily through sexual contact, shared drug injection equipment contaminated by blood, infected blood on razors or needles (used for ear piercing, tattooing), and infected blood and body fluids (health care workers are at risk). It is also passed from infected mother to her baby at birth. Hepatitis C is most commonly spread shared drug injection equipment contaminated with blood. The brochure reiterates prevention steps for each type of hepatitis C, particularly those related to good hygiene (handwashing). One sidebar reminds readers who have had hepatitis B or C that they should not donate blood or organs, should not share toothbrushes or other personal care items, should cover open sores and other breaks in the skin, and should use a latex condom during sex. One final section offers further information about the hepatitis A vaccine and the hepatitis B vaccine. ·
What I Need to Know About Hepatitis B. [Lo Que Necesito Saber Sobre la Hepatitis B] Source: Bethesda, MD: National Digestive Diseases Information Clearinghouse (NDDIC). 1999. 10 p. Contact: Available from National Digestive Diseases Information Clearinghouse (NDDIC). 2 Information Way, Bethesda, MD 20892-3570. (800) 891-5389 or (301) 654-3810. Fax (301) 907-8906. E-mail:
[email protected]. Price: Single copy free; bulk copies available. Summary: This brochure provides basic information about hepatitis B. Written in non-technical language, the brochure describes hepatitis B and the virus that causes it, explains how hepatitis B is transmitted, lists the symptoms of the disease, describes the diagnostic tests used to confirm the disease, discusses the treatment, and focuses on preventing transmission of the disease through vaccination and proper hygiene.
20 Hepatitis B
Hepatitis B, a liver disease caused by the hepatitis B virus (HBV), spreads by contact with an infected person's blood, semen, or other body fluid. The hepatitis B vaccine series can protect from hepatitis B. In addition, people who touch blood at work should wear gloves to protect themselves from hepatitis B. Treatment for hepatitis B may involve interferon shots and liver transplantation. The brochure lists two resource organizations (the American Liver Foundation and the Hepatitis Foundation International) for readers who wish to obtain more information. In addition, the contact information for the National Digestive Diseases Information Clearinghouse (NDDIC) is provided. The brochure is illustrated with simple line drawings. ·
Hepatitis B and You. Pregnant? Protect Your Baby and Yourself Source: South Deerfield, MA: Channing L. Bete Co., Inc. 1998. [4 p.]. Contact: Available from Channing L. Bete, Co., Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $0.89 each for 1-99 copies; plus shipping and handling; quantity discounts available. Order number: 31828A898. Summary: This brochure informs pregnant women about hepatitis B virus (HBV) and the risk of transmitting it to their baby. HBV attacks the liver and can cause chronic infection, cirrhosis (scarring) of the liver, liver cancer or liver failure, or even death. HBV can cause mild or severe flulike symptoms, and some people become carriers of chronic HBV infection. The brochure reviews how the disease is spread, most notably by contact with the body fluids (blood, semen, vaginal fluids) of people who are infected. HBV can also be transmitted from an infected mother to a baby at birth. Up to 90 percent of babies who are infected at birth become HBV carriers. The brochure then reviews preventive measures, encouraging readers to get tested (blood test) for the virus and explaining the actions to be taken based on a positive or negative test result. The brochure then explains the series of three vaccinations used to prevent HBV infection in babies. The brochure answers common questions about HBV and new mothers, including those about breastfeeding, financial aid programs, and other immunization recommendations. The Centers for Disease Control National Immunization Hotline telephone numbers are given (800-232-2522 for English; 800-232-0233 for Spanish). The brochure is written in nontechnical language and illustrated with full-color drawings of women and babies from various ethnic groups.
Guidelines 21
·
Hepatitis: Get Tested, Get Treated. [Hepatitis: Hagase la Prueba, Consiga Ayuda] Source: Bronx, NY: Latino Organization for Liver Awareness. 1998. [12 p.]. Contact: Available from Latino Organization for Liver Awareness (LOLA). P.O. Box 842, Throggs Neck Station, Bronx, NY 10465. (888) 3675652. Price: Single copy free. Summary: This brochure provides information about hepatitis, emphasizing the need to be tested and treated. Aimed at the Hispanic community, the brochure defines hepatitis and notes its symptoms. Many people do not find out they have hepatitis until they go to the doctor for a regular checkup; blood tests can indicate a liver function problem. Hepatitis is sometimes found when people donate blood. The brochure reviews how hepatitis is transmitted, listing the risk factors for contracting the disease, including the following: had a blood transfusion before 1992, use or used intravenous drugs, snort or snorted drugs, have been in contact with the blood of someone who has hepatitis B or C (by sharing a razor or toothbrush, for example), have a tattoo or body piercing, have a job that exposes one to human blood, or have had multiple sexual partners. The brochure then explains why hepatitis should be diagnosed and treated, even if symptoms are not apparent. Treatment options include drug therapy, notably the interferons used to treat viral hepatitis B and C. The brochure cautions that about 20 to 30 percent of untreated patients will develop cirrhosis over a period of years. Liver transplantation has become an accepted form of therapy when chronic hepatitis C becomes life threatening. Unfortunately, the hepatitis C virus usually reoccurs in the new liver, too. The brochure is produced by the Latino Organization for Liver Awareness (LOLA). LOLA is a national, bilingual bicultural voluntary organization dedicated to raising awareness, prevention, education, and treatment referral services to the Latino community and other underserved populations who have liver disease. LOLA provides culturally appropriate counseling information on liver transplantation and encourages the promotion of organ donation within the Latino community. The brochure is written in both English and Spanish and illustrated with full color photographs of a variety of people of color.
·
Hepatitis B: Understanding This Viral Infection Source: San Bruno, CA: StayWell Company. 1998. [2 p.]. Contact: Available from StayWell Company. Order Department, 1100 Grundy Lane, San Bruno, CA 94066-9821. (800) 333-3032. Fax (650) 244-
22 Hepatitis B
4512. Price: $ 17.95 for 50 copies; plus shipping and handling; bulk copies available. Order number 9781. Summary: This brochure describes hepatitis B, an inflammation of the liver caused by the hepatitis B virus (HBV). Hepatitis B infection can be acute or chronic. Symptoms of acute hepatitis B can include pain in the upper right abdomen, flulike symptoms, nausea and vomiting, diarrhea, and jaundice (yellowed skin or eyes, swelling of the abdomen, light stools, dark urine). People with chronic hepatitis B often have no symptoms. They may not know they have the virus until it causes liver disease years later. HBV is spread through blood and other body fluids; activities that can spread hepatitis B include sharing a needle with an infected person, having unprotected sex with an infected person, or using an infected person's eating utensils or personal care items. Hepatitis B is diagnosed through blood tests; other tests may diagnose associated liver damage. Patients who have chronic hepatitis B should avoid acetaminophen and other over the counter pain relievers, avoid alcohol, eat a balanced diet, keep appointments to monitor the liver's function, and get injections (of antiviral agents) if prescribed. One section outlines strategies for preventing the spread of hepatitis B. The brochure is illustrated with full color drawings. 7 figures. ·
You Don't Have to Go All the Way to Get Hepatitis A: Get Vaccinated! Source: St. Paul, MN: Hepatitis B Coalition. 1997. 2 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $1.00. Summary: This brochure reminds readers of the risks associated with hepatitis A and the guidelines for vaccinations to prevent hepatitis A. Hepatitis A is a highly contagious liver disease caused by the hepatitis A virus (HAV). The brochure discusses the complications of hepatitis A, risk factors for getting hepatitis A (including multiple sexual partners and certain sexual behaviors), how to protect oneself from getting hepatitis A (get vaccinated, use condoms for anal sexual activities), how hepatitis A is spread, the symptoms of hepatitis A, what to do after a potential exposure to hepatitis A, immune protection after having hepatitis A once, the specificity of the hepatitis A vaccine (it only protects against HAV, not against hepatitis B or C), where to receive hepatitis A shots, and how to get shots if one cannot afford them. The brochure contains slang terms for sexual activities and is illustrated with line drawings that suggest sexual activity between two men.
Guidelines 23
·
Hepatitis B Virus [and Pregnancy] Source: Washington, DC: American College of Obstetricians and Gynecologists. 1997. [2 p.]. Contact: American College of Obstetricians and Gynecologists (ACOG). 409 12th Street, SW, Washington, DC 20024-2188. (800) 762-2264 or (202) 863-2518. Fax (202) 484-1595. Price: Single copy free; bulk copies available. Summary: This brochure describes hepatitis B viral infections and why they are a special problem for women who are pregnant. Not only does a pregnant woman face the risks of hepatitis herself, she can also pass the virus to her baby. The brochure stresses that a safe, easy blood test can show whether a person has been infected with the virus and whether he or she is at risk of infecting others. With testing of pregnant women and proper treatment of their babies, the serious health risks of infection usually can be avoided. The brochure reviews the effects of hepatitis B virus infection, the effects during pregnancy, testing for the virus, and prevention of hepatitis B virus. A vaccine is available that protects people from becoming infected with hepatitis B virus. All babies should be vaccinated soon after birth. Anyone who is at risk of being infected should be vaccinated to prevent them from getting the virus and passing it on to others. One sidebar reviews the risk factors for hepatitis B, encouraging readers who have one or more of the risk factors to get vaccinated. The brochure concludes with a brief glossary of related terms. 5 figures.
·
Hepatitis B Shots Now Recommended for All New Babies: Hepatitis B Vaccine Helps Protect Your Baby's Future! Source: St. Paul, MN: Hepatitis B Coalition. 1996. 2 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Price: $1.00 per copy. Summary: The American Academy of Pediatrics, American Academy of Family Physicians, and the United States Public Health Service Advisory Committee on Immunization Practices all recommend that every baby born in the United States be vaccinated against hepatitis B. This illustrated patient education brochure reviews this recommendation and explains the importance of vaccination. Topics include a description of hepatitis B and how it is spread, statistics on the numbers of people who get hepatitis B, how many shots are in the hepatitis B series and when they should be given, the safety of the hepatitis B vaccine, and the cost of the vaccine. The brochure explains that the vaccination is also recommended for teens and pre-teens who have not been vaccinated. The
24 Hepatitis B
brochure is available in English, Spanish, Hmong, Cambodian, Laotian, Vietnamese, Russian, Chinese, or Korean. ·
Getting Hip to Hep: What You Should Know About Hepatitis A, B, and C. Source: Cedar Grove, NJ: American Liver Foundation. 1996. 8 p. Contact: Available from American Liver Foundation. 1425 Pompton Avenue, Cedar Grove, NJ 07009. (800) 223-0179 or (201) 256-2550. Price: Single copy free. Summary: This brochure reviews the common types of viral hepatitis, including hepatitis A, hepatitis B, and hepatitis C. Topics include the complications of each type of hepatitis, risk factors, transmission, symptoms, diagnostic and screening tests, and preventive issues. The brochure concludes with a brief description of the American Liver Foundation, and a toll-free telephone number for additional information. 1 table. The brochure is available in English or Spanish.
·
Hepatitis B: Stop the Spread Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1996. 15 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.25 each for 1-24 copies; discounts available for larger orders. Summary: This Scriptographic booklet provides information about hepatitis B. Written in a question and answer format, the booklet defines the disease and explains how hepatitis B virus (HBV) is transmitted; the symptoms of infection; the role of the vaccine in preventing transmission; the importance of safer sex and not sharing intravenous drug needles and syringes; and other prevention recommendations. The brochure is illustrated with line drawings of people representing a variety of ethnic groups. This booklet is available in English and Spanish.
·
Hepatitis B: An Unexpected Threat to Your Child's Life Source: Cedar Grove, NJ: Hepatitis Foundation International. 1996. 6 p. Contact: Available from Hepatitis Foundation International. 30 Sunrise Terrace, Cedar Grove, NJ 07009. (800) 891-0707 or (201) 239-1035. Fax (201) 857-5044. Price: $2.00 each; discounts available for larger orders. Free with membership. Summary: This brochure familiarizes parents with the problem of hepatitis B in children. Written in a question-and-answer format, the brochure lists the physiology of the liver, the role of the liver in everyday
Guidelines 25
metabolism and in the immune system, how children contract hepatitis B, the sexual transmission of the hepatitis B virus (HBV), statistics on the incidence of hepatitis, and the availability and importance of the hepatitis B vaccine. The brochure encourages parents to learn more, and to ensure that their children are vaccinated against hepatitis B. The brochure is illustrated with simple line drawings. ·
Living with Hepatitis B. [Como se vive con la hepatitis B] Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1996. 7 p. Contact: Available from Channing L. Bete Company, Inc. 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Price: $1.25 each for 1-24 copies; discounts available for larger orders. Summary: This brochure provides basic information about the hepatitis B virus (HBV) and recommends strategies for people who have HBV. The brochure emphasizes the importance of good general health and protecting the liver from damage. For those patients with liver problems caused by HBV, the brochure recommends that they ask their health care providers about vaccinations, not eat raw oysters, avoid breathing in chemicals or getting them on the skin, and take treatments for liver problems (drug therapy or a liver transplant). One section of the brochure describes how women with HBV can protect their babies from HBV. Another section outlines precautions that people with HBV can take to prevent transmitting HBV to others. These precautions tell people with HBV to not share personal items, cover cuts and sores, clean up blood spills with bleach and water, not give blood, not share needles, and not have sex without using a latex condom. The brochure is illustrated with cartoon-like drawings and numerous checklists and charts. The brochure is available in English and in Spanish.
·
Universal Precautions: AIDS and Hepatitis B Prevention for the Dental Health Team Contact: Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 5410253. Summary: This teaching aid, consisting of a videorecording and an accompanying study guide, teaches dental health professionals about universal precautions to prevent the transmission of the Human immunodeficiency virus (HIV) and the Hepatitis B virus (HBV). Users are asked to first take the pre-test and then to complete the five lessons, which consist of lesson from the study guide and a related video segment. Each lesson includes a summary and a list of videorecording key ideas. At the end of the five lessons, the user should take the post-
26 Hepatitis B
test. The five lessons cover Hepatitis B infection, symptoms, and treatment; HIV infection, symptoms, and risk of infection through dental work; ways in which both viruses are and are not transmitted; using personal protective equipment; and working safely to avoid puncture wounds, contact with infectious waste, and blood spills. ·
Hepatitis B and Adoption Information Source: St. Paul, MN: Immunization Action Coalition. 1997. 14 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $1.00. Summary: Chronic hepatitis B is the most common serious infectious disease affecting children adopted internationally. This information packet provides guidelines about hepatitis B for parents who adopt children internationally. The packet includes five items: a fact sheet on myths about hepatitis B in children; a fact sheet about pre-adoption screening and its drawbacks; two articles from the Adoption Medical News newsletter on the diagnosis and medical management issues of chronic hepatitis B; and information on how to subscribe to Adoption Medical News. The information stresses that all children adopted from other countries, all U.S. newborns not screened during pregnancy, and all older children should be screened (preferably twice) for hepatitis B: at the time of arrival into the adoptive home and again after the maximum incubation period has passed (at six months). Tests done in the country of origin (except for Korea) are highly unreliable. The materials provide contact information for resource organizations and support groups.
The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “hepatitis B” or synonyms. The following was recently posted: ·
Recommendations to prevent hepatitis B virus transmission-United States-Update. Source: Centers for Disease Control and Prevention.; 1999 January 22; 2 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 1208&sSearch_string=hepatitis+B
Guidelines 27
Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·
Articles Related to Hepatitis B Concerns for APIs Summary: Links to articles, essays and journal reports on Hepatitis B concerns for APIs (Asian American and Pacific Islander), available online. Source: Hepatitis B Task Force: Focus on Asian Pacific Islanders (APIs) http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5260
·
Directory of Liver Specialists Summary: This national directory is provided as a service by the Hepatitis B Foundation for use by patients and their families. Source: Hepatitis B Foundation http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5144
·
Do You Have Chronic Hepatitis B? Summary: This fact sheet outlines how hepatitis B carriers can best take care of themselves, what to do if liver disease has progressed, and how to protect others from hepatitis B. Source: Immunization Action Coalition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3382
·
Every Week Hundreds of Teens Are Infected With Hepatitis B: Get Vaccinated Against this Disease!! Summary: This brochure describes what hepatitis B is and how teens contract it. Symptoms and prevention are also covered. Source: Immunization Action Coalition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3378
28 Hepatitis B
·
FAQ - About Hepatitis B Summary: This FAQ about hepatitis B covers what it is, who is at risk, what a carrier is, and how it is and is not spread. Symptoms and explanations of blood testing are also included. Source: Immunization Action Coalition http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=3386
·
FAQs: Viral Hepatitis B Summary: Answers to questions about hepatitis B risk factors, transmission, prevention, vaccination, and treatment. Source: National Center for Infectious Diseases, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6448
·
Hepatitis B and the Vaccine: Questions and Answers Summary: Questions and answers about hepatitis B vaccine and its safety and side effects. Source: National Immunization Program, Centers for Disease Control and Prevention http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6574
·
Hepatitis B in Asian Americans Summary: Describes steps Asian Americans can take to get screened and treated for hepatitis B. Source: Asian Liver Center at Stanford University http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=6602
Guidelines 29
·
Hepatitis B Virus (HBV) Summary: Written for clinicians, this hepatitis B virus (HBV) fact sheet presents basic information about the disorder that includes diagnosis, epidemiology, disease management guidelines, data on risk groups, Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5319
·
Prevention of Hepatitis B Virus (HBV) - Vaccination Questions and Answers Summary: Guidelines for immunization against hepatitis B virus (HBV) infection. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=5320
The NIH Search Utility After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to hepatitis B. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.
PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To
30 Hepatitis B
access the database, which is more oriented to researchers than patients, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm. Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats
·
drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html
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Family Village: http://www.familyvillage.wisc.edu/specific.htm
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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/
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Med Help International: http://www.medhelp.org/HealthTopics/A.html
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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/
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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/
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WebMDÒHealth: http://my.webmd.com/health_topics
Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Antiviral: Destroying viruses or suppressing their replication. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal
Guidelines 31
microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hepatitis: Inflammation of the liver. [EU] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Intravenous: Within a vein or veins. [EU] Jaundice: A clinical manifestation of hyperbilirubinemia, consisting of deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]
32 Hepatitis B
Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH]
Seeking Guidance 33
CHAPTER 2. SEEKING GUIDANCE Overview Some patients are comforted by the knowledge that a number of organizations dedicate their resources to helping people with hepatitis B. These associations can become invaluable sources of information and advice. Many associations offer aftercare support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your physician can be a valuable source of guidance and support. Therefore, finding a physician that can work with your unique situation is a very important aspect of your care. In this chapter, we direct you to resources that can help you find patient organizations and medical specialists. We begin by describing how to find associations and peer groups that can help you better understand and cope with hepatitis B. The chapter ends with a discussion on how to find a doctor that is right for you.
Associations and Hepatitis B As mentioned by the Agency for Healthcare Research and Quality, sometimes the emotional side of an illness can be as taxing as the physical side.9 You may have fears or feel overwhelmed by your situation. Everyone has different ways of dealing with disease or physical injury. Your attitude, your expectations, and how well you cope with your condition can all Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 9 This section has been adapted from http://www.ahcpr.gov/consumer/diaginf5.htm. 8
34 Hepatitis B
influence your well-being. This is true for both minor conditions and serious illnesses. For example, a study on female breast cancer survivors revealed that women who participated in support groups lived longer and experienced better quality of life when compared with women who did not participate. In the support group, women learned coping skills and had the opportunity to share their feelings with other women in the same situation. In addition to associations or groups that your doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your insurance provider to find out if the cost will be covered): ·
American Liver Foundation Address: American Liver Foundation 75 Maiden Lane, Suite 603, New York, NY 10038 Telephone: (212) 668-1000 Toll-free: (800) 465-4837 Fax: (973) 256-3214 Email:
[email protected] Web Site: http://www.liverfoundation.or Background: The American Liver Foundation is a national voluntary notfor-profit organization dedicated to the prevention, treatment, and cure of diseases of the liver through programs of research and education. Established in 1976, the Foundation's activities include support groups, patient advocacy, support of medical research, and patient and professional education. Educational materials include brochures on Hepatitis, Cirrhosis, Biliary Atresia, liver transplantation, gallstones, and Hereditary Hemochromatosis. Fact sheets are also available on a variety of liver diseases including Alagille Syndrome, Alpha-1-Antitrypsin Deficiency, Cancer of the Liver, Fatty Liver, Gilbert Syndrome, Primary Biliary Cirrhosis, Porphyria, and others. Videotapes produced by the Foundation include 'A Healthy Liver: A Happier Life,' 'Foundations for Decision Making,' 'Hepatitis B: Patient Information,' 'Hepatitis C: A Guide for Primary Care Physicians,' and 'The Visionaries.' The Foundation also offers liver wellness and substance abuse prevention programs to elementary schools and corporations. Relevant area(s) of interest: Gallstones, Hepatitis C, Porphyria, Wilson's Disease
·
American Social Health Association Address: American Social Health Association P.O. Box 13827, Research Triangle Park, NC 27709
Seeking Guidance 35
Telephone: (919) 361-8400 Toll-free: (800) 563-5483 Fax: (919) 361-8425 Email:
[email protected] Web Site: http://www.ashastd.or Background: The American Social Health Association (ASHA) is a notfor-profit voluntary organization dedicated to stopping sexually transmitted diseases (STDs) and their harmful consequences to individuals, families, and communities. Established in 1914, ASHA provides direct patient support through the Herpes Resource Center/National Herpes Hotline and the HPV Support Group, which coordinate a network of over 100 local support groups and publish quarterly journals. ASHA also operates the National AIDS Hotline and the National STD Hotline, both under contract with the Centers for Disease Control and Prevention (CDC), as well as the FIRST STEP Hotline and Health Check Hotline, components of North Carolina's effort to improve the health and development of children in the state. In addition, ASHA advocates for increased funding for STD programs and public policies on STD control, working through its office in Washington D.C.; provides leadership for the National Coalition to Fight Sexually Transmitted Diseases; and operates the Women's Health Matters program. The organization also administers the ASHA Research Fund, the only privately funded training program for STD research. ASHA's materials include an annual report, quarterly catalog, and pamphlets. ASHA also maintains a web site at http://sunsite.unc.edu/ASHA/. Relevant area(s) of interest: Hepatitis B ·
British Liver Trust Address: British Liver Trust Ransomes Europark, Ipswich, Suffolk, 1P3 9QG, United Kingdom Telephone: 01473 276326 Toll-free: 0808 800 1000 Fax: 01473 276327 Web Site: http://www.britishlivertrust.org.u Background: The British Liver Trust is a nonprofit organization in the United Kingdom that is dedicated to helping adults with all forms of liver disease. The Trust is committed to promoting and funding liver disease research, publishing current information for affected individuals and family members, and supporting all individuals affected by liver disease and those who care for them. To fulfill its mission and objectives, the British Liver Trust offers a variety of programs and services including confidential telephone helplines, a nationwide network of support
36 Hepatitis B
groups, annual national support group conferences, a web site on the Internet, and several publications, including informational leaflets and a regular newsletter entitled 'Liver Focus.' The Trust also supports training conferences for managers and health and safety officers concerning employee protection against infection from bloodborne viruses (i.e., including those that cause different forms of hepatitis) and has promoted the development of the British Liver Trust Liver Nurses' Forum, a national organization open to any nurse who works with liver patients or who has a special interest in liver disease. The Nurses' Forum is committed to conducting biannual meetings, offering an annual conference where nurses are encouraged to present their own research and to discuss issues of special relevance to liver nurses, promoting informal links between members, and publishing a regular newsletter. The British Liver Trust's web site discusses the organization's mission, goals, and services; offers news updates and access to research information; posts recent editions of its newsletter; and provides understandable information on different forms of liver disease. Relevant area(s) of interest: Hepatitis A, Hepatitis B, Hepatitis C ·
Canadian Liver Foundation Address: Canadian Liver Foundation 365 Bloor Street, Suite 200, Toronto, Ontario, M4W 3L4, Canada Telephone: (416) 964-4935 Toll-free: (800) 563-5483 Fax: (416) 964-0024 Email:
[email protected] Web Site: http://www.liver.c Background: The Canadian Liver Foundation (CLF) is a not-for-profit health organization committed to reducing the incidence and impact of liver disease by providing support for research and education into the causes, diagnosis, prevention and treatment of more than 100 diseases of the liver. Established in 1969, the CLF has established 30 chapters across Canada and provides information in both English and French. Some of the liver diseases discussed in brochures and medical information sheets available from CLF include gallstones, hemochromatosis, primary biliary cirrhosis, several forms of hepatitis, porphyria, fatty liver, and liver cancer. Further information is provided on liver transplantation, the effects of sodium, and management of variceal bleeding. The Foundation also produces a newsletter and maintains World Wide Web site at http://www.liver.ca.
Seeking Guidance 37
Relevant area(s) of interest: Cirrhosis of the Liver, Gallstones, Hepatitis A, Hepatitis B, Hepatitis C, Porphyria ·
Children's Liver Alliance Address: Children's Liver Alliance 3835 Richmond Avenue, Suite 190, Staten Island, NY 10312-3828 Telephone: (718) 987-6200 Fax: (718) 987-6200 Email:
[email protected] Web Site: http://livertx.or Background: The Children's Liver Alliance (formerly the Biliary Atresia and Liver Transplant Network) is an international not-for-profit voluntary health organization that was established in 1995. The mission of the Children's Liver Alliance (CLA) is to empower the hearts and minds of children with liver disease, their families, and the medical professionals who care for them. CLA disseminates educational information about pediatric liver diseases and transplantation via written publications, seminars, and the Internet. CLA provides a support network for families of children with liver disease (both pre- and postliver transplantation), acts as liaison between families and health care professionals, offers networking services, and promotes the importance of organ donation and tranplantation. CLA's publications include the bimonthly newsletter 'The Biliary Tree.'. Relevant area(s) of interest: Wilson's Disease
·
Children's Liver Disease Foundation (UK) Address: Children's Liver Disease Foundation (UK) AXA Equity and Law House, 35-37 Great Charles Street Queensway, Birmingham, B3 3JY, United Kingdom Telephone: 0121 212 3839 Toll-free: (800) 652-4372 Fax: 0121 212 4300 EWeb Site: http://www.childliverdisease.or Background: The Children's Liver Disease Foundation (UK) is a voluntary not- for-profit organization in the United Kingdom that was established in 1980. The Foundation is committed to providing emotional support to children, adolescents, and families affected by liver disease; promoting research into the causes of pediatric liver disease; creating a greater awareness of such disorders and conditions in the health care communities and the public; and promoting the development of means of
38 Hepatitis B
early diagnosis and cure. The Children's Liver Disease Foundation is also dedicated to providing understandable information on pediatric liver disease through general informational brochures including 'A Guide to the Liver' and 'Signs and Symptoms of Liver Disease' as well as a leaflet series on specific pediatric liver diseases and conditions, such as Alagille syndrome; neonatal hepatitis; hepatitis A, B, C, and E; biliary atresia; and others. The Foundation's web site on the Internet discusses the organization's mission, goals, and services; enables interested individuals, family members, and health care professionals to make specific inquiries; and provides access to the Foundation's publication series. Relevant area(s) of interest: Hepatitis A, Hepatitis B, Hepatitis C, Wilson's Disease ·
Hepatitis C Society of Canada Address: Hepatitis C Society of Canada 383 Huron Street, Toronto, Ontario, M5S 2G5, Canada Telephone: (416) 979-5855 Toll-free: (800) 652-4372 Fax: (416) 979-5856 Email:
[email protected] Web Site: http://web.idirect.com/~hepc Background: The Hepatitis C Society of Canada (HeCSC) is a national voluntary nonprofit organization dedicated to providing comfort and support to those infected with the hepatitis C virus, their family members, and other concerned individuals; promoting public awareness of hepatitis C and its transmission, care, and prevention; seeking fair treatment of all people living with and affected by hepatitis C; and promoting research that will help to prevent, treat, and cure hepatitis C. Viral hepatitis is inflammatory liver disease caused by viral infection. There are several forms of viral hepatitis that may be caused by different viruses. The virus responsible for hepatitis C, known as HCV, travels in the blood to the liver where it invades liver cells, multiples, and damages or destroys liver cells. Symptoms, which may range from mild to severe, may include fatigue, abdominal pain, nausea with or without vomiting, fever, itchy skin, and yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice). The Hepatitis C Society of Canada was established in 1994 and currently has a network of over 20 support groups across Canada to promote mutual support and networking among affected individuals and family members. The Society also compiles and distributes information about hepatitis C to affected individuals and family members, the general public, the medical
Seeking Guidance 39
community, and policymakers and has established an ongoing dialogue with public health officials and government representatives to advocate for equality of access to disability pension plans, fair treatment from employers, and improvements in the security of Canada's blood supply. The Hepatitis C Society of Canada also offers local counseling, support, and referral services for affected individuals, family members, and friends via its 800 line; communicates on behalf of employees for fair treatment in the workplace; assists affected individuals in obtaining benefits from the disability pension plan; and provides representation at the Krever Commission Blood Inquiry on behalf of transfused carriers of hepatitis C. In addition, the Society conducts educational seminars, publishes a bimonthly newsletter, and maintains a web site on the Internet. Relevant area(s) of interest: Hepatitis C ·
Hepatitis Foundation International Address: Hepatitis Foundation International 30 Sunrise Terrace, Cedar Grove, NJ 07009-1423 Telephone: (973) 239-1035 Toll-free: (800) 891-0707 Fax: (973) 857-5044 Email:
[email protected] Web Site: http://www.hepFI.or Background: Hepatitis Foundation International (HFI) is a voluntary notfor- profit membership organization dedicated to increasing awareness of the worldwide problem of viral hepatitis and educating the public and health care providers about its prevention, diagnosis, and treatment. Viral hepatitis is inflammatory liver disease caused by viral infection. There are several different forms of viral hepatitis that may be caused by different viruses. Such forms of hepatitis include hepatitis A, hepatitis B, hepatitis C, hepatitis D, and hepatitis E. Depending upon the specific form of the disease and other factors, viral hepatitis may cause liver cell damage, associated scarring of the liver (cirrhosis), and, in some cases, an increased risk of liver cancer. In some cases, affected individuals may have no apparent symptoms. In other cases, some adults with hepatitis A may have dark urine and light stools and may experience fatigue, nausea, vomiting, fever, abdominal pain, and/or abnormal yellowing of the skin and the whites of the eyes (jaundice). Some individuals with hepatitis B, C, D, or E may have dark urine and light stools and experience mild flulike symptoms, fatigue, fever, and/or jaundice. Hepatitis Foundation International was established in 1995 and currently consists of approximately 35,000 members. The Foundation focuses exclusively on
40 Hepatitis B
bringing viral hepatitis under control by supporting research to find cures; providing educational programs and materials to inform health professionals, affected individuals, family members, and the public concerning new diagnostic and treatment methods; and offering a support network for those who are affected by viral hepatitis. Hepatitis Foundation International also engages in patient advocacy and lobbying, provides appropriate referrals, and has a registry. The Foundation offers a wide range of educational materials including brochures, posters, information sheets, booklets, a primer for teachers concerning hepatitis B and substance abuse prevention, a coloring book for children, and a regular newsletter entitled 'Hepatitis Alert.' In addition, Hepatitis Foundation International has a web site on the Internet. Relevant area(s) of interest: Diffuse Hepatocellular Inflammatory Disease, Hepatitis A, Hepatitis B, Hepatitis C ·
Immunization Action Coalition/Hepatitis B Coalition Address: Immunization Action Coalition/Hepatitis B Coalition 1573 Selby Avenue, St. Paul, MN 55104 Telephone: (651) 647- 9009 Toll-free: (800) 652-4372 Fax: (651) 647-9131 Email:
[email protected] Web Site: http://www.immunize.or Background: The Immunization Action Coalition/Hepatitis B Coalition (IAC) is a nonprofit organization dedicated to boosting immunization rates and promoting Hepatitis B vaccinations. Established in 1990, the Immunization Action Coalition promotes physician, community, and family awareness of and responsibility for appropriate immunization of all people of all ages against all vaccine-preventable diseases. The Hepatitis B Coalition, a program of the Immunization Action Coalition, promotes Hepatitis B vaccination for all infants, children, and adolescents. Hepatitis B is one of several viral agents that cause inflammation of the liver known as 'hepatitis' or 'diffuse hepatocellular inflammatory disease.' Hepatitis B is characterized by fever, nausea, vomiting, and persistent yellowing of the skin, mucous membranes, and whites of the eyes (jaundice). The IAC's educational materials include a newsletter, brochures, and audiovisual aids. IAC also maintains a web site on the Internet at http://www.immunize.org. Relevant area(s) of interest: Hepatitis A, Hepatitis B
Seeking Guidance 41
Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for patient associations.
The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about hepatitis B. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.
DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov/. Simply type in “hepatitis B” (or a synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.
The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “hepatitis B”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “hepatitis B” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with hepatitis B. You should check back periodically with this database since it is updated every 3 months.
42 Hepatitis B
The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific diseases. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “hepatitis B” (or a synonym) in the search box.
Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms for people with different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online self-help communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.
Finding Doctors One of the most important aspects of your treatment will be the relationship between you and your doctor or specialist. All patients with hepatitis B must go through the process of selecting a physician. While this process will vary from person to person, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:10 ·
If you are in a managed care plan, check the plan’s list of doctors first.
·
Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.
·
Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.
10
This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 43
·
Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.
Additional steps you can take to locate doctors include the following: ·
Check with the associations listed earlier in this chapter.
·
Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.
·
The American Board of Medical Specialties can tell you if your doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at http://www.abms.org/newsearch.asp.11 You can also contact the ABMS by phone at 1-866-ASK-ABMS.
·
You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.
If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.
While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 11
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Selecting Your Doctor12 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your health insurance plan and if he or she is taking new patients. If the doctor is not covered by your plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your chosen physician. During the first visit you will have the opportunity to evaluate your doctor and to find out if you feel comfortable with him or her. Ask yourself, did the doctor: ·
Give me a chance to ask questions about hepatitis B?
·
Really listen to my questions?
·
Answer in terms I understood?
·
Show respect for me?
·
Ask me questions?
·
Make me feel comfortable?
·
Address the health problem(s) I came with?
·
Ask me my preferences about different kinds of treatments for hepatitis B?
·
Spend enough time with me?
Trust your instincts when deciding if the doctor is right for you. But remember, it might take time for the relationship to develop. It takes more than one visit for you and your doctor to get to know each other.
Working with Your Doctor13 Research has shown that patients who have good relationships with their doctors tend to be more satisfied with their care and have better results. Here are some tips to help you and your doctor become partners: ·
You know important things about your symptoms and your health history. Tell your doctor what you think he or she needs to know.
·
It is important to tell your doctor personal information, even if it makes you feel embarrassed or uncomfortable.
12 This
section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. 13 This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.
Seeking Guidance 45
·
Bring a “health history” list with you (and keep it up to date).
·
Always bring any medications you are currently taking with you to the appointment, or you can bring a list of your medications including dosage and frequency information. Talk about any allergies or reactions you have had to your medications.
·
Tell your doctor about any natural or alternative medicines you are taking.
·
Bring other medical information, such as x-ray films, test results, and medical records.
·
Ask questions. If you don’t, your doctor will assume that you understood everything that was said.
·
Write down your questions before your visit. List the most important ones first to make sure that they are addressed.
·
Consider bringing a friend with you to the appointment to help you ask questions. This person can also help you understand and/or remember the answers.
·
Ask your doctor to draw pictures if you think that this would help you understand.
·
Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.
·
Let your doctor know if you need more time. If there is not time that day, perhaps you can speak to a nurse or physician assistant on staff or schedule a telephone appointment.
·
Take information home. Ask for written instructions. Your doctor may also have brochures and audio and videotapes that can help you.
·
After leaving the doctor’s office, take responsibility for your care. If you have questions, call. If your symptoms get worse or if you have problems with your medication, call. If you had tests and do not hear from your doctor, call for your test results. If your doctor recommended that you have certain tests, schedule an appointment to get them done. If your doctor said you should see an additional specialist, make an appointment.
By following these steps, you will enhance the relationship you will have with your physician.
46 Hepatitis B
Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help patients find healthcare professionals. These include:14 ·
Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html
·
Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html
·
Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html
Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU]
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
14
Clinical Trials 47
CHAPTER 3. CLINICAL TRIALS AND HEPATITIS B Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning hepatitis B.
What Is a Clinical Trial?15 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for hepatitis B is to try it on patients in a clinical trial.
The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.
15
48 Hepatitis B
What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·
Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.
·
Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on hepatitis B.
·
Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for hepatitis B compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment.
How Is a Clinical Trial Conducted? Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your visits. All doctors and researchers who take part in the study on hepatitis B carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat you in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on hepatitis B. In other clinical trials, where a new surgery or device (not a medicine) is being
Seeking Guidance 49
tested, patients in the control group may receive a “sham treatment.” This treatment, like a placebo, has no effect on hepatitis B and does not harm patients. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to participate in a clinical trial, you will not know which group you will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request to receive the new treatment instead of the placebo or sham treatment. Often, you will not know until the study is over whether you have been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the patients or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how hepatitis B develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for hepatitis B. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a disease or disorder develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a disease or disorder usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Patients in a Clinical Trial? Not everyone can take part in a clinical trial for a specific disease or disorder. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of disease or disorder, as well as, the age and previous treatment history of the patient. You or your doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you are interested in joining a clinical trial, your doctor must contact one of the trial’s investigators and provide details about your diagnosis and medical history.
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If you participate in a clinical trial, you may be required to have a number of medical tests. You may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, you may be required to receive inpatient hospital care. Or, you may have to return to the medical facility for follow-up examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.
Recent Trials on Hepatitis B The National Institutes of Health and other organizations sponsor trials on various diseases and disorders. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every disease and disorder at all times. The following lists recent trials dedicated to hepatitis B.16 If the trial listed by the NIH is still recruiting, you may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your physician who can help you determine if you might benefit from participation. ·
A Comparison Study of the Efficacy of Adefovir and Tenofovir for the Treatment of Lamivudine-Resistant Hepatitis B Virus Condition(s): HIV Infections; Hepatitis B Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: The purpose of this study is to find out if adding adefovir dipivoxil (ADV) or tenofovir disoproxil fumarate (TDF) with lamivudine (3TC) has an effect on hepatitis B virus (HBV) infection, and to study the tolerability and safety of the drugs. HBV infection that lasts for a long time is an important cause of death, occurrence of disease, and a source of potential new infections around the world. Treatment with nucleoside analogue drugs such as 3TC can help inhibit HBV, but these drugs cannot always control the infection for a long period of time. Failure of 3TC to suppress HBV is particularly common in people who
16
These are listed at www.ClinicalTrials.gov.
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are also being treated for human immunodeficiency virus (HIV). To help people whose HBV infections cannot be controlled with 3TC, researchers need to identify and study other anti-HBV drugs. Both ADV and TDF are drugs that can inhibit HBV. This study will compare the combination of ADV and 3TC with the combination of TDF and 3TC to determine which drug combination is most effective in people who are infected with both HBV and HIV. Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033163;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
A Phase III Study of Entecavir vs Lamivudine in Adults with Chronic Hepatitis B Infection and Negative for Hepatitis B Antigen Condition(s): Chronic Hepatitis B Study Status: This study is currently recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: The purpose of this clinical trial is to learn if entecavir, as compared to lamivudine, will have equal or superior clinical effectiveness in the treatment of adults with chronic hepatitis B infection who are hepatitis B e antigen negative. The safety of this treatment will also be studied. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00035789;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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A Phase III Study of Entecavir vs Lamivudine in Adults with Chronic Hepatitis B Infection and Positive for Hepatitis B Antigen Condition(s): Chronic Hepatitis B Study Status: This study is currently recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: The purpose of this clinical research study is to learn if entecavir, as compared to lamivudine, will have equal or superior clinical
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effectiveness in the treatment of adults with chronic hepatitis B infection who are hepatitis B e antigen positive. The safety of this treatment will also be studied. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00035633;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
A Phase III Study of Entecavir vs Lamivudine in Chronic Hepatitis B Subjects with Incomplete Response to Lamivudine Condition(s): Chronic Hepatitis B Study Status: This study is currently recruiting patients. Sponsor(s): Bristol-Myers Squibb Purpose - Excerpt: The purpose of this clinical trial is to learn if switching to entecavir will be superior to continued lamivudine in improving liver histology, reducing the measured hepatitis B virus in the blood to undetectable levels and in normalizing the ALT level (liver function test). The safety of this treatment will also be studied. Phase(s): Phase III Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00036608;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Adefovir Dipivoxil to Treat Hepatitis B in HIV-Infected Patients Condition(s): Hepatitis B; HIV Infection Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will evaluate the safety and effectiveness of adding the experimental drug adefovir dipivoxil to lamivudine for treating hepatitis B virus (HBV) infection in HIV-infected patients with liver cirrhosis. Adefovir inhibits HBV by interfering with replication of the virus's genetic material. In some people, the drug has been active against strains of HBV that are resistant to lamivudine; it may also have some activity against HIV. HIV-infected patients 21 years of age and
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older with chronic hepatitis B infection and liver cirrhosis who have received lamivudine treatment for at least 1 year may be eligible for this 48-week study. Candidates will be screened with a complete medical history, blood tests and a 24-hour urine collection. Blood tests include HLA typing (a test of genetic markers on white blood cells that permit specialized immunology studies). Within 4 weeks, candidates who appear eligible for the study will have a physical examination and medical history, an abdominal ultrasound (imaging test using sound waves) to check for cancer of the liver, chest X-ray and electrocardiogram (EKG). Blood and urine tests will also be done, and women who can become pregnant will have a pregnancy test. Patients who meet the study criteria and decide to participate will then start treatment with one 10-mg adefovir pill per day by mouth. In addition, patients will continue to take all other medications prescribed by their doctor. Follow-up clinic visits will be scheduled as follows: - Days 1, 3, 5, 7, 10 and 21 - Blood will be drawn for specialized immunology tests and to measure blood levels of HIV and HBV. - Weeks 2, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44 - Blood and urine (single sample) tests will be done to determine the side effects of adefovir and its effect on the HBV infection. - Week 48 or early termination (end of study) - Blood tests (including tests for hepatitis C and D), abdominal ultrasound and a 24-hour urine collection to evaluate kidney function will be done. - Monthly visits beyond week 48 - Based on the HBV response to treatment and the availability of the drug from the sponsor, patients may be offered to extend their treatment with adefovir. Those who continue will have monthly follow-up visits for blood and urine (single sample) tests. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00013702;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Frequency of Parenteral and Non-Parenteral Exposures to Blood Among Healthcare Workers at the Clinical Center, NIH and at Seven Academic Hospitals in Japan Condition(s): Hepatitis B; Hepatitis C; HIV Infection Study Status: This study is currently recruiting patients. Sponsor(s): Warren G Magnuson Clinical Center (CC) Purpose - Excerpt: Following guidelines issued by the Centers for Disease Control, the Clinical Center implemented a Universal Precautions policy in November 1987 in an attempt to reduce healthcare workers' risks for occupational exposures to bloodborne pathogens. All hospital personnel whose jobs entailed potential exposure to patients' blood and body substances were required to attend a training session and complete a written examination. Based on data from surveys conducted before and twelve months after training in Universal Precautions, the frequency of cutaneous exposure to blood decreased by 50% in temporal association with implementation of Universal Precautions. Staff at the Clinical Center are required to take a refresher course in Universal Precautions annually. The prevalence of bloodborne infections is high in Japan; however, Universal Precautions are not widely practiced in Japan. This study is designed: 1) to evaluate and compare nurses' knowledge of the epidemiology, pathogenesis, occupational risks, and appropriate prevention strategies for managing patients infected with bloodborne pathogens in the healthcare setting in seven university hospitals in Japan and at the Clinical Center of the National Institutes of Health in the US; 2) to compare self-reported levels of compliance with existing infection control recommendations designed to limit risk for exposure to bloodborne pathogens in all four institutions; 3) to compare self-reported frequencies of cutaneous exposures to blood at the four hospitals in the study; and 4) to evaluate the effect of educational intervention on nurses perceived compliance with recommendations and on the frequency of self-reported exposures to blood. Study Type: Observational Contact(s): Maryland; Warren G. Magnuson Clinical Center (CC), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001712;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Lamivudine and Adefovir to Treat Chronic Hepatitis B Condition(s): HBV; Hepatitis B; Hepatitis; Liver Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: This study will evaluate the safety and effectiveness of lamivudine plus adefovir to treat chronic hepatitis B infection. The Food and Drug Administration has approved lamivudine for the treatment of hepatitis B. However, the drug is not effective in all patients, and many of those in whom it initially works develop resistance after 1 to 3 years. Adefovir is an experimental drug that inhibits replication of the hepatitis B virus (HBV). The combination of drugs may be more effective against HBV than lamivudine alone. Patients 18 years of age and older who have been infected with HBV for at least 6 months may be eligible for this study. Candidates may not have received prior treatment with lamivudine or adefovir and must not be taking other treatments for hepatitis. They will have a blood test to confirm HBV infection. Participants will be admitted to the NIH Clinical Center for 2 to 3 days for a medical evaluation, including a history and physical examination, blood and urine tests, 24-hour urine collection, chest X-ray, electrocardiogram (EKG), abdominal ultrasound and a liver biopsy if one has not been done within the last year. This procedure involves withdrawing a small sample of liver tissue through a needle placed in the liver. One to 2 weeks after the evaluation, patients will begin taking 100 milligrams/day of lamivudine and 10 mg/day of adefovir, both in pill form. Therapy will continue for at least 12 months. Follow-up clinic visits will be scheduled weekly for the first month, then every 4 to 8 weeks for the rest of the treatment period. The visits will involve a history and physical examination and blood tests. At the end of 1 year, patients will be evaluated in the Clinical Center with the same tests done at the beginning of the study. Patients who have not improved with treatment will stop taking the drugs and will be evaluated in the clinic once every 4 weeks for another 6 months. Patients who show an improvement in their liver injury may continue taking lamivudine and adefovir for 4 more years, as long as they continue to improve with the medication. Progress will be evaluated with blood tests for HBV levels and liver enzymes. If the test results show no continued improvement or are negative for hepatitis B antigens, therapy will be stopped. Patients who continue treatment for 5 years will be readmitted to the Clinical Center for another medical evaluation and liver biopsy to assess the effects of treatment at that time. All patients will stop therapy at this point and be followed with regular clinic visits for at least 6 months.
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Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023309;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
Lamivudine and Adefovir to Treat Chronic Hepatitis B Infection in People With and Without HIV Infection Condition(s): HIV Infections; Chronic Hepatitis B Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will evaluate the safety and effectiveness of adefovir plus lamivudine for chronic hepatitis B infection in people with and without HIV infection. Lamuvidine, an FDA-approved treatment for hepatitis B infection, also works against HIV. In some patients, the hepatitis B virus (HBV) continues to reproduce despite lamivudine treatment. Adefovir is an experimental drug that inhibits HBV replication and may work against some strains of the virus that have become resistant to lamivudine. Patients 21 years of age or older with active hepatitis B infection despite treatment with lamivudine for at least 1 year may be eligible for this 48-week study. Patients both with or without HIV infection may participate. Candidates will be screened with a medical history, blood and urine tests, liver ultrasound exam, electrocardiogram (EKG) and chest X-ray. Participants will have a physical examination, review of their medical history, blood tests, and a 24-hour urine collection. They will be admitted to the hospital for a liver biopsy to determine if they can receive the study drug. For this procedure, the patient is given a sedative for relaxation. The skin over the biopsy is numbed with an anesthetic and the biopsy needle is passed rapidly into and out of the liver to collect a tissue specimen. Patients are monitored in the hospital overnight for possible complications. After discharge, they return home and begin taking the study medications. Patients will be randomized to two treatment groups. One group will take 10 milligrams/day of adefovir by mouth, and the other will take a placebo-a lookalike pill with no active ingredient. Both groups will also take 150 mg lamivudine by mouth and L-carnitine pills or liquid. Patients with HIV infection will continue to take antiretroviral therapy as well. Patients will
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be followed in the clinic at study weeks 2, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40 and 44 for blood and urine tests to determine the safety of the drug and to evaluate the response to treatment. On week 48, a repeat 24-hour urine test and repeat liver biopsy will be done. At the end of the 48 weeks, patients may continue to receive adefovir for another 48 weeks and possibly longer. All those who participate in this extension phase will receive active adefovir, regardless of whether they had previously taken adefovir or placebo. All patients will have the option to enroll in a separate study to examine the levels of HBV (and levels of HIV in HIVinfected patients) in the blood immediately after starting treatment and to determine if these initial levels can predict later outcome. This involves seven additional visits, for which participants will be compensated. At these visits, blood will be drawn on study days 0 (before starting drug treatment), 1, 3, 5, 7, 10 and 21 for HIV and HBV viral loads and specialized immunology tests. Phase(s): Phase III Study Type: Interventional Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00023153;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
Lamivudine for Chronic Hepatitis B Condition(s): Chronic Hepatitis B; Glomerulonephritis; Polyarteritis Nodosa
Chronic
Hepatitis
D;
Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Purpose - Excerpt: Chronic hepatitis B is a disease of the liver caused by the hepatitis B virus. It affects nearly 1 million Americans. Approximately 25% of patients with chronic hepatitis B will develop liver cirrhosis and 5% of patients will develop liver cancer. Presently, two medications have been shown effective in the treatment of hepatitis B: lamivudine and alpha interferon. Alpha interferon (an antiviral drug that acts through the immune system) is given by injection once daily or three times a week for four to six months. Lamivudine (also known as 3-thiacytidine: 3TC) is an antiviral medication given as a pill once a day for twelve months. These
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treatments have been known to provide long-term improvement in one third of patients receiving them. In previous research, the drug lamivudine was shown to stop the growth of the hepatitis B virus and to lead marked decreases in the levels of hepatitis B virus and to improvements in the disease in 50 to 70% of patients. However, once lamivudine therapy was discontinued the virus returned to levels noted before the therapy began. In those studies lamivudine was given for 3 to 12 months then discontinued. This study will investigate the safety and effectiveness of long-term therapy with lamivudine. This study will select 60 patients diagnosed with hepatitis B. After a thorough medical examination and liver biopsy, subjects will be given lamivudine. The drug will be taken by mouth in tablet form (100 mg) once a day for up to 5 years. Subjects will undergo regular check-ups and after 1 year of therapy be admitted to the Clinical Center for another medical examination and liver biopsy to assess progress. Patients who have benefitted from the therapy will continue taking the medication for up to 5 years. A third liver biopsy will be done during the last year of treatment. The effectiveness of lamivudine will be determined by whether levels of hepatitis B virus decrease in the blood, whether liver enzymes improve, and whether inflammation and scarring decreases in the liver biopsies. Phase(s): Phase II Study Type: Interventional Contact(s): Maryland; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222
[email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001457;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
Safety and antiviral activity study of ACH-126,443 (beta-L-Fd4C) in treatment naive adults with chronic Hepatitis B Virus infection Condition(s): Hepatitis B, Chronic Study Status: This study is currently recruiting patients. Sponsor(s): Achillion Pharmaceuticals Purpose - Excerpt: The purpose of this study is to determine the safety and anti-HBV activity of ACH-126, 443 (beta-L-Fd4C) in comparison to lamivudine or placebo in treatment naive adults with chronic Hepatitis B infection.
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Phase(s): Phase II Study Type: Interventional Contact(s): see Web site below Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00034359;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
Comparison of Immune Response to Booster Vaccines in Blood Transplant Patients and Healthy Volunteers Condition(s): Active Immunity; Healthy; Stem Cell Transplantation Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID) Purpose - Excerpt: This study will compare the immune system response to booster vaccines for tetanus/diphtheria and hepatitis B in healthy volunteers with that of patients who have had a blood transplant. (A blood transplant is an infusion of donated stem cells-i.e., cells that mature into white blood cells, red blood cells and platelets). The study will also look at how age of the blood cell donor and recipient, the type of blood transplant, the amount of certain types of white cells in donor blood, and other variables may influence the vaccine response among the transplant patients. This study includes normal volunteers and patients who have had a blood transplant. Healthy volunteers between the ages of 18 and 60 who have previously been vaccinated with the hepatitis B or tetanus/diphtheria vaccine and have not had hepatitis B may be eligible for this study. Patients enrolled in a blood cell transplant study at NIH who are between 5 and 60 years old, have been vaccinated against tetanus/diphtheria, and have not had hepatitis B may be eligible. Candidates will be screened with a medical history and blood tests. Those enrolled in the study will have about 2 tablespoons of blood drawn before vaccination with a standard tetanus/diphtheria booster shot. Volunteers who have previously been vaccinated with the hepatitis B vaccine and all blood transplant patients will also receive a hepatitis B vaccination. Participants will have blood drawn (from 1 to 5 tablespoons) up to once a week after vaccination for no more than 8 weeks to evaluate the immune response to vaccination. Study Type: Observational Contact(s): Maryland; National Institute of Allergy and Infectious Diseases (NIAID), 9000 Rockville Pike Bethesda, Maryland, 20892, United States
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Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005907;jsessionid=C6A819 30D5C0C51220D49700F23155B4 ·
Hepatitis B Vaccine Clinical Trial Condition(s): Hepatitis B; Hepatitis, Viral, Human; Liver Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To determine the efficacy of a hepatitis vaccine in preventing hepatitis B. Phase(s): Phase III Study Type: Prevention Contact(s): Kellner and Szmuness, Aaron and Wolf New York, New York, United States . Study chairs or principal investigators: Kellner and Szmuness, Aaron and Wolf, Study Chair; New York Blood Center New York, New York, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000583;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Interruption of Maternal-to-Infant Transmission of Hepatitis B by Means of Hepatitis B Immune Globulin Condition(s): Hepatitis B; Hepatitis, Viral, Human; Liver Diseases Study Status: This study is completed. Sponsor(s): National Heart, Lung, and Blood Institute (NHLBI) Purpose - Excerpt: To evaluate whether hepatitis B immune globulin with a high level of antibody against the hepatitis B antigen would be capable of interrupting maternal-fetal transmission of hepatitis B virus, the single most important route of hepatitis spread in the entire Third World. Phase(s): Phase III Study Type: Prevention Contact(s): Szmuness, Wolf New York, New York, United States . Study chairs or principal investigators: Szmuness, Wolf, Study Chair; Community Blood Council of Greater New York New York, New York, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000580;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Safety and antiviral study of ACH126, 433 (b-L-Fd4C) in adults with lamivudine-resistant chronic hepatitis B Condition(s): Chronic Hepatitis B Study Status: This study is not yet open for patient recruitment. Sponsor(s): Achillion Pharmaceuticals Purpose - Excerpt: The purpose of this study is to determine the safety and antiviral HBV activity of ACH126, 433 (b-L-Fd4C) in the treatment of adults with lamivudine-resistant chronic Hepatitis B. Phase(s): Phase II Study Type: Interventional Contact(s): John Pottage, M.D. 203-624-7000
[email protected] Aimee M Seaman 203-401-3182
[email protected]; Massachusetts; Beth Israel Deaconess Medical Center, Boston, Massachusetts, 02215, United States Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00040144;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Safety and antiviral study of ACH-126, 443 (beta-L-Fd4C) in the treatment of adults with chronic Hepatitis B infection. Condition(s): Chronic Hepatitis B Study Status: This study is not yet open for patient recruitment. Sponsor(s): Achillion Pharmaceuticals Purpose - Excerpt: The purpose of this study is to determine the safety and antiviral HBV activity of ACH-126,443 (beta-L-Fd4C) in the treatment of Subjects of Previous Achillion-Sponsored Phase 1 and 2 Studies in Chronic Hepatitis B Infection. Study Type: Interventional Contact(s): Scott C. Oshana (203) 401-3109
[email protected] John Pottage, M.D. (203) 624-7000 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00037622;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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The Tolerance of HIV-Infected Patients with Herpes Group Virus Infections to Oral Doses of FIAU Condition(s): Herpes Simplex; HIV Infections; Hepatitis B
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Study Status: This study is completed. Sponsor(s): National Institute of Allergy and Infectious Diseases (NIAID); Oclassen Pharmaceuticals Purpose - Excerpt: To determine the tolerance of HIV-infected patients to TID oral doses of FIAU syrup at 4 different dose levels. To determine the peak and trough blood levels of FIAU and its metabolites during two weeks of oral dosing with FIAU. The pyrimidine nucleoside analog FIAC and its primary deaminated uracil metabolite FIAU are highly and specifically active compounds in vitro against several herpes group viruses, particularly herpes simplex virus (HSV) types 1 and 2, varicella zoster (VZV), and cytomegalovirus (CMV), as well as hepatitis B virus (HBV). Since FIAU is the primary metabolite of FIAC and the administration of FIAU simplifies the metabolism of FIAC, it is anticipated from clinical studies of FIAC that FIAU will be tolerated at least as well as FIAC. A single-dose, pharmacokinetic (blood level) study showed that FIAC, when taken orally, is readily absorbed into the bloodstream, and most of it is converted to FIAU. Daily oral doses are expected to provide concentrations of FIAU exceeding the in vitro minimum inhibitory concentration for nearly all the herpes group viruses. Phase(s): Phase II Study Type: Interventional Contact(s): Alabama; Univ of Alabama at Birmingham, Birmingham, Alabama, 35294, United States; California; Univ of California / San Diego Treatment Ctr, San Diego, California, 921036325, United States; Maryland; Natl Institute of Health, Bethesda, Maryland, 20892, United States; Washington; Univ of Washington / Madison Clinic, Seattle, Washington, 98122, United States. Study chairs or principal investigators: D Richman, Study Chair Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000654;jsessionid=C6A819 30D5C0C51220D49700F23155B4
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Benefits and Risks17 What Are the Benefits of Participating in a Clinical Trial? If you are interested in a clinical trial, it is important to realize that your participation can bring many benefits to you and society at large: ·
A new treatment could be more effective than the current treatment for hepatitis B. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.
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If the treatment is effective, then it may improve health or prevent diseases or disorders.
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Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.
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People who take part in trials contribute to scientific discoveries that may help other people with hepatitis B. In cases where certain diseases or disorders run in families, your participation may lead to better care or prevention for your family members. The Informed Consent
Once you agree to take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you, and your rights as a patient.
What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment you receive may cause side effects that are serious enough to require medical attention. This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f291. 17
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How Is Patient Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect patients can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect patient safety. During a clinical trial, doctors will closely watch you to see if the treatment is working and if you are experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. You will only be asked to take part in a clinical trial as a volunteer giving informed consent. What Are a Patient’s Rights in a Clinical Trial? If you are eligible for a clinical trial, you will be given information to help you decide whether or not you want to participate. As a patient, you have the right to: ·
Information on all known risks and benefits of the treatments in the study.
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Know how the researchers plan to carry out the study, for how long, and where.
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Know what is expected of you.
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Know any costs involved for you or your insurance provider.
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Know before any of your medical or personal information is shared with other researchers involved in the clinical trial.
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Talk openly with doctors and ask any questions.
After you join a clinical trial, you have the right to: ·
Leave the study at any time. Participation is strictly voluntary. However, you should not enroll if you do not plan to complete the study.
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Receive any new information about the new treatment.
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Continue to ask questions and get answers.
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Maintain your privacy. Your name will not appear in any reports based on the study.
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·
Know whether you participated in the treatment group or the control group (once the study has been completed).
What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing to participation in the trial. If you have health insurance, find out exactly what it will cover. If you don’t have health insurance, or if your insurance company will not cover your costs, talk to the clinic staff about other options for covering the cost of your care. What Should You Ask before Deciding to Join a Clinical Trial? Questions you should ask when thinking about joining a clinical trial include the following: ·
What is the purpose of the clinical trial?
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What are the standard treatments for hepatitis B? Why do researchers think the new treatment may be better? What is likely to happen to me with or without the new treatment?
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What tests and treatments will I need? Will I need surgery? Medication? Hospitalization?
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How long will the treatment last? How often will I have to come back for follow-up exams?
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What are the treatment’s possible benefits to my condition? What are the short- and long-term risks? What are the possible side effects?
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Will the treatment be uncomfortable? Will it make me feel sick? If so, for how long?
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How will my health be monitored?
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Where will I need to go for the clinical trial? How will I get there?
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How much will it cost to be in the study? What costs are covered by the study? How much will my health insurance cover?
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Will I be able to see my own doctor? Who will be in charge of my care?
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Will taking part in the study affect my daily life? Do I have time to participate?
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How do I feel about taking part in a clinical trial? Are there family members or friends who may benefit from my contributions to new medical knowledge?
Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide patients, family members, and physicians with current information about clinical research across the broadest number of diseases and conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “hepatitis B” (or synonyms). While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·
For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/
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For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html
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For trials on diseases of the digestive system and kidneys, and diabetes, visit the National Institute of Diabetes and Digestive and Kidney Diseases: http://www.niddk.nih.gov/patient/patient.htm
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General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna
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A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna
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The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna
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The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna
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Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna
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Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna
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Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna
68 Hepatitis B
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Anthrax: An infectious bacterial zoonotic disease usually acquired by ingestion of Bacillus anthracis or its spores from infected pastures by herbivores or indirectly from infected carcasses by carnivores. It is transmitted to humans usually by contact with infected animals or their discharges (agricultural a.) or with contaminated animal products (industrial a.). Anthrax is classified by primary routes of inoculation as : cutaneous, gastrointestinal, and inhalational. Called also charbon, milzbrand and splenic fever. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for
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introduction into the bladder through the urethra for the withdraw of urine. [EU]
Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as an opportunistic infection in AIDS. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU]
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Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathogen: Any disease-producing microorganism. [EU] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor. Plasmapheresis is also employed for therapeutic use. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Prevalence: The number of people in a given group or population who are
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reported to have a disease. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Refractory: Not readily yielding to treatment. [EU] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury, such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU]
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PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL
ABOUT PART II In Part II, we introduce you to additional resources and advanced research on hepatitis B. All too often, patients who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on hepatitis B. In Part II, as in Part I, our objective is not to interpret the latest advances on hepatitis B or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with hepatitis B is suggested.
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CHAPTER 4. STUDIES ON HEPATITIS B Overview Every year, academic studies are published on hepatitis B or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on hepatitis B. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on hepatitis B and teach you how to keep current on new studies as they are published or undertaken by the scientific community.
The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and hepatitis B, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the
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format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “hepatitis B” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·
HIV and Hepatitis B Infection and Risk Behavior in Young Gay and Bisexual Men Source: Public Health Reports; Vol. 112, March/April 1997. Contact: Boston University School of Public Health, Department of Epidemiology and Biostatistics, 80 East Concord St, Boston, MA, 02118, (617) 638-7718. Summary: This article describes a study conducted to estimate the prevalence of, and identify risks for, HIV type I (HIV-I) and hepatitis B virus (HBV) infections and unprotected anal intercourse among young homosexual and bisexual men. The authors performed a cross-sectional analysis of data from a prospective cohort of 508 gay and bisexual men aged 18-24. HIV-I seroprevalence was 2.4 percent with five of 390 college students and seven of 117 non-students infected. HIV-I infection was associated with having a history of a sexually transmitted disease (STD) other than HIV-I or hepatitis B. The prevalence of hepatitis B markers in unvaccinated men was 12.9 percent. This was significantly associated with Asian ethnicity, off-campus residence, and a history of an STD other than HIV-I or HBV. It was inversely associated with recent nonintravenous drug use. Eighteen percent of the participants reported having had sex with women during the previous 12 months, and 26.4 percent reported a history of unprotected anal intercourse during the previous 6 months. Men who reported unprotected anal intercourse were more likely to have a steady partner, to have met their partners in anonymous settings, and to be identified as probably alcohol-dependent. Although prevalence of HIV-I infection among young homosexual and bisexual men in Boston was relatively low, the high rates of unprotected anal intercourse suggest a potential for future HIV-I and HBV transmission. Interventions should focus on young men with histories of sexually transmitted diseases, alcohol abuse, and depression.
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Preventing Transmission of HIV and Hepatitis B in Day Care Source: Epidemiology Bulletin; Vol. 93, No. 2.
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Contact: Oklahoma State Department of Health, Disease & Prevention Services, HIV/STD Service, 1000 NE 10th St, Oklahoma City, OK, 731171299, (405) 271-4636, http://www.health.state.ok.us/program/hivstd/index.html. Summary: This journal article presents prevention measures for avoiding the spread of HIV and Hepatitis B in day care settings. Methods of exposure and transmission are discussed, with an emphasis on the fact that exposure does not necessarily lead to infection. The minimal risk of transmission in day care is indicated. A fact sheet lists precautions for day care centers to follow, with a recommendation that these become general policy for all centers in the State of Oklahoma. The list includes suggestions on staff training, sanitation, and the handling of blood. Guidelines for dealing with infected children are also provided. These recommend against exclusion from day care, and urge that other parents or uninvolved staff members not be informed. Suggestions are made for managing aggressive behavior, such as biting, that could result in transmission. Other suggestions involve what to do should a potentially infectious event occur. ·
Prevalence of Syphilis, Hepatitis B Virus (HBV), and Human Immunodeficiency Virus (HIV) Infection in New Arrestees at the Lake County Jail, Crown Point, Indiana Source: Journal of Prison & Jail Health; Vol. 12, no. 2, Winter 1993. Contact: Eli Lilly and Company, Eli Lilly Corporate Center, Indianapolis, IN, 46285, (317) 276-2000, http://www.lilly.com. Summary: This article reviews a study conducted to determine the prevalence in arrestees of syphilis, hepatitis B virus (HBV), and HIV infection by demographic and behavioral characteristics, and to evaluate the costs associated with universal screening for these sexually transmitted diseases compared with a theoretical targeted screening program. Three hundred and nineteen arrestees were screened for syphilis, HBV, and anonymously for HIV infection. The prevalence of syphilis was 2.5 percent; hepatitis B surface antigen prevalence was 1.6 percent; the prevalence of past or present HBV infection was 21.9 percent; and the prevalence of HIV infection was 1.6 percent. Targeted screening for sexually transmitted diseases was found to be more cost-effective.
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Dermatologic Manifestations of Gastrointestinal Disorders Source: Gastroenterology Clinics of North America. 27(3): 615-636. September 1998.
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Summary: This journal article provides health professionals with information on the dermatologic manifestations of gastrointestinal disorders. Many disorders of the gastrointestinal tract have cutaneous manifestations, so a careful examination of the skin may reveal clues to underlying diseases of the liver, gastrointestinal tract, and pancreas. Hepatitis A virus infection rarely causes cutaneous involvement. Jaundice is the main cutaneous manifestation in more fulminant cases of this infection. Hepatitis B virus infection may produce vasculitic and nonvasculitic cutaneous eruptions. Hepatitis C infection may produce cutaneous eruptions such as lichen planus and porphyria cutanea tarda. Cutaneous symptoms associated with cholestatic liver disease include pruritus and pigmentary changes such as jaundice and hypermelanosis. Liver dysfunction may result in vascular lesions such as spider angiomas and alterations in the normal appearance of the fingernails and toenails. Many conditions are characterized by gastrointestinal hemorrhage. Hereditary hemorrhagic telangiectasia is an autosomal dominant disorder characterized by vascular dilations of the skin and the oral, nasal, and gastrointestinal mucosa. Various skin lesions are associated with blue rubber bleb nevus syndrome. This is a rare disorder which is characterized by large cutaneous hemangiomas and gastrointestinal bleeding from vascular malformations. Kaposi's sarcoma, a neoplasm of vascular endothelium and pericapillary cells that often presents on the skin, is associated with human immunodeficiency virus. Pseudoxanthoma elasticum, a genetic disorder of elastic fibers, is associated with distinctive skin abnormalities. Other hemorrhagic disorders with cutaneous manifestations include Ehlers-Danlos syndrome and malignant atrophic papulosis. Various gastrointestinal conditions producing polyps have cutaneous manifestations. Gardner's syndrome produces skin and bone lesions. Peutz-Jeghers syndrome causes small dark freckles on the lips and buccal mucosa. CanadaCronkhite syndrome is a rare disease characterized by cutaneous hyperpigmentation, alopecia, and nail changes. Other diseases producing gastrointestinal polyps and cutaneous manifestations include neurofibromatosis, Cowden's disease, Muir-Torre syndrome, and acrochordons. Cutaneous conditions associated with gastrointestinal neoplasms include cutaneous metastic disease, acanthosis nigricans, Leser-Trelat sign, tylosis palmaris et plantaris, carcinoid syndrome, and glucogonoma syndrome. Cutaneous manifestations such as erythema nodosum, oral aphthous ulcers, and pyoderma gangrenosum are associated with ulcerative colitis and Crohn's disease. Acute pancreatitis can be associated with Turner's sign and Cullen's sign. Pancreatic panniculitis also produces cutaneous manifestations. 10 figures and 77 references.
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·
Comparison of Clinical, Virologic and Pathologic Features in Patients with Acute Hepatitis B and C Source: Journal of Gastroenterology and Hepatology. 16(2): 209-214. February 2001. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: The clinical outcomes of adult acquired acute infection of hepatitis C virus (HCV) and hepatitis B virus (HBV) are quite different. This article reports on a comparison of clinical, biochemical, virologic, and pathologic pictures in 22 adults patients with acute hepatitis C and 16 adult patients with acute hepatitis B. Liver biopsies were performed within 3 months of acute onset of the illness in each of these patients. The results showed that a significantly younger age; a higher ratio of the clinical symptoms of jaundice, nausea, vomiting, and poor appetite; a higher mean serum (blood) level of alanine transaminase; aspartate transaminase, and total bilirubin were present in patients with acute hepatitis B, compared to those with acute hepatitis C. There was a significantly higher degree of periportal inflammation and total necroinflammatory activity in the acute hepatitis B patients. Fifteen (68.2 percent) of the 22 patients with acute hepatitis C had detectable serum HCV RNA, but only two (14.3 percent) of the 14 tested patients with acute hepatitis B had detectable serum HCV DNA, detected by using the branched DNA signal amplification assay. Eighteen (82 percent) of the 22 acute hepatitis C patients and none of the 16 acute hepatitis B patients progressed into a chronic hepatitis stage. 3 tables. 35 references.
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Hepatitis B Infection in Patients with Acute Liver Failure in the United States Source: Hepatology. 33(4): 972-976. April 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Occult (hidden) hepatitis B virus (HBV) infection has been reported in 30 to 50 percent of patients with acute liver failure (ALF) in small case series. This article reports on a study undertaken to determine the prevalence of occult HBV infection in a large series of ALF patients in the United States and the prevalence of precore and core promoter variants in patients with ALF caused by hepatitis B. Sera (blood products) from patients in the US ALF study and liver, when available, were tested using nested polymerase chain reaction (PCR) with primers in the HBV S and precore regions. PCR positive samples were sequenced.
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Sera and or liver from 139 patients (39 males, 100 females; mean age 42 years) were studied between January 1998 and December 1999. Twelve patients were diagnosed with hepatitis B, one with hepatitis B, C, and D coinfection, and 22 had indeterminate etiology (cause). HBV DNA was detected in the sera of 9 patients (6 percent); all 9 had ALF caused by hepatitis B. HBV genotypes A, B, C, and D were present in 4, 3, 1, and 1 patients, respectively. Seven of these 9 patients had precore or core promoter variants. Liver from 19 patients were examined. HBV DNA was detected in the liver of 3 patients with ALF caused by hepatitis B, but in none of the remaining 16 patients with non B ALF. Contrary to earlier reports, occult HBV infection was not present in this large series of ALF patients in the United States. 1 appendix. 3 tables. 34 references. ·
Adding to the Hepatitis B Virus Treatment Arsenal: Glucosidase Inhibitor Derivatives (editorial) Source: Hepatology. 33(6): 1544-1546. June 2001. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 19106-3399. (800) 654-2452 or (407) 345-4000. Summary: Chronic hepatitis B virus (HBV) infection is a major cause of cirrhosis (scarring) and hepatocellular carcinoma (liver cancer) in the United States and worldwide. Eradication of the infection and prevention of complications of chronic infection are the dual goals of treatment. This editorial comments on an accompanying article which reports on the use of alfa glucosidase inhibitor derivatives in the drug therapy for HBV infections. The agents under consideration (N nonyl DNJ and N nonyl DGJ) appear to have a mechanism of action that is unique and potentially complementary to that of nucleoside analogues. As new agents for treatment of HBV infection become available for clinical use, combination treatment of chronic HBV infection can be anticipated. The editorial stresses that designing the optimal combination therapy for HBV will need to take into account drug potency, mechanism of drug uptake and activation, sites of drug action, effect on cccDNA, and specific viral mutations arising with prolonged therapy. The author concludes that it remains to be seen whether these imino sugars (N nonyl DNJ and N nonyl DGJ) will join the growing list of anti HBV drugs. However, if the present results can be reproduced in animal studies and clinical trials (with humans), this novel class of agents may be a welcome addition to the arsenal of anti HBV drugs. 1 figure. 1 table. 13 references.
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Kidney Transplantation in Patients with Chronic Hepatitis B Virus Infection: Is the Prognosis Worse? Source: Digestive Diseases and Sciences. 46(3): 469-475. March 2001.
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Contact: Available from Kluwer Academic/Plenum Publishers. 233 Spring Street, New York, NY 10013-1578. (212) 620-8000. Fax (212) 8071047. Summary: The impact of hepatitis B virus (HBV) infection on the long term outcome of kidney transplant patients is controversial. This study included a total of 34 chronic hepatitis B surface antigen (HBsAg) carriers among 143 renal (kidney) allograft recipients (mean follow up period: 5.6 years plus or minus 3.3 years; range 1 to 13 years). During the follow up, one HBsAg positive recipient with preexisting cirrhosis died of liver failure, and seven (21 percent) others developed serious HBV related complications (4 had fulminant hepatitis, 2 hepatocellular carcinoma or liver cancer, and 1 cirrhosis), and four died. Although HBsAg positive recipients had a higher rate of liver related complications and deaths than HBsAg negative recipients did, there were no significant differences in the long term graft and patient survival between the two groups. The survival rates, liver related complications, and deaths in HBsAg positive allograft recipients and 28 HBsAg positive uremic patients under dialysis were similar. The authors conclude that HBV infection is not a contraindication to kidney transplantation. However, pretransplant candidates should be warned of potentially serious liver related complications. 3 figures. 4 tables. 28 references.
Federally-Funded Research on Hepatitis B The U.S. Government supports a variety of research studies relating to hepatitis B and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.18 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to hepatitis B and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, 18 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).
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many federally-funded studies use animals or simulated models to explore hepatitis B and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of the type of information found when searching the CRISP database for hepatitis B: ·
Project Title: Adefovir Dipivoxil In Hbeag+ Chronic Hepatitis B Infected PTS Principal Investigator & Institution: Fried, Michael J.; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000; Project Start 1-OCT-1974; Project End 0-NOV2002 Summary: The goal of this study is to assess the effectiveness and safety of adefovir dipivoxil (an experimental drug) compared to placebo (inactive treatment) in the treatment of chronic hepatitis B. All patients enrolled in the study will, however, be assigned to receive at least one year of active treatment with adefovir dipivoxil. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Extended Lamivudine Treatment for Hepatitis B Patients Principal Investigator & Institution: Grimm, Ian J.; University of North Carolina Chapel Hill Box 2688, 910 Raleigh Rd Chapel Hill, Nc 27515 Timing: Fiscal Year 2000 Summary: The purpose of this research is to offer lamivudine treatment to patients who were participating in earlier lamivudine protocols and who did not maintain a response. This means that at the end of the study hepatitis B virus was still present in the blood. Also, researchers would like to gain information on the long term use of lamivudine in the treatment of hepatitis B infection. Lamivudine is an investigational medicine. Early studies in animals and in more that 850 patients with chronic hepatitis B infection have shown that it may inhibit or suppress hepatitis infection. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: HBIG as Immunoprophylaxis for Recurrent Hepatitis B Following Orthoto Principal Investigator & Institution: Luketic, Velimir; Virginia Commonwealth University 901 W Franklin St Richmond, Va 23284 Timing: Fiscal Year 2000
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Summary: A research study to determine if the recurrence of Hepatitis B (HBV) virus after liver transplantation (OLT) can be delayed or prevented by the administration of hepatitis B immune globulin (H-BIG). The subjects of this study are patients who have end stage liver disease due to Hepatitis B and who have been accepted as candidates for liver transplantation. The HBV virus recurs in virtually all such patients, although the pace of hepatitis appears accelerated and progression to liver failure and/or cirrhosis occurs within one or two years following OLT. The primary objective of this study is to provide investigational HBIG to prevent HBV reinfection following OLT in patients with end stage liver disease due to HBV. The secondary objectives of this study are to expand the safety profile of the H-BIG administered to OLT patients and to collect data on anti-HBs levels in patients receiving H-BIG as these data are relevant to understanding any recurrence of HBV infection after transplantation. Initially, H-BIG, 20,000 IU, will be administered intravenously at the time of the transplant operation. Then H-BIG will be given intramuscularly, daily for one week until adequate blood levels of antibodies to HBV have been achieved. Further dosing will be based on serum levels of anti-HBV antibodies. Qualifying subjects, for the first three months following transplantation must be monitored for the presence of HBV infection according to the standard of practice at the clinical sight. During this 90 days, anti-HB levels must be obtained whenever HBsAg levels are obtained. The tests will be evaluated by the investigator. Follow up will consist of periodic blood testing for HBV. If found positive for HBsAg and/or HBV DNA, lamivudine will be given as standard care. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Hepatitis B and C Among Homeless Adults Principal Investigator & Institution: Gelberg, Lillian; Family Medicine; University of California Los Angeles Box 951361, 405 Hilgard Ave Los Angeles, Ca 90095 Timing: Fiscal Year 2001; Project Start 1-JUL-2001; Project End 1-MAY2004 Summary: Applicant's Abstract Persons infected with the hepatitis B virus (HBV) or hepatitis C virus (HCV) are at high risk for serious longterm health problems, and they are potentially infectious to others. Because of the seriousness of these infections, the NIH has developed a national agenda for preventing the spread and consequences of HBV and HCV. This agenda includes early detection, treatment, and prevention efforts for high-risk and infected persons. Homelessness has reached crisis proportions in the US today. Recent research by our team and
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others suggests that homeless adults in urban areas are a group at particularly high risk for HBV and HCV infections due to high rates of risky drug use and risky sexual behaviors. Despite the apparent high risk, however, there is only limited research on viral hepatitis in this group. We propose to conduct epidemiologic and health services research regarding HBV and HCV in a population-based sample of 500 homeless adults. We will recruit a probability sample of homeless adults with oversampling of injection drug users from 30 shelters and meal programs in the Skid Row area of Los Angeles. Respondents will undergo a two-hour interview (including the Diagnostic Interview Schedule-DIS-IV) and blood draw for hepatitis serology. We will estimate the prevalence of HBV and HCV and identify risk factors for each. We will evaluate whether homeless adults with histories of injection and non-injection drug use, risky sex, serious alcohol or mental disorders, or chronic homelessness have an elevated risk for these infections. We will also conduct health services research in which we will describe the respondents' past history of HBV/HCV testing, awareness of infection status, medical care for HBV and HCV, and willingness to return for HBV/HCV test results. Further, we will identify utilization of medical and non-medical settings to identify sites for future screening, treatment, and prevention efforts. We will provide hepatitis B immunization to those that test negative for hepatitis B. We will bridge the gap between research and prevention by using the Theory of Planned Behavior to understand protective behaviors used by homeless adults to avoid exposure to infectious diseases. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Lamivudine in Pediatric Subjects with Hepatitis B Principal Investigator & Institution: Maller, Eric S.; Children's Hospital of Philadelphia 34Th St and Civic Ctr Blvd Philadelphia, Pa 19104 Timing: Fiscal Year 2000; Project Start 1-DEC-1976; Project End 8-FEB2001 Summary: The hypothesis of this study is that Lamivudine will be welltolerated, safe and effective compared to placebo when used as treatment for chronic hepatitis B in children. The first aim is to compare the efficacy of lamivudine versus placebo in children with chronic hepatitis B with regard to complete virologic response (loss of detectable HbeAg and HBV DNA in serum) and sustained normalization of serum alanine aminotransferase (ALT). The second aim is to compare the safety and tolerability of lamivudine versus placebo in children with chronic HBV infection. This protocol was designed as a phase 3 trial to determine the efficacy and safety of 3 mg/kg Lamivudine in children aged 2 to 16 years
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with chronic e-antigen positive hepatitis B. This was a randomized, double blind, placebo-controlled study enrolling two patients in the treatment arm for every one control patient enrolled. Two patients enrolled in our center. One patient has finished uneventfully but remains positive for hepatitis e-antigen. This patient was eligible to be enrolled in a follow-on two year study of continued open label treatment with Lamivudine which the patient has already enrolled in. We do not yet know whether she was originally in the treatment or the control group. The other patient is still being treated in the 1681 protocol, and thus we do not know her current HBV antigen status. No serious adverse or unanticipated events or side effects have occurred thus far during treatment. There have been no changes to the protocol. It is anticipated that the last subject will finish the protocol and be enrolled into the follow-on two year study with open label treatment with Lamivudine if still HBV e-antigen positive or two year observational/monitoring study to assess the durability of response to Lamivudine and natural history of spontaneous e-antigen conversion if the patient is negative for e-antigen at the end of this treatment study. As the study is not completed around the world yet, no data are yet available on the preliminary end of treatment response to Lamivudine vs. placebo in the treatment of HBV in children. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Mechanisms of Chronic Hepatitis B Infection Principal Investigator & Institution: Milich, David R.; Associate Professor; Immune Complex Corporation 3347 Industrial Crt San Diego, Ca 92121 Timing: Fiscal Year 2000; Project Start 1-MAY-1984; Project End 1-OCT2000 Summary: A number of recent studies both in murine model systems and in hepatitis B virus (HBV)-infected patients indicate the importance of the immune response to the nucleocapsid antigens of the HBV in the induction and/or maintenance of chronic infection. Therefore, the purpose of this application is a detailed analysis of the immune responses to the particulate hepatitis B core antigen (HBcAg) and the secreted nonparticulate form of the nucleocapsid, namely the HBeAg. This analysis will include: (1) establishing HBeAg-expressing transgenic (Tg) mice as a model of HBeAg/anti-HBe seroconversion in chronic HBV infection and a model in which to screen immunotherapeutic protocols; (2) use of novel immunoassays to examine serological and cellular responses to the nucleocapsid antigens in HBV-infected patients; (3) exploration of the importance of Th1 and Th2 cell subsets in the immune response to HBV nucleocapsid antigens and their possible role in chronicity; (4) analysis of
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the unique features of antigen presentation of the HBV nucleocapsid antigens to The cells and its possible role in chronicity; and (5) production of HBc/eAg-specific T cell receptor (TCR) transgenic mice and dual Tg mice expressing the HBc/eAgs as well as TCRs specific for these antigens. Although the specific aims represent basic and applied approaches, each project has been designed to answer questions relevant to chronic HBV infection. For example, does T cell tolerance play a role in chronic HBV infection? Do the enhanced humoral immune responses and relatively weak cellular responses observed in HBV chronic carriers reflect an imbalance in Th1 -Th2 cell subsets? If so, can the Th1 -Th2 imbalance be corrected in vivo? Does the enhanced immunogenicity of the HBcAg derive from entry into a specialized antigen presentation pathway? What effect does maternal anti-HBc have on the neonates HBcAg-specific The cell response? It is anticipated that the results of these studies will have diagnostic, therapeutic, and vaccine applications and will provide a better understanding of basic immune mechanisms responsible for viral persistence and clearance in chronic and acute HBV infection. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: New Hepatitis B Small Molecule Inhibitors Principal Investigator & Institution: Mehta, Anand D.; Synergy Pharmaceuticals, Inc. 2 Executive Dr, Ste 450 Somerset, Nj 08873 Timing: Fiscal Year 2001; Project Start 1-SEP-2001; Project End 1-AUG2003 Summary: (provided by applicant): The over-all goal of this "fast track" proposal is to develop a new class of orally available compounds for the treatment of chronic human hepatitis B virus (HBV) infection through a "proof of principle" Phase I/IIa Human clinical trial. With our colleagues, we have shown that alkylated imino sugars, called "alkovirs," are novel and effective in preventing HBV replication in tissue culture systems under conditions where there is no detectable cyto-toxicity. The alkovirs are previously undescribed synthetic (hence completely characterized) small molecules. Unlike the glucosidase inhibitors, (another class of imino sugars that we have been studying) alkovirs do not inhibit glucosidases, making them distinct and conferring certain advantages. Moreover, although alkovirs inhibit HBV replication, they do not target the viral polymerase, as do most nucleoside analogues. Thus, alkovirs should be effective against lamivudine "resistant" HBV mutants. The objectives of this "fast track" proposal are intended to be straightforward and defined by clear milestones: In phase I, the Alkovir(s) with the most potent anti-HBV activity against wild type virus and lamivudine resistant
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virus will be selected and tested for in vivo toxicity and pharmacokinetics in a rat model. In Phase II, the efficacy and toxicity of the candidate Alkovir(s) selected in Phase I will be evaluated in the woodchuck model of chronic hepatitis virus infection both as monotherapy and in combination with 3TC-lamivudine. Other work, to be performed in parallel with this study, will explore the precise mechanism of action of alkovirs and possibility that (a) they are effective against other viruses and (b) are a class of compounds to which mutant viruses do not frequently emerge. Accomplishment of these Aims will permit the introduction of alkovirs for human clinical trials. Given the need to find complements to nucleoside analogues, the introduction of new antihepatitis B virus agents as described here is extremely important. Proposed Commercial Application: Not Available Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Racivir for Treatment of Hepatitis B and HIV Infections Principal Investigator & Institution: Otto, Michael J.; Pharmasset, Inc. 1860 Montreal Rd Tucker, Ga 30084 Timing: Fiscal Year 2000; Project Start 5-SEP-2000; Project End 4-SEP-2001 Summary: Hepatitis B virus infection afflicts as many as 300 million people worldwide. Current therapy for chronically infected patients is suboptimal because of drug-related toxicity, low response rates and/or unsustained viral load reduction, and emergence of resistance. In addition, current drugs and compounds under development are quite costly making their availability to developing countries problematic. Effective long-term treatment with multiple low cost drugs will be required to address the needs of the majority of HBV- infected individuals. RacivirTM, (+/-)-beta-2,3' -dideoxy-3' -thia-5-fluorocytosine, [(+/-)KFC, RCV] is a 50:50 mixture of the two enantiomers of FTC. It has a similar virological profile when compared to (-)-beta-2',3' -dideoxy-3' thia-5- fluorocytosine, [(-)-FTC, Coviracil, Emtricitabine], a drug with a proven safety and efficacy profile currently in Phase III clinical trials for HIV infections. Unlike (+)-BCH-189 (the plus-beta- enantiomer of 3TC), (+)- FTC is essentially non-toxic in various sophisticated in vitro toxicity assays. Like (-)-FTC and 3TC (Lamivudine) RCV is effective against HBV as well as HIV-1, HIV-2, and SIV (simian immunodeficiency virus) in vitro. Based on the cross-resistance profile, preliminary pharmacokinetic (PK) studies in SCID mice and in vitro selection studies with (+)-BCH189, (+)-FTC, (-)- FTC, and RCV, we believe that RCV has a very desirable virological profile. We see RCV as a combined therapeutic modality, which is different from (-)-FTC and 3TC. This SBIR Phase 1 will focus on comparative PK and Toxicity studies in rats with Racivir and (+)-FTC.
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We wish to determine the maximum tolerated dose (MTD) of Racivir compared to (+)-FTC and establish a rationale, based on the safety profile, for proceeding to more advanced preclinical studies required for an IND filing for Racivir. The goal of the Phase 1 is to reach a decision point for the future development of Racivir. If the data indicate that Racivir has an acceptable toxicity profile in rats, then Phase 2 will focus on completing the preclinical safety and efficacy package required for an IND submission for Racivir, first as treatment for HBV infections and second as a treatment for HIV infections. PROPOSED COMMERCIAL APPLICATIONS: There is a need worldwide for effective, low cost, combination therapy for hepatitis B and HIV infections. Racivir has the potential to be superior to and less costly than the single enantiomers, FTC and 3TC. As such it should expand the market for effective treatments, especially in developing countries. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Randomized Hepatitis B Vaccine Delivery Trial for IDUS Principal Investigator & Institution: Seal, Karen H.; Assistant Professor; Inst for Health Policy Studies; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000; Project Start 5-MAY-1998; Project End 0-APR2001 Summary: Applicant's Abstract The purpose of this study is to compare the effectiveness and cost-effectiveness of two strategies for enrolling and retaining injected drug users (IDUs) in a six-month program to provide them with a full series of three hepatitis B vaccine doses. One method will use periodic contact with street outreach staff, similar to that which has been used successfully in administering directly observed therapy ("DOT") for tuberculosis. The other will use cash incentives such as those that have traditionally been successful in retaining participants in longitudinal research on substance use. Hepatitis B is among the serious clinical medical consequences of drug abuse, and vaccinations administered using similar schedules, such as those for human immunodeficiency virus. Study participants will be recruited from among IDUs participating in the Urban Health Study's ongoing dynamic cohort study in six communities in the San Francisco Bay Area. Cohort participants will be screened with serologic tests for hepatitis B surface antigen (HBsAg), antibody to HBsAg (anti-HBs), and antibody to hepatitis B core antigen (anti-HBc). Enrollment will be offered to those with no serologic markers of hepatitis B and to those with "isolated core antibody" - that is, those with anti-HBc but neither HBsAg nor anti-HBs. Although isolated core antibody is rare in most populations, it is found in
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10-35% of IDUs, and its interpretation remains uncertain. IDUs with isolated core antibody will be vaccinated, and their immunologic responses to vaccination will be measured, to answer the question of whether and in what proportion such persons have been or are currently infected with HBV or are susceptible and in need of vaccination. The principle aims of this study are to compare the effectiveness and costeffectiveness of two methods of delivering a three-dose vaccine series to injecting drug users, and to determine the biological meaning of the isolated core antibody serological profile. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Recurrent Hepatitis B After Liver Transplantation Principal Investigator & Institution: Lok, Anna S.; Professor; Internal Medicine; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2001; Project Start 1-JUN-2001; Project End 1-MAY2008 Summary: Hepatitis B accounts for approximately 5000 deaths/yr in the United States. Early results with orthotopic liver transplantation (OLT) for hepatitis B were poor with recurrence rates of >80% and 2-year mortality rates of 50%. Recent studies found that continuous high dose IV hepatitis B immune globulin (HBIG) can decrease the rate of reinfection to <20%. However, high dose HBIG is very expensive ($30,000$50,000/yr) and the efficacy is low in patients with replicative infection pre-OLT. Pilot studies showed that lamivudine (LAM, an oral nucleoside analog which costs $1,200-$1,500 per yr) can decrease the rate of recurrent hepatitis B to <30% during the first post-OLT year but the long-term efficacy is limited by drug resistant mutants. Three pilot studies reported that combination therapy of HBIG and LAM is more effective than either agent alone with recurrence rates <5%, but it is not clear how long HBIG needs to be administered. Given the high costs and the inconvenience of life-long HBIG therapy, there is a need for a prospective, randomized controlled trial to determine if prophylaxis with LAM and short-term HBIG is as effective as LAM and long-term HBIG in the prevention of recurrent hepatitis B post-OLT. The use of antiviral agents with potential activity against LAM resistant HBV mutants, such as adefovir dipivoxil, also needs to be evaluated. The specific aims of our study are: (1) To compare the safety, efficacy and cost-effectiveness of combination therapy with LAM and a 6-month course of HBIG with LAM and a 3-yr course of HBIG in the prevention of recurrent hepatitis B post-OLT. (2) To identify the epidemiological, clinical and virological factors that are associated with recurrent hepatitis B post-OLT. (3) To determine the safety and efficacy of adefovir dipivoxil in the suppression of HBV
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replication in patients who have developed LAM resistant HBV mutants and to compare the rate of recurrent hepatitis B post-OLT in patients with and without LAM resistant mutants prior to transplant. This is a prospective, randomized, multi-center clinical trial involving 20 liver transplant centers in N. America, to be conducted under an investigator IND 59,167. 290 patients with hepatitis B who are listed for OLT as UNOS status 1 or 2 will be enrolled. Open label LAM will be administered to decrease virus load pre-OLT. Patients will be randomized after OLT to Group I: LAM and 3 yr-course of HBIG or Group II: LAM and 6-month course of HBIG. Patients who develop LAM resistant mutants pre- or post- OLT will additionally receive adefovir dipivoxil. The primary endpoint of this trial is the rate of recurrent hepatitis B during the first 3 yr post-OLT. This trial will provide definitive answers whether combination therapy with LAM and a 6-mon course of HBIG is as efficacious and more cost-effective than LAM and a 3-yr course of HBIG in the prevention of recurrent hepatitis B post-OLT. In addition, crucial data will be generated on the efficacy of pre-OLT LAM in virus clearance, incidence and outcome of silent allograft infection, clinical outcome of patients with LAM resistant HBV mutants, and management of patients with LAM resistant mutants. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Role of Self Hypnosis in Hepatitis B Vaccinations w/ Respect to Distress Principal Investigator & Institution: Jacobson, Robert M.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2000 Summary: The purposes of this investigation are to: a) determine if self hypnosis with a specific suggestion to prevent distress results in a reduction in distress in a large cohort of children undergoing hepatitis B vaccination; and b) determine if self hypnosis with a specific suggestion to increase immune response results in an increase in antibody to hepatitis B surface antigen (Anti-HBs) levels following immunization in a large cohort of children undergoing hepatitis B vaccination. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
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Project Title: Novel L-Nucleoside Combination Anti-HBV Therapy Principal Investigator & Institution: Bryant, Martin L.; Executive Vice President for R&c; Novirio Pharmaceuticals, Inc. 125 Cambridgepark Dr Cambridge, Ma 02140
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Timing: Fiscal Year 2000; Project Start 5-JUL-2000; Project End 5-JAN2001 Summary: (Adapted from Applicant's Abstract): This is a new, fast track application that explains the need for additional therapeutics for the treatment of chronic hepatitis B virus (HBV) infection. Discovery of novel non cytotoxic L-nucleosides with potent anti-HBV activity that, when used in combination, act synergistically is described. These L-nucleosides are reported to inhibit the viral DNA polymerase and replication without effect upon cellular polymerases or mitocohndrial function and have been shown to significantly reduce viral load in the chronic woodchuck hepatitis model. Funding from SBIR phase 1 and 2 will be used to select and develop the combination of the L-nucleosides with the greatest potential for commercialization. Phase 1 will determine pharmacology, toxicology and antiviral potency of two and three L nucleoside combinations in the woodchuck chronic hepatitis model. Proposed Commercial Application: Chronic treatment of Hepatitis B virus infection. Delay in progression to cirrhosis and hepatocellular carcinoma. Possible elimination of Hepatitis B virus. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Role of HBX Protein in HBV Replication Principal Investigator & Institution: Schneider, Robert J.; Professor; Biochemistry; New York University School of Medicine 550 1St Ave New York, Ny 10016 Timing: Fiscal Year 2001; Project Start 1-APR-1992; Project End 1-MAR2006 Summary: (provided by applicant): The long term objectives of this proposal are to understand the roles of the hepatitis B virus (HBV) HBx gene in viral infection. Please note that the title of this grant has been changed from "Transcription and Transformation by Hepatitis B Virus HBx Protein," to" Role of HBx protein in HBV replication" to reflect the progression of our studies on HBx. AIM 1: Molecular mechanism for human hepatitis B virus (HBV) HBx protein action. HBx activates cytoplasmic signal transduction pathways. HBx activation of the Pyk2Src tyrosine kinase signalling pathway represents an important activity for viral replication in hepatocytic cell lines. Studies are outlined to understand the molecular mechanism for HBx activation of Pyk2-Src signal transduction, since it is tightly linked to HBx stimulation of viral replication. In addition, HBx appears to possess nuclear functions that may stimulate viral transcription. Studies will also investigate the mechanism by which HBx functions in viral transcription, including a possible role in the nucleus, and its impact on viral replication. AIM 2:
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Role of HBx protein in HBVreplication. Studies are proposed to determine the molecular basis for HBx activation of HBV reverse transcription and DNA replication. Model systems have been developed for delivery of hepadnavirus genomes to differentiated hepatocytic cell lines and rodent primary hepatocytes in culture, that permit viral replication in an HBx-dependent manner. Studies will investigate the role of HBx in viral replication in a biologically relevant system, focusing on HBx induction of HBV core protein phosphorylation, control of the cell cycle, and induction of nucleotide metabolism. HBx-dependent HBV replication will also be studied in primary hepatocytes prepared from mice that are deficient in genes that impact on HBV replication, including knockouts of Src and Pyk2 kinases, to better understand their importance for viral replication. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Self Cleaving RNA and Trans Acting Ribozymes Principal Investigator & Institution: Been, Michael D.; Professor; Biochemistry; Duke University Durham, Nc 27706 Timing: Fiscal Year 2000; Project Start 0-SEP-1992; Project End 1-DEC2001 Summary: The objective of the proposed research is to understand the structure, mechanism, and biological role of self-processing RNA (ribozymes). The ribozymes being studied are self-cleaving sequence associated with the genomic and antigenomic RNA of hepatitis delta virus (HDV). HDV is a human pathogen but is always found in association with hepatitis B virus. The combination leads to serious liver damage with a higher fatality rate that in patients infected only with hepatitis B virus. Thus, in populations where hepatitis B is endemic, HDV can be a serious health threat. It can either be co-transmitted with hepatitis B causing the acute form of the disease or it can infect hepatitis B carriers; the later tends to be more serious. The ribozyme activity is thought to be essential to the replication of the RNA genome of this virus. A greater understanding of the ribozyme structure, cleavage mechanism, and role in replication could lead to a method to block viral replication. In addition because the self-cleaving RNA from HDV is the first clear example of a self-cleaving RNA that functions naturally in human cells; an understanding those features that are unique to this RNA may facilitate the design of ribozymes to be used in therapeutics. The specific aims of the proposal are: (1) To generate and refine a three dimensional model for the HDV ribozyme and utilize the models to evaluate biochemical and genetic data on the ribozyme structure and mechanism. Molecular modeling programs, some of which are designed Specifically
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for RNA, will be used to generate models that are consistent with constraints on the structure established experimentally. Data gathered from physical methods will also be used, and towards this end methods for making large quantities of circular RNA will be used to produce RNA for crystallography. (2) To test and refine the structure through biochemical and genetic approaches. Methods include chemical protection, substitution interference, in vitro mutagenesis and in vitro selection. (3) To define the mechanism and requirements of the reaction. A complete kinetic scheme for the trans-reaction will developed and the stereochemistry of the reaction will defined. (4) To characterize and define cis-acting sequences that interfere with cleavage activity and may limit ribozyme cleavage to the nascent transcript. As part of this study templates for making concatameric RNA sequences that mimic replication of the RNA from a circular template will be developed. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·
Project Title: Viral Antigen Glycosylation--Marker for HBV Induced Hcc? Principal Investigator & Institution: Block, Timothy M.; Professor and Director; Biochem & Molecular Pharmacol; Thomas Jefferson University 1020 Walnut St Philadelphia, Pa 19107 Timing: Fiscal Year 2002; Project Start 1-APR-2002; Project End 1-MAR2003 Summary: (provided by applicant): In this exploratory program we propose to test the hypothesis that oligosaccharides associated with serum proteins can accurately serve as biomarkers. Oligosaccharide profiles of hepatitis B surface antigens (HBsAg), purified from patient sera of different clinical populations, will be generated using novel HPLC sequencing technology that can reproducibly quantitate greater than 0.1 percent of an individual oligosaccharide in a glycan pool. Our sample population will consist of patients at risk for, or diagnosed with, hepatocellular carcinoma (HCC). The data generated will allow HBsAg oligosaccharides to be compared between different patient populations and the potential diagnostic value to be assessed. Alteration in the oligosaccharides associated with glycoproteins is one of the many molecular changes that accompany malignant transformations. In the case of HCC, an increase in fucosylation of secreted liver proteins is a common alteration. This increase in fucosylation has been postulated as a marker for HCC, however, the proteins of interest that show this alteration are typically found in low abundance (e.g. alpha fetoprotein). Our hypothesis is that, in cases where infection with hepatitis B virus (HBV) leads to the development of HCC, the viral glycoproteins (present
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up to mg/ml concentration) themselves may display aberrant oligosaccharides that could serve as early detection markers for HCC. Infection with HBV is the major etiology of HCC and, although HCC is a less common cancer in the USA, recent studies have shown that the incidence of HCC is rising both in the USA and worldwide. In addition, HCC is one of the most aggressive malignancies with prognosis being poor due to the late diagnosis. With the paucity of organ donors for liver transplantation and the small number of treatable patients (due to, in part, late diagnosis), early diagnosis will allow intervention at an earlier stage. We expect that this pilot study will firstly generate preliminary data to support the stated hypothesis; secondly, the study will allow the feasibility of a larger study to be determined, and thirdly, the parameters required to design a larger study to determine the value of oligosaccharide structures as potential markers of disease status will be obtained. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket
E-Journals: PubMed Central19 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).20 Access to this growing archive of e-journals is free and unrestricted.21 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “hepatitis B” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for hepatitis B in the PubMed Central database: ·
A Hepatitis B Virus Pre-S-Retinoic Acid Receptor [beta] Chimera Transforms Erythrocytic Progenitor Cells In vitro by M Garcia, H de The, P Tiollais, J Samarut, and A Dejean; 1993 January 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45605
Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 20 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 21 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 19
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A Multicenter Study Evaluation of the Digene Hybrid Capture II Signal Amplification Technique for Detection of Hepatitis B Virus DNA in Serum Samples and Testing of EUROHEP Standards by Hubert G. M. Niesters, Mel Krajden, Lynda Cork, Maria de Medina, Mary Hill, Edwin Fries, and Albert D. M. E. Osterhaus; 2000 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86750&ren dertype=external
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A Trans-Activator Function is Generated by Integration of Hepatitis B Virus PreS/S Sequences in Human Hepatocellular Carcinoma DNA by WH Caselmann, M Meyer, AS Kekule, U Lauer, PH Hofschneider, and R Koshy; 1990 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53815
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A Truncated Mutant (Residues 58-140) of the Hepatitis B Virus X Protein Retains Transactivation Function by V Kumar, N Jayasuryan, and R Kumar; 1996 May 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39302
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Aberrant trafficking of hepatitis B virus glycoproteins in cells in which N-glycan processing is inhibited by Xuanyong Lu, Anand Mehta, Mitra Dadmarz, Raymond Dwek, Baruch S. Blumberg, and Timothy M. Block; 1997 March 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20096
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Accuracy of perceptions of hepatitis B and C status: cross sectional investigation of opiate addicts in treatment by David Best, Alison Noble, Emily Finch, Michael Gossop, Clare Sidwell, and John Strang; 1999 July 31 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28181
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Acute hepatitis B infection associated with blood transfusion in England and Wales, 1991-7: review of database by K Soldan, M Ramsay, and M Collins; 1999 January 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27683
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Acute Hepatitis in Rats Expressing Human Hepatitis B Virus Transgenes by H Takahashi, J Fujimoto, S Hanada, and KJ Isselbacher; 1995 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42541
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Apical sorting of hepatitis B surface antigen (HBsAg) is independent of N-glycosylation and glycosylphosphatidylinositol-anchored protein
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segregation by Maria Paz Marzolo, Paulina Bull, and Alfonso Gonzalez; 1997 March 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20003 ·
Autoantibody Production in Hepatitis B e Antigen Transgenic Mice Elicited with a Self T-Cell Peptide and Inhibited with Nonself Peptides by DR Milich, A McLachlan, AK Raney, R Houghten, GB Thornton, T Maruyama, JL Hughes, and JE Jones; 1991 May 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51656
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Automated Multiplex Assay System for Simultaneous Detection of Hepatitis B Virus DNA, Hepatitis C Virus RNA, and Human Immunodeficiency Virus Type 1 RNA by Q. Meng, C. Wong, A. Rangachari, S. Tamatsukuri, M. Sasaki, E. Fiss, L. Cheng, T. Ramankutty, D. Clarke, H. Yawata, Y. Sakakura, T. Hirose, and C. Impraim; 2001 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88264&ren dertype=external
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Automated Quantitative Analysis of Hepatitis B Virus DNA by Using the Cobas Amplicor HBV Monitor Test by Ulrika Noborg, Annkatrin Gusdal, Eva K. Pisa, Anders Hedrum, and Magnus Lindh; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85382&ren dertype=external
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Cell Cycle Regulation of Nuclear Localization of Hepatitis B Virus Core Protein by C Yeh, SW Wong, Y Fung, and J Ou; 1993 July 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46951
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Comparison of the Second-Generation Digene Hybrid Capture Assay with the Branched-DNA Assay for Measurement of Hepatitis B Virus DNA in Serum by Stephen K. N. Ho, Tak Mao Chan, Ignatius K. P. Cheng, and Kar Neng Lai; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85256&ren dertype=external
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Comparison of Three Different Sensitive Assays for Hepatitis B Virus DNA in Monitoring of Responses to Antiviral Therapy by Henry L. Y. Chan, Nancy W. Y. Leung, Tracy C. M. Lau, May L. Wong, and Joseph J. Y. Sung; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87356&ren dertype=external
Studies 97
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Costimulatory Protein B7-1 Enhances the Cytotoxic T Cell Response and Antibody Response to Hepatitis B Surface Antigen by X He, H Chen, K Chu, M Rivkina, and WS Robinson; 1996 July 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38973
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CpG DNA can induce strong Th1 humoral and cell-mediated immune responses against hepatitis B surface antigen in young mice by Cynthia L. Brazolot Millan, Risini Weeratna, Arthur M. Krieg, Claire-Anne Siegrist, and Heather L. Davis; 1998 December 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=28081
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Cytotoxic T Lymphocytes Inhibit Hepatitis B Virus Gene Expression by a Noncytolytic Mechanism in Transgenic Mice by LG Guidotti, K Ando, MV Hobbs, T Ishikawa, L Runkel, RD Schreiber, and FV Chisari; 1994 April 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43662
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Delineation of the Minimal Hepatitis B Surface Antigen-Specific Band T-Cell Epitope Contained within an Anti-Idiotype-Derived Pentadecapeptide by M Rajadhyaksha and Y Thanavala; 1995 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42562
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Development of a Quantitative Real-Time Detection Assay for Hepatitis B Virus DNA and Comparison with Two Commercial Assays by Suzan D. Pas, Edwin Fries, Robert A. De Man, Albert D. M. E. Osterhaus, and Hubert G. M. Niesters; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87141&ren dertype=external
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Discontinuous Epitopes of Hepatitis B Surface Antigen Derived from a Filamentous Phage Peptide Library by YJ Chen, K Delbrook, C Dealwis, L Mimms, IK Mushahwar, and W Mandecki; 1996 March 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39898
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DNA Vaccine for Hepatitis B: Evidence for Immunogenicity in Chimpanzees and Comparison with Other Vaccines by HL Davis, MJ McCluskie, JL Gerin, and RH Purcell; 1996 July 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38962
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DNA-Mediated Immunization in a Transgenic Mouse Model of the Hepatitis B Surface Antigen Chronic Carrier State by M Mancini, M
98 Hepatitis B
Hadchouel, HL Davis, RG Whalen, P Tiollais, and M Michel; 1996 October 29 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38020 ·
DNA-Mediated Immunization to the Hepatitis B Surface Antigen in Mice: Aspects of the Humoral Response Mimic Hepatitis B Viral Infection in Humans by M Michel, HL Davis, M Schleef, M Mancini, P Tiollais, and RG Whalen; 1995 June 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41683
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Effect of Multiple Freeze-Thaw Cycles on Hepatitis B Virus DNA and Hepatitis C Virus RNA Quantification as Measured with BranchedDNA Technology by Mel Krajden, James M. Minor, Oretta Rifkin, and Lorraine Comanor; 1999 June http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84922&ren dertype=external
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Efficient Extraction of Virus DNA by NucliSens Extractor Allows Sensitive Detection of Hepatitis B Virus by PCR by Erik Gobbers, Tom A. M. Oosterlaken, Mario J. A. W. M. van Bussel, Roel Melsert, Aloys C. M. Kroes, and Eric C. J. Claas; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88546&ren dertype=external
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Efficient pyrophosphorolysis by a hepatitis B virus polymerase may be a primer-unblocking mechanism by Sinisa Urban, Severin Urban, Karl P. Fischer, and D. Lorne Tyrrell; 2001 April 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33150
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Enhanced Immunogenicity of a Sequence Derived from Hepatitis B Virus Surface Antigen in a Composite Peptide that Includes the Immunostimulatory Region from Human Interleukin 1 by KVS Rao and AR Nayak; 1990 July 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54356
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Epidemiology of Hepatitis B, C, E, and G Virus Infections and Molecular Analysis of Hepatitis G Virus Isolates in Bolivia by Nami Konomi, Chiaki Miyoshi, Carlos La Fuente Zerain, Tian-Cheng Li, Yasuyuki Arakawa, and Kenji Abe; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85549&ren dertype=external
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European Proficiency Testing Program for Molecular Detection and Quantitation of Hepatitis B Virus DNA by Elizabeth Valentine-Thon,
Studies 99
Anton M. van Loon, Jurjen Schirm, Jim Reid, Paul E. Klapper, and Graham M. Cleator; 2001 December http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88557&ren dertype=external ·
Evidence for Increased in vitro Recombination with Insertion of Human Hepatitis B Virus DNA by O Hino, S Tabata, and Y Hotta; 1991 October 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52691
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Evidence that the RNAseH activity of the duck hepatitis B virus is unable to act on exogenous substrates by Yunhao Gong, Ermei Yao, and John E. Tavis; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=37354
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Expression of Functional Hepatitis B Virus Polymerase in Yeast Reveals it to be the Sole Viral Protein Required for Correct Initiation of Reverse Transcription by JE Tavis and D Ganem; 1993 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46455
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Expression of Hepatitis B Surface Antigen in Transgenic Plants by HS Mason, DM Lam, and CJ Arntzen; 1992 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50633
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Expression of the Terminal Protein Region of Hepatitis B Virus Inhibits Cellular Responses to Interferons [alpha] and [gamma] and Double-Stranded RNA by GR Foster, AM Ackrill, RD Goldin, IM Kerr, HC Thomas, and GR Stark; 1991 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51345
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Functional Analysis of a Liver-Specific Enhancer of the Hepatitis B Virus by MA Trujillo, J Letovsky, HF Maguire, M Lopez-Cabrera, and A Siddiqui; 1991 May 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51540
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Hepatitis B and medical students by Robert Colistro; 2000 August 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=80278&ren dertype=external
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Hepatitis B immunisation in renal units in the United Kingdom: questionnaire study by Sunanda Ray, Terry Samuel, Jeremy Hawker, and Steve Smith; 2002 April 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=101399
100 Hepatitis B
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Hepatitis B virus (HBV) envelope glycoproteins vary drastically in their sensitivity to glycan processing: Evidence that alteration of a single N-linked glycosylation site can regulate HBV secretion by Anand Mehta, Xuanyong Lu, Timothy M. Block, Baruch S. Blumberg, and Raymond A. Dwek; 1997 March 4 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=20001
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Hepatitis B Virus Capsid Particles are Assembled from Core-Protein Dimer Precursors by S Zhou and DN Standring; 1992 November 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50274
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Hepatitis B Virus HBx Protein Activates Ras-GTP Complex Formation and Establishes a Ras, Raf, MAP Kinase Signaling Cascade by J Benn and RJ Schneider; 1994 October 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=45017
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Hepatitis B Virus HBx Protein Deregulates Cell Cycle Checkpoint Controls by J Benn and RJ Schneider; 1995 November 21 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40602
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Hepatitis B virus HBx protein sensitizes cells to apoptotic killing by tumor necrosis factor [alpha] by Fei Su and Robert J. Schneider; 1997 August 5 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23107
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Hepatitis B virus infected physicians and disclosure of transmission risks to patients: A critical analysis by Diana L. Barrigar, , David C. Flagel, , and Ross EG. Upshur,; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59900
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Hepatitis B Virus Surface Antigen (HBsAg) Mutants in Singapore Adults and Vaccinated Children with High Anti-Hepatitis B Virus Antibody Levels but Negative for HBsAg by Wei Ning Chen and Chong Jin Oon; 2000 July http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87037&ren dertype=external
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Hepatitis B Virus Transactivator Protein X Interacts with the TATABinding Protein by I Qadri, HF Maguire, and A Siddiqui; 1995 February 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42625
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Hepatitis B Virus Transactivator Protein, HBx, Associates with the Components of TFIIH and Stimulates the DNA Helicase Activity of
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TFIIH by I Qadri, JW Conaway, RC Conaway, J Schaack, and A Siddiqui; 1996 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38195 ·
Hepatitis B virus X protein and p53 tumor suppressor interactions in the modulation of apoptosis by Lynne W. Elmore, Amy R. Hancock, Shau-Feng Chang, Xin W. Wang, Seung Chang, Christiana P. Callahan, David A. Geller, Hans Will, and Curtis C. Harris; 1997 December 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=25100
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Hepatitis B Virus X Protein Inhibits p53 Sequence-Specific DNA Binding, Transcriptional Activity, and Association with Transcription Factor ERCC3 by XW Wang, K Forrester, H Yeh, MA Feitelson, J Gu, and CC Harris; 1994 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43344
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HLA Class I-Restricted Human Cytotoxic T Cells Recognize Endogenously Synthesized Hepatitis B Virus Nucleocapsid Antigen by A Bertoletti, C Ferrari, F Fiaccadori, A Penna, R Margolskee, HJ schlicht, P Fowler, S Guilhot, and FV Chisari; 1991 December 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52945
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Horizontal Transmission of a Hepatitis B Virus Surface Antigen Mutant by Wei Ning Chen, Chong Jin Oon, and Shiuan Koh; 2000 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86257&ren dertype=external
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Hsp90 is Required for the Activity of a Hepatitis B Virus Reverse Transcriptase by J Hu and C Seeger; 1996 February 6 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40030
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Human Combinatorial Antibody Libraries to Hepatitis B Surface Antigen by SL Zebedee, CF Barbas, Y Hom, RH Coathien, R Graff, J DeGraw, J Pyati, R LaPolla, DR Burton, RA Lerner, and GB Thorton; 1992 April 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48828
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Identification of hepatitis B virus indigenous to chimpanzees by Xiaolei Hu, Harold S. Margolis, Robert H. Purcell, James Ebert, and Betty H. Robertson; 2000 February 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26492
102 Hepatitis B
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Immunisation of infants at risk of perinatal transmission of hepatitis B: retrospective audit of vaccine uptake by Diane E Wallis and Elizabeth H Boxall; 1999 April 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27844
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Immunogenicity of Transgenic Plant-Derived Hepatitis B Surface Antigen by Y Thanavala, Y Yang, P Lyons, HS Mason, and C Arntzen; 1995 April 11 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42165
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Immunological Properties of Hepatitis B Core Antigen Fusion Proteins by MJ Francis, GZ Hastings, AL Brown, KG Grace, DJ Rowlands, F Brown, and BE Clarke; 1990 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=53726
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Improved Detection of Hepatitis B Virus Surface Antigen by a New Rapid Automated Assay by Bernard Weber, Anja Bayer, Peter Kirch, Volker Schluter, Dietmar Schlieper, and Walter Melchior; 1999 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85302&ren dertype=external
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Inhibition of the Replication of Hepatitis B Virus in vitro by 2',3'Dideoxy-3'-Thiacytidine and Related Analogues by S Doong, C Tsai, RF Schinazi, DC Liotta, and Y Cheng; 1991 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=52535
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Interferon gene transfer by a hepatitis B virus vector efficiently suppresses wild-type virus infection by Ulrike Protzer, Michael Nassal, Pei-Wen Chiang, Michael Kirschfink, and Heinz Schaller; 1999 September 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=17966
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Interleukin 12 Suppresses Autoantibody Production by Reversing Helper T-Cell Phenotype in Hepatitis B e Antigen Transgenic Mice by DR Milich, SF Wolf, JL Hughes, and JE Jones; 1995 July 18 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41426
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Is a Function of the Secreted Hepatitis B e Antigen to Induce Immunologic Tolerance in utero? by DR Milich, JE Jones, JL Hughes, J Price, AK Raney, and A McLachlan; 1990 September 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54584
Studies 103
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Line Probe Assay for Monitoring Drug Resistance in Hepatitis B VirusInfected Patients during Antiviral Therapy by Lieven Stuyver, Caroline Van Geyt, Sija De Gendt, Georges Van Reybroeck, Fabien Zoulim, Geert Leroux-Roels, and Rudi Rossau; 2000 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86181&ren dertype=external
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Localization of the C terminus of the assembly domain of hepatitis B virus capsid protein: Implications for morphogenesis and organization of encapsidated RNA by A. Zlotnick, N. Cheng, S. J. Stahl, J. F. Conway, A. C. Steven, and P. T. Wingfield; 1997 September 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=23216
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Localization of the N terminus of hepatitis B virus capsid protein by peptide-based difference mapping from cryoelectron microscopy by J. F. Conway, N. Cheng, A. Zlotnick, S. J. Stahl, P. T. Wingfield, and A. C. Steven; 1998 December 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=24499
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Low frequency of mutations in the core promoter and precore regions of hepatitis B virus in anti-HBe positive Brazilian carriers by Liane De Castro, Christian Niel, and Selma A. Gomes; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=35280
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Markedly Prolonged Incubation Period of Hepatitis B in a Chimpanzee Passively Immunized with a Human Monoclonal Antibody to the a Determinant of Hepatitis B Surface Antigen by N Ogata, L Ostberg, PH Ehrlich, DC Wong, RH Miller, and RH Purcell; 1993 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=46227
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Molecular Characteristic-Based Epidemiology of Hepatitis B, C, and E Viruses and GB Virus C/Hepatitis G Virus in Myanmar by Kazuhiko Nakai, Khin Maung Win, San San Oo, Yasuyuki Arakawa, and Kenji Abe; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87966&ren dertype=external
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Molecular Cloning of a Rat Chromosome Putative Recombinogenic Sequence Homologous to the Hepatitis B Virus Encapsidation Signal by H Aoki, K Kajino, Y Arakawa, and O Hino; 1996 July 9 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=38978
104 Hepatitis B
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Molecular Epidemiology of an Outbreak of Fulminant Hepatitis B by Nicola Petrosillo, Giuseppe Ippolito, Laura Solforosi, Pietro E. Varaldo, Massimo Clementi, and Aldo Manzin; 2000 August http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87163&ren dertype=external
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Molecular Mimicry of Hepatitis B Surface Antigen by an AntiIdiotype-Derived Synthetic Peptide by MW Pride, H Shi, JM Anchin, DS Linthicum, PT LoVerde, A Thakur, and Y Thanavala; 1992 December 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50665
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Monitoring the Emergence of Hepatitis B Virus Polymerase Gene Variants during Lamivudine Therapy Using the LightCycler by Simon A. Whalley, Dave Brown, Chong Gee Teo, Geoffrey M. Dusheiko, and Nicholas A. Saunders; 2001 April http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87954&ren dertype=external
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Multiple Liver-Specific Factors Bind to the Hepatitis B Virus Core/ Pregenomic Promoter: Trans-Activation and Repression by CCAAT/Enhancer Binding Protein by M Lopez-Cabrera, J Letovsky, K Hu, and A Siddiqui; 1990 July 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54263
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Mutations in the Pre-Core Region of Hepatitis B Virus Serve to Enhance the Stability of the Secondary Structure of the Pre-Genome Encapsidation Signal by ASF Lok, U Akarca, and S Greene; 1994 April 26 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43726
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Native display of complete foreign protein domains on the surface of hepatitis B virus capsids by Peter A. Kratz, Bettina Bottcher, and Michael Nassal; 1999 March 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=26711
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Note:Baculovirus Expression of Chimeric Hepatitis B Virus Core Particles with Hepatitis E Virus Epitopes and Their Use in a Hepatitis E Immunoassay by Antoine Touze, Nathalie Enogat, Yves Buisson, and Pierre Coursaget; 1999 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84333&ren dertype=external
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Note:Comparative Evaluation of Semiautomated COBAS AMPLICOR Hepatitis B Virus (HBV) MONITOR Test and Manual Microwell PlateBased AMPLICOR HBV MONITOR Test by Irena J. Marin, Mario
Studies 105
Poljak, Katja Seme, Jelka Meglic-Volkar, Mojca Maticic, Gorazd Lesnicar, and Vladimir Brinovec; 2001 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87814&ren dertype=external ·
Note:Comparison of Sequence Analysis and the INNO-LiPA HBV DR Line Probe Assay for Detection of Lamivudine-Resistant Hepatitis B Virus Strains in Patients under Various Clinical Conditions by Stephan W. Aberle, Josef Kletzmayr, Bruno Watschinger, Brigitte Schmied, Norbert Vetter, and Elisabeth Puchhammer-Stockl; 2001 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88061&ren dertype=external
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Note:Evaluation of Quantitative PCR and Branched-Chain DNA Assay for Detection of Hepatitis B Virus DNA in Sera from Hepatocellular Carcinoma and Liver Transplant Patients by Tao Chen, John M. Luk, Siu-Tim Cheung, Wan-Ching Yu, and Sheung-Tat Fan; 2000 May http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86641&ren dertype=external
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Note:Hepatitis B Virus (HBV) Mutations Associated with Resistance to Lamivudine in Patients Coinfected with HBV and Human Immunodeficiency Virus by Vincent Thibault, Yves Benhamou, Christophe Seguret, Marie Bochet, Christine Katlama, Francois Bricaire, Pierre Opolon, Thierry Poynard, and Henri Agut; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85438&ren dertype=external
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Note:Rapid and Specific Genotyping System for Hepatitis B Virus Corresponding to Six Major Genotypes by PCR Using Type-Specific Primers by Hideo Naito, Shigeki Hayashi, and Kenji Abe; 2001 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87732&ren dertype=external
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Note:Viral Superinfection in Previously Unrecognized Chronic Carriers of Hepatitis B Virus with Superimposed Acute Fulminant versus Nonfulminant Hepatitis by Chia-Ming Chu, Chau-Ting Yeh, and Yun-Fan Liaw; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84220&ren dertype=external
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Nucleic Acid-Based Cross-Linking Assay for Detection and Quantification of Hepatitis B Virus DNA by Vicky C. H. Lai, Richard Guan, Michael L. Wood, Su Kong Lo, Man-Fung Yuen, and Ching-Lung Lai; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84196&ren dertype=external
106 Hepatitis B
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Oral immunization with hepatitis B surface antigen expressed in transgenic plants by Qingxian Kong, Liz Richter, Yu Fang Yang, Charles J. Arntzen, Hugh S. Mason, and Yasmin Thanavala; 2001 September 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=58765
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p53-Mediated Cellular Response to DNA Damage in Cells with Replicative Hepatitis B Virus by A Puisieux, J Ji, C Guillot, Y Legros, T Soussi, K Isselbacher, and M Ozturk; 1995 February 28 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42515
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Perspective:Hepatitis B virus, the vaccine, and the control of primary cancer of the liver by Baruch S. Blumberg; 1997 July 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=33676
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Phylogenetic Origin of Hepatitis B Virus Strains with Precore C-1858 Variant by Erik Alestig, Charles Hannoun, Peter Horal, and Magnus Lindh; 2001 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88319&ren dertype=external
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Posttranscriptional Clearance of Hepatitis B Virus RNA by Cytotoxic T Lymphocyte-Activated Hepatocytes by LV Tsui, LG Guidotti, T Ishikawa, and FV Chisari; 1995 December 19 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=40365
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Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in entrants to Irish prisons: a national cross sectional survey by Jean Long, Shane Allwright, Joseph Barry, Sheilagh Reaper Reynolds, Lelia Thornton, Fiona Bradley, and John V Parry; 2001 November 24 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=59992
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Prevalence of antibodies to hepatitis B, hepatitis C, and HIV and risk factors in Irish prisoners: results of a national cross sectional survey by Shane Allwright, Fiona Bradley, Jean Long, Joseph Barry, Lelia Thornton, and John V Parry; 2000 July 8 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27426
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Prevalence of hepatitis B and C markers in high-risk hospitalised patients in Crete: a five-year observational study by Meri Koulentaki, Maria Ergazaki, Joanna Moschandrea, Stelios Spanoudakis, Nikolaos Tzagarakis, Pandelis E. Drandakis, Dimitrios A. Spandidos, and Elias A. Kouroumalis; 2001 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=64645
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Quantitation of Hepatitis B Virus Genomic DNA by Real-Time Detection PCR by Aki Abe, Kazuaki Inoue, Takeshi Tanaka, Junko Kato,
Studies 107
Naoki Kajiyama, Ryuji Kawaguchi, Satoshi Tanaka, Makoto Yoshiba, and Michinori Kohara; 1999 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85408&ren dertype=external ·
Quantitative Detection of Hepatitis B Virus by Transcription-Mediated Amplification and Hybridization Protection Assay by Keiichi Kamisango, Chieko Kamogawa, Mayumi Sumi, Susumu Goto, Akihide Hirao, Frank Gonzales, Kiyomi Yasuda, and Shiro Iino; 1999 February http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84293&ren dertype=external
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Quantitative Detection of Hepatitis B Virus DNA by Real-Time Nucleic Acid Sequence-Based Amplification with Molecular Beacon Detection by Sol Yates, Maarten Penning, Jaap Goudsmit, Inge Frantzen, Bert van de Weijer, Dianne van Strijp, and Bob van Gemen; 2001 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=88403&ren dertype=external
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Quantitative Detection of Hepatitis B Virus DNA in Two International Reference Plasma Preparations by Klaus-Hinrich Heermann, Wolfram H. Gerlich, Michael Chudy, Stephan Schaefer, Reiner Thomssen, and The Eurohep Pathobiology Group; 1999 January http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=84170&ren dertype=external
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Recent High Incidence of Fulminant Hepatitis in Samara, Russia: Molecular Analysis of Prevailing Hepatitis B and D Virus Strains by Erik Flodgren, Susanne Bengtsson, Mikael Knutsson, Elena A. Strebkova, Alistair H. Kidd, Oleg A. Alexeyev, and Karin Kidd-Ljunggren; 2000 September http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=87379&ren dertype=external
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Regulation of Hepatitis B Virus Gene Expression by Its Two Enhancers by H Su and J Yee; 1992 April 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=48731
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Retinoid X Receptor RXR[alpha] Binds to and Trans-Activates the Hepatitis B Virus Enhancer by B Huan and A Siddiqui; 1992 October 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50064
108 Hepatitis B
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Role of B cells in antigen presentation of the hepatitis B core by David R. Milich, Margaret Chen, Florian Schodel, Darrell L. Peterson, Joyce E. Jones, and Janice L. Hughes; 1997 December 23 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=25082
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Secretion of Human Hepatitis B Virus is Inhibited by the Imino Sugar N- Butyldeoxynojirimycin by TM Block, X Lu, FM Platt, GR Foster, WH Gerlich, BS Blumberg, and RA Dwek; 1994 March 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=43345
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Selection of Peptide Inhibitors of Interactions Involved in Complex Protein Assemblies: Association of the Core and Surface Antigens of Hepatitis B Virus by MR Dyson and K Murray; 1995 March 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42450
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Simultaneous Detection of Multiplex-Amplified Human Immunodeficiency Virus Type 1 RNA, Hepatitis C Virus RNA, and Hepatitis B Virus DNA Using a Flow Cytometer Microsphere-Based Hybridization Assay by J.-P. Defoort, M. Martin, B. Casano, S. Prato, C. Camilla, and V. Fert; 2000 March http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=86341&ren dertype=external
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The Dynamics of Hepatitis B Virus Infection by RJH Payne, MA Nowak, and BS Blumberg; 1996 June 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39060
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The frequency and significance of isolated hepatitis B core antibody and the suggested management of patients by Khalid A. AlMekhaizeem, Michael Miriello, and Averell H. Sherker; 2001 October 16 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=81543&ren dertype=external
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The hepatitis B virus X gene induces p53-mediated programmed cell death by Paolo Chirillo, Sabrina Pagano, Gioacchino Natoli, Pier Lorenzo Puri, Vito Lelio Burgio, Clara Balsano, and Massimo Levrero; 1997 July 22 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=21574
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The Hepatitis B Virus X Protein Targets the Basic Region-Leucine Zipper Domain of CREB by JS Williams and OM Andrisani; 1995 April 25 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=42053
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The Pre-S Domain of the Large Viral Envelope Protein Determines Host Range in Avian Hepatitis B Viruses by T Ishikawa and D Ganem; 1995 July 3 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=41497
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The Role of Envelope Proteins in Hepatitis B Virus Assembly by V Bruss and D Ganem; 1991 February 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50954
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Transactivation by Hepatitis B Virus X Protein is Promiscuous and Dependent on Mitogen-Activated Cellular Serine/Threonine Kinases by JC Cross, P Wen, and WJ Rutter; 1993 September 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=47291
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Trans-Activation Function of a 3' Truncated X Gene-Cell Fusion Product from Integrated Hepatitis B Virus DNA in Chronic Hepatitis Tissues by S Takada and K Koike; 1990 August 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54380
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Trans-Activation of HLA-DR Gene by Hepatitis B Virus X Gene Product by K Hu, JM Vierling, and A Siddiqui; 1990 September 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54699
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Transcriptional regulation of hepatitis B virus by nuclear hormone receptors is a critical determinant of viral tropism by Hong Tang and Alan McLachlan; 2001 February 13 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=29344
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Two Sensitive PCR-Based Methods for Detection of Hepatitis B Virus Variants Associated with Reduced Susceptibility to Lamivudine by Marchelle I. Allen, Josee Gauthier, Manon DesLauriers, Eric J. Bourne, Kevin M. Carrick, Fausto Baldanti, Lisa L. Ross, Michael W. Lutz, and Lynn D. Condreay; 1999 October http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=85560&ren dertype=external
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Up-Regulation of Intercellular Adhesion Molecule 1 Transcription by Hepatitis B Virus X Protein by K Hu, C Yu, and JM Vierling; 1992 December 1 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=50567
110 Hepatitis B
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Viral Cross Talk: Intracellular Inactivation of the Hepatitis B Virus during an Unrelated Viral Infection of the Liver by LG Guidotti, P Borrow, MV Hobbs, B Matzke, I Gresser, MBA Oldstone, and FV Chisari; 1996 May 14 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39321
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Viral Dynamics in Hepatitis B Virus Infection by MA Nowak, S Bonhoeffer, AM Hill, R Boehme, HC Thomas, and H McDade; 1996 April 30 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=39549
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Wild-Type and e Antigen-Minus Hepatitis B Viruses and Course of Chronic Hepatitis by MR Brunetto, MM Giarin, F Oliveri, E Chiaberge, M Baldi, A Alfarano, A Serra, G Saracco, G Verme, H Will, and F Bonino; 1991 May 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=51623
The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.22 If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with hepatitis B, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “hepatitis B” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “hepatitis B” (hyperlinks lead to article summaries): PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.
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Studies 111
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Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Author(s): Leelarasamee A, Trakulsomboon S, Maunwongyathi P, Somanabandhu A, Pidetcha P, Matrakool B, Lebnak T, Ridthimat W, Chandanayingyong D. Source: Lancet. 1990 June 30; 335(8705): 1600-1. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1972525&dopt=Abstract
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Familial clustering of hepatitis B and C viruses in Korea. Author(s): Kim YS, Ahn YO, Kim DW. Source: Journal of Korean Medical Science. 1994 December; 9(6): 444-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7786439&dopt=Abstract
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Functional and structural similarity between the X protein of hepatitis B virus and nucleoside diphosphate kinases. Author(s): De-Medina T, Shaul Y. Source: Febs Letters. 1994 September 12; 351(3): 423-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8082807&dopt=Abstract
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Genus Phyllanthus for chronic hepatitis B virus infection: a systematic review. Author(s): Liu J, Lin H, McIntosh H. Source: Journal of Viral Hepatitis. 2001 September; 8(5): 358-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11555193&dopt=Abstract
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HBsAg-like structures in immunosuppressed mice inoculated with human hepatitis B virus. Author(s): Schaff Z, Pohl O, Bencsath M, Brojnas J, Lapis K, Kopper L, Hollos I. Source: Virchows Arch B Cell Pathol Incl Mol Pathol. 1982 August; 40(2): 249-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6127839&dopt=Abstract
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Hepatitis after withdrawal of chemotherapy in a patient with chronic hepatitis B. Author(s): Schofield K, Morris D, Klapper P.
112 Hepatitis B
Source: The Journal of Infection. 1993 July; 27(1): 101-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7690376&dopt=Abstract ·
Hepatitis B and C virus, Clonorchis sinensis for the risk of liver cancer: a case-control study in Pusan, Korea. Author(s): Shin HR, Lee CU, Park HJ, Seol SY, Chung JM, Choi HC, Ahn YO, Shigemastu T. Source: International Journal of Epidemiology. 1996 October; 25(5): 93340. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8921477&dopt=Abstract
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Hepatitis B antigen, alpha-fetoglobulins and primary hepatocellular carcinoma in Ethiopia. Author(s): Tsega E, Gold P, Shuster J, Whittemore B, Lester FT. Source: J Trop Med Hyg. 1976 October; 79(10): 230-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=64619&dopt=Abstract
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Hepatitis B control in China: knowledge and practices among village doctors. Author(s): Clayton S, Yang H, Guan J, Lin Z, Wang R. Source: American Journal of Public Health. 1993 December; 83(12): 16858. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8259795&dopt=Abstract
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Hepatitis B epidemiology and cultural practices in Amerindian populations of Amazonia: the Tupi-Monde and the Xavante from Brazil. Author(s): Coimbra Junior CE, Santos RV, Yoshida CF, Baptista ML, Flowers NM, do Valle AC. Source: Social Science & Medicine (1982). 1996 June; 42(12): 1735-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8783434&dopt=Abstract
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Hepatitis B in Nuremberg, Germany. Epidemiology of a drugassociated epidemic. Among US Army soldiers. Author(s): Cates W Jr, Warren JW.
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Source: Jama : the Journal of the American Medical Association. 1975 December 1; 234(9): 930-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1242490&dopt=Abstract ·
Hepatitis B infection and renal transplantation: the absence of antidelta antibodies and the possible beneficial effect of silymarin during acute episodes of hepatic dysfunction. Author(s): Chan MK, Chan PC, Wong KK, Cheng IK, Li MK, Chang WK. Source: Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association. 1989; 4(4): 297-301. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2502738&dopt=Abstract
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Hepatitis B infection in China. Author(s): Lau GK. Source: Clin Liver Dis. 2001 May; 5(2): 361-79. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11385968&dopt=Abstract
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Hepatitis B infection in patients with lymphomas. Author(s): Liang RH, Lok AS, Lai CL, Chan TK, Todd D, Chiu EK. Source: Hematological Oncology. 1990 September-October; 8(5): 261-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1701155&dopt=Abstract
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Hepatitis B vaccination in the skin penetration industry. Author(s): Bouwman R, Cannata S, Fett MJ. Source: Med J Aust. 1994 February 7; 160(3): 165. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8295594&dopt=Abstract
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Hepatitis B virus and hepatocellular carcinoma--treatment of HBV carriers with Phyllanthus amarus. Author(s): Blumberg BS, Millman I, Venkateswaran PS, Thyagarajan SP. Source: Cancer Detection and Prevention. 1989; 14(2): 195-201. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2559794&dopt=Abstract
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Hepatitis B virus and primary hepatocellular carcinoma: treatment of HBV carriers with Phyllanthus amarus. Author(s): Blumberg BS, Millman I, Venkateswaran PS, Thyagarajan SP. Source: Vaccine. 1990 March; 8 Suppl: S86-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2158192&dopt=Abstract
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Hepatitis B virus transactivator MHBst: activation of NF-kappa B, selective inhibition by antioxidants and integral membrane localization. Author(s): Meyer M, Caselmann WH, Schluter V, Schreck R, Hofschneider PH, Baeuerle PA. Source: The Embo Journal. 1992 August; 11(8): 2991-3001. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1639069&dopt=Abstract
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Hepatitis B: therapeutic perspectives. Author(s): Rizzetto M, Lagget M. Source: Forum (Genova). 2001 April-June; 11(2): 137-50. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11948359&dopt=Abstract
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Hepatocellular carcinoma, hepatic cirrhosis, and hepatitis B virus infection in Nigeria. Author(s): Otu AA. Source: Cancer. 1987 November 15; 60(10): 2581-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2822223&dopt=Abstract
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Herbs of the genus Phyllanthus in the treatment of chronic hepatitis B: observations with three preparations from different geographic sites. Author(s): Wang M, Cheng H, Li Y, Meng L, Zhao G, Mai K. Source: The Journal of Laboratory and Clinical Medicine. 1995 October; 126(4): 350-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7561442&dopt=Abstract
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High cytoplasmic expression in E. coli, purification, and in vitro refolding of a single chain Fv antibody fragment against the hepatitis B surface antigen. Author(s): Sanchez L, Ayala M, Freyre F, Pedroso I, Bell H, Falcon V, Gavilondo JV.
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Source: Journal of Biotechnology. 1999 June 11; 72(1-2): 13-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10406095&dopt=Abstract ·
History of blood transfusion, tattooing, acupuncture and risk of hepatitis B surface antigenaemia among Chinese men in Singapore. Author(s): Phoon WO, Fong NP, Lee J. Source: American Journal of Public Health. 1988 August; 78(8): 958-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3389434&dopt=Abstract
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Identification of a protein kinase C (PKC) activator, daphnoretin, that suppresses hepatitis B virus gene expression in human hepatoma cells. Author(s): Chen HC, Chou CK, Kuo YH, Yeh SF. Source: Biochemical Pharmacology. 1996 October 11; 52(7): 1025-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8831721&dopt=Abstract
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In vitro studies on the effect of certain natural products against hepatitis B virus. Author(s): Mehrotra R, Rawat S, Kulshreshtha DK, Patnaik GK, Dhawan BN. Source: The Indian Journal of Medical Research. 1990 April; 92: 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2370093&dopt=Abstract
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Influence of perceived psychological stress and distress on antibody response to low dose rDNA hepatitis B vaccine. Author(s): Jabaaij L, Grosheide PM, Heijtink RA, Duivenvoorden HJ, Ballieux RE, Vingerhoets AJ. Source: Journal of Psychosomatic Research. 1993 May; 37(4): 361-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8510062&dopt=Abstract
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Leeches and hepatitis B. Author(s): Narendranathan M. Source: Lancet. 1992 May 30; 339(8805): 1362. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1350029&dopt=Abstract
116 Hepatitis B
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Misuse of randomization: a review of Chinese randomized trials of herbal medicines for chronic hepatitis B. Author(s): Liu J, Kjaergard LL, Gluud C. Source: Am J Chin Med. 2002; 30(1): 173-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12067091&dopt=Abstract
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Modulation of immune response to rDNA hepatitis B vaccination by psychological stress. Author(s): Jabaaij L, van Hattum J, Vingerhoets JJ, Oostveen FG, Duivenvoorden HJ, Ballieux RE. Source: Journal of Psychosomatic Research. 1996 August; 41(2): 129-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8887826&dopt=Abstract
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Molecular epidemiology of a large outbreak of hepatitis B linked to autohaemotherapy. Author(s): Webster GJ, Hallett R, Whalley SA, Meltzer M, Balogun K, Brown D, Farrington CP, Sharma S, Hamilton G, Farrow SC, Ramsay ME, Teo CG, Dusheiko GM. Source: Lancet. 2000 July 29; 356(9227): 379-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10972370&dopt=Abstract
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Obstacles to hepatitis B vaccine uptake by health care staff. Author(s): Briggs MJ, Thomas J. Source: Public Health. 1994 March; 108(2): 137-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8183969&dopt=Abstract
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Occurrence of hepatitis and hepatitis B surface antigen in adult patients with acute leukemia. Author(s): Cowan DH, Kouroupis GM, Leers WD. Source: Can Med Assoc J. 1975 March 22; 112(6): 693-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1054615&dopt=Abstract
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Osthole increases glycosylation of hepatitis B surface antigen and suppresses the secretion of hepatitis B virus in vitro. Author(s): Huang RL, Chen CC, Huang YL, Hsieh DJ, Hu CP, Chen CF, Chang C.
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Source: Hepatology (Baltimore, Md.). 1996 September; 24(3): 508-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8781315&dopt=Abstract ·
Outbreak of hepatitis B associated with acupuncture. Author(s): Stryker WS, Gunn RA, Francis DP. Source: The Journal of Family Practice. 1986 February; 22(2): 155-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3944549&dopt=Abstract
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Outbreak of hepatitis B in an acupuncture clinic. Author(s): Walsh B, Maguire H, Carrington D. Source: Commun Dis Public Health. 1999 June; 2(2): 137-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10402750&dopt=Abstract
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Parenteral and mucosal prime-boost immunization strategies in mice with hepatitis B surface antigen and CpG DNA. Author(s): McCluskie MJ, Weeratna RD, Payette PJ, Davis HL. Source: Fems Immunology and Medical Microbiology. 2002 February 18; 32(3): 179-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11934561&dopt=Abstract
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Phyllanthus amarus and hepatitis B. Author(s): Thyagarajan SP, Jayaram S, Valliammai T, Madanagopalan N, Pal VG, Jayaraman K. Source: Lancet. 1990 October 13; 336(8720): 949-50. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1976968&dopt=Abstract
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Phyllanthus amarus down-regulates hepatitis B virus mRNA transcription and replication. Author(s): Lee CD, Ott M, Thyagarajan SP, Shafritz DA, Burk RD, Gupta S. Source: European Journal of Clinical Investigation. 1996 December; 26(12): 1069-76. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9013081&dopt=Abstract
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Phyllanthus amarus suppresses hepatitis B virus by interrupting interactions between HBV enhancer I and cellular transcription factors. Author(s): Ott M, Thyagarajan SP, Gupta S. Source: European Journal of Clinical Investigation. 1997 November; 27(11): 908-15. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9395786&dopt=Abstract
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Potent synergistic effect of sho-saiko-to, a herbal medicine, during vaccine therapy in a murine model of hepatitis B virus carrier. Author(s): Akbar SM, Yamamoto K, Abe M, Ninomiya T, Tanimoto K, Masumoto T, Michitaka K, Horiike N, Onji M. Source: European Journal of Clinical Investigation. 1999 September; 29(9): 786-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10469167&dopt=Abstract
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Pretreatment of whole blood for use in immunochromatographic assays for hepatitis B virus surface antigen. Author(s): Shin HS, Kim CK, Shin KS, Chung HK, Heo TR. Source: Clinical and Diagnostic Laboratory Immunology. 2001 January; 8(1): 9-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11139189&dopt=Abstract
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Prevalence of hepatitis B and C viruses in healthy Indonesian blood donors. Author(s): Sulaiman HA, Julitasari, Sie A, Rustam M, Melani W, Corwin A, Jennings GB. Source: Trans R Soc Trop Med Hyg. 1995 March-April; 89(2): 167-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7539951&dopt=Abstract
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Prevalence of syphilis and hepatitis B among homosexual men in two saunas in Amsterdam. Author(s): Bleeker A, Coutinho RA, Bakker-Kok J, Tio D, de Koning GA. Source: Br J Vener Dis. 1981 June; 57(3): 196-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7237084&dopt=Abstract
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Prevention and therapy of hepatitis B. Author(s): Tao Q, Feng B.
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Source: Chin Med J (Engl). 1999 October; 112(10): 942-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11717982&dopt=Abstract ·
Primary prophylaxis with lamivudine of hepatitis B virus reactivation in chronic HbsAg carriers with lymphoid malignancies treated with chemotherapy. Author(s): Rossi G, Pelizzari A, Motta M, Puoti M. Source: British Journal of Haematology. 2001 October; 115(1): 58-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11722410&dopt=Abstract
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Prophylactic effect of interferon-alpha for exacerbation of hepatitis B after high-dose chemotherapy. Author(s): Matano S, Kobayashi K, Ohta H, Minouchi K, Sanada T, Sugimoto T. Source: Acta Haematologica. 2001; 106(3): 138-40. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11713383&dopt=Abstract
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Reversal of the immunosenescent phenotype by dehydroepiandrosterone: hormone treatment provides an adjuvant effect on the immunization of aged mice with recombinant hepatitis B surface antigen. Author(s): Araneo BA, Woods ML 2nd, Daynes RA. Source: The Journal of Infectious Diseases. 1993 April; 167(4): 830-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8450248&dopt=Abstract
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Seroconversion rate, hepatitis B vaccination, hemodialysis, and zinc supplementation. Author(s): Rawer P, Willems WR, Breidenbach T, Guttmann W, Pabst W, Schutterle G. Source: Kidney Int Suppl. 1987 October; 22: 149-52. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3481000&dopt=Abstract
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Simultaneous extraction of hepatitis C virus (HCV), hepatitis B virus, and HIV-1 from plasma and detection of HCV RNA by a reverse transcriptase-polymerase chain reaction assay designed for screening pooled units of donated blood.
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Author(s): Sun R, Schilling W, Jayakar H, Ku J, Wang J, Rosenstraus M, Spadoro J. Source: Transfusion. 1999 October; 39(10): 1111-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10532606&dopt=Abstract ·
Specific expression of hepatitis B surface antigen (HBsAg) in transgenic mice. Author(s): Babinet C, Farza H, Morello D, Hadchouel M, Pourcel C. Source: Science. 1985 December 6; 230(4730): 1160-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3865370&dopt=Abstract
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Steroid-free chemotherapy decreases the risk of hepatitis flare-up in hepatitis B virus carriers with non-Hodgkin's lymphoma. Author(s): Cheng AL. Source: Blood. 1996 February 1; 87(3): 1202. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8562950&dopt=Abstract
Vocabulary Builder Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Adverse: Harmful. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU]
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Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH]
Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU]
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Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU] Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Haematological: Relating to haematology, that is that branch of medical science which treats of the morphology of the blood and blood-forming tissues. [EU] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of
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anaesthesia or unconsciousness by use of appropriate agents. [EU] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Nasal: Pertaining to the nose. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nucleocapsid: A protein-nucleic acid complex which forms part or all of a virion. It consists of a capsid plus enclosed nucleic acid. Depending on the virus, the nucleocapsid may correspond to a naked core or be surrounded by a membranous envelope. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH]
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Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH] Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU]
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Reactivation: The restoration of activity to something that has been inactivated. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Sizofiran: A beta-D-glucan obtained from the Aphyllophoral fungus Schizophyllum commune. It is used as an immunoadjuvant in the treatment of neoplasms, especially tumors found in the stomach. [NIH] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the original infection or at a remote site. [EU]
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Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Transaminase: Aminotransferase (= a subclass of enzymes of the transferase class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU]
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CHAPTER 5. PATENTS ON HEPATITIS B Overview You can learn about innovations relating to hepatitis B by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.23 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available to patients with hepatitis B within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available to patients with hepatitis B. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.
Adapted from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.
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Patents on Hepatitis B By performing a patent search focusing on hepatitis B, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on hepatitis B: ·
Process for purifying hepatitis B viral surface antigen comprising preS2 peptide Inventor(s): Park; Soon-Jae (Daejeon, KR), Lee; Young-Mee (Daejeon, KR), Yoon; Kyung-Hee (Daejeon, KR), Lim; Kook-Jin (Daejeon, KR), Kwon; Young-Sun (Daejeon, KR) Assignee(s): LG Chemical Limited (KR) Patent Number: 6,362,320 Date filed: November 2, 1999 Abstract: A process for purifying hepatitis B viral surface antigen comprising the preS2 peptide from the cells of a recombinant organism is carried out by a sequence of steps which includes the step of disrupting the cells using a buffer containing a chaotropic salt to obtain a cell homogenate and the step of alkalifying the cell homogenate to a pH ranging from 11.0 to 13.5. Excerpt(s): The present invention relates to a process for purifying hepatitis B viral surface antigen containing a preS2 peptide; and, more specifically, to a process for purifying hepatitis B viral surface antigen containing a preS2 peptide from a recombinant yeast cell, which includes a cell disruption step carried out in the presence of a chaotropic salt to obtain a cell homogenate and the step of alkalifying the cell homogenate to enhance the solubilization of the surface antigen. ... Hepatitis B is one of the worldwide public health problems and approximately 200 to 300 millions of the world population are said to carry hepatitis B virus("HBV"). The HBV infection frequently progresses into cirrhosis and hepatocellular carcinoma, leading to the possible death of the patient. ... Hitherto, no treating agent for hepatitis B has been developed, and, as such, the importance of vaccines has been emphasized. Web site: http://www.delphion.com/details?pn=US06362320__
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·
Dicaffeoylquinic acid for treating hepatitis B and the diseases associated with retrovirus, and the new caffeoylquinic acid derivatives Inventor(s): Dong; Junxing (Beijing, CN), Tang; Zhongming (Beijing, CN), Mi; Zhibao (Beijing, CN), Wang; Bingji (Beijing, CN) Assignee(s): Institute of Radiation Medicine Academy of Military Medical Sciences of the (Beijing, CN) Patent Number: 6,331,565 Date filed: March 1, 1999 Abstract: This invention relates to the new use of dicaffeoylquinic acid derivatives for treating Hepatitis B and diseases associated with retrovirus (such as HIV), the new caffeoylquinic acid derivatives and the composition containing the same. Excerpt(s): The invention relates to the new use of dicaffeoylquinic acid derivatives for treating Hepatitis B and diseases associated with retrovirus (such as HIV), the new caffeoylquinic acid derivatives and the pharmaceutical composition containing the same. ... Hepatitis B is a serious worldwide disease infected by hepatitis B virus. Over 300 million individuals are chronically infected with HBV. China is a highly epidemic area of hepatitis B. In addition to causing both acute and chronic liver diseases, HBV infection is epidemically associated with a high risk of developing cirrhosis and primary hepatocellular carcinoma in human. Several types of treatment regiments have been reported for individuals with chronic HBV infection, including interferons and nucleoside analogs. However, these treatments have moderated to serious side effects, are only transiently effective in suppressing HBV, or are effective for only a small percentage of the general population of HBV-infected individuals. Even after universal implementation of neonatal vaccination there will still remain the existing carriers requiring on going treatment. There are no effective treatment for retrovirus associated disease, such as AIDS caused by HIV. Development of new effective drugs to eradicate HBV and retrovirus, such as HIV, in chronic carriers is, therefor of great potential importance. ... The object of the invention is to provide a new class of drugs for treating hepatitis B and anti-retrovirus with high effective, low side action and no HBV rebound after stopping the administration of the drug. Web site: http://www.delphion.com/details?pn=US06331565__
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·
HLA-restricted hepatitis B virus CTL epitopes Inventor(s): Vitiello; Maria A. (La Jolla, CA), Chesnut; Robert W. (Cardiff by the Sea, CA) Assignee(s): Epimmune, Inc. (San Diego, CA) Patent Number: 6,322,789 Date filed: June 5, 1995 Abstract: Cytotoxic T lymphocyte-stimulating peptides induce HLArestricted responses to hepatitis B virus antigens. The peptides, derived from CTL epitopic regions of both HBV surface and nucleocapsid antigens, are particularly useful in the treatment and prevention of HBV infection, including the treatment of chronically infected HBV carriers. The peptides can be formulated as HBV vaccines and pharmaceutical compositions, such as lipid-containing compositions for enhancing the HLA-restricted CTL responses. The peptides are also useful in diagnostic methods, such as predicting which HBV-infected individuals are prone to developing chronic infection. Excerpt(s): The hepatitis B virus (HBV) is not believed to be directly responsible for damage to hepatocytes, despite its predilection for infecting such cells. Rather, non-viral host factors are implicated in the pathogenesis of hepatitis. It is suspected that a variation in immune responsiveness to HBV infection may account for the wide diversity of syndromes associated with HBV infection. ... The immune response to hepatitis B virus is as complex as the disease. A variety of humoral and cellular responses have been identified to different regions of the HBV nucleocapsid core and surface antigens. T cell mediated immunity, particularly involving class I major histocompatibility complex (MHC)restricted cytotoxic T lymphocytes (CTL), is believed to play an important role in resistance to hepatitis as well as several other viral infections. CTL recognize antigen in the form of small peptides in association with the class I histocompatibility molecules. The antigen-specific CTL, when stimulated, can secrete mediators which inhibit viral replication and eliminate infected cells, thereby contributing to an individual's recovery from the infection. Although studies suggest that the T cell repertoire of class I-restricted responses is focused on a limited number of discrete immunodominant epitopes of a viral protein (Braciale et al., Proc. Natl. Acad. Sci. USA 86:277-281 (1989)), for many viruses, including the hepatitis viruses and particularly HBV, few epitopes have been identified. See also Barnaba et al., Nature 345:258 (1990) have identified an All restricted epitope while Jin et al., J. Exp. Med. 168:293 (1988) have identified an A3 restricted epitope. Aichele et al., J. Exp. Med. 171:18151820 (1990), have demonstrated induction in vivo of an antiviral CTL
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response in an MHC class-I dependent fashion with a peptide from the nucleoprotein of lymphocytic choriomeningitis virus. Recently, Kast et al., Proc. Natl. Acad. Sci. USA 88:2283-2287 (1991), described in stimulation of Sendai virus-specific CTL in vivo using free synthetic peptide derived from the nucleoprotein to confer protection against subsequent viral challenge. ... With respect to hepatitis B, as set forth in more detail below, usually at least four, sometimes six, often seven or more residues of the peptide or a majority of amino acids of that peptide will be identical or homologous when compared to the corresponding portion of the naturally occurring HBenv sequence identified as HBenv.sub.309-328 (peptide 799.08) or HBenv.sub.329-349 (peptide 799.09) or HBenv.sub.349-368 (peptide 799.10), or the HBc region HBc.sub.91-110 (peptide 802.03). Web site: http://www.delphion.com/details?pn=US06322789__ ·
Method of immunizing against hepatitis B virus Inventor(s): Neurath; Alexander Robert (New York, NY), Strick; Nathan (New York, NY), Thanavala; Yasmin M. (Buffalo, NY), Pride; Michael W. (Buffalo, NY) Assignee(s): Health Research, Inc. (Buffalo, NY) Patent Number: 6,319,501 Date filed: November 12, 1993 Abstract: A method for immunizing a human against hepatitis B virus comprising administering to the human a vaccine comprising a hepatitis B virus surface antigen, wherein included in the vaccine is one or more antigens of non-permitted variant sequences within residues S(139-147) of the hepatitis B virus surface antigen. Excerpt(s): The present invention concerns an improved method for immunizing against hepatitis B virus (HBV) by including in a hepatitis B virus vaccine one or more antigens of non-permitted variant sequences within residues S(139-147) of the hepatitis B virus surface antigen. ... There are approximately 600,000 persistent carriers of hepatitis B virus (HBV) in the United States; the estimated total number of carriers in the world is 300 million. A considerable portion of HBV carriers have chronic liver disease. The involvement of HBV in liver cancer has been demonstrated (W. Szmuness, Prog. Med. Virol. 24, 40 (1978) and R. P. Beasley, L.-Y. Hwang, C. -C. Ling, C.-S. Chien, Lancet, Nov., 21, 1129 (1981)). ... Several antigenic subtypes of HBV and of subviral approximately 22 nm diameter particles (hepatitis B surface antigen; HBsAg) have been recognized (G. Le Bouvier, A. Williams, Am. J. Med.
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Sci., 270,.165 (1975)). All of these subtypes (for example, ayw, adyw, adw2, adw and adr) share common (group-specific) envelope epitopes, the immune response against which appears sufficient for protection against infection by any of the virus subtypes (W. Szmuness, C. E. Stevens, E. J. Hartley, E. A. Zang, H. J. Alter, P. E. Taylor, A. DeVera, G. T. S. Chen, A. Kellner et al, N. Enql. J. Med., 307, 1481, (1982)). Web site: http://www.delphion.com/details?pn=US06319501__ ·
Inhibition and treatment of Hepatitis B virus and Flavivirus by Helioxanthin and its analogs Inventor(s): Cheng; Yung-Chi (Woodbridge, CT), Chou; Chen-Kung (Taipei, TW), Fu; Lei (Hamilton, CA), Kuo; Yueh-Hsiung (Taipei, TW), Yeh; Sheau-Farn (Taipei, TW), Zhu; Juliang (Hamden, CT), Zhu; Yonglian (New Haven, CT) Assignee(s): Yale University (New Haven, CT), N. Y. Mu, N.T.U., V.G.H (Taipei, TW) Patent Number: 6,306,899 Date filed: August 23, 1999 Abstract: This invention relates to anti-viral drugs such as Helioxanthin and its analogs. The present compounds may be used alone or in combination with other drugs for the treatment of Hepatitis B virus (HBV), Hepatitis C virus (HCV), Yellow Fever, Dengue Virus, Japanese Encephalitis, West Nile virus and related flaviviruses. In addition, compounds according to the present invention can be used to prevent hepatoma secondary to virus infection as well as other infections or disease states which are secondary to the virus infection. Excerpt(s): This invention relates to the anti-viral drugs such as Helioxanthin and its analogs compounds. These compounds may be used alone or in combination with other drugs for the treatment of the following: Hepatitis B virus (HBV), Hepatitis C virus (HCV), Yellow Fever, Dengue Virus, Japanese Encephalitis, West Nile virus and related flaviviruses. In addition, compounds according to the present invention can be used to prevent hepatoma secondary to virus infection as well as other infections or disease states which are secondary to the virus infection. ... Hepatitis B virus infection is a major health problem worldwide. HBV is a causative agent of both an acute and chronic form of hepatitis. More than 300 million people throughout the world are chronic carriers of HBV. Typically, the human host is unaware of infection and HBV infection leads to acute hepatitis and liver damage, abdominal pain, jaundice and elevated blood levels of certain enzymes.
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Additionally, HBV contributes to the formation of hepatocellular carcinoma and is second only to tobacco as a cause of human cancer. The mechanism by which HBV induces cancer is unknown, although it has been postulated that it may directly trigger tumor development or indirectly trigger tumor formation through chronic inflammation, cirrhosis and cell regeneration associated with the infection. ... The core gene contains the nucleocapsid protein (183-185 aa) and the hepatitis B core antigen. The precore region, upstream of the core region, consists of 87 nucleotides that codes for 29 amino acids and is in phase with the core region. The first 19 amino acids of the precore region act as a signal for membrane translocation and eventual secretion of the precore gene product, the Hbe antigen. Web site: http://www.delphion.com/details?pn=US06306899__ ·
Treatment of hepatitis B infection with thymosin alpha 1 in combination with lamivudine or in combination with lamivudine and famciclovir Inventor(s): Leung; Ying-Kit (Hong Kong, CN) Assignee(s): SciClone Pharmaceuticals, Inc. (San Mateo, CA) Patent Number: 6,288,033 Date filed: October 9, 1998 Abstract: A method of treatment of hepatitis B virus (HBV) infection in a patient by administering to the patient a drug regimen including an antiviral-effective amount of thymosin alpha 1 (T.alpha.1), an antiviraleffective amount of lamivudine, and optionally an antiviral-effective amount of famciclovir is disclosed. Excerpt(s): The present invention relates to the field of hepatitis B treatment. ... Chronic hepatitis B virus (HBV) infection is a serious global health problem affecting around 300 million individuals. Among them, approximately seventy-five percent are believed to be Asian. It also is estimated that 25-40% of these HBV carriers will die of cirrhosis or hepatocellular carcinoma. ... So far, therapeutic trials have mainly been directed toward utilization of anti-viral agents, immunomodulators, immunosuppressives or certain specific combinations of these. At present, interferon-alpha is the only therapeutic approach that has had regulatory approval in a number of countries. However, interferon therapy has been reported to produce sustained clearance of hepatitis B e antigen (HBeAg) in 30-40% of North America and European patients, but only 25-65% of these patients ultimately cleared hepatitis B surface antigen (HBsAg). The response rate in Asian patients is lower:
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approximately 15-20% will clear HBeAg, of these only approximately 10% will clear HBsAg. One of the factors that affects the antiviral effects of these immunomodulatory agents is the high pretreatment HBV DNA level. Recently, second generation nucleoside analogs, such as lamivudine and famciclovir, have been shown to be effective in suppressing HBV replication with a good safety profile. However the nucleoside analogs have not been shown to maintain durable HBV DNA suppression once therapy is removed. Hence, the combination therapy goal is suppression and clearance. Web site: http://www.delphion.com/details?pn=US06288033__ ·
Human monoclonal antibodies to the hepatitis B surface antigen Inventor(s): Reisner; Yair (Old Jaffa, IL), Dagan; Shlomo (Rehovot, IL) Assignee(s): Yeda Research & Development Co. Ltd (Rehovot, IL), XTL Biopharmaceuticals Ltd (Rehovot, IL) Patent Number: 6,254,867 Date filed: December 10, 1998 Abstract: Disclosed is a process for obtaining hybridoma cell lines which produce human antibodies capable of binding to the hepatitis B virus surface antigen (HBVsAg), as well as the hybridoma cell lines, and antibodies produced by the cell lines. Also disclosed are various uses of said antibodies in the prevention and treatment of HBV infection. Peripheral blood lymphocytes obtained from human donors having a high titer of anti HBVsAg antibodies are engrafted into normal strains of mice which were lethally irradiated and radioprotected with SCID bone marrow. After immunization of such chimeric mice with HBVsAg, human cells are obtained from the mice spleens and fused in vitro with heteromyeloma cells to generate hybridomas secreting human antibodies having a high affinity and specificity to HBVsAg. Excerpt(s): The present invention concerns a process for obtaining hybridoma cell lines which produce human antibodies capable of binding to the hepatitis B virus surface antigen, the hybridoma cell lines, antibodies produced by the cell lines, and various uses thereof. ... Hepatitis B virus (HBV) infection is a major worldwide health problem. Approximately 5% of the world population is infected by HBV and chronically infected patients carry a high risk of developing cirrhosis and hepatocellular carcinoma. (Progress in Hepatitis Research: Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Hepatitis Delta virus (HDV) Ed. O. Crivelli, Sorin Biomedica, 1991). ... Interferon-.alpha. has been used
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in the therapy of Hepatitis B infection showing an efficacy of only 30-40% in highly selected patients. Web site: http://www.delphion.com/details?pn=US06254867__ ·
Antiviral liponucleosides: treatment of hepatitis B Inventor(s): Hostetler; Karl Y. (Del Mar, CA) Assignee(s): NeXstar Pharmaceuticals, Inc. (Boulder, CO) Patent Number: 6,252,060 Date filed: April 4, 1994 Abstract: Compounds for treating hepatitis B infections. The compounds consist of nucleoside analogues having anti-hepatitis B activity which are linked, commonly through a 5' phosphate of the pentose residue, to one of a selected group of lipids. The lipophilic nature of these compounds provides an advantage over the use of the nucleoside analogue alone, making it possible to incorporate them into the lamellar structure of liposomes, either alone or in combination with similar lipid molecules. In the form of appropriately sized liposomes, these anti-hepatitis B agents are preferentially taken up by the liver cells which have been found to harbor the target virus. Excerpt(s): Many nucleoside analogues are known to have activity against the hepatitis B virus (HBV). Recently, Lee et al.(1) as well as Kassanides et al.(2) have shown that dideoxynucleosides such as dideoxycytidine (ddC), dideoxyinosine (ddI), dideoxyadenosine (ddA), dideoxythymidine (ddT), dideoxyguanosine (ddG) and dideoxydiaminopurine are active against duck hepatitis B in vitro and in vivo (1,2). These drugs are thought to be effective because they inhibit a reverse transcriptase the hepatitis B virus utilizes at some stage of its life cycle. The triphosphates of other nucleosides such as acyclovir (ACV), bromovinyldeoxyuridine (BVdU), and deoxyfluoroarabinosyliodocytosine (FIAC) have also been reported to inhibit the DNA polymerase of hepatitis B virus from humans and woodchucks (3). The arabinofuranosyladenines (ara-A) and arabinofuranosyl-cytidines (ara-C) inhibit the human hepatitis B DNA polymerase, and ara-A has activity when administered to individuals suffering from chronic type B hepatitis (4). Further, Matthes et al. report that 2',3'-dideoxy-3'fluorothymidine (FddThd), 2',3'-didehydro-2',3'-dideoxythymidine (ddeThd), 3'-fluoro-5-methyl-deoxycytidine (FddMeCyt), 3'-chloro-5methyl-deoxycytidine ((ClddMeCyt), and 3'-amino-5-methyldeoxycytidine (AddMeCyt) almost completely block production of hepatitis B virus particles in an HBV DNA-transfected cell line in vitro
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(5). ... The antihepatitis B nucleoside analogues described above have very short half lives when administered to humans or animals as the free compound. After 4 to 6 hours, their levels in tissue and plasma are very low or negligible. These nucleoside analogues are also toxic, and their toxicity can be a limiting factor in therapeutic regimens. Clearly, it would be useful to administer the antihepatitis B nucleosides (dideoxynucleosides, acyclic nucleosides, and deoxynucleosides) in a form which could be targeted to the liver parenchymal cells, and which could maintain higher tissue levels over longer time periods. ... The invention provides, in one embodiment, a compound having antiviral properties, comprising an antihepatitis B nucleoside analogue having a base portion comprising a purine or pyrimidine or analogue thereof, and a sugar portion comprising a pentose residue, wherein at least one portion is a non-naturally occurring nucleoside component; and a lipid moiety linked to the pentose residue; with the proviso that the compound is in the form of a liposome when the pentose residue is arabinofuranose and the base portion is cytosine or adenine. The non-naturally occurring nucleoside component can be an analogue of a naturally occurring base or pentose by virtue of substitution, deletion, or replacement. In preferred embodiments, the pentose residue is a 2',3'-dideoxy, 2',3'didehydro, or halo derivative of ribose, or an acyclic hydroxylated fragment of ribose. In particularly preferred embodiments, the pentose residue is a 2',3'-dideoxyribose, and the nucleoside analogue is 2',3'dideoxycytidine; 2',3'-dideoxythymidine; 2',3'-dideoxyguanosine; 2',3'dideoxyadenosine; 2',3'-dideoxyinosine; or 2,6-diaminopurine, 2',3'dideoxyriboside. In other preferred embodiments, the pentose group is a halo- or an amino derivative of ribose and the nucleoside is 3'-fluoro-5methyl-deoxycytidine(FddMeCyt),3'-chloro-5-methyl-deoxycytidin e(ClddMeCyt), 3'-amino-5-methyl-deoxycytidine(AddMeCyt), or 2',3'dideoxy-3'-fluorothymidine. The nucleoside analogue can alternatively be acyclovir, 1-(2'-deoxy-2'-fluoro-1-.beta.-D-arabinofuranosyl) -5iodocytosine (FIAC) or 1(2'-deoxy-2'-fluoro-1-.beta.-D-arabinofuranosyl)5-iodouracil (FIAU). In particularly preferred embodiments, the nucleoside analogue is 2',3'-didehydro-2',3'-dideoxythymidine. Web site: http://www.delphion.com/details?pn=US06252060__
Patents 137
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Nucleosides with anti-hepatitis B virus activity Inventor(s): Schinazi; Raymond F. (Decatur, GA), Sommadossi; JeanPierre (Birmingham, AL), Gosselin; Gilles (Montpellier, FR), Imbach; Jean-Louis (Montpellier, FR) Assignee(s): Emory University (Atlanta, GA) Patent Number: 6,245,749 Date filed: July 9, 1998 Abstract: A method for the treatment of a host, and in particular, a human, infected with hepatitis B virus (HBV) is provided that includes administering an effective amount of a nucleotide prodrug of .beta.- L-2', 3'-dideoxyadenosine, wherein the prodrug component of the nucleotide provides controlled delivery of the active species. Excerpt(s): This invention is in the area of methods for the treatment of hepatitis B virus (also referred to as "HBV") that includes administering an effective amount of one or more of the active compounds disclosed herein, or a pharmaceutically acceptable derivative or prodrug of one of these compounds. ... Hepatitis B virus has reached epidemic levels worldwide. After a two to six month incubation period in which the host is unaware of the infection, HBV infection can lead to acute hepatitis and liver damage, that causes abdominal pain, jaundice, and elevated blood levels of certain enzymes. HBV can cause fulminant hepatitis, a rapidly progressive, often fatal form of the disease in which massive sections of the liver are destroyed. Patients typically recover from acute viral hepatitis. In some patients, however, high levels of viral antigen persist in the blood for an extended, or indefinite, period, causing a chronic infection. Chronic infections can lead to chronic persistent hepatitis. Patients infected with chronic persistent HBV are most common in developing countries. By mid-1991, there were approximately 225 million chronic carriers of HBV in Asia alone, and worldwide, almost 300 million carriers. Chronic persistent hepatitis can cause fatigue, cirrhosis of the liver, and hepatocellular carcinoma, a primary liver cancer. In western industrialized countries, high risk groups for HBV infection include those in contact with HBV carriers or their blood samples. The epidemiology of HBV is in fact very similar to that of acquired immunodeficiency syndrome, which accounts for why HBV infection is common among patients with AIDS or HIV-associated infections. However, HBV is more contagious than HIV. ... European Patent Application No. 92304530.6 discloses that a group of 1,2-oxathiolane nucleosides are useful in the treatment of hepatitis B infections. It has been reported that the 2hydroxymethyl-5-(cytosin-1-yl)-1,3-oxathiolane has anti-hepatitis B activity. Doong, et al., Proc. of Natl. Acad. Sci USA, 88, 8495-8499 (1991);
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Chang, et al., J. of Biological Chem., Vol 267(20), 13938-13942. The antihepatitis B activity of the (-) and (+)-enantiomers of 2-hydroxymethyl-5(5-fluorocytosin-1-yl)-1,3-oxathiolane has been published by Furman, et al., in Antimicrobial Agents and Chemotherapy, Dec. 1992, pages 26862692. Web site: http://www.delphion.com/details?pn=US06245749__ ·
Peptides for inducing cytotoxic T lymphocyte responses to hepatitis B virus Inventor(s): Chisari; Francis V. (Del Mar, CA) Assignee(s): The Scripps Research Institute (La Jolla, CA) Patent Number: 6,235,288 Date filed: June 5, 1995 Abstract: Peptides are used to define epitopes that stimulate HLArestricted cytotoxic T lymphocyte activity against hepatitis B virus antigens. The peptides are derived from regions of HBV envelope, and are particularly useful in treating or preventing HBV infection, including methods for stimulating the immune response of chronically infected individuals to respond to HBV antigens. Excerpt(s): Hepatitis B Virus ("HBV") is a non-lytic virus which has currently infected approximately 250 million people worldwide. HBV infection in adults typically leads to an acute disease in the majority of cases, and to a chronic disease state in a minority of patients. This ratio of acute to chronic is reversed when the infection occurs close to the time of birth. There is an increased incidence of hepatocellular carcinoma in chronic HBV infection. A small percentage of individuals who are infected with HBV in adulthood develop fulminant hepatitis associated with a strong immune response with high lethality. ... Seven ideal HLAA2.1 allele specific binding motifs, defined as peptides between 9-10 residues in length that contain a leucine in the second position and a valine as the carboxy-terminal residue, are present in the HBsAg region of the HBV envelope protein (Table III). Based on the results obtained in Example I, the ability of these seven envelope peptides, plus the known HLA-A2 restricted HBV nucleocapsid epitope (HBcAg18-27), to stimulate a CTL response in 12 HLA-A2 positive patients with acute hepatitis B, was examined. For comparison, six HLA-A2 positive patients with chronic hepatitis and 6 uninfected normal controls were tested for responsiveness to the same panel of peptides. Web site: http://www.delphion.com/details?pn=US06235288__
Patents 139
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Strategically modified hepatitis B core proteins and their derivatives Inventor(s): Birkett; Ashley J. (Solana Beach, CA) Assignee(s): Immune Complex Corporation (San Diego, CA) Patent Number: 6,231,864 Date filed: February 11, 1999 Abstract: A strategically modified hepatitis B core protein is described, where an insert is provided, preferably in an immunodominant region of the nucleocapsid protein, containing a chemically reactive amino acid residue. The modified hepatitis B core protein or its aggregated nucleocapsid protein particles can be pendently linked to a hapten to form a modified nucleocapsid conjugate. Such a conjugate is useful in the preparation of vaccines or antibodies. The modified hepatitis B core protein can also be modified to include a T cell epitope. Excerpt(s): Gerin et al., Proc. Natl. Acad. Sci. USA, 80:2365 (1983), showed limited protection of chimpanzees from hepatitis B virus upon immunization with carrier-bound synthetic polypeptides having amino acid residue sequences that correspond to the sequence of a determinant portion of HBsAg; in particular, residues 110-137 of the "S" (surface) region. However, the carrier protein used in those studies was keyhole limpet hemocyanin (KLH), a T cell-dependent carrier that is not fit for use in medical applications to humans because it is a source of irritation that leads to severe inflammation. ... The hepatitis B surface protein has been proposed as a carrier for heterologous epitopes. Delpeyroux et al., Science, 233:472-475 (1986), reported the use of the HBV surface protein (S protein) as a carrier for a poliovirus polypeptide hapten. Those investigators constructed a recombinant deoxyribonucleic acid (DNA) protein expression vehicle that produces a fusion protein, designated HBsPolioAg, capable of forming particles closely resembling authentic 22-nanometer HBsAg particles. HBsPolioAg consists of HBV S protein having an 11 amino acid residue sequence insert corresponding to amino acids 93-103 of capsid protein VPI of poliovirus type 1 (Mahoney strain). ... Hepadnavirus nucleocapsid proteins have been used as hapten carriers. Heterologous immunogenic peptide sequences inserted internally in the hepatitis B core, expressed as fusion particles, elicited very high immune responses in immunized animals in the absence of adjuvants. B. E. Clarke et al. Vaccines 91:313-318 (1991); F. Schodel et al. J. Virol. 66(1):106-114 (1992). U.S. Pat. Nos. 4,818,527, 4,882,145, and 5,143,726, the disclosures of which are incorporated herein by reference, describe the use of the carrier effect with hepatitis B virus nucleocapsid protein to enhance the immunogenicity of an operatively linked polypeptide hapten. Those patents describe the linking of a polypeptide
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hapten to hepatitis B virus nucleocapsid protein through an amino acid residue side chain that occurs naturally in the hepatitis B nucleocapsid protein sequence. Web site: http://www.delphion.com/details?pn=US06231864__ ·
Process for the production of DNA comprising the genome of the hepatitis B virus and vector including it Inventor(s): Tiollais; Pierre (Paris, FR), Fritsch; Alex (Paris, FR), Pourcel; Christine (Paris, FR), Charnay; Patrick (Boulogne, FR) Assignee(s): Institut Pasteur (Paris, FR), Institut National de la Santa et de la Recherche Medicale (Paris, FR) Patent Number: 6,225,458 Date filed: November 23, 1994 Abstract: The invention relates to a process for producing DNA corresponding to that of the DNA of the virus of B hepatitis. It comprises cloning in bacteria the latter DNA, previously repaired by means of the corresponding precursor nucleotides in the presence of a polymerase. The invention also relates to vectors containing said cloned DNA in their genomes. The cloned DNA is useful as a probe for detecting the presence of the virus of B hepatitis in biological samples, particularly blood or plasma. Its expression in bacteria provides a hybrid protein containing a protein fragment having vaccinating properties against hepatitis B. Excerpt(s): Thus it was clearly established in the prior art that in vitro polymerase-repaired DNA derived from the genomes of hepatitis B virus still contained monocatenary regions, i.e. nuclease S1 susceptible sites. As a matter of fact it was well known in the art that the nuclease S1 enzyme can cleave DNA only in areas of monostranded portions and not in the double-stranded portions. ... The invention finally also concerns a method for the production of a hybrid protein containing a protein fragment having vaccinating activity against hepatitis B which-comprises introducing the above defined vector in bacteria, causing the latter to translate at least the part of said vector which contains the DNA corresponding to that of hepatitis B and recovering said hybrid protein. Web site: http://www.delphion.com/details?pn=US06225458__
Patents 141
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Escape mutant of the surface antigen of hepatitis B virus Inventor(s): Primi; Daniele (Brescia, IT), Fiordalisi; Gianfranco (Breno Brescia, IT), Palla; Mario (Saluggia, IT) Assignee(s): DiaSorin International Inc. (New York, NY) Patent Number: 6,172,193 Date filed: November 16, 1998 Abstract: The invention provides an isolated mutant hepatitis B surface antigen protein which comprises an amino acid sequence of a surface antigen protein of hepatitis B virus which infects humans, in which the amino acid at position 121 is not cysteine and. at least one of the amino acids at positions 120, 122, 123, 147, or 149 is not a conserved amino acid for its position. The invention also provides a method for detecting in a sample a mutant hepatitis B surface antigen protein or a particle containing the protein. Excerpt(s): The present invention relates to an escape mutant of the surface antigen of the hepatitis B virus. ... Serum from patients infected with hepatitis B virus (HBV) commonly have three distinct structures that contain the hepatitis B surface antigen (HBsAg): Dane particles, spherical particles, and filamentous particles. Dane particles are spheres that are 42 nm in diameter with a core that is 28 nm in diameter. The spherical particles have a diameter of about 22 nm. Filamentous particles have a diameter of about 22 nm and a length from about 50 nm to about 230 nm. ... The particles contain three glycoprotein designated the major, middle, and large proteins. The hepatitis B surface antigen open reading frame of HBV-DNA is divided into three regions, pre-S 1, pre-S2, and S. This open reading frame encodes the major, middle, and large proteins. The complete amino acid sequence for the major protein is given in Valenzuela et al., Nature, 280:815-819 (1979). The amino acid sequence in Valenzuela et al. is 226 amino acids long and the amino acid positions referred to in this application refer to the amino acid sequence disclosed in Valenzuela et al. HBsAg contains several antigenic determinant,;, the most important of these are the a determinant, the d/y determinant, and the w/r determinant. Web site: http://www.delphion.com/details?pn=US06172193__
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Patent Applications on Hepatitis B As of December 2000, U.S. patent applications are open to public viewing.24 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years). The following patent applications have been filed since December 2000 relating to hepatitis B: ·
Preventive and therapeutic antiviral drug for aids, hepatitis B, hepatitis C and influenza Inventor(s): Fujisaki, Shigemi ; (Nishinomiya-shi, JP), Honda, Mitsuo ; (Mitaka-shi, JP) Correspondence: Nixon Peabody, LLP; 8180 Greensboro Drive; Suite 800; McLean; VA; 22102; US Patent Application Number: 20020068055 Date filed: August 21, 2001 Abstract: The present invention provides a preventive and therapeutic antiviral drug for AIDS, hepatitis B, hepatitis c and influenza containing MEP-F (metalloendopeptidase-F) and proteases (protein decomposition enzymes) as effective ingredients.Viruses should pass through CD4 receptors on the surface of the cell membrane for invading into the cell. However, since MEP-F extinguishes the activity of CD4 to prevent the viruses from invading into the cell, growth and proliferation of the virus are inhibited, manifesting preventive and therapeutic efficacy for viral infection. Excerpt(s): The present invention relates to a preventive and therapeutic antiviral drug for AIDS, hepatitis B, hepatitis C and influenza. ... The therapeutic and preventive antiviral drug according to the present invention contains MEP-F and other proteases as effective ingredients, and their efficacy is applicable to AIDS, hepatitis B, hepatitis C and influenza. ... (iv) Results of tests for viral infections: No symptoms of hepatitis B and hepatitis C and no abnormal findings were noted in serologic tests for HBV, HCV and antigens. Positive responses were noted in the HIV test and ELISA test, and the result of reconfirmation by the western blot technique also positive. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
24
This has been a common practice outside the United States prior to December 2000.
Patents 143
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Synthetic peptides that bind to the hepatitis B virus core and e antigens Inventor(s): Sallberg, Matti ; (Alvsjo, SE) Correspondence: Knobbe Martens Olson & Bear LLP; 620 Newport Center Drive; Sixteenth Floor; Newport Beach; CA; 92660; US Patent Application Number: 20020058247 Date filed: April 20, 2001 Abstract: The present invention relates generally to the field of virology. More particularly, the invention relates to the discovery that peptides, which bind to the Hepatitis B virus (HBV) core and e antigens, can be used to inhibit HBV infection. Embodiments concern "binding partners", which include peptides, peptidomimetics, and chemicals that resemble these molecules that interact with HBV core and e antigens, biological complexes having HBV core and e antigens joined to said binding partners, methods of identifying such binding partners, pharmaceuticals having binding partners, and methods of treatments and prevention of HBV infection. Excerpt(s): The present invention relates generally to the field of virology. More particularly, the invention relates to the discovery that peptides that bind to the hepatitis B virus (HBV) core and e antigens can be used to inhibit HBV infection. ... Of the many viral causes of human hepatitis, few are of greater global importance than hepatitis B virus (HBV). Approximately 300 million people worldwide are chronically infected and some of these chronically infected individuals develop severe pathologic consequences including chronic hepatic insufficiency, cirrhosis, and hepatocellular carcinoma (HCC). (See Fields Virology, third ed., edited by Fields et al., Lipponcott-Raven Publishers, Philidelphia 1996 pp. 2703 and Lee et al., Cancer, 72:2564-7 (1993)). Primary infection may be asymptomatic (e.g., in chronically infected individuals) or may result in varying degrees of acute liver injury. (Milich et al., Springer Seminars in Immunopathology, 17:149-66 (1995)). ... The disclosure herein describes the manufacture, characterization, and use of molecules that bind hepatitis B virus (HBV) core (HBcAg) and e (HBeAg) antigens and thereby inhibit HBV infection and/or modulate a host immune system response. The molecules that bind to HBcAg and/or HBeAg, such as peptides, modified or derivatized peptides, peptidomimetics, and chemicals, are collectively referred to as "binding partners". Binding partners can be obtained by synthesizing the heavy (VH) and light (VL) chains of antibodies (e.g., polyclonal, monoclonal, or fragments thereof), synthesizing the domains of proteins that interact with HBcAg and/or HBeAg, and by employing techniques in rational drug design and combinatorial chemistry.
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Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Hepatitis B virus vectors for gene therapy Inventor(s): Ryu, Wang-Shick ; (Yangcheon-gu, KR), Lee, Jehan ; (Goyang-shi, KR), Jeong, Jong Keun ; (Sungbuk-gu, KR), Cho, Woo Young ; (Gangnam-gu, KR), Yoon, Gye Soon ; (Sungnam-shi, KR) Correspondence: TransPotomac Plaza; Suite 306; 1033 N. Fairfax St.; Alexandria; VA; 22314; US Patent Application Number: 20010049145 Date filed: April 19, 2001 Abstract: The present invention relates to novel hepatitis B virus vectors for use in gene therapy which can deliver therapeutic genes to liver cells. The invention also provides methods for the production of novel recombinant hepatitis B viruses. The recombinant viruses produced by this invention can deliver therapeutic genes specifically to liver cells either through in vivo or ex vivo therapy protocols. This vector can be used not only to treat liver diseases but also genetic diseases. Excerpt(s): The present invention relates to recombinant hepatitis B viral vectors useful for the expression of heterologous genes in liver cells. The invention also provides methods for the production of novel recombinant hepatitis B viruses. Liver-specific targeting ability of these HBV vectors extend its use for in vivo gene therapy protocol as well as for ex vivo therapy protocol. The recombinant viruses produced by this invention can deliver therapeutic genes specifically to liver cells either in vivo therapy protocol or ex vivo therapy protocol. This vector can be used not only to treat liver diseases but also genetic diseases. ... Ideally, liverdirected gene therapy would be achieved by in vivo transfer of vectors which specifically target hepatocytes. Vectors derived from hepatotropic viruses, such as hepatitis B viruses (HBV), can be administered via circulation and target hepatocytes using the same receptor as the wildtype virus. However, the hepatitis B viruses have not been explored as a gene therapy vector due to lack of information on cis-acting elements essential for HBV genome replication. ... Hepatitis B virus (HBV) is the prototype of the hepadnaviridae, a family of a small enveloped DNA virus with pronounced host and tissue specificity (Ganem, 1996). Hepadnaviruses have been found in mammals, e.g., human (HBV), woodchuck (WHV) and ground squirrels (GSHV), as well as in birds, e. g., Pekins ducks (DHBV) and grey herons (HHBV). Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Patents 145
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Combination therapy method for treating chronic hepatitis B Inventor(s): Horwitz, David L. ; (Hillsborough, CA) Correspondence: Townsend and Townsend and Crew; Two Embarcadero Center; Eighth Floor; San Francisco; CA; 94111-3834; US Patent Application Number: 20010012830 Date filed: January 17, 2001 Abstract: The present invention is aimed at augmenting the success rate of using thymosin in treatment of chronic hepatitis B, by employing a combination therapy using thymosin with antiviral agents which are effective in inhibiting DNA synthesis or DNA polymerase during replication of the hepatitis B virus. Excerpt(s): The instant invention relates to a method for treating chronic hepatitis B infections. More specifically, the instant invention relates to a method for treating chronic hepatitis B infections using both thymosin and an antiviral drug. ... Hepatitis B is the most prevalent form of hepatitis and is the second most common infectious disease worldwide. Worldwide estimates of those chronically infected with hepatitis B virus (HBV) are in excess of 300,000,000. The disease is caused by the hepatitis B virus, a DNA virus. The virus is transmitted through blood transfusions, contaminated needles, sexual contact and vertical transmission from mother to child. Moreover, a significant number of people are infected by unknown means. ... Carriers of the virus can exhibit various forms of disease, one of which is chronic hepatitis B. Approximately 50% of the carriers show chronic inflammatory changes in the liver and, of these, about 50% have histopathologic changes, which are termed "chronic active hepatitis", that may lead to fibrosis and ultimately to cirrhosis and progressive liver failure. Carriers without chronic inflammatory changes may also develop chronic active hepatitis. Liver cancer develops in about 10 to 30% of hepatitis B carriers. It has been estimated that approximately 4 million carriers of hepatitis B virus die each year from liver cancer or cirrhosis. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
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Predictive test for hepatitis-B resistance Inventor(s): Hill, Adrian V.S. ; (Oxford, GB), Thursz, Mark R. ; (London, GB), Thomas, Howard C. ; (London, GB) Correspondence: Nixon & Vanderhye P.C.; 8th Floor; 1100 N. Glebe Rd.; Arlington; VA; 22201; US Patent Application Number: 20010005507 Date filed: January 5, 2001 Abstract: Methods of identifying resistance to Hepatitis B infection are disclosed, as well as peptides capable of modifying immune response and methods of treating Hepatitis B. Excerpt(s): The present invention relates to a novel method of predicting resistance to Hepatitis B, peptides useful in modifying immune response to Hepatitis B, vaccines against Hepatitis B and methods of treating Hepatitis B. ... Infection with hepatitis B virus (HVB) may result in a number of disease states ranging from fulminant hepatitis with liver failure to asymptomatic persistent carriage. Most patients will suffer an acute hepatitis during which the virus is eliminated. About 5% of patients in North America and Europe fail to eliminate the virus, whereas in West Africa up to 15% of infected patients fail to clear HVB (Ryder, R. W. et al, Lancet, ii(8400): 449-52 1984). Persistent HBV infection predisposes the host to chronic liver disease and hepatocellular carcinoma (Beasley, R. et al, Lancet, ii, 1159-63, 1981), which is a common cause of death in adults of working age in West Africa (Ryder, R. W. et al., Am. J. Epidemiol., 136(9): 1122-31, 1992). ... Recognition of foreign antigens by T lymphocytes is achieved through the presentation of antigenic peptides in the groove of MHC encoded HLA molecules. Such immunological responses are MHC restricted, meaning that foreign antigens are only recognised when presented by specific class I or class II molecules. In patients with acute hepatitis B, class I restricted cytotoxic T lymphocytes (CTL) are present in the peripheral blood which recognise the nucleocapsid and envelope antigens of HBV (Bertoletti, A. et al, Proc. Natl. Acad. Sci, USA, 88(23): 10445-9, 1991). In addition there is a strong class II restricted proliferative response to the nucleocapsid antigens (Ferrari, C. et al, J. Clin. Invest, 88: 214-22, 1991). CD4+ T helper cell responses to the nucleocapsid and envelope antigens of the virus are required to support anti-HBe and anti-HBs antibody development (Milich, D. et al, Nature, 319: 547-9, 1987). In patients with chronic HBV infection, CTL are not detectable and the proliferative response is absent or significantly reduced (Ferrari, C. et al, J. Immumol., 145(10): 3442-9, 1990; and Tsai, S. et al, J. Clin. Invest., 89: 87-96 1992).
Patents 147
Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html ·
Hepatitis B core antigen nucleic acid vaccine Inventor(s): Lu, Shan ; (Northborough, MA), Huang, Zuhu ; (Nanjing, CN), Herrmann, John E. ; (Northborough, MA) Correspondence: J, Peter Fasse; Fish & Richardson P.C.; 225 Franklin Street; Boston; MA; 02110-2804; US Patent Application Number: 20010001098 Date filed: January 8, 2001 Abstract: Hepatitis B virus core antigen nucleic acid vaccines and their use are disclosed. In the vaccines and methods of the invention, precore sequences in the 5' untranslated region of the core antigen mRNA are not present. Excerpt(s): 3. Hepatitis B virus (HBV) chronically infects liver tissue in humans, with the highest prevalence of infection in Asia. HBV infection has been correlated with liver cirrhosis, liver failure, and liver cancer. ... 4. HBV-infected individuals often produce an immune response to the major viral nucleocapsid protein, the hepatitis B viral core antigen (HBcAg). HBcAg is encoded by the viral pre-C/C gene, which transcribes a long and short mRNA. The long mRNA contains a first AUG, beginning the coding sequence for the precore polypeptide, and a second AUG downstream and inframe with the first, beginning the coding sequence for HBcAg. The short mRNA contains only the second AUG encoding HBcAg and a precore 5' untranslated region (UTR). Thus, the polypeptide translated from the long mRNA contains the HBcAg polypeptide sequence with a N-terminal precore amino acid sequence. Transcription of the long and short mRNA is regulated during the viral life cycle. ... 8. The entire 5' untranslated region of the mRNA can be free from SEQ ID NO:1. The composition is administered to the mammal so that the HBcAg protein is expressed in the mammal at a level sufficient to elicit an immune response against the hepatitis B virus. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html
Keeping Current In order to stay informed about patents and patent applications dealing with hepatitis B, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address:
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http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “hepatitis B” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on hepatitis B. You can also use this procedure to view pending patent applications concerning hepatitis B. Simply go back to the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.
Vocabulary Builder Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Dideoxynucleosides: Nucleosides that have two hydroxy groups removed from the sugar moiety. The majority of these compounds have broadspectrum antiretroviral activity due to their action as antimetabolites. The nucleosides are phosphorylated intracellularly to their 5'-triphosphates and act as chain-terminating inhibitors of viral reverse transcription. [NIH] Flavivirus: A genus of flaviviridae, also known as Group B arbovirus, containing several subgroups and species. Most are arboviruses transmitted by mosquitoes or ticks. The type species is yellow fever virus. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or
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fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Thymosin: Thymosin. A family of heat-stable, polypeptide hormones secreted by the thymus gland. Their biological activities include lymphocytopoiesis, restoration of immunological competence and enhancement of expression of T-cell characteristics and function. They have therapeutic potential in patients having primary or secondary immunodeficiency diseases, cancer or diseases related to aging. [NIH] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH]
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CHAPTER 6. BOOKS ON HEPATITIS B Overview This chapter provides bibliographic book references relating to hepatitis B. You have many options to locate books on hepatitis B. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some patients, however, feel uncomfortable approaching their local booksellers and prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on hepatitis B include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.
Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “hepatitis B” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on hepatitis B:
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A Curriculum Guide for Public - Safety and Emergency - Response Workers: Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus Contact: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Information Resources Branch, 4676 Columbia Pky C13, Cincinnati, OH, 45226, (800) 356-4674, http://www.cdc.gov/niosh/homepage.html. Summary: This teaching guide provides a model curriculum for training public safety and Emergency medical services (EMS) personnel in prevention practices specific to occupational exposure to Human immunodeficiency virus (HIV) and HepatitisB virus. Each is defined, and a glossary of related terms and descriptive case studies included. The curriculum builds on guidelines developed by the National Institute for Occupational Safety and Health in collaboration with the Centers for Disease Control (CDC). Topics addressed include what responses are appropriate in given instances for fire service, law enforcement, correctional facility, paramedic, and emergency medical technician personnel; the use of protective equipment; universal precautions; specific workplace prevention measures; decontamination procedures; and the management of exposures. A lecture outline with accompanying tips for trainers, overheads, and a comprehensive listing of information sources for each worker group concludes the guide.
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Be in Charge : A Guide to Living With Chronic Hepatitis B and C Contact: Schering - Plough Corporation, 2000 Galloping Hill Rd, Kenilworth, NJ, 07033, (908) 298-5790. Summary: This monograph provides information and guidelines for persons living with chronic hepatitis B or C. It contains a resource list and 12 chapters: (1) Fighting Back Against Hepatitis, (2) Understanding How Your Liver Works, (3) Learning About Viruses, (4) Stopping the Spread of the Virus, (5) Hearing Your Diagnosis, (6) Treating Your Chronic Hepatitis B or C, (7) Taking Care of Symptoms, (8) Eating Right (and Drinking Too), (9) Coping with Your Feelings, (10) Gaining Support from Family and Friends, (11) Managing Work and Finances, and (12) Looking to the Future.
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Evidence Based Gastroenterology and Hepatology Source: London, UK: BMJ Publishing Group. 1999. 557 p. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. E-
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mail:
[email protected]. Website: www.bmjbooks.com. Price: Contact publisher for price. ISBN: 0727911821. Summary: This book emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). The authors use clinical epidemiology to present the strongest and most current evidence for interventions for the major diseases of the gastrointestinal tract and liver. Thirty chapters are included: an introduction to evidence based gastroenterology and hepatology; gastroesophageal reflux disease (GERD); ulcer disease and Helicobacter pylori; ulcer disease and nonsteroidal antiinflammatory drugs; treatment options for non-variceal gastrointestinal hemorrhage; the diagnosis and treatment of functional dyspepsia (indigestion); the diagnosis, treatment, and prognosis of celiac disease (gluten intolerance); the treatment of Crohn's disease; the diagnosis, prognosis, and treatment of ulcerative colitis (UC); pouchitis after restorative proctocolectomy; metabolic bone disease in gastrointestinal disorders; colorectal cancer in UC and the role of surveillance; population based screening and surveillance for colorectal cancer; irritable bowel syndrome (IBS); the surgical treatment of gallstone disease; the prognosis and treatment of acute pancreatitis; hepatitis C; hepatitis B; the screening and treatment of alcoholic liver disease; hemochromatosis and Wilson disease; primary biliary cirrhosis (PBC); autoimmune hepatitis; primary sclerosing cholangitis (PSC); the prevention and treatment of portal hypertensive bleeding; ascites, hepatorenal syndrome, and spontaneous bacterial peritonitis; hepatic encephalopathy; hepatocellular carcinoma; fulminant hepatic failure; the prevention and treatment of rejection after liver transplantation; and the prevention and treatment of infection after liver transplantation. Each chapter features the grading of recommendations and levels of evidence used by the authors to note the research basis on which their clinical guidelines are formed. Chapters conclude with extensive reference lists; the text concludes with a subject index. A glossary of acronyms is also provided. ·
Be in Charge: A Guide to Living with Chronic Hepatitis B and C Source: Kenilworth, NJ: Schering Corporation. 1998. 100 p. Contact: Available from Scherling Corporation. 2000 Galloping Hill Road Kenilworth, NJ 07033. (800) 446-8766 or (908) 298-4000. Fax (908) 2984490. Price: Single copy free for patients; available to health professionals through local sales representatives. Summary: This handbook offers an upbeat, colorful approach to the information that patients need in order to live a long and health life while
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coping with chronic hepatitis (liver infection) B and C. Twelve chapters include an overview of hepatitis, how the liver functions, viruses and viral infections, stopping the spread of the virus (transmission), diagnosis, treatment options for chronic hepatitis B or C, taking care of symptoms, the role of proper nutrition and diet therapy, coping with the emotions of living with hepatitis, gaining support from family and friends, managing work and finances, and research and prevention strategies currently under investigation. Throughout the handbook there are tools, such as quizzes, to keep readers sharp on the facts being provided, and places for jotting down thoughts or questions for the physician. Each chapter also lists action steps that can be a starting point for taking control of one's own life and fighting the virus. The Resource List at the end of the handbook includes information about important resources, including groups that may be able to help readers continue learning about the disease and how to combat it. The handbook is illustrated with extensive line drawings, brightly colored graphics, and checklists of steps to undertake. ·
Gastroenterology and Hepatology: The Comprehensive Visual Reference. Volume 1: The Liver Source: Philadelphia, PA: Current Medicine. 1996. [200 p.]. Contact: Available from Current Medicine. 400 Market Street, Suite 700, Philadelphia, PA 19106. (800) 427-1796 or (215) 574-2266. Fax (215) 5742270. E-mail:
[email protected]. Website: current-medicine.com. Price: $125.00 plus shipping and handling. ISBN: 1878132784. Summary: This atlas is one in an 8-volume collection of images that pictorially displays the gastrointestinal tract, liver, biliary tree, and pancreas in health and disease, both in children and adults. This volume includes 14 chapters on the liver. Several chapters deal with the major manifestations of liver disease, providing reviews of jaundice, portal hypertension, hepatic encephalopathy, ascites, hepatorenal syndrome, and spontaneous bacterial peritonitis. The spectrum of manifestations of hepatitis (viral, autoimmune, and drug induced) is interwoven throughout the book. In addition, there is a comprehensive discussion of the problems attendant to the development of acute liver failure. The various causes of acute and chronic hepatitis are covered in depth and Hepatitis B and hepatitis C receive individual attention in separate chapters. The spectrum of drug-induced liver disease and the mechanisms by which drug-related liver injuries develop (and can be detected or prevented) is discussed. Liver disease caused by copper and iron receive special attention as do those disorders predominantly affecting the hepatic vasculature or the parnechyma in the form of
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abscesses or cysts. The volume describes tumors of the liver, once considered therapeutically hopeless, with emphasis on recently acquired information regarding the pathogenic roles of hepatitis B, hepatitis C, iron, and environmental toxins. The book includes a status report evaluating the roles of hepatic resection and transplantation as treatments for tumors. The last chapter of the book covers liver transplantation. The format of the atlas is visual images supported by relatively brief text. Tables, charts, diagrams, and photomicrographs are used extensively.
Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to hepatitis B (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·
Hepatitis B Virus and Primary Liver Cancer by P. Maupas (Editor), Joseph L. Melnick (Editor) (1981); ISBN: 380551784X; http://www.amazon.com/exec/obidos/ASIN/380551784X/icongroupi nterna
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Proceedings of the European Symposium on Hepatitis B by Saul Krugman, Sheila Sherlock (1981); ISBN: 0865550085; http://www.amazon.com/exec/obidos/ASIN/0865550085/icongroupin terna
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Hepatitis B Vaccine: Proceedings of the International Symposium on Hepatitis B Vaccine Held in Paris (France), 8-9 December, 1980 (Inserm Science ser by France) International Symposium on Hepatitis B Vaccine 1980 Paris (1981); ISBN: 0444803254; http://www.amazon.com/exec/obidos/ASIN/0444803254/icongroupin terna
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Immunological Aspects of Liver Disease by H. C. Thomas (1982); ISBN: 038711310X; http://www.amazon.com/exec/obidos/ASIN/038711310X/icongroupi nterna
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Viral Hepatitis: Second International Max V. Pettenkofer Symposium (Infectious Diseases and Antimicrobial Agents, 4) by Germany) International Max Von Pettenkofer Symposium 1982 Munich (1983);
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ISBN: 0824770463; http://www.amazon.com/exec/obidos/ASIN/0824770463/icongroupin terna ·
Viral Hepatitis: Standardization in Immuniprophylaxis of Infections by Hepatitis Viruses by G. Papavangelou, W. Hennessen (1983); ISBN: 380553826X; http://www.amazon.com/exec/obidos/ASIN/380553826X/icongroupi nterna
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Viral Hepatitis B Infection in the Western Pacific Region: Vaccine and Control by S.K. Lam, et al (1984); ISBN: 9971950804; http://www.amazon.com/exec/obidos/ASIN/9971950804/icongroupin terna
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Hepatitis B: The Virus, the Disease and the Vaccine by Irving Millman, et al (1984); ISBN: 0306417235; http://www.amazon.com/exec/obidos/ASIN/0306417235/icongroupin terna
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Molecular Components of Hepatitis B Virus (Developments in Molecular Virology : 6) by Mark Feitelson (1985); ISBN: 0898386969; http://www.amazon.com/exec/obidos/ASIN/0898386969/icongroupin terna
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Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health-Care and Public Safety Workers Response to p (1989); ISBN: 9990470073; http://www.amazon.com/exec/obidos/ASIN/9990470073/icongroupin terna
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Guidelines for Prevention of Transmission Human Immunodeficiency Virus and Hepatitis B (1989); ISBN: 0016002539; http://www.amazon.com/exec/obidos/ASIN/0016002539/icongroupin terna
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Molecular Biology of the Hepatitis B Virus by Alan McLachlan (Editor) (1991); ISBN: 0849355168; http://www.amazon.com/exec/obidos/ASIN/0849355168/icongroupin terna
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Assessment and Management of Risks Associated With Hyperlipidemia, Osteoporosis, and Hepatitis B: Effectiveness of Intervention (Medical Advisory Co) by R. Gordon Douglas (Editor) (1991); ISBN: 1560530227; http://www.amazon.com/exec/obidos/ASIN/1560530227/icongroupin terna
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Assessment and Management of Risks Associated With Hepatitis B: Effectiveness of Intervention (Medac, 90) by Maurice R. Hilleman, R. Gordon Douglas (Editor) (1991); ISBN: 1560530235; http://www.amazon.com/exec/obidos/ASIN/1560530235/icongroupin terna
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Hepatitis B: A Sexually Transmitted Disease in Heterosexuals: Proceedings of a Symposium Held in Barcelona, 6-7 May, 1990 (International Congress S) by P. Piot, F.E. Andre (Editor) (1991); ISBN: 044481356X; http://www.amazon.com/exec/obidos/ASIN/044481356X/icongroupi nterna
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Care of the Maternity Patient With Hepatitis B Infection: Clinical Features and Peri-Natal Inplications by Martin (1993); ISBN: 0683172204; http://www.amazon.com/exec/obidos/ASIN/0683172204/icongroupin terna
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Research in Chronic Viral Hepatitis (Archives of Virology. Supplementum 8) by W. H. Gerlich (Editor) (1994); ISBN: 0387824979; http://www.amazon.com/exec/obidos/ASIN/0387824979/icongroupin terna
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The War Against Hepatitis B: A History of the International Task Force on Hepatitis B Immunization by William A. Muraskin (1995); ISBN: 0812232674; http://www.amazon.com/exec/obidos/ASIN/0812232674/icongroupin terna
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Hepatitis B Virus: Selected Topics (Journal - Intervirology , Vol 38, No 1-2) by W.H. Gerlich (Editor) (1995); ISBN: 3805562527; http://www.amazon.com/exec/obidos/ASIN/3805562527/icongroupin terna
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Review of the Fialuridine (Fiau Clinical Trails) by Frederick J. Manning, Morton Swartz (Editor) (1995); ISBN: 0309052793; http://www.amazon.com/exec/obidos/ASIN/0309052793/icongroupin terna
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Contagious and Non-Contagious Infectious Diseases Sourcebook: Basic Information About Contagious Diseases Like Measles, Polio, Hepatitis B, and infec by Karen Bellenir (Editor), Peter D. Dresser (Editor) (1996); ISBN: 0780800753; http://www.amazon.com/exec/obidos/ASIN/0780800753/icongroupin terna
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Hepatitis B Virus: Molecular Mechanisms in Disease and Novel Strategies for Therapy by Rajen Koshy (Editor), et al (1998); ISBN:
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1860940072; http://www.amazon.com/exec/obidos/ASIN/1860940072/icongroupin terna ·
Living with Hepatitis B: A Survivor's Guide by Gregory T. Everson, et al (2002); ISBN: 1578260841; http://www.amazon.com/exec/obidos/ASIN/1578260841/icongroupin terna
The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “hepatitis B” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:25 ·
Abstracts of papers presented at the 1996 meeting on molecular biology of hepatitis B viruses: September 18-September 22, 1996. Author: arranged by Robert Lanford, Michael Nassal; Year: 1996; Cold Spring Harbor, N.Y.: Cold Spring Harbor Laboratory, [1996]
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Blood supply [electronic resource]: transfusion-associated risks: report to the Ranking Minority Member, Committee on Commerce, House of Representatives. Author: United States General Accounting Office; Year: 1997; Washington, D.C.: The Office [1997]
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Bloodborne pathogens standard: a pragmatic approach. Author: Jon T. O'Neal; Year: 1996; New York: Van Nostrand Reinhold, c1996; ISBN: 0442017790 (hardcover) http://www.amazon.com/exec/obidos/ASIN/0442017790/icongroupin terna
In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.
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Chronic hepatitis: new concepts of pathogenesis, diagnosis and treatment: proceedings of the Falk Workshop held in Cologne, Germany, 27-28 January 2000. Author: edited by H.P. Dienes ... [et al.]; Year: 2000; Dordrecht; Boston: Kluwer Academic, c2000; ISBN: 0792387635 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0792387635/icongroupin terna
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Compliance with CDC guidelines to prevent occupational transmission of human immunodeficiency virus and hepatitis B virus: evaluation findings from a national survey of health care workers: (final report). Author: James C. Hersey ... [et al.]; Year: 1992; Atlanta, Ga.: Centers for Disease Control, National Institute of Occupational Safety and Health, [1992]
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Disease costs of hepatitis B in Australia. Author: Kathryn M. Antioch ... [et al.]; Year: 1993; Canberra, ACT: Australian Institute of Health & Welfare, [1993]; ISBN: 0644433558
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Economic evaluation of hepatitis B vaccination strategies: a systematic review of the literature. Author: G.A. de Wit, R. Welte; Year: 1999; Bilthoven: National Institute of Public Health and the Environment, [1999]
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Evaluation of seventeen hepatitis B surface antibody (anti HBs) assays. Author: A. E. Hardiman, P. C. Grint, C. J. Ronalds; Year: 1990; London: Department of Health, 1990
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Feasibility of screening for and surveillance of hepatitis B in a single geographic area: report to the Director-General of Health of the Working Party on Hepatitis B. Author: New Zealand. Working Party on Hepatitis B; Year: 1996; [Wellington, N.Z.]: Ministry of Health, [1996]; ISBN: 0478094809
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HBsAg commercial panel data: comparative performance data for HBsAg assays using commercial seroconversion panels. Author: Ralph E. Giles ... [et al.]; Year: 1999; London: Department of Health, c1999; ISBN: 1 84182 079 2
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Hepatitis B: the hunt for a killer virus. Author: Baruch S. Blumberg; Year: 2002; Princeton, N.J.: Princeton University Press, c2002; ISBN: 069100692X (alk. paper) http://www.amazon.com/exec/obidos/ASIN/069100692X/icongroupi nterna
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Hepatitis B and C: management and treatment. Author: Thierry Poynard; Year: 2002; London: Martin Dunitz; Florence, KY: Distributed in the USA by Taylor & Francis, 2002; ISBN: 1841840777
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http://www.amazon.com/exec/obidos/ASIN/1841840777/icongroupin terna ·
Hepatitis B and the newborns: situation in Belgium. Author: P. van Damme, W. Eylenbosch, R. Clara; Year: 1990; Antwerpen: University of Antwerp, [1990]; ISBN: 9073155010
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Hepatitis B immunization: introducing hepatitis B vaccine into national immunization services. Author: Poynard, T. (Thierry); Year: 2001; Geneva: Dept. of Vaccines and Biologicals, World Health Organization, 2001
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Hepatitis B in Asian-Pacific region. Author: edited by Arie Zuckerman; Year: 9999; London: Royal College of Physicians of London, 1997-; ISBN: 1860160638 (v. 1)
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Hepatitis B virus: molecular mechanisms in disease and novel strategies for therapy. Author: editors, Rajen Koshy, Wolfgang H. Caselmann; Year: 1998; London: Imperial College Press; River Edge, NJ: Distributed by World Scientific Pub. Co., c1998; ISBN: 1860940072 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/1860940072/icongroupin terna
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Hepatitis B virus and the public health: selected papers of Baruch S. Blumberg. Author: Blumberg, Baruch S., 1925-; Year: 1992; Bangalore: Indian Academy of Sciences, c1992; ISBN: 8185324131
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Hepatitis virus infections. Author: onder redactie van W.J.M. Spaan ... [et al.]; Year: 1995; [Leiden ]: Boerhaave Commissie voor Postacademisch Onderwijs in de Geneeskunde, Rijksuniversiteit Leiden, [1995]; ISBN: 9067672629
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Human immunodediciency virus and hepatitis B and the workplace. Author: National Occupational Health and Safety Commission; Year: 1993; Canberra: Australian Govt. Pub. Service, c1993; ISBN: 0644332026
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Infectious diseases: analysis of eradication or elimination estimates. Testimony before the Committee on International Relations, House of Representatives. Author: B. F. Nelson; Year: 1998; Washington, DC: U.S. GAO, 1998
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International Symposium on East-West Medicine: Sheraton Walker Hill Hotel, Seoul, Korea October 19-20, 1994: commemorating the 45th anniversary of the foundation of Kyung Hee University. Author: organized by WHO Collarorating Centre for Traditional Medicine, E; Year: 1995; [Seoul, Korea]: The University, [1995]
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Management of chronic viral hepatitis. Author: edited by Stuart C. Gordon; Year: 2002; New York: M. Dekker, c2002; ISBN: 0824705823 (alk. paper)
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http://www.amazon.com/exec/obidos/ASIN/0824705823/icongroupin terna ·
Occurrence and distribution of hepatitis B infection in the aboriginal population of Western Australia. Author: Epidemiology Branch ... [et al.]; Year: 1987; Perth: Health Dept. of Western Australia, 1987
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OSHA handbook: guidelines for compliance in healthcare facilities and interpretive guidelines for the bloodborne pathogen standard. Author: Brenda Goodner; Year: 1997; El Paso, Tex.: Skidmore-Roth Pub., c1997; ISBN: 1569300690 http://www.amazon.com/exec/obidos/ASIN/1569300690/icongroupin terna
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Prevalence of hepatitis B viral markers in the Dutch population: a population-based serosurveillance study (Pienter project). Author: C.J. van Marrewijk ... [et al.]; Year: 1999; Bilthoven: RIVM, [1999]
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Protection of laboratory workers from infectious disease transmitted by blood, body fluids, and tissue (tentative guideline). Author: S. Bauer ... [et al.]; Year: 1989; Villanova, PA: NCCLS, 1989
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Public health implications of medical waste: a report to Congress [microform]. Author: M. Y. Lichtveld, S. E. Rodenbeck, J. A. Lybarger; Year: 1990; Atlanta, GA: Agency for Toxic Substances and Disease Registry, 1990
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Report. Author: WHO/UNICEF Workshop on the Expanded Programme on Immunization and Control of Vaccine-Preventable Diseases in Pacific Island Countries and Areas, Nadi, Fiji, 26-30 August 1996; Year: 1997; Manila, Philippines: Printed and distributed by the Regional Office for the Western Pacific, World Health Organization, [1997]
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Review of the fialuridine (FIAU) clinical trials. Author: Committee to Review the Fialuridine (FIAU/FIAC) Clinical Trials, Division of Health Sciences Policy, Institute of Medicine; Frederick J. Manning and Morton Swartz, editors; Year: 1995; Washington, D.C.: National Academy Press, 1995; ISBN: 0309052793 http://www.amazon.com/exec/obidos/ASIN/0309052793/icongroupin terna
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War against hepatitis B: a history of the International Task Force on Hepatitis B Immunization. Author: William Muraskin; Year: 1995; Philadelphia: University of Pennsylvania Press, c1995; ISBN: 0812232674 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0812232674/icongroupin terna
162 Hepatitis B
Chapters on Hepatitis B Frequently, hepatitis B will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with hepatitis B, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and hepatitis B using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “hepatitis B” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on hepatitis B: ·
Hepatitis B Virology: Acute and Chronic Infection: Wild-Type HBV and HBV Variants Source: in Gordon, S.C. Management of Chronic Viral Hepatitis. New York, NY: Marcel Dekker Inc. 2002. p. 1-32. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. Price: $150.00 plus shipping and handling. ISBN: 0824705823. Summary: This chapter on hepatitis B virology is from a monograph on the management of chronic viral hepatitis (liver inflammation), bringing the advances of clinical and basic research into the doctor's office. Three brief clinical case presentations address the real life intricacies of managing patients who present with viral hepatitis. The authors focus on wild type hepatitis B viruses (HBV) and HBV variants. Case 1 presented with acute hepatitis, as evidenced by the presence of HBsAg and IgM anti-HBc. The authors comment on the need for prophylaxis for this patient's wife. Case 2 had perinatally (during birth) acquired HBV infection with exacerbation of chronic hepatitis B. This patient may benefit from antiviral therapy if the exacerbation does not result in sustained HBeAg seroconversion. Because of his family history of hepatocellular carcinoma (HCC, liver cancer), surveillance for HCC is recommended. Case 3 most likely was infected with a precore variant, as evidenced by the detection of HBV DNA despite the presence of anti HBe. 6 figures. 1 table. 85 references.
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Current Treatment of Chronic Hepatitis B Source: in Gordon, S.C. Management of Chronic Viral Hepatitis. New York, NY: Marcel Dekker Inc. 2002. p. 65-89. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. Price: $150.00 plus shipping and handling. ISBN: 0824705823. Summary: This chapter on the current treatment of hepatitis B is from a monograph on the management of chronic viral hepatitis (liver inflammation), bringing the advances of clinical and basic research into the doctor's office. This chapter uses a brief clinical case presentation in order to address the real life intricacies of managing patients who present with viral hepatitis. The case patient is a 25 year old Asian American man who presented for evaluation of recently discovered hepatitis B surface antigenemia. The patient has a significant family history of liver disease with his father having had a diagnosis of hepatocellular carcinoma (liver cancer) and chronic hepatitis B. Because the patient had persistent replication with HBeAg and HBV DNA present at follow up 3 months later, treatment was advised. The role of interferon and lamivudine were discussed and he elected to receive therapy with lamivudine. The patient had rapid normalization of liver chemistries with clearance of serum HBV DNA within 12 weeks of start of the therapy. The authors note that the treatment options for chronic HBV have broadened considerably with the advent of lamivudine, the first of undoubtedly many newer agents for therapy. There is still, however, an important role for interferon therapy in well selected patients, particularly as its successful use clearly leads to loss of HBsAg. Factors to weigh in choosing an initial agent include the patient's likely tolerance of interferon side effects and predictors of successful response, notably low pretherapy HBV DNA and elevated ALT levels. The absence of severe side effects with lamivudine makes compliance easy, although by not using interferon therapy, the patient may at least theoretically be deprived of a chance of subsequent HBsAg clearance. 2 figures. 2 tables. 72 references.
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Treatment of Chronic Hepatitis B: Future Approaches Source: in Gordon, S.C. Management of Chronic Viral Hepatitis. New York, NY: Marcel Dekker Inc. 2002. p. 91-118. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. Price: $150.00 plus shipping and handling. ISBN: 0824705823.
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Summary: This chapter on future treatment options for hepatitis B is from a monograph on the management of chronic viral hepatitis (liver inflammation), bringing the advances of clinical and basic research into the doctor's office. This chapter uses a brief clinical case presentation in order to address the real life intricacies of managing patients who present with viral hepatitis. The case patient is a 39 year old white man who was referred in consultation seeking a second opinion regarding his well known history (10 years) of chronic hepatitis B. The authors use this case to consider the role of long term therapeutic agents, the indications for lamivudine therapy, new antivirals that may be in the research stages, and strategies to improve the host immune response and thus obtain an immunological clearance of the hepatitis B virus (HBV). The authors conclude that although significant advances have been made in the treatment of chronic hepatitis B, there is still a high proportion of these patients in whom a sustained eradication of the viral infection cannot be achieved with either interferons or lamivudine monotherapy. However, combination therapy has been shown to improve the success rate in chronic hepatitis C and HIV; the authors speculate that it may also be helpful in the treatment of chronic hepatitis B patients. The preliminary experience with combination therapy of interferons and lamivudine has been frustrating. A wide range of novel antiviral approaches such as cytokine therapy, vaccine adjuvant, DNA vaccines, antisense therapy, and other forms of gene therapy are currently under investigation. 3 figures. 1 table. 72 references. ·
Treatment of Chronic Hepatitis B in Transplant Recipients Source: in Gordon, S.C. Management of Chronic Viral Hepatitis. New York, NY: Marcel Dekker Inc. 2002. p. 119-157. Contact: Available from Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016. (212) 696-9000. Fax (212) 685-4540. Website: www.dekker.com. Price: $150.00 plus shipping and handling. ISBN: 0824705823. Summary: This chapter on the treatment of hepatitis B in transplant recipients is from a monograph on the management of chronic viral hepatitis (liver inflammation), bringing the advances of clinical and basic research into the doctor's office. Three clinical case presentations address the real life intricacies of managing patients who present with viral hepatitis. Originally, a high rate of graft infection and early graft failure, as well as frequent patient death, led to skepticism about the use of orthotopic liver transplantation (OLT) for chronic HBV infection. Marked improvements in long term survival have resulted from the use of low dose immunosuppressive therapy and administration of indefinite
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hepatitis B immune globulin. The goals of treatment of HBV infection include decreasing viral load, lessening infectivity, decreasing the level of hepatic inflammation, preventing or slowing the development of cirrhosis (liver scarring) and liver failure, delaying time to liver transplantation, and prevention of liver cancer. Lamivudine alone or in combination with hepatitis B immune globulin (HBIG) has been shown to be effective in the long term management of recipients of liver transplants. The combination of lamivudine and HBIG is probably the best current therapy, since lamivudine monotherapy, especially in the setting of immunosuppression, has a very high mutation rate leading to resistance and active viral replication in more than 40 percent of patients after 2 years of therapy post-transplantation. Patients with severe recurrent HBV infection, including fibrosing cholestatic hepatitis (FCH), can undergo liver retransplantation but costs are extremely high and long term survival is inferior to that of patients undergoing a first liver transplantation. 2 figures. 3 tables. 165 references. ·
Hepatitis B: Prognosis and Treatment Source: in McDonald, J.W.D.; Burroughs, A.K.; Feagan, B.G., eds. Evidence Based Gastroenterology and Hepatology. London, UK: BMJ Publishing Group. 1999. p. 305-321. Contact: Available from BMJ Publishing Group. BMA Books, BMA House, Tavistock Square, London WCIH 9JR. Fax 44 (0)20 7383 6402. Email:
[email protected]. Website: www.bmjbooks.com. Price: Contact publisher for price. Summary: Hepatitis B virus (HBV) infection, together with hepatitis C and alcohol abuse, is among the leading causes of cirrhosis and hepatocellular carcinoma (HCC) worldwide. This chapter on the diagnosis and treatment of hepatitis B is from a book that emphasizes the approaches of evidence based medicine in gastroenterology (the study of the gastrointestinal tract and gastrointestinal diseases) and hepatology (the study of the liver and liver diseases). The natural history of chronic hepatitis is variable according to phenotypic and ethnic background, and is also influenced by viral coinfections and toxic cofactors. At least 20 percent of patients develop clinically significant liver disease in the long term. Presence of markers of HBV replication and of continuing liver necroinflammation predict an adverse outcome. Interferon therapy results in stable clearance of HBeAg in 25 percent of all patients chronically infected by type HBV, but only rarely results in HBsAg clearance. Interferon therapy results in stable clearance of HBV DNA in 25 percent of all patients chronically infected by HBe minus HBV. Lamivudine is effective in clearing HBV DNA and normalizing ALT
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during therapy in 65 percent of patients, but its long term effectiveness is unknown. The authors conclude that there is no acceptable evidence for a protective effect of interferon therapy against the development of hepatocellular carcinoma (HCC) in HBV related cirrhosis. 4 figures. 2 tables. 150 references. ·
Hepatitis B. [Adults and Older Adults: Immunization and Prophylaxis] Source: in Office of Disease Prevention and Health Promotion, U.S. Public Health Service. Put Prevention Into Practice: Clinician's Handbook of Preventive Services. 2nd ed. Germantown, MD: International Medical Publishing, Inc. 1998. p. 337-344. Contact: Available from International Medical Publishing, Inc. Reiter's Scientific and Professional Books, 2021 K Street, NW, Washington, DC 20006. (800) 591-2713 or (202) 223-3327. Fax (202) 296-9103. Price: $20.00 plus shipping and handling. ISBN: 1883205328. Also available from the U.S. Government Printing Office. Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (202) 512-1800. Fax (202) 512-2250. Summary: At least 200,000 new cases of hepatitis B virus (HBV) infection occur each year in the United States. Most of them occur in young adults, primarily as a result of blood or sexual contact. HBV infection causes significant morbidity and mortality, and up to 10 percent of adults with acute infection become chronically infected. The risk of liver cirrhosis, failure, and cancer is significantly increased in people with chronic HBV infection. This chapter on hepatitis immunization and prophylaxis in adults is from a handbook on preventive services published by the U.S. Government. Hepatitis B vaccine is 95 percent effective in preventing infection. For persons experiencing percutaneous or sexual contact with HBV, administration of hepatitis B immune globulin is approximately 75 percent effective in preventing infection. This chapter summarizes the recommendations of major authorities, including the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the U.S. Preventive Services Task Force, for immunization and prophylaxis against HBV in adults. The basics of hepatitis B immunization are discussed: vaccine types, schedule, immunity, dose and administration, contraindications and precautions, adverse reactions, patient education, and vaccine storage and handling. The basics of hepatitis B postexposure prophylaxis are also noted: indications, schedule, dose and administration, contraindications and precautions, and adverse reactions. The chapter concludes with a brief list of patient and provider resources. 2 tables. 8 references.
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Hepatitis B. [Children and Adolescents: Immunization and Prophylaxis] Source: in Office of Disease Prevention and Health Promotion, U.S. Public Health Service. Put Prevention Into Practice: Clinician's Handbook of Preventive Services. 2nd ed. Germantown, MD: International Medical Publishing, Inc. 1998. p. 91-98. Contact: Available from International Medical Publishing, Inc. Reiter's Scientific and Professional Books, 2021 K Street, NW, Washington, DC 20006. (800) 591-2713 or (202) 223-3327. Fax (202) 296-9103. Price: $20.00 plus shipping and handling. ISBN: 1883205328. Also available from the U.S. Government Printing Office. Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (202) 512-1800. Fax (202) 512-2250. Summary: At least 200,000 new cases of hepatitis B virus (HBV) infections occur yearly in the United States. Most of them occur in young adults, primarily as a result of blood or sexual contact, injection drug use, or occupational or household contact. HBV infection causes significant morbidity and mortality, and up to 10 percent of adults with acute infection become chronically infected. The risk of liver cirrhosis, failure, and cancer is significantly increased in people with chronic HBV infection. This chapter on hepatitis immunization and prophylaxis in children and adolescents is from a handbook on preventive services published by the U.S. Government. Hepatitis B vaccine is 95 percent effective in preventing infection. This chapter summarizes the recommendations of major authorities, including the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Preventive Medicine, the American Medical Association, the Canadian Task Force on the Periodic Health Examination, and the U.S. Preventive Services Task Force, for immunization and prophylaxis against HBV in adults. The basics of hepatitis B immunization are discussed: vaccine types, schedule, immunity, dose and administration, contraindications and precautions, adverse reactions, patient education, and vaccine storage and handling. The basics of hepatitis B postexposure prophylaxis are also noted: schedule, dose and administration, contraindications and precautions, and adverse reactions. The chapter concludes with a brief list of patient and provider resources. 3 tables. 12 references.
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Screening for Hepatitis B Virus Infection Source: in U.S. Preventive Services Task Force (USPSTF). Guide to Clinical Preventive Services. 2nd ed. Germantown, MD: International Medical Publishing, Inc. 1996. p. 269-276.
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Contact: Available from International Medical Publishing, Inc. Reiter's Scientific and Professional Books, 2021 K Street, NW, Washington, DC 20006. (800) 591-2713 or (202) 223-3327. Fax (202) 296-9103. Price: $24.00 plus shipping and handling. ISBN: 1883205131. Also available from the U.S. Government Printing Office. Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. (202) 512-1800. Fax (202) 512-2250. Summary: This chapter on screening for hepatitis B virus (HBV) infection is from a guide to clinical preventive services published by the U.S. Preventive Services Task Force. Screening with hepatitis B surface antigen (HBsAg) to detect active (acute or chronic) HBV infection is recommended for all pregnant women at their first prenatal visit. The test may be repeated in the third trimester in women who are initially HBsAg negative but are at increased risk of HBV infection during pregnancy. Routine screening of the general population is not recommended. Certain persons at high risk may be screened to assess eligibility for vaccination. The chapter discusses the accuracy of screening tests, the effectiveness of early detection, and the recommendations of other groups. The chapter concludes with a summary of recommended clinical interventions. 56 references. (AA-M). ·
Hepatitis and Renal Disease Source: in Nissenson, A.R., Fine, R.N., and Gentile, D.E., eds. Clinical Dialysis. 3rd ed. Norwalk, CT: Appleton and Lange. 1995. p. 574-606. Contact: Available from Appleton and Lange. 25 Van Zant Street, P.O. Box 5630, Norwalk, CT 06856. (800) 423-1359 or (203) 838-4400. Price: $175.00. ISBN: 0838513794. Summary: This chapter from a textbook of clinical dialysis covers hepatitis and renal disease. The author first provides an overview of hepatitis, including related definitions, terms, and concepts; the serology and epidemiology; the clinical course; and prophylaxis and treatment methods. The author then addresses the renal implications of hepatitis, including nephrologic complications, the influence of hepatitis on renal disorders, hepatitis in dialysis units, diagnostic considerations, and the prevention of hepatitis transmission in dialysis settings. One section also discusses the risk factors to health care workers of hepatitis B exposure. 12 tables. 577 references.
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Gastrointestinal Disease and Hepatitis Source: in Andersen, R.D., et al. Infections in Children: A Sourcebook for Educators and Child Care Providers. Aspen Publishers, Inc. 1994. p. 137146.
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Contact: Available from Aspen Publishers, Inc. 7201 McKinney Circle, Frederick, MD 21701. (800) 638-8437 or (301) 417-7500. Price: $36. ISBN: 0834203871. Summary: This chapter, from a handbook for educators and child care providers on infections in children, addresses gastrointestinal disease and hepatitis. The chapter covers vomiting; diarrhea; common causes of infectious diarrhea, including rotavirus, Escherichia coli, campylobacter species, salmonella, and shigella; hepatitis A; hepatitis B; and hepatitis C. In each section, the authors review the illness and its symptoms, consider etiology, review transmission and its prevention, and remind readers of the situations in which consultation of a health care provider is indicated. 3 references. ·
Hepatitis B Virus Source: in Hollinger, F.B., et al. Viral Hepatitis: Biological and Clinical Features, Specific Diagnosis, and Prophylaxis. 2nd ed. New York, NY: Raven Press, Ltd. 1991. p. 73-138. Contact: Available from Raven Press. 1185 Avenue of the Americas, Dept. 5B, New York, NY 10036. (800) 777-2836 or (212) 930-9500. Fax (212) 8693495. Price: $91.50 plus shipping (as of 1995). ISBN: 0881677272. Summary: This chapter, from a book that examines the fundamental aspects of viral hepatitis, discusses the hepatitis B virus (HBV). Topics covered include the history of this disease; the infectious agent itself; its clinical features, including incubation period, the clinical signs and symptoms of acute viral hepatitis, laboratory evaluation, pathogenesis and pathology of acute viral hepatitis, management issues, extrahepatic manifestations of viral hepatitis, chronic viral hepatitis, the management of chronic hepatitis, and the immunopathogenesis of viral hepatitis B; immunodiagnosis, including viral hepatitis serologic profiles; epidemiology, including modes of spread, factors influencing the development of persistent infection, and association of HBV with primary hepatocellular carcinoma; and prevention and control considerations, notably risk factors, routine practices, immune globulin immunoprophylaxis, established hepatitis B vaccines, factors influencing the immune response, alternative hepatitis B vaccines, and suggested guidelines for immunoprophylaxis. 21 figures. 16 tables. 715 references.
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Hepatitis and Dialysis Source: in Lameire, N. and Mehta, R.L., eds. Complications of Dialysis. New York, NY: Marcel Dekker, Inc. 2000. p. 673-696.
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Contact: Available from Marcel Dekker, Inc. Cimarron Road, P.O. Box 5005, Monticello, NY 12701. (800) 228-1160 or (845) 796-1919. Fax (845) 796-1772. E-mail:
[email protected]. International E-mail:
[email protected]. Website: www.dekker.com. Price: $250.00 plus shipping and handling. ISBN: 0824788710. Summary: Patients on maintenance hemodialysis are at increased risk for parenterally transmitted hepatitis viruses. This chapter on hepatitis and dialysis is from a book that offers a comprehensive, multidisciplinary resource for the nephrologist and caregiver providing dialysis, covering all aspects of dialysis therapies and their complications. The authors of this chapter focus mainly on hepatitis B virus (HBV) and hepatitis C (HCV), which remain the most problematic viral hepatic (liver) infections in hemodialysis patients; hepatitis G virus (HGV) is discussed briefly in the final section of the chapter. For each of these types, the authors consider pathogenesis, transmission and preventive measures, epidemiology (prevalence and incidence), vaccination, and implications for kidney transplantation. Besides the known parenterally transmitted hepatitis viruses, other yet undefined but potentially dangerous viruses may exist. Every nephrologist (kidney specialist) faces some dialysis patients who have inexplicable liver disease in which no responsible virus has been identified. The authors stress that it is therefore advisable to consider all patients as potentially infectious, especially since the level of transaminase is not always a reliable marker for the detection of liver damage in the dialysis population. Isolation procedures are warranted not only for viral infection but also for bacterial infection such as certain drug resistant strains. 2 figures. 4 tables. 243 references.
General Home References In addition to references for hepatitis B, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · The Digestive System (21st Century Health and Wellness) by Regina Avraham; Library Binding (February 2000), Chelsea House Publishing (Library); ISBN: 0791055264; http://www.amazon.com/exec/obidos/ASIN/0791055264/icongroupinterna · American College of Physicians Complete Home Medical Guide (with Interactive Human Anatomy CD-ROM) by David R. Goldmann (Editor), American College of Physicians; Hardcover - 1104 pages, Book & CD-Rom
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edition (1999), DK Publishing; ISBN: 0789444127; http://www.amazon.com/exec/obidos/ASIN/0789444127/icongroupinterna · The American Medical Association Guide to Home Caregiving by the American Medical Association (Editor); Paperback - 256 pages 1 edition (2001), John Wiley & Sons; ISBN: 0471414093; http://www.amazon.com/exec/obidos/ASIN/0471414093/icongroupinterna · Anatomica : The Complete Home Medical Reference by Peter Forrestal (Editor); Hardcover (2000), Book Sales; ISBN: 1740480309; http://www.amazon.com/exec/obidos/ASIN/1740480309/icongroupinterna · The HarperCollins Illustrated Medical Dictionary : The Complete Home Medical Dictionary by Ida G. Dox, et al; Paperback - 656 pages 4th edition (2001), Harper Resource; ISBN: 0062736469; http://www.amazon.com/exec/obidos/ASIN/0062736469/icongroupinterna · Mayo Clinic Guide to Self-Care: Answers for Everyday Health Problems by Philip Hagen, M.D. (Editor), et al; Paperback - 279 pages, 2nd edition (December 15, 1999), Kensington Publishing Corp.; ISBN: 0962786578; http://www.amazon.com/exec/obidos/ASIN/0962786578/icongroupinterna · The Merck Manual of Medical Information : Home Edition (Merck Manual of Medical Information Home Edition (Trade Paper) by Robert Berkow (Editor), Mark H. Beers, M.D. (Editor); Paperback - 1536 pages (2000), Pocket Books; ISBN: 0671027263; http://www.amazon.com/exec/obidos/ASIN/0671027263/icongroupinterna
Vocabulary Builder Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Decontamination: The removal of contaminating material, such as radioactive materials, biological materials, or chemical warfare agents, from a person or object. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU]
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Encephalopathy: Any degenerative disease of the brain. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hyperlipidemia: An excess of lipids in the blood. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH]
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CHAPTER 7. MULTIMEDIA ON HEPATITIS B Overview Information on hepatitis B can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on hepatitis B. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.
Video Recordings Most diseases do not have a video dedicated to them. If they do, they are often rather technical in nature. An excellent source of multimedia information on hepatitis B is the Combined Health Information Database. You will need to limit your search to “video recording” and “hepatitis B” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” By making these selections and typing “hepatitis B” (or synonyms) into the “For these words:” box, you will only receive results on video productions. The following is a typical result when searching for video recordings on hepatitis B: ·
Hepatitis B: A Family's Story. Our Family, Our Strength Source: St. Paul, MN: Hepatitis B Coalition. 1995. (videorecording).
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Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $10.00. Summary: This videotape program educates viewers about hepatitis B and its potential impact. The first part of the program, presented in the Cambodian language, features a narrator who introduces Dr. Hie-Won Hann, a physician helping Asian families fighting hepatitis B. The program shows Dr. Hann interviewing a pregnant Cambodian woman; a second scenario features Dr. Hann and the woman's family, who have all come in to learn more about hepatitis B. Topics covered include the complications of hepatitis B (acute disease, liver cancer), chronic infection with hepatitis B, how to protect a baby from getting hepatitis B, testing family members, protecting uninfected family members, treating the chronic carrier, how the disease is transmitted (perinatal, sexual transmission, and close familial contact, i.e., sharing toothbrushes, razors, etc.), why the disease is common among Asian people, and the importance of achieving widespread vaccination. The videorecording comes with an English and a Cambodian copy of the script. The second part of the tape, presented in English, features Dr. Haing S. Ngor introducing the history of Indo-Chinese people in the U.S. and stressing the important place that family serves in these cultures. The remainder of the tape is the same as the Cambodian language part, but in English. ·
AIDS, Hepatitis and the Emergency Responder: Update Contact: Commonwealth Films, 223 Commonwealth Ave, Boston, MA, 02116, (617) 262-5634. Summary: This video focuses on the risks of exposure to bloodborne pathogens, especially HIV and Hepatitis B, that emergency responders face. Starting with scenes of a city night and a drive-by shooting, the video urges the use of universal precautions and other measures to prevent the transmission of HIV and hepatitis for personnel involved in emergency situations. Following a discussion on HIV transmission and high-risk behaviors, the video discusses hepatitis, especially Hepatitis B. Modes of transmission are outlined, and OSHA standards, vaccination information, and universal precautions are explained. The video concludes with a short discussion on medical waste and the best ways to dispose of used sharps and needles.
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Universal Precautions: AIDS and Hepatitis B Prevention for the Medical Office Contact: Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 5410253.
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Summary: This videorecording focuses on prevention of exposure to HIV and Hepatitis B virus (HBV). What HIV and HBV are, and how they can be transmitted in an occupational setting, are discussed. Symptoms are described. The videorecording discusses the Occupational Safety and Health (OSHA) regulations on infectious bloodborne diseases and the universal precautions that have been established for health-care workers to prevent occupational exposure. Safe work practices are illustrated, including the use of barrier methods of protection, and needle and sharps disposal. Standard equipment care, disinfection techniques, and biohazard waste disposal are explained. ·
Universal Precautions: AIDS and Hepatitis B Protection for Healthcare workers in Long Term Care Facilities Contact: Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 5410253. Summary: This videorecording focuses on prevention of exposure to the Human immunodeficiency virus (HIV) and Hepatitis B virus (HBV). What HIV and HBV are, and how they can be transmitted in an occupational setting are discussed. Symptoms are described. The videorecording discusses the Occupational Safety and Health (OSHA) regulations on infectious bloodborne diseases and the universal precautions that have been established for health-care workers to prevent occupational exposure. Safe work practices are illustrated, including the use of barrier methods of protection, and needle and sharps disposal. Standard equipment care, disinfection techniques, and biohazard waste disposal are explained.
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AIDS and Hepatitis B: What's Your Risk? Contact: Gulf Publishing Company, PO Box 2608, Houston, TX, 772522608, (713) 529-4301. Summary: This videorecording discusses the guidelines necessary for all categories of health care workers to minimize their risk of exposure to Acquired immunodeficiency syndrome (AIDS) and Hepatitis B. The Human immunodeficiency virus (HIV) and the Hepatitis B virus are defined, and the routes of transmission discussed. The OSHA-defined risk categories based on level of contact to blood and body fluids are explained. The universal blood and body fluids guidelines are discussed. The importance of protective clothing and proper disposal, in relation to all employees in a health care setting, is emphasized.
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Silent Stalker: A Video Promoting Prevention of Hepatitis and Substance Abuse Source: Cedar Grove, NJ: Hepatitis Foundation International. 2000. (videocassette). Contact: Available from Hepatitis Foundation International. 30 Sunrise Terrace, Cedar Grove, NJ 07009-1423. (800) 891-0707. E-mail:
[email protected]. Website: www.hepfi.org. Price: $35.00 plus shipping and handling. Summary: This health promotion video describes hepatitis, a viral infection of the liver. The program begins in black and white, with spooky music, and introduces hepatitis as the Silent Stalker; various people are shown running in fear from a mysterious assailant. Then, young adult narrators stress that knowledge is power, which can be used to prevent hepatitis. The anatomy and physiology of the liver is briefly reviewed; the liver's roles as the body's chemical power plant, storage for energy supply, protein manufacturer (to build and repair muscles), and protector against germs, viruses, and poisons from alcohol and drugs. The program notes that the body usually offers pain to indicate damage or disease, however, the liver is an uncomplaining organ, so it can be under great stress or damage without symptoms. Hepatitis B and hepatitis C are reviewed, and viewers are encouraged to get the hepatitis B vaccine. The narrators then review the strategies to prevent hepatitis C, including avoiding shared injectable drug equipment (needles), making sure that body piercing or tattooing needles used are sterilized, and practicing safe sex by using a condom. The narrators stress that they are not judging peoples' activities, just providing information and encouraging viewers to make healthy decisions for themselves. The theme of 'you've got the power' (to prevent infection) is reiterated. The program concludes with the same people that were shown fleeing at the beginning; the ending is filmed in color, with upbeat music and smiling faces. Contact information for the Hepatitis Foundation International is also provided (www.hepfi.org; 800-891-0707).
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Hepatitis B: The Enemy Within Source: Princeton, NJ: Films for the Humanities and Sciences. 1996. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail:
[email protected]. Website: www.films.com. Price: $99.00 plus shipping and handling. Order number CAF6423.
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Summary: This program, featuring Dr. Harold Margolis and Dr. Frank Mahoney of the Centers for Disease Control and Prevention, explains current knowledge about hepatitis B, and its causes, treatment, and prevention. The program is designed like a news report and begins with an overview of the role and functions of the liver. The program then reviews the various forms of the hepatitis virus, noting that all forms cause liver inflammation and cirrhosis and can cause symptoms like the flu, dark urine, or jaundice (yellowing of the skin). The narrators then review how each type of hepatitis is transmitted, the symptoms, the treatment and side effects, prognostic factors, the availability of immunization, and risk factors for hepatitis A and C. The program then goes into more depth on hepatitis B, interviewing patients and health care providers. One young woman (age 26) who contracted hepatitis B at birth, describes her experiences with the disease and the psychosocial impact it has had on her life. The program discusses occupational risk factors, transmission, the geographic incidence and prevalence of hepatitis B, its typical course, and the problems associated with the development of chronic active hepatitis. A brief section describes the use of liver transplantation as the final option for end stage liver failure caused by hepatitis. The program then focuses on immunization programs, including those designed to vaccinate babies at birth, infants (during routine immunization), and adolescents. There is also some discussion about the difficulties of instituting successful vaccination programs for some high risk groups, including intravenous (IV) drug users and people with multiple sexual partners. ·
Hepatitis B: A Family's Story. Our Family, Our Strength Source: St. Paul, MN: Hepatitis B Coalition. 1995. (videorecording). Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $10.00. Summary: This videotape program educates viewers about hepatitis B and its potential impact. The first part of the program, presented in the Cambodian language, features a narrator who introduces Dr. Hie-Won Hann, a physician helping Asian families fighting hepatitis B. The program shows Dr. Hann interviewing a pregnant Cambodian woman; a second scenario features Dr. Hann and the woman's family, who have all come in to learn more about hepatitis B. Topics covered include the complications of hepatitis B (acute disease, liver cancer), chronic infection with hepatitis B, how to protect a baby from getting hepatitis B, testing family members, protecting uninfected family members, treating the chronic carrier, how the disease is transmitted (perinatal, sexual transmission, and close familial contact, i.e., sharing toothbrushes, razors,
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etc.), why the disease is common among Asian people, and the importance of achieving widespread vaccination. The videorecording comes with an English and a Cambodian copy of the script. The second part of the tape, presented in English, features Dr. Haing S. Ngor introducing the history of Indo-Chinese people in the U.S. and stressing the important place that family serves in these cultures. The remainder of the tape is the same as the Cambodian language part, but in English. ·
Hepatitis A, B, C, D and E Source: Atlanta, GA: Emory University School of Medicine. 1990. Contact: Available from Emory University School of Medicine. Lynne Wise, Department of Medical Education, 69 Butler Street, SE, Atlanta, GA 30303. (404) 616-3556. Price: $100 plus $5 shipping and handling. (RENTAL $45 for 2 weeks). Order Number 90-01. Summary: This videotape covers all of the known types of viral hepatitis, but concentrates on Hepatitis B. The tape opens with a discussion of the mechanisms of injury to the liver and continues with a detailed look at the prevalence of hepatitis B (200,000 cases per year in the U.S.) and the various known risk factors. Extensive coverage is given to the serologic findings in both acute and chronic disease. Finally, the author outlines the current treatment with interferon and the use of vaccines. (AA).
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Hepatitis B: A Discovery Channel Program Source: Cedar Grove, NJ: Hepatitis Foundation International. 199x. (videocassette). Contact: Available from Hepatitis Foundation International. 30 Sunrise Terrace, Cedar Grove, NJ 07009. (800) 891-0707 or (201) 239-1035. Fax (201) 857-5044. Price: Free with membership; contact directly for current price for nonmembers. Summary: This video presents a health update on hepatitis B. After an introduction that reviews the anatomy and physiology of the liver, various health care providers (including two epidemiologists from the CDC) describe how all types of hepatitis affect the liver. The program continues with a discussion of hepatitis A, B, and C, and how each is transmitted and treated. The program then focuses on hepatitis B, covering details of transmission, symptoms, risk factors and behaviors, complications of hepatitis B virus (HBV) infection, including an increased risk of liver cancer, epidemiology, fulminant hepatitis, and the progression of HBV to chronic, carrier state. Additional sections describe the use of liver transplantation for people with hepatitis B and the psychosocial impact of chronic HBV infection. The program concludes
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with an interview with Thelma King Thiel, the founder and CEO of the Hepatitis Foundation International, an educational and support organization.
Audio Recordings The Combined Health Information Database contains abstracts on audio productions. To search CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find audio productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Sound Recordings.” By making these selections and typing “hepatitis B” (or synonyms) into the “For these words:” box, you will only receive results on sound recordings (again, most diseases do not have results, so do not expect to find many). The following is a typical result when searching for sound recordings on hepatitis B: ·
Plenary Session: Vaccine Development and Testing: Global View Hepatitis and AIDS Source: 3rd National Forum on AIDS and Hepatitis B. Washington, DC, November 21-22, 1988. Contact: National Foundation for Infectious Diseases, 4733 Bethesda Ave Ste 750, Bethesda, MD, 20814-5228, (301) 656-0003, http://www.nfid.org. Sound Solution, PO Box 566074, Dallas, TX, 75356, (214) 258-6144. Summary: This sound recording contains proceedings of the 3rd National Forum on AIDS and Hepatitis B held in Washington, DC on November 21-22, 1988. It discusses the history of the Hepatitis B vaccine and relates it to the ongoing efforts to develop a vaccine for the Human immunodeficiency virus (HIV). What retroviruses are, how the antigenic response occurs, and how the Hepatitis B surface antigen was discovered are recounted. The difficulty surrounding effective vaccine development for Acquired immunodeficiency syndrome (AIDS)is emphasized. The cost-effectiveness of vaccines and their applications to improving the quality of human life are explored.
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OSHA/CDC Guidelines to Protect Health Care Workers Against AIDS and Hepatitis B Source: 3rd National Forum on AIDS and Hepatitis B. Washington, DC, November 21-22, 1988.
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Contact: National Foundation for Infectious Diseases, 4733 Bethesda Ave Ste 750, Bethesda, MD, 20814-5228, (301) 656-0003, http://www.nfid.org. Sound Solution, PO Box 566074, Dallas, TX, 75356, (214) 258-6144. Summary: This sound recording contains proceedings of the 3rd National Forum on AIDS and Hepatitis B held in Washington, DC on November 21-22, 1988. It discusses the Occupational Health and Safety Administration (OSHA) and Centers for Disease Control and Prevention (CDC) guidelines that are established to protect health care workers against Acquired immunodeficiency syndrome (AIDS) and Hepatitis B. The history of the development of the guidelines and regulations for the proper procedures surrounding blood and body fluids are outlined. The need to extend these regulations to ancillary staff in the hospital and to home health care workers who may not have access to institutional training is emphasized. The problems that may be encountered are discussed. The need to educate the classes of employees that encounter the greatest exposure to blood and body fluids is emphasized.
Bibliography: Multimedia on Hepatitis B The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in hepatitis B (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on hepatitis B. For more information, follow the hyperlink indicated: ·
AIDS, hepatitis B : what's your risk. Source: produced by Media Productions, Medical Illustration and Audiovisual Education, Baylor College of Medicine; Year: 1988; Format: Videorecording; Houston, Tex.: The College, c1988
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AIDS, hepatitis, and the emergency responder. Source: a presentation of Commonwealth Films; a Detrick Lawrence production; Year: 1988; Format: Videorecording; [Boston, Mass.]: Commonwealth Films; [Duxbury, Mass.]: D. Lawrence, c1988
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Bloodborne pathogens : "bloodbug" barriers. Source: produced by Coastal Video Communications Corp; Year: 1996; Format: Videorecording; Virginia Beach, VA: Coastal Video Communications, c1996
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Bloodborne pathogens : protect yourself. Source: produced by Coastal Training Technologies Corp; Year: 1999; Format: Videorecording; Virginia Beach, VA: Coastal Training Technologies, c1999
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Bloodborne pathogens in the healthcare environment. Source: [presented by] the MARCOM Group, Ltd; Year: 1992; Format: Videorecording; [Wilmington, Del.]: The Group, c1992
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Bloodborne pathogens standard for environmental workers. Source: [presented by] Medfilms; author, Alan K. Reeter; Year: 1992; Format: Videorecording; [Tucson, Ariz.]: Medfilms, c1992
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Bloodborne pathogens standard for nurses. Source: [produced by] Medfilms; Year: 1992; Format: Videorecording; [Tucson, Ariz.]: Medfilms, c1992
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Bloodborne pathogens standard for the laboratory. Source: [produced by] Medfilms; Year: 1992; Format: Videorecording; [Tucson, Ariz.]: Medfilms, c1992
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Ethical issues and considerations surrounding genetics ; Polymerase chain reaction (PCR): technology in infectious diseases. Source: HSTN; Year: 2002; Format: Videorecording; Carrollton, TX: PRIMEDIA Workplace Learning, c2002
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Hepatitis & you as a healthcare worker. Part 2 : hepatitis B & C. Year: 2001; Format: Videorecording; Carrollton, TX: HSTN, c2001
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Hepatitis B : an update. Source: the University of Texas Medical School at Houston; produced by UT-TV, Houston; Year: 1992; Format: Videorecording; [Houston, Tex.: UT/TV], c1992
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Hepatitis B : the enemy within. Source: a presentation of Films for the Humanities & Sciences; Year: 1996; Format: Videorecording; [United States]: Information Television Network, 1996
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Hepatitis B infection : maternal. Source: newborn evaluation and management / written by E. Jean Martin and John P. Manos; Year: 1993; Format: Electronic resource; Baltimore, Md.: Williams & Wilkins; Edwardsville, Kan.: Medi-Sim, c1993
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Infection control for hemodialysis. Source: participating organizations, Health Industry Manufacturers Association ... [et al.]; Year: 1990; Format: Videorecording; [Washington, D.C.]: FDA, [1990]
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Line of defense : viral precautions in the operating room. Year: 1991; Format: Videorecording; Danbury, Conn.: American College of Surgeons, Davis & Geck Surgical Film-Video Library, c1990
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O.S.H.A., what you must know. Source: American Dental Association; Year: 1992; Format: Videorecording; Chicago, Ill.: The Association, c1992
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OSHA's bloodborne pathogens standard for emergency and public safety workers. Source: [presented by] SAVANT, Sloane Audio Visuals for Analysis and Training; Year: 1992; Format: Videorecording; Fullerton, CA: SAVANT, c1992
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OSHA's bloodborne pathogens standard for laboratory and healthcare workers. Source: [presented by] SAVANT, Sloane Audio Visuals for Analysis and Training; Year: 1992; Format: Videorecording; Fullerton, CA: SAVANT, c1992
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OSHA's bloodborne pathogens standards : compliance in the clinical laboratory. Source: [presented by] the ASCP Press; Year: 1992; Format: Videorecording; [Chicago, Ill.]: American Society of Clinical Pathologists, c1992
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Protecting yourself from bloodborne pathogens. Source: produced by Cinecraft Productions, Inc; Year: 1992; Format: Videorecording; Cleveland, Ohio: Cinecraft Productions, c1992
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Recent developments in our knowledge of serum hepatitis. Source: a National Medical Audiovisual Center production; Year: 1970; Format: Videorecording; [United States]: The Center, 1970
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Techniques for the prevention of HIV and hepatitis infection in health care workers. Source: presented as an educational service by Glaxo; produced by Vision Associates/Medical Vision; Year: 1989; Format: Videorecording; Research Triangle Park, NC: Glaxo, 1989
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Treatment of chronic hepatitis. Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital, [and] Marshfield Medical Research Foundation; Year: 1991; Format: Videorecording; Marshfield, WI: Marshfield Regional Video Network, [1991]
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Tutorial for health care providers to control blood borne disease infections. Source: LMD, Learner Managed Designs, Inc; Year: 1989; Format: Electronic resource; Birmingham, AL: Health Promotion Services, c1989
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Universal precautions : AIDS & hepatitis B prevention for healthcare workers. Source: produced by Medcom/Trainex Inc., in association with the Presbyterian Hospital in the City of New York at ColumbiaPresbyterian Medical Center; Year: 1992; Format: Videorecording; Garden Grove, CA: Medcom, c1992
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Universal precautions : AIDS and hepatitis B prevention. Source: [presented by] Medcom; produced by Medcom Trainex, Inc., in association with the Presbyterian Hospital in the City of New York at Columbia-Presbyterian Medical Center; Year: 1997; Format: Videorecording; Cypress, CA: Medcom, c1997
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Universal precautions : guidelines for hospital employees. Source: presented by the Infection Control Committee of the U.T., M.D. Anderson Cancer Center; Year: 1989; Format: Videorecording; [Houston, Tex.]: The Center, [1989]
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Universal precautions. Source: produced by Cinecraft Productions; Year: 1989; Format: Videorecording; Cleveland, OH: Cinecraft Productions, c1989
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Update on HIV and hepatitis B infection. Source: [presented by] the Cleveland Clinic Foundation; Year: 1993; Format: Videorecording; [Cleveland, Ohio]: The Foundation, c1993
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Why me : dealing with an occupational exposure to a bloodborne virus. Source: Envision, Incorporated; Year: 1992; Format: Videorecording; [Nashville, Tenn.]: Envision [and] VU, VUMC, c1992
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CHAPTER 8. PERIODICALS AND NEWS ON HEPATITIS B Overview Keeping up on the news relating to hepatitis B can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on hepatitis B. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover hepatitis B beyond and including those which are published by patient associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.
News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on hepatitis B is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.
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PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “hepatitis B” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased. The following is typical of press releases that can be found on PR Newswire: ·
Crucell and Genexine Announce Agreement for Hepatitis B Vaccine Summary: Leiden, The Netherlands, July 3 /PRNewswire-FirstCall/ -Dutch antibody and vaccine company Crucell N.V. (Nasdaq, Euronext: CRXL) and Genexine Co. Ltd., a Korean drug development company, today announced that they have entered into a licensing agreement wherein Crucell's PER.C6(TM) cell line will be used by Genexine for the research, development and manufacture of a recombinant therapeutic vaccine against Hepatitis B. Under the terms of the agreement, Genexine obtains a worldwide nonexclusive license for the use of Crucell's PER.C6(TM) cell line to research and develop a therapeutic vaccine against Hepatitis B. Furthermore, the agreement includes the option for a commercial license. Crucell will receive upfront and annual payments; further financial details were not disclosed. "400 million individuals world-wide are Hepatitis B virus (HBV) carriers running the risk of developing cirrhosis and eventually liver cancer. It has recently been shown in an animal model that a vector-based vaccine may be able to reduce the HBV viremia(1). This makes the current agreement with Genexine, for the development of an adeno-vector based vaccine produced on PER.C6(TM) cells, very valuable for Crucell", comments Jaap Goudsmit, Chief Medical Officer of Crucell. "Crucell launched PER.C6(TM) as a vaccine platform through a licensing agreement with Merck & Co. for its HIV vaccine. We are now expanding our PER.C6(TM) business in the field of vaccines. The contract with Genexine, together with an agreement signed earlier this year with Rhein Biotech for a Japanese Encephalitis vaccine, endorses our strategy." "Hepatitis B is one of the major infectious diseases affecting people throughout Asia. The need for an effective vaccine that can treat, as well as prevent, Hepatitis B infections is paramount", says Prof. Sung, Chief
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Technology Officer of Genexine. "Crucell's PER.C6(TM) human cell line provides the perfect platform for the research and development of a therapeutic, adenovirus DNA vaccine." Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to hepatitis B. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “hepatitis B” (or synonyms). The following was recently listed in this archive for hepatitis B: ·
Oxxon starts phase II trials of therapeutic hepatitis B vaccine Source: Reuters Industry Breifing Date: July 01, 2002 http://www.reuters.gov/archive/2002/07/01/business/links/20020701 drgd001.html
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Severe isoniazid hepatotoxicity more likely in presence of active hepatitis B Source: Reuters Medical News Date: June 24, 2002 http://www.reuters.gov/archive/2002/06/24/professional/links/20020 624epid002.html
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Lamivudine superior to famciclovir against chronic hepatitis B Source: Reuters Industry Breifing Date: June 24, 2002 http://www.reuters.gov/archive/2002/06/24/business/links/20020624 clin012.html
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China launches hepatitis B vaccine project Source: Reuters Health eLine Date: June 03, 2002 http://www.reuters.gov/archive/2002/06/03/eline/links/20020603elin 021.html
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US Institute of Medicine finds hepatitis B vaccine safe Source: Reuters Industry Breifing Date: May 31, 2002 http://www.reuters.gov/archive/2002/05/31/business/links/20020531 plcy002.html
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Lamivudine moderately effective in children with chronic hepatitis B Source: Reuters Industry Breifing Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/business/links/20020530 clin016.html
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Hepatitis B, nerve diseases not linked: US report Source: Reuters Health eLine Date: May 30, 2002 http://www.reuters.gov/archive/2002/05/30/eline/links/20020530elin 029.html
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Scientists grow carrots containing hepatitis B vaccine Source: Reuters Industry Breifing Date: May 10, 2002 http://www.reuters.gov/archive/2002/05/10/business/links/20020510 drgd003.html
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Recombinant carrots may help prevent hepatitis B infection Source: Reuters Medical News Date: May 10, 2002 http://www.reuters.gov/archive/2002/05/10/professional/links/20020 510scie003.html
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Carrots modified to contain hepatitis B vaccine Source: Reuters Health eLine Date: May 10, 2002 http://www.reuters.gov/archive/2002/05/10/eline/links/20020510elin 029.html
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Hepatitis B vaccine uptake in neonates linked to gestational age Source: Reuters Medical News Date: April 29, 2002 http://www.reuters.gov/archive/2002/04/29/professional/links/20020 429clin003.html
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Gilead licenses hepatitis B drug to Glaxo in Asia, other markets Source: Reuters Industry Breifing Date: April 29, 2002 http://www.reuters.gov/archive/2002/04/29/business/links/20020429 inds012.html
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Roche's Pegasys effective in hepatitis B study Source: Reuters Industry Breifing Date: April 19, 2002 http://www.reuters.gov/archive/2002/04/19/business/links/20020419 drgd003.html
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Adoptive transfer of hepatitis B core antigen immunity resolves chronic hepatitis B Source: Reuters Medical News Date: April 01, 2002 http://www.reuters.gov/archive/2002/04/01/professional/links/20020 401clin005.html
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Intradermal hepatitis B vaccination succeeds where IM administration has failed Source: Reuters Medical News Date: March 28, 2002 http://www.reuters.gov/archive/2002/03/28/professional/links/20020 328clin011.html
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Nabi to begin shipment of hepatitis B vaccine from newly finished plant Source: Reuters Industry Breifing Date: March 27, 2002 http://www.reuters.gov/archive/2002/03/27/business/links/20020327 rglt002.html
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Most hepatitis B cases preventable with routine vaccination Source: Reuters Medical News Date: March 26, 2002 http://www.reuters.gov/archive/2002/03/26/professional/links/20020 326publ001.html
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Gilead files for approval of hepatitis B drug in Europe Source: Reuters Industry Breifing Date: March 26, 2002 http://www.reuters.gov/archive/2002/03/26/business/links/20020326 rglt005.html
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Gilead Sciences files for US approval of hepatitis B therapy Source: Reuters Industry Breifing Date: March 22, 2002 http://www.reuters.gov/archive/2002/03/22/business/links/20020322 rglt005.html
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Hepatitis B on decline but many still at risk Source: Reuters Health eLine Date: March 18, 2002 http://www.reuters.gov/archive/2002/03/18/eline/links/20020318elin 010.html
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Thymalfasin plus interferon successful in phase II hepatitis B study Source: Reuters Medical News Date: March 13, 2002 http://www.reuters.gov/archive/2002/03/13/professional/links/20020 313drgd001.html
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SciClone's Zadaxin combined with interferon successful in phase II hepatitis B study Source: Reuters Industry Breifing Date: March 13, 2002 http://www.reuters.gov/archive/2002/03/13/business/links/20020313 drgd003.html
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Gilead starts early-access program for hepatitis B drug Source: Reuters Industry Breifing Date: March 12, 2002 http://www.reuters.gov/archive/2002/03/12/business/links/20020312 inds008.html
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Early-access program for adefovir announced for treatment of hepatitis B Source: Reuters Medical News Date: March 12, 2002 http://www.reuters.gov/archive/2002/03/12/professional/links/20020 312inds017.html
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Hepatitis B linked to carotid atherosclerosis in the Japanese population Source: Reuters Medical News Date: March 07, 2002 http://www.reuters.gov/archive/2002/03/07/professional/links/20020 307epid005.html
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SciClone drug performs well in phase III hepatitis B study Source: Reuters Industry Breifing Date: March 05, 2002 http://www.reuters.gov/archive/2002/03/05/business/links/20020305 drgd002.html
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Achillion moves hepatitis B drug into phase II studies Source: Reuters Industry Breifing Date: February 28, 2002 http://www.reuters.gov/archive/2002/02/28/business/links/20020228 drgd005.html
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Hepatitis B cases linked to NYC doctor's office Source: Reuters Health eLine Date: January 14, 2002 http://www.reuters.gov/archive/2002/01/14/eline/links/20020114elin 024.html
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Corixa adjuvant performs well in phase III hepatitis B vaccine study Source: Reuters Industry Breifing Date: January 09, 2002 http://www.reuters.gov/archive/2002/01/09/business/links/20020109 drgd004.html
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Adjuvant performs well in phase III hepatitis B vaccine study Source: Reuters Medical News Date: January 09, 2002 http://www.reuters.gov/archive/2002/01/09/professional/links/20020 109drgd005.html
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Dynavax, Triangle hepatitis B prophylaxis effective in phase I/II Source: Reuters Industry Breifing Date: December 18, 2001 http://www.reuters.gov/archive/2001/12/18/business/links/20011218 drgd004.html
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Hepatitis B lingers in lamivudine-treated liver transplant recipients Source: Reuters Industry Breifing Date: November 20, 2001 http://www.reuters.gov/archive/2001/11/20/business/links/20011120 clin002.html
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Entecavir may broaden hepatitis B armamentarium Source: Reuters Industry Breifing Date: November 14, 2001 http://www.reuters.gov/archive/2001/11/14/business/links/20011114 drgd009.html
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Gilead hepatitis B drug appears successful in phase III Source: Reuters Industry Breifing Date: November 09, 2001 http://www.reuters.gov/archive/2001/11/09/business/links/20011109 drgd001.html
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Infectious hepatitis B status usually clears within 10 years Source: Reuters Medical News Date: November 06, 2001 http://www.reuters.gov/archive/2001/11/06/professional/links/20011 106epid005.html
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Hepatitis B vaccination is working, research shows Source: Reuters Health eLine Date: November 06, 2001 http://www.reuters.gov/archive/2001/11/06/eline/links/20011106elin 004.html
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Universal vaccination has greatly reduced hepatitis B carrier rate in Taiwan Source: Reuters Medical News Date: November 05, 2001 http://www.reuters.gov/archive/2001/11/05/professional/links/20011 105publ008.html
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Many clear hepatitis B proteins without treatment Source: Reuters Health eLine Date: November 05, 2001 http://www.reuters.gov/archive/2001/11/05/eline/links/20011105elin 010.html
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Enzo's hepatitis B drug appears promising in phase II Source: Reuters Industry Breifing Date: October 12, 2001 http://www.reuters.gov/archive/2001/10/12/business/links/20011012 drgd004.html
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Gilead hepatitis B drug successful in second phase III trial Source: Reuters Industry Breifing Date: September 19, 2001 http://www.reuters.gov/archive/2001/09/19/business/links/20010919 drgd004.html The NIH
Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.
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Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.
Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “hepatitis B” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.
Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “hepatitis B” (or synonyms). If you know the name of a company that is relevant to hepatitis B, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “hepatitis B” (or synonyms).
Newsletters on Hepatitis B Given their focus on current and relevant developments, newsletters are often more useful to patients than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “hepatitis B.” Go to
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the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “hepatitis B” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·
Needle tips and Hepatitis B Coalition news Source: Saint Paul, MN: Hepatitis B Coalition, and Immunization Action Coalition. 1993-. semiannual. Contact: Available from Immunization Action Coalition, 1573 Selby Avenue, Suite 234, Saint Paul, MN 55104. Telephone: (651) 647-9009 / fax: (651) 647-9131 / e-mail:
[email protected],
[email protected] / Web site: http://www.immunize.org. Summary: This newsletter is addressed to the health professional. It includes a variety of material about immunization against communicable diseases, with special emphasis on hepatitis B. The newsletter includes a catalog of publications, videos, and resources, many available in Spanish, Hmong, Cambodian, Laotian, Vietnamese, Tagalog, Russian, Chinese, or Korean, and designed for use with populations of foreign origin.
Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “hepatitis B” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on hepatitis B: ·
Hepatitis B in Asia Source: Asian Pacific Gastroenterology News. Issue 4: 12-13. June 2000.
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Contact: Available from Blackwell Science Asia. 54 University Street, Carlton, Victoria 3053, Australia. 61 3 9347 0300. Fax 61 3 9347 5001. Email:
[email protected]. Summary: Five to 20 percent of the population of Asia and Africa are chronically infected with hepatitis B virus (HBV). This article reviews the main issues related to hepatitis B in Asia, including the evaluation and treatment of infected but asymptomatic subjects, the so-called HBV carriers; the continued horizontal spread of HBV infection, emergence of HBV mutants, and implementation of vaccination programs. The author contends that the term 'carrier' should therefore be deleted from the terminology of hepatitis B and should be replaced by 'chronic hepatitis B virus infection.' Evaluation of a subject with chronic HBV infection should include a reliable ALT (repeated three times), an HbeAg test, and if needed, an HBV DNA ultrasound and liver biopsy. The prevalence of HBV and hepatitis C (HCV) in chronic liver disease has been reported to be approximately 15 percent in the Asian region. In several countries in Asia, vaccination against HBV has been successfully included in the EPI program. This has led to a substantial reduction in the chronic HBV infection in the pediatric population. 1 table. 6 references. ·
Be As Sure As You Can Be!: Give Babies Hepatitis B Vaccine at Birth Source: Needle Tips and the Hepatitis B Coalition News. 10(1): 3. SpringSummer 2000. Contact: Available from Hepatitis B Coalition. Immunization Action Coalition, 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 6479009. Fax (612) 647-9131. E-mail:
[email protected]. Website: www.winternet.com. Summary: In the past year, the successful strategy of initiating hepatitis B immunization at birth has been interrupted by concerns regarding thimerosal, the commonly used vaccine preservative. This article briefly reviews the concerns with thimerosal, then notes that vaccine manufacturers now have sufficient supplies of preservative free hepatitis B vaccine to meet the vaccination needs of all children in the United States. Advisory groups have recommended that routine newborn vaccination policies be reintroduced in hospitals where they were discontinued. In addition, both advisory groups (the Centers for Disease Control and Prevention, or CDC, and the American Academy of Pediatrics, AAP) have emphasized that hepatitis B vaccination should not be delayed for infants born to HBsAg negative mothers as was recommended by the AAP in July 1999. The article lists and discusses five reasons that infant vaccine is critical: prevention of perinatal hepatitis B virus (HBV) infection; hepatitis B vaccination at birth provides a safety
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net; infants and children are exposed to HBV even though their mothers are HBsAg negative; infant immunization is part of the nation's strategy to eliminate HBV transmission; and the birth dose of hepatitis B vaccine increases completion of the three dose series and other childhood vaccines. 1 reference. ·
Here's the Score!: Hepatitis B Vaccine is Safe and Effective Source: Needle Tips and the Hepatitis B Coalition News. 9(1): 6. SpringSummer 1999. Contact: Available from Immunization Action Coalition. Hepatitis B Coalition. 1573 Selby Avenue, Suite 234, St. Paul, MN 55104. (651-) 6479009. Fax (651) 647-9131. Website: www.immunize.org. Summary: Hepatitis B vaccines provide protection against serious and life threatening liver diseases, including cancer of the liver. This article reviews the safety and efficacy of hepatitis B vaccine. The author notes that recent news items have questioned the safety of hepatitis B vaccines and suggested associations between the vaccine and multiple sclerosis (MS) and other autoimmune disorders. The author emphasizes that these news reports have not included the results of expert panels who have carefully reviewed the data and found no scientific evidence of a causal relationship between hepatitis B vaccine and MS and other disorders. The author describes this review process and refers readers to numerous vaccine safety resources (telephone numbers and websites). The author stresses that parents should not be misled by the occasional inflammatory reports in the press. Hepatitis B vaccines are very safe and effective and should continue to be given to all children as part of their routine vaccination schedule.
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Hepatitis B and the Health Care Worker Source: St. Paul, MN: Immunization Action Coalition. 1998. 1 p. Contact: Available from Immunization Action Coalition. 1573 Selby Avenue, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. E-mail:
[email protected]. Price: $1.00 per copy; available for free at www.immunize.org/catg.d/free.htm. Summary: Persons who have a reasonable expectation of being exposed to blood on the job should be offered hepatitis B vaccine. This fact sheet answers commonly asked questions about how to protect health care workers from hepatitis B. Written in a question and answer format, the fact sheet discusses appropriate sites for administering the vaccine, specific dosage and administration issues, the safety of vaccinating pregnant health care workers, the indications for serologic testings after
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receiving three doses of the vaccine, methods for dealing with nonresponders to hepatitis B vaccination, and the indications for ongoing testing for anti-HBs. The fact sheet reiterates that a health care worker who has been vaccinated does not need to be tested unless he or she has an exposure. Persons who perform invasive procedures should be treated the same as other health care workers with respect to anti-HBs testing. One table notes the guidelines for postexposure prophylaxis, to be consulted when a health care worker has an exposure (e.g., needlestick). 1 table. ·
Hepatitis B Toolbox Source: Needle Tips and the Hepatitis B Coalition News. 6(1): 16. January 1996. Contact: Available from Hepatitis B Coalition. Immunization Action Coalition, 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 6479009. Fax (612) 647-9131. E-mail:
[email protected]. Web site: http://www.winternet.com/. Summary: This fact sheet provides a summary of information for health care providers on hepatitis B. Three sections outline groups at risk for hepatitis B virus infection, interpretation of the hepatitis B panel, and the laboratory diagnosis of chronic hepatitis B, C, and D. Brief information is included with the summary boxes. The fact sheet is designed to be posted as a reminder for health care providers.
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Preventing Transmission of HIV and Hepatitis B in Day Care Source: Oklahoma HIV/STD Update. 93(2): 3-4. Spring 1993. Contact: Available from Oklahoma State Department of Health. 1000 North East 10th Street, Oklahoma City, OK 73117-1299. (405) 271-4636. Price: Single copy free. Summary: This article reviews how to prevent transmission of HIV and hepatitis B in day care settings. Designed to inform day care workers about the risk of transmission, the article focuses on how to protect both day care workers and children from exposure. The article reviews how HIV and hepatitis B are transmitted, the risks of transmission in the day care setting (very low for both diseases), and the recommendations of the Oklahoma State Department of Health. The article emphasizes that, despite the fact that the risk of transmission of HIV or hepatitis B in day care settings is very low, precautions must be taken to ensure that situations that could potentially result in transmission are avoided. The recommendations include staff training, hand washing, universal precautions, housekeeping considerations, disposal of blood
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contaminated materials, and what to do in case of a potentially infectious event.
Academic Periodicals covering Hepatitis B Academic periodicals can be a highly technical yet valuable source of information on hepatitis B. We have compiled the following list of periodicals known to publish articles relating to hepatitis B and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on hepatitis B published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published. If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on hepatitis B: ·
Acta Haematologica. (Acta Haematol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Haematologica&dispmax=20&dispstart=0
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American Journal of Public Health. (Am J Public Health) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=A merican+Journal+of+Public+Health&dispmax=20&dispstart=0
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Biochemical Pharmacology. (Biochem Pharmacol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Bi ochemical+Pharmacology&dispmax=20&dispstart=0
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Cancer Detection and Prevention. (Cancer Detect Prev) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ca ncer+Detection+and+Prevention&dispmax=20&dispstart=0
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Hepatology (Baltimore, Md. . (Hepatology) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=He patology+(Baltimore,+Md.+&dispmax=20&dispstart=0
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Journal of Biotechnology. (J Biotechnol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Biotechnology&dispmax=20&dispstart=0
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Journal of Gastroenterology and Hepatology. (J Gastroenterol Hepatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology+and+Hepatology&dispmax=20&dispstart=0
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Journal of Gastroenterology. (J Gastroenterol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Gastroenterology&dispmax=20&dispstart=0
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Journal of Hepatology. (J Hepatol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Hepatology&dispmax=20&dispstart=0
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Kidney International. (Kidney Int) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ki dney+International&dispmax=20&dispstart=0
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Social Science & Medicine (1982). (Soc Sci Med) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=So cial+Science+&+Medicine+(1982)&dispmax=20&dispstart=0
Vocabulary Builder Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Thimerosal: A topical antiseptic used on skin and mucous membranes. It is also used as a preservative in pharmaceuticals. [NIH]
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CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help patients with their conditions. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.
NIH Guidelines For the more common diseases, The National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·
Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm
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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/
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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html
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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm
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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·
Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html
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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html
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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html
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Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/
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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html
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Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html
Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26
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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/
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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html
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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html
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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html
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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html
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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html
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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html
While all of the above references may be of interest to physicians who study and treat hepatitis B, the following are particularly noteworthy.
The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and hepatitis B using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “hepatitis B” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with hepatitis B. The following is a sample result:
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Comments on OSHA's Advance Notice of Proposed Rulemaking to Control Occupational Exposures to Hepatitis B and AIDS Contact: Service Employees International Union, Education and Support Fund, 1313 L St NW, Washington, DC, 20005, (202) 898-3443, http://www.seiu.org. Summary: This report presents comments from the Service Employees International Union (SEIU) regarding development of standards for infection-control procedures by the Occupational Safety and Health Act. It comments on issues not adequately covered in the Joint Advisory Notice, on the basis of a survey conducted by SEIU of infection-control procedures in 100 departments of health and correctional facilities across the United States. It urges the agency to define scope of coverage on the basis of potential exposure to Human immunodeficiency virus (HIV) infection and Acquired immunodeficiency syndrome (AIDS) or other bloodborne diseases. Modes of transmission and protective equipment are discussed, as well as vaccination programs, training, and education.
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Guidelines for Prevention of Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Health - Care and Public - Safety Workers. A Response to P.L. 100 - 607, The Health Contact: US Government Printing Office, PO Box 371954, Pittsburgh, PA, 15250-7954, (202) 512-1800, http://www.access.gpo.gov. CDC National Prevention Information Network, PO Box 6003, Rockville, MD, 208496003, (800) 458-5231, http://cdcnpin.org. Summary: Intended for use by an audience that is technically informed on existing principles of infection control, this report provides an overview of HIV for health care and public safety workers. It also presents information concerning the protection of workers against acquisition of Hepatitis B virus, whose mode of transmission is similar to those of HIV. Developed by the National Institute of Occupational Safety and Health (NIOSH), it includes specific risk-control recommendations, as well as information on the medical management of persons who have sustained workplace exposure to either virus. Information is provided for fire fighters, emergency medical services (EMS) personnel, and law enforcement and correctional facility personnel. Because of the risks of exposure associated with parenteral (including open wound) and mucous membrane exposure to blood and other potentially infectious body fluids, observance of universal precautions is urged as a cornerstone of worker safety.
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Guidelines for Informing School Employees about Preventing the Spread of Infectious Diseases, Including Hepatitis B and AIDS/HIV Infections and Policies for Dealing With HIV - Infected Persons in Contact: California Department of Education, Office of Healthy Kids, Healthy California Unit, PO Box 944272, Sacramento, CA, 94244-2720, (916) 322-4018. Summary: This policy statement gives guidelines for schools and school districts regarding information to be given to school employees about universal precautions to prevent the spread of all infectious diseases. It includes specific suggestions about Acquired immunodeficiency syndrome (AIDS) and Hepatitis B. School districts are required by law to provide this information. The guidelines give an overview of infection control precautions and present the rationale for implementing these precautions. It looks at the risk of infection with Human immunodeficiency virus (HIV) and Hepatitis B, and explains the symptoms of both infections and methods by which the viruses are transmitted. Means of precaution are explained, and universal precautions listed. The need for school policies on infectious diseases is discussed.
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Protejase: Hepatitis B y C: Enterese. [Protect Yourself: Hepatitis B & C: Get the Facts] Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 950618466, (831) 423-1400, http://www.promotehealth.com. Summary: This brochure provides information on hepatitis B and C. It discusses the transmission, symptoms, long-term effects, and available medical treatment for hepatitis B and C. It recommends that individuals take measures to help prevent hepatitis A and B including using condoms, not sharing personal articles that may contain blood (e.g., needles and razors), and getting vaccinated for hepatitis B.
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Making Good Decisions : Tattoos and Body Piercing : Protecting Yourself From Hepatitis and HIV : Reducing Your Risk Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 950618466, (831) 423-1400, http://www.promotehealth.com. Summary: This brochure, written for the general public, presents information on the relationship between body art (tattoos and body piercing) and the transmission of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), hepatitis B (HBV), hepatitis C (HCV), tuberculosis (TB), and tetanus. It discusses how unsterilized needles can lead to the transmission of these diseases and
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recommends that individuals consider the possible risks associated with body art, resist peer pressure to undergo such a procedure, and take steps to prevent HIV/hepatitis (i.e., by visiting a body art professional who sterilizes the equipment, uses new disposable needles for each customer, and does not use a piercing gun). It recommends that customers ask their body art professional a list of questions before getting a tattoo or piercing. ·
Protect Yourself : Hepatitis B & C : Get the Facts Contact: Journeyworks Publishing, PO Box 8466, Santa Cruz, CA, 950618466, (831) 423-1400, http://www.promotehealth.com. Summary: This brochure provides information on hepatitis B and C. The brochure discusses transmission, symptoms, long-term effects, and available medical treatment of hepatitis B and C. It recommends that individuals take preventative measures against hepatitis A and B such as using condoms, not sharing personal articles that may contain blood such as needles and razors, and getting vaccinated for hepatitis B.
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Merge With Caution : If You Think You Have an STD... Make Sure You're Vaccinated Against Hepatitis B Contact: SmithKline Beecham Pharmaceuticals, PO Box 7929, Philadelphia, PA, 19101, (800) 366-8900, http://www.sb.com/. Summary: This brochure presents information to the general public about the hepatitis B virus (HBV). The brochure describes HBV, its modes of transmission, and its symptoms. It describes the vaccination process for HBV and its effectiveness against the virus. The brochure identifies the high-risk behaviors including unprotected sexual intercourse, associated with the transmission of HBV and risk factors, such as previoulsy being infected with a sexually transmitted disease (STD), that can help to facilitate its spread.
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Hepatitis B and Me : Straight Talk for Teens : I Got Vaxed : And You Should, Too : Preteens/Teens : Vax : Prevent Hepatitis B Now Contact: SmithKline Beecham Pharmaceuticals, PO Box 7929, Philadelphia, PA, 19101, (800) 366-8900, http://www.sb.com/. Summary: This brochure discusses the vaccine, Vax, for the hepatitis B virus (HBV). The brochure states the HBV is a very serious illness that can last for long periods of time, but can be easily prevented through vaccination. It explains the process involved in getting vaccinated for HBV, and also the ways that the virus is transmitted from person to person.
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What Every Parent Should Know : Hepatitis B and Adolescents : Preteens/Teens : Vax : Prevent Hepatitis B Now Contact: SmithKline Beecham Pharmaceuticals, PO Box 7929, Philadelphia, PA, 19101, (800) 366-8900, http://www.sb.com/. Summary: This brochure discusses the hepatitis B virus (HBV) and vaccination, Vax, as a method of HBV prevention. The brochure describes HBV and the vaccination for infants and adolescents against the disease. It identifies the methods by which HBV is transmitted and describes the vaccination process. The brochure explains that HBV is a serious threat to children and adolescents and provides an epidemiological overview of the infection in the United States.
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Infectious Diseases in the School Setting: HIV/AIDS, Hepatitis B, and Other Common Infectious Diseases Contact: Feature Facts Incorporated, PO Box 2208, Merced, CA, 95344, (209) 383-1008. Summary: This brochure discusses diseases that a person could be exposed to in the classroom, with particular attention paid to Human immunodeficiency virus (HIV) and Hepatitis B. The brochure tells what HIV, the etiologic agent of Acquired immunodeficiency syndrome (AIDS), and Hepatitis are, and discusses ways in which they are spread and how transmission can be avoided. It also addresses new OSHA bloodborne pathogens regulations that are applicable to schools, an expanded Universal Precautions section, additional avoidance strategies, and information resources. Particular attention is given to prevention of all infections in the school setting.
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Oregon Health Division's Guidelines for Schools With Children Who Have Hepatitis B Virus or Human Immunodeficiency Virus Infections Contact: Oregon Department of Human Services, Health Division, Center for Disease Prevention and Epidemiology, HIV/STD/TB Program, PO Box 14450, Portland, OR, 97214-0450, (503) 731-4029, http://www.ohd.hr.state.or.us/hiv/welcome.htm. Summary: This policy statement includes recommended guidelines for Oregon school administrators who are developing procedures on safely educating children with Hepatitis B or Acquired immunodeficiency syndrome (AIDS). It gives background information on the illnesses and studies legal and confidentiality issues. General recommendations cover education about the two viruses and use of infection-control procedures. The HIV-specific recommendations include one that says it is expected
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that HIV-infected school-age children will be able to attend school without restriction. ·
Chronic Hepatitis B Virus Infection in Asian Countries Source: Journal of Gastroenterology and Hepatology. 15(12): 1356-1361. December 2000. Contact: Available from Blackwell Science. 54 University Street, Carlton South 3053, Victoria, Australia. +61393470300. Fax +61393475001. E-mail:
[email protected]. Website: www.blackwell-science.com. Summary: Of the estimated 50 million new cases of hepatitis B virus (HBV) infection diagnosed annually, 5 to 10 percent of adults and up to 90 percent of infants will become chronically infected. Of those who become chronically infected, 75 percent are in Asia where hepatitis B is the leading cause of chronic hepatitis (liver infection), cirrhosis (liver scarring), and hepatocellular carcinoma (liver cancer). This article offers detailed statistics on chronic HBV infection in Asian countries, including Indonesia, the Phillipines, Thailand, China, Taiwan, and Malaysia. In the highly endemic countries in Asia (places where HBV is found on a routine basis in the population), the majority of infections are contracted postnatally or perinatally (during birth). Three phases of chronic HBV infection are recognized: phase 1 patients are HBeAg positive with high levels of virus in the serum (blood) and minimal hepatic (liver) inflammation; phase 2 patients have intermittent or continuous hepatitis of varying degrees of severity; phase 3 is the inactive phase during which viral concentrations are low and there is minimal inflammatory activity in the liver. In general, patients who clear HBeAg have a better prognosis than patients who remain HBeAg positive for prolonged periods of time. The outcome after anti HBe seroconversion depends on the degree of preexisting liver damage and any subsequent HBV reactivation. Without preexisting cirrhosis, there may be only slight fibrosis or mild chronic hepatitis, but with preexisting cirrhosis, further complications may happen. The annual incidence of hepatic decompensation (reduction in liver function) in HBV related cirrhosis varies from 2 to 10 percent and in these patients, the 5 year survival rate drops dramatically to 14 to 35 percent. The annual risk of developing HCC (liver cancer) in patients with cirrhosis varies between 1 and 6 percent. Chronic hepatitis B is not a static disease and the natural history of the disease is affected by both viral and host factors. The prognosis is poor with decompensated cirrhosis and effective treatment options are limited. The authors conclude that prevention of HBV infection through vaccination is still therefore the best strategy for decreasing the incidence of hepatitis B associated cirrhosis and HCC. 1 table. 32 references.
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Hepatitis B Update. Revised ed Source: St. Paul, MN: Hepatitis B Coalition. 1996. 13 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Price: $5.00. Summary: This document, designed for use by health care professionals, discusses contemporary and prevention issues of hepatitis B. Focusing on the Asian-American population, the document provides an overview of hepatitis B, its incidence and prevalence; transmission of hepatitis B; risk factors; hepatitis B virus (HBV) structure and nomenclature; clinical presentation; laboratory testing and interpretation; treatment; natural history; correlation with primary hepatocellular carcinoma (PHC); use of the hepatitis B vaccine; administration and dosage of the vaccine; and post-exposure recommendations. One section presents an excerpt from the most recent recommendations of the Immunization Practices Advisory Committee (ACIP) regarding hepatitis B vaccination. 1 figure. 9 tables. 49 references.
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Every Week Hundreds of Teenagers Are Infected With Hepatitis B: Get Vaccinated Against This Disease! Contact: Immunization Action Coalition, 1573 Selby Ave Ste 234, St Paul, MN, 55104, (651) 647-9009, http://www.immunize.org. Summary: This brochure, written for adolescents, discusses the hepatitis B virus (HBV) and vaccination. Hepatitis B is a viral liver disease, caused by HBV, which can cause severe illness and possibly death. Hepatitis B can be a chronic disease in some people who have contracted it. HBV is transmitted through unprotected sex, the sharing of personal products that may contain blood such as toothbrushes or razors, contact with infected blood, and tattoos or body piercings given with unsterile equipment. The symptoms of hepatitis B include jaundice, a bloated abdomen that is painful, loss of appetite, fatigue, nausea, fever, darkcolored urine, and a full body rash. The HBV vaccine, administered in three shots, is the best way for individuals to protect themselves from this disease. Personal physicians, schools, and city or county health departments may administer this vaccine to adolescents. The brochure lists other vaccinations that the readers may want to consider and additional sources of information on HBV.
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Universal Precautions: AIDS and Hepatitis B Prevention for Correctional Officers Contact: Medcom Incorporated, PO Box 6003, Cypress, CA, (800) 5410253.
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Summary: This teaching aid, consisting of a videorecording and an accompanying employee workbook, is used by the California Department of Corrections to train personnel about universal precautions. The program consists of five lessons that entail an introduction, a case study, application exercises, a videorecording segment, and a lesson summary. The five lessons study the following topics: information on Hepatitis B virus (HBV), information on the HIV, how HIV and HBV are transmitted, universal precautions through use of personal protective equipment, and universal precautions through occupational safety. ·
Preventing AIDS and Hepatitis B in the Workplace Contact: de'MEDICI Systems, 1047 El Camino Real Ste 202, Menlo Park, CA, 94025, (415) 326-1600. Summary: This information package describes a computer-assisted instruction, interactive software package designed to prevent hospital employee exposure to Hepatitis B and Human immunodeficiency virus (HIV), the etiologic agent of Acquired immunodeficiency syndrome (AIDS). The training program ensures that hospitals comply with occupational safety standards. A recordkeeping system tracks employee vaccinations and training sessions.
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Management of Chronic Hepatitis B in Children and Adults Source: St. Paul, MN: Hepatitis B Coalition. 1997. 12 p. Contact: Available from Hepatitis B Coalition. 1573 Selby Avenue, Suite 229, St. Paul, MN 55104. (612) 647-9009. Fax (612) 647-9131. Price: $5.00. Summary: This information packet contains six fact sheets addressing common concerns that health care providers may have about chronic hepatitis B virus (HBV) infection in children and adults. The six fact sheets are: Does Your Patient Have Chronic Hepatitis B?; Management of the HBsAg Positive Patient; Management of Chronic Hepatitis B in Adults; Management of Chronic Hepatitis B in Children and Adults; and What the Physician Can Do to Help the Child Who is a Hepatitis B Carrier. Topics include how chronic HBV infection is diagnosed; the outcomes in a patient with chronic infection, including the possibilities of liver cirrhosis and primary hepatocellular carcinoma (HCC, or liver cancer); the liver damage caused by HBV; the need for ongoing patient followup, even when test batteries indicate a lower infection rate; the management of patients who are chronically infected with HBV; the treatment modalities available; the natural history of HBV; risk factors for
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transmission; indications for testing of sexual and household contacts; and diagnostic testing and followup in children. 2 figures. 2 tables. ·
Review of Adolescent School-Based Hepatitis B Vaccination Projects Source: Atlanta, GA: Centers for Disease Control and Prevention, Hepatitis Branch. 1996. 115 p. Contact: Available from Information/Distribution, National Immunization Program. Mailstop E-34, CDC, 1600 Clifton Road NE, Atlanta, GA 30333. Fax (404) 639-8828. Price: Single copy free to health professionals. Summary: This report on adolescent school-based hepatitis B vaccination is part of a resource kit designed to be used in a hepatitis B prevention program. These materials were developed to help facilitate the implementation of 1995 recommendations of the Advisory Committee on Immunization Practices (ACIP) which emphasized the need for vaccination of all 11 to 12 year old children who have not previously received hepatitis B vaccine. Catchup vaccination of adolescents is a key element in the strategy to eliminate hepatitis B virus (HBV) in the United States and presents an opportunity to provide other preventive health services to this underserved population. The report summarizes the experience of 13 different school-based projects and contains information on issues such as obtaining consent, selecting appropriate grades to target, educating teachers and students, and obtaining support from school officials, health department staff, and primary care providers. In addition, the report describes a variety of approaches to mobilize resources for school programs. 1 figure. 26 tables. 3 references. (AA-M).
·
Hepatitis B Virus Infection Without Immunological Markers After Open-Heart Surgery Source: Lancet. 345(8946): 355-357. February 11, 1995. Summary: Posttransfusion hepatitis is still an important problem, despite the screening of blood donors for hepatitis B virus (HBV) and hepatitis C virus infections. This article reports on a study in which the researchers assessed whether HBV DNA might be detected by PCR in prospectively collected serum samples of patients with unexplained posttransfusion hepatitis but no immunological HBV markers. They found HBV DNA in 4 (20 percent) of 20 patients with unexplained posttransfusion hepatitis and in 5 patients with mildly increased aminotransferases. The clinical course of these HBV infections was usually mild and self-limiting. The researchers conclude that low-titre, immunologically negative HBV
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infections do exist and might represent a significant cause of posttransfusion hepatitis. ·
Recommendations for Preventing Transmission of Human Immunodeficiency Virus and Hepatitis B Virus to Patients During Exposure-Prone Invasive Procedures Source: MMWR. Morbidity and Mortality Weekly Report. 40(RR-8): 1-9. July 12, 1991. Contact: Available from National Prevention Information Network. P.O. Box 6003, Rockville, MD 20850. (800) 458-5231. PRICE: Single copy free. Summary: This document has been developed by the Centers for Disease Control (CDC) to update recommendations for prevention of transmission of human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in the health-care setting. Current data suggest that the risk for such transmission from a health-care worker to a patient during an invasive procedure is small. This document contains recommendations to provide guidance for prevention of HIV and HBV transmission during those invasive procedures that are considered exposure-prone. A brief appendix provides a definition of invasive procedures. 44 references. (AA-M).
·
Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination: Recommendations of the Immunization Practices Advisory Source: MMWR. Morbidity and Mortality Weekly Report. 40(RR-13): 125. November 22, 1991. Summary: This document provides the rationale for a comprehensive strategy to eliminate transmission of hepatitis B virus (HBV) in the United States. The report updates all previous recommendations on protection against HBV infection. This prevention strategy includes making hepatitis B vaccine a part of routine vaccination schedules for all infants. Six sections cover the epidemiology and prevention of HBV infection; the epidemiology and prevention of hepatitis delta virus infection; a strategy to eliminate HBV transmission; prophylaxis against hepatitis B infection; recommendations; and evolving issues in hepatitis B immunization programs. 5 tables. 71 references.
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The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, patients, their families, and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “hepatitis B” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 343187 Books / Periodicals / Audio Visual 2561 Consumer Health 292 Meeting Abstracts 3093 Other Collections 100 Total 349233
Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 29
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HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “hepatitis B” (or synonyms) at the following Web site: http://text.nlm.nih.gov. Coffee Break: Tutorials for Biologists34 Some patients may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 31 32
Physician Guidelines and Databases 215
articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. You can access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.
Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·
CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.
·
Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.
·
Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.
·
MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.
·
Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.
The Genome Project and Hepatitis B With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and patients want to know about how human genes relate to hepatitis B. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.
216 Hepatitis B
Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “hepatitis B” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for hepatitis B: ·
Hepatitis B Vaccine, Response to Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?142395
Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.
37
Physician Guidelines and Databases 217
Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·
Immune System: Fights invaders. Examples: Asthma, autoimmune polyglandular syndrome, Crohn’s disease, DiGeorge syndrome, familial Mediterranean fever, immunodeficiency with Hyper-IgM, severe combined immunodeficiency. Web site: http://www.ncbi.nlm.nih.gov/disease/Immune.html
·
Metabolism: Food and energy. Examples: Adreno-leukodystrophy, Atherosclerosis, Best disease, Gaucher disease, Glucose galactose malabsorption, Gyrate atrophy, Juvenile onset diabetes, Obesity, Paroxysmal nocturnal hemoglobinuria, Phenylketonuria, Refsum disease, Tangier disease, Tay-Sachs disease. Web site: http://www.ncbi.nlm.nih.gov/disease/Metabolism.html
·
Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html
·
Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html
·
Transporters: Pumps and channels. Examples: Cystic Fibrosis, deafness, diastrophic dysplasia, Hemophilia A, long-QT syndrome, Menkes syndrome, Pendred syndrome, polycystic kidney disease, sickle cell anemia, Wilson’s disease, Zellweger syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Transporters.html Entrez
Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences,
218 Hepatitis B
macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·
PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed
·
Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide
·
Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein
·
Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure
·
Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome
·
PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset
·
OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM
·
Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy
·
Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books
·
ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo
·
NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/
To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “hepatitis B” (or synonyms) and click “Go.”
Physician Guidelines and Databases 219
Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html you can also search across syndromes using an alphabetical index. You can also search at http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “hepatitis B” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for specialists. The articles are the results which are the most accessible to non-professionals and Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38
220 Hepatitis B
often listed under the heading “Citations.” The contact names are also accessible to non-professionals.
Specialized References The following books are specialized references written for professionals interested in hepatitis B (sorted alphabetically by title, hyperlinks provide rankings, information, and reviews at Amazon.com): · Blackwell’s Primary Care Essentials: Gastointestinal Disease by David W. Hay; Paperback, 1st edition (December 15, 2001), Blackwell Science Inc; ISBN: 0632045035; http://www.amazon.com/exec/obidos/ASIN/0632045035/icongroupinterna · Gastrointestinal Problems by Martin S. Lipsky, M.D. (Editor), Richard Sadovsky, M.D. (Editor); Paperback - 194 pages, 1st edition (August 15, 2000), Lippincott, Williams & Wilkins Publishers; ISBN: 0781720540; http://www.amazon.com/exec/obidos/ASIN/0781720540/icongroupinterna · Rome II: The Functional Gastrointestinal Disorders by Douglas A. Drossman (Editor); Paperback - 800 pages, 2nd edition (March 1, 2000), Degnon Associates Inc.; ISBN: 0965683729; http://www.amazon.com/exec/obidos/ASIN/0965683729/icongroupinterna
Vocabulary Builder Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Titre: The quantity of a substance required to produce a reaction with a given volume of another substance, or the amount of one substance required to correspond with a given amount of another substance. [EU]
Dissertations 221
CHAPTER 10. DISSERTATIONS ON HEPATITIS B Overview University researchers are active in studying almost all known diseases. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to hepatitis B. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.
Dissertations on Hepatitis B ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to hepatitis B. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with hepatitis B: ·
Assessment of Reasons for Refusing Hepatitis a (hav) and Hepatitis B (hbv) Vaccinations and of Willingness-to-pay for Hav and Hbv Vaccinations in a Sexually Transmitted Disease (std) Clinic Setting by
222 Hepatitis B
Thometz, Ellen Marie; Phd from University of California, Los Angeles, 2001, 210 pages http://wwwlib.umi.com/dissertations/fullcit/3024048 ·
Design and Generation of a Recombinant Hepatitis B-based Viral Vector System for Use in Cellular Receptor Studies by Garces, Robert George; Msc from University of Toronto (canada), 2001, 131 pages http://wwwlib.umi.com/dissertations/fullcit/MQ58692
·
Determinants of the Sex Ratio at Birth (hepatitis B) by Chahnazarian, Anouch, Phd from Princeton University, 1986, 195 pages http://wwwlib.umi.com/dissertations/fullcit/8621187
·
Family Behavior and the Transmission of Hepatitis B Virus in Malo, New Hebrides. Ethology, Ethnography and Epidemiology in the Study of the Natural History of Disease by Dickie, Elizabeth Reed, Phd from University of Pennsylvania, 1979, 321 pages http://wwwlib.umi.com/dissertations/fullcit/8009393
·
Hepatitis B Virus X Protein (hbx), Human Voltage-dependent Anion Channel 3 (hvdac3) and Mitochondria by Huh, Kyung-won; Phd from University of Colorado Health Sciences Center, 2001, 148 pages http://wwwlib.umi.com/dissertations/fullcit/3030653
·
Mapping Disasters: the Application of a Disaster-sociological 'theoretical Superstructure' and Methodology in a Prima Facie Case for Investigating the Role of Hepatitis B Vaccines in the Contamination of the Canadian Blood Supply with Human Immunodeficien by Krassnitzky, Olaf; Phd from Carleton University (canada), 2000, 483 pages http://wwwlib.umi.com/dissertations/fullcit/NQ52326
·
Personal and Social Effects of Being a Carrier of Hepatitis B (chronicity, Interactionalism) by Foley, Maryann Brichler, Phd from Case Western Reserve University, 1984, 227 pages http://wwwlib.umi.com/dissertations/fullcit/8425584
·
The Analysis of Hepatitis B Virus Core-polymerase Interactions for Encapsidation and Genomic Replication by Lott, Lisa; Phd from The University of Texas Health Science Center at San Antonio, 2001, 152 pages http://wwwlib.umi.com/dissertations/fullcit/3026441
·
The Politics of Scientific Practice in Taiwan: the Hepatitis B Control Program (china) by Lin, Chung-hsi, Phd from Virginia Polytechnic Institute and State University, 1994, 393 pages http://wwwlib.umi.com/dissertations/fullcit/9426267
Dissertations 223
·
Viral Mutations and Natural Course of Hbeag Negative Chronic Hepatitis B Virus Infection by Chan, Lik Yuen Henry; Md from Chinese University of Hong Kong (people's Republic of China), 2001, 223 pages http://wwwlib.umi.com/dissertations/fullcit/3025880
Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to hepatitis B is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.
225
PART III. APPENDICES
ABOUT PART III Part III is a collection of appendices on general medical topics which may be of interest to patients with hepatitis B and related conditions.
Researching Your Medications 227
APPENDIX A. RESEARCHING YOUR MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to patients with hepatitis B. While a number of hard copy or CD-Rom resources are available to patients and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your medications. You may also want to research medications that you are currently taking for other conditions as they may interact with medications for hepatitis B. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of hepatitis B. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.
228 Hepatitis B
Your Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on how you can best participate in the medication aspects of hepatitis B. Taking medicines is not always as simple as swallowing a pill. It can involve many steps and decisions each day. The AHCRQ recommends that patients with hepatitis B take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions early, you may avoid problems later. Here are some points to cover each time a new medicine is prescribed: ·
Ask about all parts of your treatment, including diet changes, exercise, and medicines.
·
Ask about the risks and benefits of each medicine or other treatment you might receive.
·
Ask how often you or your doctor will check for side effects from a given medication.
Do not hesitate to ask what is important to you about your medicines. You may want a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost, or how the medicine might affect how you live or work. Or, you may want the medicine your doctor believes will work the best. Telling your doctor will help him or her select the best treatment for you. Do not be afraid to “bother” your doctor with your concerns and questions about medications for hepatitis B. You can also talk to a nurse or a pharmacist. They can help you better understand your treatment plan. Feel free to bring a friend or family member with you when you visit your doctor. Talking over your options with someone you trust can help you make better choices, especially if you are not feeling well. Specifically, ask your doctor the following: ·
The name of the medicine and what it is supposed to do.
·
How and when to take the medicine, how much to take, and for how long.
·
What food, drinks, other medicines, or activities you should avoid while taking the medicine.
·
What side effects the medicine may have, and what to do if they occur.
·
If you can get a refill, and how often.
40
This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.
Researching Your Medications 229
·
About any terms or directions you do not understand.
·
What to do if you miss a dose.
·
If there is written information you can take home (most pharmacies have information sheets on your prescription medicines; some even offer large-print or Spanish versions).
Do not forget to tell your doctor about all the medicines you are currently taking (not just those for hepatitis B). This includes prescription medicines and the medicines that you buy over the counter. Then your doctor can avoid giving you a new medicine that may not work well with the medications you take now. When talking to your doctor, you may wish to prepare a list of medicines you currently take, the reason you take them, and how you take them. Be sure to include the following information for each: ·
Name of medicine
·
Reason taken
·
Dosage
·
Time(s) of day
Also include any over-the-counter medicines, such as: ·
Laxatives
·
Diet pills
·
Vitamins
·
Cold medicine
·
Aspirin or other pain, headache, or fever medicine
·
Cough medicine
·
Allergy relief medicine
·
Antacids
·
Sleeping pills
·
Others (include names)
Learning More about Your Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications your doctor has recommended for hepatitis B. One such source
230 Hepatitis B
is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications you are taking. Therefore, we have compiled a list of medications associated with the treatment of hepatitis B. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to hepatitis B: Alpha 1 -Proteinase Inhibitor, Human ·
Systemic - U.S. Brands: Prolastin http://www.nlm.nih.gov/medlineplus/druginfo/alpha1proteinas einhibitorhuman202022.html
Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.
41
Researching Your Medications 231
Antihemophilic Factor ·
Systemic - U.S. Brands: Alphanate; Bioclate; Helixate; Humate-P; Hyate:C; Koate-HP; Kogenate; Monarc-M; Monoclate-P; Recombinate http://www.nlm.nih.gov/medlineplus/druginfo/antihemophilicf actorsystemic202671.html
Factor Ix ·
Systemic - U.S. Brands: BeneFix; Mononine http://www.nlm.nih.gov/medlineplus/druginfo/factorixsystemic 202674.html
Famciclovir ·
Systemic - U.S. Brands: Famvir http://www.nlm.nih.gov/medlineplus/druginfo/famciclovirsyste mic202723.html
Hepatitis B Vaccine Recombinant ·
Systemic - U.S. Brands: Engerix-B http://www.nlm.nih.gov/medlineplus/druginfo/hepatitisbvaccin erecombinantsy202281.html
Lamivudine ·
Systemic - U.S. Brands: Epivir; Epivir-HBV http://www.nlm.nih.gov/medlineplus/druginfo/idoxuridineopht halmic202292.html
·
Systemic - U.S. Brands: Epivir; Epivir-HBV http://www.nlm.nih.gov/medlineplus/druginfo/lamivudinesyste mic202791.html
·
Systemic - U.S. Brands: Epivir; Epivir-HBV http://www.nlm.nih.gov/medlineplus/druginfo/trastuzumabsys temic203689.html
Neomycin ·
Oral - U.S. Brands: Mycifradin http://www.nlm.nih.gov/medlineplus/druginfo/neomycinoral20 2396.html
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Topical - U.S. Brands: Myciguent http://www.nlm.nih.gov/medlineplus/druginfo/neomycintopica l202397.html
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Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your doctor’s office.
Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html. The following medications are listed in the Reuters’ database as associated with hepatitis B (including those with contraindications):42 ·
Betamethasone http://www.reutershealth.com/atoz/html/Betamethasone.htm
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Cortisone http://www.reutershealth.com/atoz/html/Cortisone.htm
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Cortisone (Cortisone Acetate) http://www.reutershealth.com/atoz/html/Cortisone_(Cortisone_Acetat e).htm
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Dexamethasone http://www.reutershealth.com/atoz/html/Dexamethasone.htm
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Diphtheria Tetanus Toxoids Acellular Pertussis Vaccine (DTaP) http://www.reutershealth.com/atoz/html/Diphtheria_Tetanus_Toxoid s_Acellular_Pertussis_Vaccine_(DTaP).htm
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Diphtheria Tetanus Toxoids Whole-Cell Pertussis Vaccine (DTwP) http://www.reutershealth.com/atoz/html/Diphtheria_Tetanus_Toxoid s_Whole-Cell_Pertussis_Vaccine_(DTwP).htm
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Efavirenz http://www.reutershealth.com/atoz/html/Efavirenz.htm
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Factor IX Concentrates http://www.reutershealth.com/atoz/html/Factor_IX_Concentrates.htm
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Haemophilus b Conjugate Vaccine http://www.reutershealth.com/atoz/html/Haemophilus_b_Conjugate_ Vaccine.htm
42
Adapted from A to Z Drug Facts by Facts and Comparisons.
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Hepatitis B Immune Globulin (HBIG) http://www.reutershealth.com/atoz/html/Hepatitis_B_Immune_Globu lin_(HBIG).htm
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Hepatitis B Vaccine http://www.reutershealth.com/atoz/html/Hepatitis_B_Vaccine.htm
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Hydrocortisone (Cortisol) http://www.reutershealth.com/atoz/html/Hydrocortisone_(Cortisol).ht m
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Lamivudine http://www.reutershealth.com/atoz/html/Lamivudine.htm
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Methylprednisolone http://www.reutershealth.com/atoz/html/Methylprednisolone.htm
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Poliovirus Vaccine Inactivated http://www.reutershealth.com/atoz/html/Poliovirus_Vaccine_Inactiva ted.htm
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Poliovirus Vaccine Live Oral Trivalent http://www.reutershealth.com/atoz/html/Poliovirus_Vaccine_Live_Or al_Trivalent.htm
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Prednisolone http://www.reutershealth.com/atoz/html/Prednisolone.htm
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Prednisone http://www.reutershealth.com/atoz/html/Prednisone.htm
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Tetanus and Diphtheria Toxoids http://www.reutershealth.com/atoz/html/Tetanus_and_Diphtheria_To xoids.htm
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Triamcinolone http://www.reutershealth.com/atoz/html/Triamcinolone.htm
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Zalcitabine http://www.reutershealth.com/atoz/html/Zalcitabine.htm
Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.
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Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.
Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.
Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for patients with hepatitis B--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat hepatitis B or potentially create deleterious side effects in patients with hepatitis B. You should ask your physician about any contraindications, especially as these might apply to other medications that you may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect. Drug interactions may make your medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to you. Be sure to read the label every time you use a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense.
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Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes available. This is why it’s especially important to read the label every time you use a medication. When your doctor prescribes a new drug, discuss all over-thecounter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals you take as well as the foods you eat. Ask your pharmacist for the package insert for each prescription drug you take. The package insert provides more information about potential drug interactions.
A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for patients with hepatitis B. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt you. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with hepatitis B. The FDA warns patients to watch out for43: ·
Secret formulas (real scientists share what they know)
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Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)
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Quick, painless, or guaranteed cures
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If it sounds too good to be true, it probably isn’t true.
If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.
43
This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.
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General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Drug Development: Molecular Targets for Gi Diseases by Timothy S. Gaginella (Editor), Antonio Guglietta (Editor); Hardcover - 288 pages (December 1999), Humana Press; ISBN: 0896035891; http://www.amazon.com/exec/obidos/ASIN/0896035891/icongroupinterna · Drug Therapy for Gastrointestinal and Liver Diseases by Michael J.G. Farthing, M.D. (Editor), Anne B. Ballinger (Editor); Hardcover - 346 pages, 1st edition (August 15, 2001), Martin Dunitz Ltd.; ISBN: 1853177334; http://www.amazon.com/exec/obidos/ASIN/1853177334/icongroupinterna · Immunopharmacology of the Gastrointestinal System (Handbook of Immunopharmacology) by John L. Wallace (Editor); Hardcover (October 1997), Academic Press; ISBN: 0127328602; http://www.amazon.com/exec/obidos/ASIN/0127328602/icongroupinterna · A Pharmacologic Approach to Gastrointestinal Disorders by James H. Lewis, M.D. (Editor); Hardcover – (February 1994), Lippincott, Williams & Wilkins; ISBN: 0683049704; http://www.amazon.com/exec/obidos/ASIN/0683049704/icongroupinterna
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Systemic: Pertaining to or affecting the body as a whole. [EU]
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Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxoids: Preparations of pathogenic organisms or their derivatives made nontoxic and intended for active immunologic prophylaxis. They include deactivated toxins. [NIH] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]
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APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your friends or doctor have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to hepatitis B. Finally, at the conclusion of this chapter, we will provide a list of readings on hepatitis B from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.
What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and 44
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is.
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treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.
What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are
45
Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.
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practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and disease, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness. Naturopathic medicine is based on the theory that disease is a manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than disease treatment. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.
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Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing.
Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat disease with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory diseases.
Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues.
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Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects the patient’s recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.
Can Alternatives Affect My Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your medical treatment. It becomes all the more important to speak with your doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for patients of both genders and all ages.46
46
Adapted from http://www.4woman.gov/faq/alternative.htm.
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Is It Okay to Want Both Traditional and Alternative Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires knowledge of both conventional and alternative therapies you are taking for the practitioner to have a complete picture of your treatment plan. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.
Finding CAM References on Hepatitis B Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for hepatitis B. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.
The Combined Health Information Database For a targeted search, The Combined Health Information Database is a bibliographic database produced by health-related agencies of the Federal Government (mostly from the National Institutes of Health). This database is updated four times a year at the end of January, April, July, and October. Check the titles, summaries, and availability of CAM-related information by using the “Simple Search” option at the following Web site: http://chid.nih.gov/simple/simple.html. In the drop box at the top, select “Complementary and Alternative Medicine.” Then type “hepatitis B” (or synonyms) in the second search box. We recommend that you select 100 “documents per page” and to check the “whole records” options. The following was extracted using this technique: ·
Chinese Medicinal Herbs for Chronic Hepatitis B: A Systematic Review Source: Liver. 21(4): 280-286. August 2001.
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Summary: This journal article reviews the literature on the efficacy and safety of Chinese medicinal herbs for chronic hepatitis B. Computerized databases were searched and the Chinese literature handsearched to identify randomized clinical trials comparing Chinese medicinal herbs with placebo, no intervention, nonspecific treatment, or interferon treatment for chronic hepatitis B, with at least 3 months followup. No language or blinding limitations were applied. Data were extracted independently by two reviewers, and methodological quality was assessed with the Jadad scale plus allocation concealment. Nine trials involving a total of 936 patients were included; only one was judged to be of high quality. Compared with nonspecific treatment or placebo, the herbal compound Fuzheng Jiedu Tang showed an effect on clearance of serum HBsAg, HBeAg, and HBV DNA. 'Polyporus umbellatus' polysaccharide showed an effect on serum HBeAg and HBV DNA, and 'Phyllanthus amarus' showed an effect on serum HBeAg. 'Phyllanthus' compound and kurorinone showed no significant difference on clearance of serum HBeAg and HBV DNA or on alanine aminotransferase normalization compared with interferon. No serious adverse events were reported. The authors conclude that Chinese medicinal herbs cannot be recommended for chronic hepatitis B due to publication bias and the low quality of existing trials. The article has 1 figure, 2 tables, and 55 references. (AA-M). ·
Systematic Review of Adverse Events Following Acupuncture: The Japanese Literature Source: Complementary Therapies in Medicine. 9(6): 98-104. June 2001. Summary: This journal article reviews the Japanese literature for reports of adverse events after acupuncture. A search was performed using the 'Igaku Chuo Zasshi' (Japana Centra Revuo Medicina) CD-ROM version for the period 1987 to 1999. This database contains approximately 3 million articles from 2,357 medical journals issued in Japan. Case reports of adverse events suspected to be due to acupuncture treatment were included. Experimental studies, surveys, and news articles were excluded. Two reviewers independently extracted data in a structured fashion and assessed the likelihood of causality in each case. Eighty-nine articles reporting 124 cases were identified. The most frequent adverse events were pneumothorax (25 cases), spinal cord injury (18 cases), acute hepatitis B (11 cases), and localized argyria (10 cases). There were two fatalities from infections. Forty-eight events were caused by needle breakage (26 cases of intentionally embedded needles and 16 cases of accidental breakage). There were 10 cases of injury from self treatment. In the authors' opinion, these findings suggest that many acupuncturists
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would benefit from more adequate training, and that unsupervised self treatment should be discouraged. The article has 2 tables and 53 references. (AA-M). ·
Effects of Acupuncture on the Immunological Functions in Hepatitis B Virus Carriers Source: Journal of Traditional Chinese Medicine. 19(4): 268-272. 1999. Summary: This journal article describes the effects of manual acupuncture and electroacupuncture in patients with hepatitis B virus (HBV) infection. Three groups were compared: 30 patients treated with manual acupuncture at the Zusanli (ST 36) point, 30 patients treated with electroacupuncture at the same site, and a control group of 30 patients treated orally with vitamin C, vitamin B, and inosine. All patients were treated for 60 days before evaluating therapeutic effects. Both acupuncture groups exhibited significant reductions in the HBsAg level along with negative turnover rates in HBsAg, HBeAg, HBcAg, and antiHBc, and positive turnover rates in anti-HBs and anti-HBe, compared with the control group. Acupuncture treatment also helped decrease levels of serum IgG, IgA, and complement C3. It increased the number of CD3 and CD4 cells and elevated the CD4/CD8 ratio while reducing the number of CD8 cells. Therapeutic effects in the electroacupuncture group were somewhat better than those in the manual acupuncture group. The results suggest that the impaired cellular and humoral immunity associated with HBV infection can be improved with acupuncture treatment. The article has 7 tables and 6 references (in Chinese).
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Phytotherapeutic Alternatives for Chronic Active Hepatitis Source: Quarterly Review of Natural Medicine. p. 103-108. Summer 1997. Summary: This journal article discusses herbal alternatives to alpha interferon for the treatment of chronic active hepatitis. Alpha interferon is a common treatment for chronic hepatitis, but it has only a 20-40 percent success rate and is associated with serious side effects. Phyllanthus, a traditional Ayurvedic remedy, has been shown to be significantly more effective than placebo in eliminating viral hepatitis markers, but it appears to be less effective in patients with active viral replication. Also, efficacy may vary with different species of Phyllanthus. Shosaiko-to, a Japanese Kampo formula based on a traditional Chinese herbal combination, may be of benefit in children with chronic persistent and active hepatitis B infection. Catechin, a flavonoid isolated from black catechu and other medicinal plants, has shown promising therapeutic effects in clinical trials, but can cause side effects such as fever and hemolytic anemia. Glycyrrhizin, a component of licorice root, has been
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used in Japan to treat chronic hepatitis B and C, and can be combined with alpha interferon to treat therapy resistant cases. The hepatoprotective effects of silymarin, a flavonoid found in milk thistle, are well documented. Although it does not appear to affect the markers of hepatitis infection, it does improve the results of liver function tests. The article has 23 references.
National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow patients to search for articles that specifically relate to hepatitis B and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “hepatitis B” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to hepatitis B: ·
A comparative study of Phyllanthus amarus compound and interferon in the treatment of chronic viral hepatitis B. Author(s): Xin-Hua W, Chang-Qing L, Xing-Bo G, Lin-Chun F. Source: Southeast Asian J Trop Med Public Health. 2001 March; 32(1): 140-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11485076&dopt=Abstract
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A large outbreak of acupuncture-associated hepatitis B. Author(s): Kent GP, Brondum J, Keenlyside RA, LaFazia LM, Scott HD. Source: American Journal of Epidemiology. 1988 March; 127(3): 591-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3341362&dopt=Abstract
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A novel oral adjuvant for hepatitis B virus (HBV) vaccines. Author(s): Ishizaka S, Kuriyama S, Kikuchi E, Nishimura K, Tsujii T. Source: Journal of Hepatology. 1990 November; 11(3): 326-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2290023&dopt=Abstract
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A plant-derived edible vaccine against hepatitis B virus. Author(s): Kapusta J, Modelska A, Figlerowicz M, Pniewski T, Letellier M, Lisowa O, Yusibov V, Koprowski H, Plucienniczak A, Legocki AB. Source: The Faseb Journal : Official Publication of the Federation of American Societies for Experimental Biology. 1999 October; 13(13): 17969. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10506582&dopt=Abstract
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A randomized controlled trial of kurorinone versus interferon-alpha2a treatment in patients with chronic hepatitis B. Author(s): Chen C, Guo SM, Liu B. Source: Journal of Viral Hepatitis. 2000 May; 7(3): 225-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10849265&dopt=Abstract
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A two-stage clinical trial of Phyllanthus amarus in hepatitis B carriers: failure to eradicate the surface antigen. Author(s): Doshi JC, Vaidya AB, Antarkar DS, Deolalikar R, Antani DH. Source: Indian J Gastroenterol. 1994 January; 13(1): 7-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8119752&dopt=Abstract
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Acupuncture and possible hepatitis B infection. Author(s): Li FP, Shiang EL. Source: Jama : the Journal of the American Medical Association. 1980 April 11; 243(14): 1423. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7359710&dopt=Abstract
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Acute exacerbation of hepatitis due to reactivation of hepatitis B virus with mutations in the core region after chemotherapy for malignant lymphoma. Author(s): Sato T, Kato J, Kawanishi J, Kogawa K, Ohya M, Sakamaki S, Niitsu Y. Source: Journal of Gastroenterology. 1997 October; 32(5): 668-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9349995&dopt=Abstract
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Acute hepatic injury after discontinuation of chemotherapy in a patient with non-Hodgkin's lymphoma and chronic hepatitis B virus infection. Author(s): Haanen JB, Bieger R, van't Wout JW.
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Source: The Netherlands Journal of Medicine. 1996 December; 49(6): 23943. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8990863&dopt=Abstract ·
Aflatoxin exposure, hepatitis B virus infection and liver cancer in Swaziland. Author(s): Peers F, Bosch X, Kaldor J, Linsell A, Pluijmen M. Source: International Journal of Cancer. Journal International Du Cancer. 1987 May 15; 39(5): 545-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3570547&dopt=Abstract
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AM3, an adjuvant to hepatitis B revaccination in non-responder healthy persons. Author(s): Sanchez L, Pena E, Civantos A, Sada G, Alvarez MM, Chirigos MA, Villarrubia VG. Source: Journal of Hepatology. 1995 January; 22(1): 119-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7751580&dopt=Abstract
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An acupuncture-associated outbreak of hepatitis B in Jerusalem. Author(s): Slater PE, Ben-Ishai P, Leventhal A, Zahger D, Bashary A, Moses A, Costin C, Shouval D. Source: European Journal of Epidemiology. 1988 September; 4(3): 322-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3181383&dopt=Abstract
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Anti-hepatitis B virus effects of wogonin isolated from Scutellaria baicalensis. Author(s): Huang RL, Chen CC, Huang HL, Chang CG, Chen CF, Chang C, Hsieh MT. Source: Planta Medica. 2000 December; 66(8): 694-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11199123&dopt=Abstract
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Antiviral activities of extracts isolated from Terminalis chebula Retz., Sanguisorba officinalis L., Rubus coreanus Miq. and Rheum palmatum L. against hepatitis B virus. Author(s): Kim TG, Kang SY, Jung KK, Kang JH, Lee E, Han HM, Kim SH.
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Source: Phytotherapy Research : Ptr. 2001 December; 15(8): 718-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11746867&dopt=Abstract ·
Beneficial effects of Phyllanthus amarus for chronic hepatitis B, not confirmed. Author(s): Berk L, de Man RA, Schalm SW, Labadie RP, Heijtink RA. Source: Journal of Hepatology. 1991 May; 12(3): 405-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1940272&dopt=Abstract
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Chinese medicinal herbs for asymptomatic carriers of hepatitis B virus infection. Author(s): Liu JP, McIntosh H, Lin H. Source: Cochrane Database Syst Rev. 2001; (2): Cd002231. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11406038&dopt=Abstract
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Chinese medicinal herbs for chronic hepatitis B. Author(s): Liu JP, McIntosh H, Lin H. Source: Cochrane Database Syst Rev. 2001; (1): Cd001940. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11279742&dopt=Abstract
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Chinese medicinal herbs for chronic hepatitis B: a systematic review. Author(s): Liu J, McIntosh H, Lin H. Source: Liver. 2001 August; 21(4): 280-6. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11454192&dopt=Abstract
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Clinical study on the treatment of liver fibrosis due to hepatitis B by IFN-alpha(1) and traditional medicine preparation. Author(s): Cheng ML, Wu YY, Huang KF, Luo TY, Ding YS, Lu YY, Liu RC, Wu J. Source: World Journal of Gastroenterology : Wjg. 1999 June; 5(3): 267-269. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11819444&dopt=Abstract
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Complement-mediated changes in morphology of hepatitis B antigenantibody complexes. Author(s): Hirschman SZ, Kochwa S, Rosenfield R, Schwartz J. Source: Vox Sanguinis. 1974 March; 26(3): 222-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4209321&dopt=Abstract
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Detection of hepatitis B and woodchuck hepatitis viral DNA in plasma and mononuclear cells from heparinized blood by the polymerase chain reaction. Author(s): Pardoe IU, Michalak TI. Source: Journal of Virological Methods. 1995 February; 51(2-3): 277-88. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7738148&dopt=Abstract
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Development of an enzyme immunoassay for the detection of hepatitis B surface antigen employing monoclonal antibodies. Author(s): Toplikar E, Carlomagno A, Rojkin LF, Gariglio R, Lorenzo LE. Source: Journal of Clinical Laboratory Analysis. 1993; 7(6): 324-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8277356&dopt=Abstract
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Disclosure of trauma and immune response to a hepatitis B vaccination program. Author(s): Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG. Source: J Consult Clin Psychol. 1995 October; 63(5): 787-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7593871&dopt=Abstract
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Do bedbugs transmit hepatitis B? Author(s): Mayans MV, Hall AJ, Inskip HM, Lindsay SW, Chotard J, Mendy M, Whittle HC. Source: Lancet. 1994 March 26; 343(8900): 761-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7907732&dopt=Abstract
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Duck hepatitis B virus model for screening of antiviral agents from medicinal herbs. Author(s): Mi Z, Chen H, Zhang X, Shao X, Li Z, Wu X.
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Source: Chin Med J (Engl). 1995 September; 108(9): 660-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8575230&dopt=Abstract ·
Effect of an extract from Phyllanthus amarus on hepatitis B surface antigen gene expression in human hepatoma cells. Author(s): Yeh SF, Hong CY, Huang YL, Liu TY, Choo KB, Chou CK. Source: Antiviral Research. 1993 March; 20(3): 185-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8470882&dopt=Abstract
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Effect of lymphatic and splenic pump techniques on the antibody response to hepatitis B vaccine: a pilot study. Author(s): Jackson KM, Steele TF, Dugan EP, Kukulka G, Blue W, Roberts A. Source: J Am Osteopath Assoc. 1998 March; 98(3): 155-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9558831&dopt=Abstract
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Effect of misoprostol on serum beta2-microglobulin in the course of viral hepatitis B. Author(s): Flisiak R, Prokopowicz D. Source: European Journal of Gastroenterology & Hepatology. 1999 November; 11(11): 1227-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10563531&dopt=Abstract
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Effect of misoprostol on the course of viral hepatitis B. Author(s): Flisiak R, Prokopowicz D. Source: Hepatogastroenterology. 1997 September-October; 44(17): 141925. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9356866&dopt=Abstract
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Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Author(s): Brook MG. Source: Lancet. 1988 October 29; 2(8618): 1017-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2902445&dopt=Abstract
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Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Author(s): Thyagarajan SP, Subramanian S, Thirunalasundari T, Venkateswaran PS, Blumberg BS. Source: Lancet. 1988 October 1; 2(8614): 764-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2901611&dopt=Abstract
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Effect of Phyllanthus amarus on duck hepatitis B virus replication in vivo. Author(s): Niu JZ, Wang YY, Qiao M, Gowans E, Edwards P, Thyagarajan SP, Gust I, Locarnini S. Source: Journal of Medical Virology. 1990 December; 32(4): 212-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2081970&dopt=Abstract
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Effect of sho-saiko-to(xiao-chai-hu-tang) on HBeAg clearance in children with chronic hepatitis B virus infection and with sustained liver disease. Author(s): Tajiri H, Kozaiwa K, Ozaki Y, Miki K, Shimuzu K, Okada S. Source: Am J Chin Med. 1991; 19(2): 121-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1816724&dopt=Abstract
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Effect of sizofiran, a polysaccharide, on interferon gamma, antibody production and lymphocyte proliferation specific for hepatitis B virus antigen in patients with chronic hepatitis B. Author(s): Kakumu S, Ishikawa T, Wakita T, Yoshioka K, Ito Y, Shinagawa T. Source: International Journal of Immunopharmacology. 1991; 13(7): 96975. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1761362&dopt=Abstract
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Effect of thymic extract on allogeneic MLR and mitogen-induced responses in patients with chronic active hepatitis B. Author(s): Zeman K, Dworniak D, Tchorzewski H, Pokoca L, Majewska E. Source: Immunol Invest. 1991 December; 20(7): 545-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1836778&dopt=Abstract
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Effectiveness of thymostimulin treatment in hepatitis B surface antigen-positive chronic active liver disease. Results of a randomized clinical trial. Author(s): Romeo F, Arcoria D, Palmisano L, Polosa P. Source: Arzneimittel-Forschung. 1985; 35(8): 1317-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3907642&dopt=Abstract
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Effects of acupuncture on the immunological functions in hepatitis B virus carriers. Author(s): Chen J, Chen M, Zhao B, Wang Y. Source: J Tradit Chin Med. 1999 December; 19(4): 268-72. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10921130&dopt=Abstract
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Effects of an extract from Phyllanthus niruri on hepatitis B and woodchuck hepatitis viruses: in vitro and in vivo studies. Author(s): Venkateswaran PS, Millman I, Blumberg BS. Source: Proceedings of the National Academy of Sciences of the United States of America. 1987 January; 84(1): 274-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3467354&dopt=Abstract
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Effects of Fuzheng Huayu 319 recipe on liver fibrosis in chronic hepatitis B. Author(s): Liu P, Liu C, Xu LM, Hu YY, Xue HM, Liu CH, Zhang ZQ. Source: World Journal of Gastroenterology : Wjg. 1998 August; 4(4): 348353. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11819318&dopt=Abstract
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Effects of Phyllanthus plant extracts on duck hepatitis B virus in vitro and in vivo. Author(s): Shead A, Vickery K, Pajkos A, Medhurst R, Freiman J, Dixon R, Cossart Y. Source: Antiviral Research. 1992 June; 18(2): 127-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1416905&dopt=Abstract
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Effects of TJ-9 Sho-saiko-to (kampo medicine) on interferon gamma and antibody production specific for hepatitis B virus antigen in
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patients with type B chronic hepatitis. Author(s): Kakumu S, Yoshioka K, Wakita T, Ishikawa T. Source: International Journal of Immunopharmacology. 1991; 13(2-3): 141-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1906436&dopt=Abstract ·
Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers. Author(s): Thamlikitkul V, Wasuwat S, Kanchanapee P. Source: J Med Assoc Thai. 1991 September; 74(9): 381-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1791391&dopt=Abstract
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Enzyme-antibody conjugation by a heterobifunctional reagent and its application in enzyme-linked immunosorbent assay (ELISA) for the detection of hepatitis B surface antigen. Author(s): Gadkari DA, Fields HA, Maynard JE. Source: Journal of Virological Methods. 1985 March; 10(3): 215-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3886682&dopt=Abstract
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Epidemiology of hepatitis B virus infection in the Asia-Pacific region. Author(s): Chen CJ, Wang LY, Yu MW. Source: Journal of Gastroenterology and Hepatology. 2000 May; 15 Suppl: E3-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10921373&dopt=Abstract
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Essential fatty acid supplementation in chronic hepatitis B. Author(s): Jenkins AP, Green AT, Thompson RP. Source: Alimentary Pharmacology & Therapeutics. 1996 August; 10(4): 665-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8853774&dopt=Abstract
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Evaluation of anti-hepadnavirus activity of Phyllanthus amarus and Phyllanthus maderaspatensis in duck hepatitis B virus carrier Pekin ducks. Author(s): Munshi A, Mehrotra R, Ramesh R, Panda SK.
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Source: Journal of Medical Virology. 1993 December; 41(4): 275-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8106861&dopt=Abstract ·
Evaluation of Phyllanthus amarus and Phyllanthus maderaspatensis as agents for postexposure prophylaxis in neonatal duck hepatitis B virus infection. Author(s): Munshi A, Mehrotra R, Panda SK. Source: Journal of Medical Virology. 1993 May; 40(1): 53-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8515247&dopt=Abstract
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Exacerbation of hepatitis in hepatitis B carriers following chemotherapy for haematological malignancies. Author(s): Wong GC, Tan P, Goh YT, Ng HS, Chong R, Lee LH. Source: Ann Acad Med Singapore. 1996 July; 25(4): 500-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8893918&dopt=Abstract
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Experimental studies on the inhibition effects of 1000 Chinese medicinal herbs on the surface antigen of hepatitis B virus. Author(s): Zheng M, Zheng Y. Source: J Tradit Chin Med. 1992 September; 12(3): 193-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1453758&dopt=Abstract
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Failure of New Zealand hepatitis B carriers to respond to Phyllanthus amarus. Author(s): Milne A, Hopkirk N, Lucas CR, Waldon J, Foo Y. Source: N Z Med J. 1994 June 22; 107(980): 243. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8208497&dopt=Abstract
Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·
Alternative Medicine Foundation, Inc.: http://www.herbmed.org/
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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats
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Chinese Medicine: http://www.newcenturynutrition.com/
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drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html
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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm
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Google: http://directory.google.com/Top/Health/Alternative/
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Healthnotes: http://www.thedacare.org/healthnotes/
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Open Directory Project: http://dmoz.org/Health/Alternative/
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TPN.com: http://www.tnp.com/
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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/
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WebMDÒHealth: http://my.webmd.com/drugs_and_herbs
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WellNet: http://www.wellnet.ca/herbsa-c.htm
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to hepatitis B; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Alternative Therapy Acupuncture Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,663, 00.html
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Herbs and Supplements Alpha-Lipoic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com
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Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Alph aLipoicAcidcs.html Amino acids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Astragalus mem Alternative names: Huang-Qi; Astragalus membranaceus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Bupleurum Alternative names: Bupleurum chinense, Bupleurum falcatum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Bupleurum.htm Estrogen Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Glutathione Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Green Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Inosine Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Interferon Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Interferon.htm Interferon Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Interferon Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Lecithin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Licorice Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Licorice Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Liver Extracts Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Milk Thistle Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
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Oral Contraceptives Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Phyllanthus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Phyllanthus Alternative names: Phyllanthus niruri Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Phyllanthus.htm Phyllanthus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Phyllanthus/Ayurvedic liver support combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,100 50,00.html Picrorhiza Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Reishi.htm S-Adenosylmethionine Source: Healthnotes, Inc.; www.healthnotes.com
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Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Schisandra Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Shiitake Alternative names: Lentinus edodes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Shiitake.htm Smilax Alternative names: Sarsaparilla; Smilax glabra Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tanacetum v Alternative names: Tansy; Tanacetum vulgare (L.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Taraxacum Alternative names: Dandelion; Taraxacum officinale (Dhudhal) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Thymus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Thymus Extracts Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html ·
Related Conditions
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Cancer Prevention and Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Cancer_Diet.htm Hemophilia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hemo philiacc.html Hepatitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Hepatitis, Viral Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsConditions/Hepati tisViralcc.html Hives Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hives.htm Viral Hepatitis Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by
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title; hyperlinks Amazon.com):
provide
rankings,
information,
and
reviews
at
· Gastrointestinal Disorders and Nutrition by Tonia Reinhard; Paperback 192 pages (January 24, 2002), McGraw-Hill Professional Publishing; ISBN: 0737303611; http://www.amazon.com/exec/obidos/ASIN/0737303611/icongroupinterna · Healthy Digestion the Natural Way: Preventing and Healing Heartburn, Constipation, Gas, Diarrhea, Inflammatory Bowel and Gallbladder Diseases, Ulcers, Irritable Bowel Syndrome, and More by D. Lindsey Berkson, et al; Paperback - 256 pages, 1st edition (February 2000), John Wiley & Sons; ISBN: 0471349623; http://www.amazon.com/exec/obidos/ASIN/0471349623/icongroupinterna · No More Heartburn: Stop the Pain in 30 Days--Naturally!: The Safe, Effective Way to Prevent and Heal Chronic Gastrointestinal Disorders by Sherry A. Rogers, M.D.; Paperback - 320 pages (February 2000), Kensington Publishing Corp.; ISBN: 1575665107; http://www.amazon.com/exec/obidos/ASIN/1575665107/icongroupinterna For additional information on complementary and alternative medicine, ask your doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218
Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH]
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Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Lentinan: Polysaccharide isolated from the edible mushroom Lentinus edodes. The exact composition is unknown. [NIH]
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APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to patients’ health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements to patients with hepatitis B. Any dietary recommendation is based on a patient’s age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with hepatitis B may be given different recommendations. Some recommendations may be directly related to hepatitis B, while others may be more related to the patient’s general health. These recommendations, themselves, may differ from what official sources recommend for the average person. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of hepatitis B. We will then show you how to find studies dedicated specifically to nutrition and hepatitis B.
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Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·
Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.
·
Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.
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Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.
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Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.
Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·
Vitamin A is important to the health of your eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.
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Vitamin B1, also known as thiamine, is important for your nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.
·
Vitamin B2, also known as riboflavin, is important for your nervous system and muscles, but is also involved in the release of proteins from
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nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·
Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains
·
Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.
·
Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.
·
Vitamin C allows the body’s immune system to fight various diseases, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.
·
Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.
·
Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.
·
Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.
·
Folic Acid maintains healthy cells and blood and, when taken by a pregnant woman, can prevent her fetus from developing neural tube defects; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.
It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·
Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.
·
Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.
268 Hepatitis B
·
Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.
·
Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.
·
Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.
·
Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.
·
Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.
·
Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.
·
Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.
The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, your doctor may encourage deviations from the average official recommendation based on your specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/labcons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·
DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.
·
DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.
47
Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.
Researching Nutrition 269
·
RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”
·
RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge. What Are Dietary Supplements?48
Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of disease and on the maintenance of health.50 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail:
[email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48
270 Hepatitis B
the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail:
[email protected]
Finding Studies on Hepatitis B The NIH maintains an office dedicated to patient nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.
51
Researching Nutrition 271
periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “hepatitis B” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “hepatitis B” (or a synonym): ·
Detection of hepatitis B virus DNA in human serum by dot hybridization using a biotin-labelled probe. Source: Roe, I H Roe, J H Lee, D H Korean-J-Intern-Med. 1988 January; 3(1): 9-14 0494-4712
·
Detection of hepatitis B virus DNA in serum by spot hybridization technique: sensitivity and specificity of radiolabeled and biotinlabeled probes. Author(s): Clinica delle Malattie Infettive, Universita degli Studi di Bari. Source: Santantonio, T Pontisso, P Milella, M Chemello, L Luchena, N Pastore, G Ric-Clin-Lab. 1990 Jan-March; 20(1): 29-35 0390-5748
·
Detection of hepatitis B virus DNA in serum with nucleic acid probes labelled with 32P, biotin, alkaline phosphatase or sulphone. Author(s): Staatliches Hygiene-Institut, Abteilung Virologie, St.Jurgenstr., Bremen, Germany. Source: Valentine Thon, E Steinmann, J Arnold, W Mol-Cell-Probes. 1991 August; 5(4): 299-305 0890-8508
·
Effect of misoprostol on the course of viral hepatitis B. Author(s): Department of Infectious Diseases, University Medical School, Bialystok, Poland. Source: Flisiak, R Prokopowicz, D Hepatogastroenterology. 1997 SepOctober; 44(17): 1419-25 0172-6390
·
Expression of hepatitis B virus middle and large surface antigen genes in Saccharomyces cerevisiae. Source: Imamura, T. Araki, M. Miyanohara, A. Nakao, J. Yonemura, H. Ohtomo, N. Matsubara, K. Journal-of-virology (USA). (November 1987). volume 61(11) page 3543-3549. mankind saccharomyces cerevisiae liver diseases viroses viruses antigens genes genomes 0022-538X
272 Hepatitis B
·
G1 phase dependent nuclear localization of relaxed-circular hepatitis B virus DNA and aphidicolin-induced accumulation of covalently closed circular DNA. Author(s): Liver Research Unit, Chang Gung Memorial Hospital and Medical College, Taipei, Taiwan. Source: Yeh, C T Chiu, H T Chu, C M Liaw, Y F J-Med-Virol. 1998 May; 55(1): 42-50 0146-6615
·
Hepatitis B infection in patients with lymphomas. Author(s): Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam. Source: Liang, R H Lok, A S Lai, C L Chan, T K Todd, D Chiu, E K Hematol-Oncol. 1990 Sep-October; 8(5): 261-70 0278-0232
·
In situ hybridization using a biotinylated DNA probe on formalinfixed liver biopsies with hepatitis B virus infections: in situ hybridization superior to immunochemistry. Author(s): Department of Pathology, Bronx-Lebanon Hospital Center, New York. Source: Choi, Y J Mod-Pathol. 1990 May; 3(3): 343-7 0893-3952
·
Leptomycin B inhibits equine infectious anemia virus Rev and feline immunodeficiency virus rev function but not the function of the hepatitis B virus posttranscriptional regulatory element. Author(s): Infectious Disease Laboratory, The Salk Institute for Biological Studies, La Jolla, California 92037, USA. Source: Otero, G C Harris, M E Donello, J E Hope, T J J-Virol. 1998 September; 72(9): 7593-7 0022-538X
·
Oral immunization with hepatitis B surface antigen expressed in transgenic plants. Source: Kong, Q. Richter, L. Yang, Y.F. Arntzen, C.J. Mason, H.S. Thanavala, Y. Proc-Natl-Acad-Sci-U-S-A. Washington, D.C. : National Academy of Sciences,. Sept 25, 2001. volume 98 (20) page 11539-11544. 0027-8424
·
Possible role of retinoids in hepatitis B virus-associated liver damage. Author(s): Public Health Program, Des Moines University Osteopathic Medical Center, 3200 Grand Avenue, Des Moines, Iowa 50312, USA.
[email protected] Source: Mawson, A R Steele, T A Exp-Biol-Med-(Maywood). 2001 September; 226(8): 734-9 1535-3702
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Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·
healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0
·
The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov
·
The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov
·
The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/
·
The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/
·
Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/
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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/
·
Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/
Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·
AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats
·
Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html
·
Google: http://directory.google.com/Top/Health/Nutrition/
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Healthnotes: http://www.thedacare.org/healthnotes/
·
Open Directory Project: http://dmoz.org/Health/Nutrition/
274 Hepatitis B
·
Yahoo.com: http://dir.yahoo.com/Health/Nutrition/
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WebMDÒHealth: http://my.webmd.com/nutrition
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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html
The following is a specific Web list relating to hepatitis B; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·
Vitamins Niacinamide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Vitamin E Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000092.html
·
Minerals D-Alpha-Tocopherol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Iron Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Phosphatidylcholine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Phosphatidylcholine Source: Prima Communications, Inc.
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Hyperlink: http://www.personalhealthzone.com/pg000255.html Selenium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000233.html ·
Food and Diet Asparagus Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Coffee Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Fruit Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Lettuce Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Milk Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Mushrooms Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Seeds Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
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Tea Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Tea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html Water Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hepatitis.htm Water Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000255.html
Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Aphidicolin: An antiviral antibiotic produced by Cephalosporium aphidicola and other fungi. It inhibits the growth of eukaryotic cells and certain animal viruses by selectively inhibiting the cellular replication of DNA polymerase II or the viral-induced DNA polymerases. The drug may be useful for controlling excessive cell proliferation in patients with cancer, psoriasis or other dermatitis with little or no adverse effect upon nonmultiplying cells. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They
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also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Saccharomyces: A genus of ascomycetous fungi Saccharomycetaceae, order saccharomycetales. [NIH]
of the
family
Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH]
Finding Medical Libraries 279
APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.
Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52
52
Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.
280 Hepatitis B
Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.
Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·
Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/
·
Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM
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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm
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California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html
·
California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html
·
California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html
·
California: Gateway Health Library (Sutter Gould Medical Foundation)
·
California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/
53
Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.
Finding Medical Libraries 281
·
California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp
·
California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html
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California: San José PlaneTree Health Library, http://planetreesanjose.org/
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California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html
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California: University of California, Davis. Health Sciences Libraries
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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html
·
California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/
·
Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm
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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/
·
Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/
·
Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml
·
Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm
·
Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html
·
Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm
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Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp
·
Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/
282 Hepatitis B
·
Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm
·
Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html
·
Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/
·
Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm
·
Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/
·
Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/
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Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/
·
Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm
·
Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html
·
Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm
·
Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/
·
Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library
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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10
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Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html
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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html
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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml
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·
Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp
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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/
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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html
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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm
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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp
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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/
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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html
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Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/
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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm
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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/
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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html
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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm
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Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html
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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41
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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html
·
National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/
·
National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/
·
Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm
·
New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/
·
New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm
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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm
·
New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/
·
New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html
·
New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/
·
New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html
·
New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/
·
Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm
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Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp
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·
Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/
·
Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/
·
Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml
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Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html
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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html
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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml
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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp
·
Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm
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Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/
·
South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm
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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/
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Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html
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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/
·
Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/
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APPENDIX E. YOUR RIGHTS AND INSURANCE Overview Any patient with hepatitis B faces a series of issues related more to the healthcare industry than to the medical condition itself. This appendix covers two important topics in this regard: your rights and responsibilities as a patient, and how to get the most out of your medical insurance plan.
Your Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your rights as a patient.54 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·
Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.
54Adapted
from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.
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·
Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.
·
Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.
·
Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.
Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·
Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.
·
Women’s health services. Women should be able to choose a qualified provider offered by a plan -- such as gynecologists, certified nurse midwives, and other qualified healthcare providers -- for the provision of covered care necessary to provide routine and preventative women’s healthcare services.
·
Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.
·
Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition (or who are in the second or third trimester of a pregnancy) at the time they involuntarily change health
Your Rights and Insurance 289
plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days (or through completion of postpartum care) to allow for transition of care. ·
Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.
Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.
Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·
Provide patients with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.
·
Discuss all treatment options with a patient in a culturally competent manner, including the option of no treatment at all.
·
Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.
·
Discuss all current treatments a consumer may be undergoing.
·
Discuss all risks, nontreatment.
·
Give patients the opportunity to refuse treatment and to express preferences about future treatment decisions.
benefits,
and
consequences
to
treatment
or
290 Hepatitis B
·
Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with patients and their designated family members.
·
Abide by the decisions made by their patients and/or their designated representatives consistent with the informed consent process.
Health plans, health providers, and healthcare facilities should: ·
Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.
·
Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise patients about medically necessary treatment options.
·
Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients.
Respect and Nondiscrimination Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·
Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.
·
Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Confidentiality of Health Information
Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable
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healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records. Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.55
Patient Responsibilities Treatment is a two-way street between you and your healthcare providers. To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that patients understand the following “Consumer Responsibilities.”56 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater individual involvement by the consumer in his or her care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·
Take responsibility for maximizing healthy habits such as exercising, not smoking, and eating a healthy diet.
·
Work collaboratively with healthcare providers in developing and carrying out agreed-upon treatment plans.
·
Disclose relevant information and clearly communicate wants and needs.
·
Use your health insurance plan’s internal complaint and appeal processes to address your concerns.
·
Avoid knowingly spreading disease.
To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 55
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·
Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.
·
Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to other patients and the community.
·
Become knowledgeable about your health plan’s coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules, appropriate processes to secure additional information, and the process to appeal coverage decisions.
·
Show respect for other patients and health workers.
·
Make a good-faith effort to meet financial obligations.
·
Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.
Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.57 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for you.58 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Matching your needs and those of your family members will result in the best possible benefits. Cheapest may not always be best. Your goal is high quality health benefits.
More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 58 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 57
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3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to you. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer. 4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time.
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7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits you will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if your health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits you receive. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.
Medicare and Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. The Health Care Financing Administration (HCFA) administers Medicare, the nation’s largest health insurance program, which covers 39 million Americans. In the following pages, you will learn the basics about Medicare insurance as well as useful
Your Rights and Insurance 295
contact information on how to find more in-depth information about Medicaid.59
Who is Eligible for Medicare? Generally, you are eligible for Medicare if you or your spouse worked for at least 10 years in Medicare-covered employment and you are 65 years old and a citizen or permanent resident of the United States. You might also qualify for coverage if you are under age 65 but have a disability or EndStage Renal disease (permanent kidney failure requiring dialysis or transplant). Here are some simple guidelines: You can get Part A at age 65 without having to pay premiums if: ·
You are already receiving retirement benefits from Social Security or the Railroad Retirement Board.
·
You are eligible to receive Social Security or Railroad benefits but have not yet filed for them.
·
You or your spouse had Medicare-covered government employment.
If you are under 65, you can get Part A without having to pay premiums if: ·
You have received Social Security or Railroad Retirement Board disability benefit for 24 months.
·
You are a kidney dialysis or kidney transplant patient.
Medicare has two parts: ·
Part A (Hospital Insurance). Most people do not have to pay for Part A.
·
Part B (Medical Insurance). Most people pay monthly for Part B. Part A (Hospital Insurance)
Helps Pay For: Inpatient hospital care, care in critical access hospitals (small facilities that give limited outpatient and inpatient services to people in rural areas) and skilled nursing facilities, hospice care, and some home healthcare.
This section has been adapted from the Official U.S. Site for Medicare Information: http://www.medicare.gov/Basics/Overview.asp.
59
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Cost: Most people get Part A automatically when they turn age 65. You do not have to pay a monthly payment called a premium for Part A because you or a spouse paid Medicare taxes while you were working. If you (or your spouse) did not pay Medicare taxes while you were working and you are age 65 or older, you still may be able to buy Part A. If you are not sure you have Part A, look on your red, white, and blue Medicare card. It will show “Hospital Part A” on the lower left corner of the card. You can also call the Social Security Administration toll free at 1-800-772-1213 or call your local Social Security office for more information about buying Part A. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Fiscal Intermediary about Part A bills and services. The phone number for the Fiscal Intermediary office in your area can be obtained from the following Web site: http://www.medicare.gov/Contacts/home.asp. Part B (Medical Insurance) Helps Pay For: Doctors, services, outpatient hospital care, and some other medical services that Part A does not cover, such as the services of physical and occupational therapists, and some home healthcare. Part B helps pay for covered services and supplies when they are medically necessary. Cost: As of 2001, you pay the Medicare Part B premium of $50.00 per month. In some cases this amount may be higher if you did not choose Part B when you first became eligible at age 65. The cost of Part B may go up 10% for each 12-month period that you were eligible for Part B but declined coverage, except in special cases. You will have to pay the extra 10% cost for the rest of your life. Enrolling in Part B is your choice. You can sign up for Part B anytime during a 7-month period that begins 3 months before you turn 65. Visit your local Social Security office, or call the Social Security Administration at 1-800-7721213 to sign up. If you choose to enroll in Part B, the premium is usually taken out of your monthly Social Security, Railroad Retirement, or Civil Service Retirement payment. If you do not receive any of the above payments, Medicare sends you a bill for your part B premium every 3 months. You should receive your Medicare premium bill in the mail by the 10th of the month. If you do not, call the Social Security Administration at 1800-772-1213, or your local Social Security office. If you get benefits from the Railroad Retirement Board, call your local RRB office or 1-800-808-0772. For more information, call your Medicare carrier about bills and services. The
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phone number for the Medicare carrier in your area can be found at the following Web site: http://www.medicare.gov/Contacts/home.asp. You may have choices in how you get your healthcare including the Original Medicare Plan, Medicare Managed Care Plans (like HMOs), and Medicare Private Fee-for-Service Plans.
Medicaid Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. People on Medicaid may also get coverage for nursing home care and outpatient prescription drugs which are not covered by Medicare. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm. States also have programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a low income. To qualify, you must have: ·
Part A (Hospital Insurance),
·
Assets, such as bank accounts, stocks, and bonds that are not more than $4,000 for a single person, or $6,000 for a couple, and
·
A monthly income that is below certain limits.
For more information on these programs, look at the Medicare Savings Programs brochure, http://www.medicare.gov/Library/PDFNavigation/PDFInterim.asp?Langua ge=English&Type=Pub&PubID=10126. There are also Prescription Drug Assistance Programs available. Find information on these programs which offer discounts or free medications to individuals in need at http://www.medicare.gov/Prescription/Home.asp.
NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.60 NORD Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30.
60
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programs ensure that certain vital drugs are available “to those individuals whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare diseases or disorders. For more information, visit www.rarediseases.org.
Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:61 ·
Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html
·
Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html
·
HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html
·
Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html
·
Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html
·
Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html
·
Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html
·
Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html
·
Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html
You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.
61
Your Rights and Insurance 299
Vocabulary Builder Arthralgia: Pain in a joint. [EU] Hepatomegaly: Enlargement of the liver. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Splenomegaly: Enlargement of the spleen. [EU]
Online Glossaries 301
ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·
ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html
·
MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp
·
Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/
·
Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html
·
On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/
·
Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm
·
Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html
Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a) and drkoop.com (http://www.drkoop.com/). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to hepatitis B and keep them on file. The NIH, in particular, suggests that patients with hepatitis B visit the following Web sites in the ADAM Medical Encyclopedia:
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·
Basic Guidelines for Hepatitis B Chronic persistent hepatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000219.htm Cirrhosis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000255.htm Hepatitis Web site: http://www.nlm.nih.gov/medlineplus/ency/article/001154.htm Hepatitis B Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000279.htm Hepatocellular carcinoma Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000280.htm
·
Signs & Symptoms for Hepatitis B Abdominal pain Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003120.htm Arthralgia Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003261.htm Fever Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003090.htm Hepatomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003275.htm
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Jaundice Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003243.htm Loss of appetite Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003121.htm Malaise Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003089.htm Pruritus Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003217.htm Splenomegaly Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003276.htm Vomiting Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003117.htm ·
Diagnostics and Tests for Hepatitis B Albumin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003480.htm Alkaline phosphatase Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003470.htm ALT Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003473.htm AST Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003472.htm
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Bilirubin Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003479.htm Biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003416.htm CBC Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm ESR Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003638.htm Hb Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003645.htm HBsAg Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003558.htm Hepatitis B surface antigen Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003558.htm Liver biopsy Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003895.htm Liver function tests Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003436.htm Prothrombin time Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003652.htm
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Serology Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003511.htm Sonogram Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003336.htm ·
Surgery and Procedures for Hepatitis B Liver transplant Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003006.htm
·
Background Topics for Hepatitis B Acute Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002215.htm Chronic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002312.htm Condoms Web site: http://www.nlm.nih.gov/medlineplus/ency/article/004001.htm Hepatic Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002378.htm Hepatitis B vaccine Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002022.htm Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm
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Liver disease - support group Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002182.htm
Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·
Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical
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MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html
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Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/
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Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine
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HEPATITIS B GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak anti-inflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acetylcysteine: The N-acetyl derivative of cysteine. It is used as a mucolytic agent to reduce the viscosity of mucous secretions. It has also been shown to have antiviral effects in patients with HIV due to inhibition of viral stimulation by reactive oxygen intermediates. [NIH] Acyclovir: Functional analog of the nucleoside guanosine. It acts as an antimetabolite, especially in viruses. It is used as an antiviral agent, especially in herpes infections. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU] Alanine: A non-essential amino acid that occurs in high levels in its free state in plasma. It is produced from pyruvate by transamination. It is involved in sugar and acid metabolism, increases immunity, and provides energy for muscle tissue, brain, and the central nervous system. [NIH] Alimentary: Pertaining to food or nutritive material, or to the organs of digestion. [EU] Alopecia: Baldness; absence of the hair from skin areas where it normally is present. [EU] Anorexia: Lack or loss of the appetite for food. [EU] Anthrax: An infectious bacterial zoonotic disease usually acquired by ingestion of Bacillus anthracis or its spores from infected pastures by herbivores or indirectly from infected carcasses by carnivores. It is transmitted to humans usually by contact with infected animals or their discharges (agricultural a.) or with contaminated animal products (industrial a.). Anthrax is classified by primary routes of inoculation as : cutaneous,
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gastrointestinal, and inhalational. Called also charbon, milzbrand and splenic fever. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antibodies: Proteins that the body makes to protect itself from foreign substances. In diabetes, the body sometimes makes antibodies to work against pork or beef insulins because they are not exactly the same as human insulin or because they have impurities. The antibodies can keep the insulin from working well and may even cause the person with diabetes to have an allergic or bad reaction to the beef or pork insulins. [NIH] Antibody: An immunoglobulin molecule that has a specific amino acid sequence by virtue of which it interacts only with the antigen that induced its synthesis in cells of the lymphoid series (especially plasma cells), or with antigen closely related to it. Antibodies are classified according to their ode of action as agglutinins, bacteriolysins, haemolysins, opsonins, precipitins, etc. [EU] Antidiabetic: An agent that prevents or alleviates diabetes. [EU] Antigens: Substances that cause an immune response in the body. The body "sees" the antigens as harmful or foreign. To fight them, the body produces antibodies, which attack and try to eliminate the antigens. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antioxidant: One of many widely used synthetic or natural substances added to a product to prevent or delay its deterioration by action of oxygen in the air. Rubber, paints, vegetable oils, and prepared foods commonly contain antioxidants. [EU] Aphidicolin: An antiviral antibiotic produced by Cephalosporium aphidicola and other fungi. It inhibits the growth of eukaryotic cells and certain animal viruses by selectively inhibiting the cellular replication of DNA polymerase II or the viral-induced DNA polymerases. The drug may be useful for controlling excessive cell proliferation in patients with cancer, psoriasis or other dermatitis with little or no adverse effect upon nonmultiplying cells. [NIH] Ascites: Effusion and accumulation of serous fluid in the abdominal cavity; called also abdominal or peritoneal dropsy, hydroperitonia, and hydrops abdominis. [EU] Assay: Determination of the amount of a particular constituent of a mixture,
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or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: No symptoms; no clear sign of disease present. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Biliary: Pertaining to the bile, to the bile ducts, or to the gallbladder. [EU] Bilirubin: A bile pigment that is a degradation product of heme. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biopsy: The removal and examination, usually microscopic, of tissue from the living body, performed to establish precise diagnosis. [EU] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Campylobacter: A genus of bacteria found in the reproductive organs, intestinal tract, and oral cavity of animals and man. Some species are pathogenic. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Carcinoma: A malignant new growth made up of epithelial cells tending to infiltrate the surrounding tissues and give rise to metastases. [EU] Carnitine: Constituent of striated muscle and liver. It is used therapeutically to stimulate gastric and pancreatic secretions and in the treatment of hyperlipoproteinemias. [NIH] Catechin: Extracted from Uncaria gambier, Acacia catechu and other plants; it stabilizes collagen and is therefore used in tanning and dyeing; it prevents capillary fragility and abnormal permeability, but was formerly used as an antidiarrheal. [NIH] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]
Causality: The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient
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when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors. [NIH] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chimera: An individual that contains cell populations derived from different zygotes. [NIH] Cholangitis: Inflammation of a bile duct. [EU] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Chronic: Persisting over a long period of time. [EU] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Colitis: Inflammation of the colon. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Condoms: A sheath that is worn over the penis during sexual behavior in order to prevent pregnancy or spread of sexually transmitted disease. [NIH] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cytokines: Non-antibody proteins secreted by inflammatory leukocytes and some non-leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than endocrine manner. [NIH] Cytomegalovirus: A genus of the family herpesviridae, subfamily betaherpesvirinae, infecting the salivary glands, liver, spleen, lungs, eyes, and other organs, in which they produce characteristically enlarged cells with intranuclear inclusions. Infection with Cytomegalovirus is also seen as
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an opportunistic infection in AIDS. [NIH] Cytotoxic: Pertaining to or exhibiting cytotoxicity. [EU] Decompensation: Failure of compensation; cardiac decompensation is marked by dyspnea, venous engorgement, and edema. [EU] Decontamination: The removal of contaminating material, such as radioactive materials, biological materials, or chemical warfare agents, from a person or object. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Dideoxynucleosides: Nucleosides that have two hydroxy groups removed from the sugar moiety. The majority of these compounds have broadspectrum antiretroviral activity due to their action as antimetabolites. The nucleosides are phosphorylated intracellularly to their 5'-triphosphates and act as chain-terminating inhibitors of viral reverse transcription. [NIH] Diphtheria: A localized infection of mucous membranes or skin caused by toxigenic strains of corynebacterium diphtheriae. It is characterized by the presence of a pseudomembrane at the site of infection. Diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. [NIH] Disinfection: Rendering pathogens harmless through the use of heat, antiseptics, antibacterial agents, etc. [NIH] Dyspepsia: Impairment of the power of function of digestion; usually applied to epigastric discomfort following meals. [EU] Effusion: The escape of fluid into a part or tissue, as an exudation or a transudation. [EU] Electroacupuncture: A form of acupuncture using low frequency electrically stimulated needles to produce analgesia and anesthesia and to treat disease. [NIH]
Encephalitis: Inflammation of the brain. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Endemic: Present or usually prevalent in a population or geographical area at all times; said of a disease or agent. Called also endemial. [EU] Endocrinology: A subspecialty of internal medicine concerned with the metabolism, physiology, and disorders of the endocrine system. [NIH] Endothelium: The layer of epithelial cells that lines the cavities of the heart and of the blood and lymph vessels, and the serous cavities of the body, originating from the mesoderm. [EU]
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Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epidemiological: Relating to, or involving epidemiology. [EU] Epitopes: Sites on an antigen that interact with specific antibodies. [NIH] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Escherichia: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria whose organisms occur in the lower part of the intestine of warmblooded animals. The species are either nonpathogenic or opportunistic pathogens. [NIH] Ethology: The discipline pertaining to the study of animal behavior. [NIH] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extraction: The process or act of pulling or drawing out. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fats: One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are two types of fats: saturated and unsaturated. [NIH] Feces: The excrement discharged from the intestines, consisting of bacteria, cells exfoliated from the intestines, secretions, chiefly of the liver, and a small amount of food residue. [EU] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Flavivirus: A genus of flaviviridae, also known as Group B arbovirus, containing several subgroups and species. Most are arboviruses transmitted by mosquitoes or ticks. The type species is yellow fever virus. [NIH] Gastrointestinal: Pertaining to or communicating with the stomach and intestine, as a gastrointestinal fistula. [EU]
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Genotype: The genetic constitution of the individual; the characterization of the genes. [NIH] Glomerulonephritis: A variety of nephritis characterized by inflammation of the capillary loops in the glomeruli of the kidney. It occurs in acute, subacute, and chronic forms and may be secondary to haemolytic streptococcal infection. Evidence also supports possible immune or autoimmune mechanisms. [EU] Gluten: The protein of wheat and other grains which gives to the dough its tough elastic character. [EU] Glycoproteins: Conjugated protein-carbohydrate compounds including mucins, mucoid, and amyloid glycoproteins. [NIH] Glycosylation: The chemical or biochemical addition of carbohydrate or glycosyl groups to other chemicals, especially peptides or proteins. Glycosyl transferases are used in this biochemical reaction. [NIH] Haematological: Relating to haematology, that is that branch of medical science which treats of the morphology of the blood and blood-forming tissues. [EU] Handwashing: The act of cleansing the hands with water or other liquid, with or without the inclusion of soap or other detergent, for the purpose of removing soil or microorganisms. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Helicobacter: A genus of gram-negative, spiral-shaped bacteria that is pathogenic and has been isolated from the intestinal tract of mammals, including humans. [NIH] Hematology: A subspecialty of internal medicine concerned with morphology, physiology, and pathology of the blood and blood-forming tissues. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hepatic: Pertaining to the liver. [EU] Hepatitis: Inflammation of the liver. [EU] Hepatocellular: Pertaining to or affecting liver cells. [EU] Hepatocytes: The main structural component of the liver. They are specialized epithelial cells that are organized into interconnected plates called lobules. [NIH] Hepatomegaly: Enlargement of the liver. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU]
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Herpesviridae: A family of enveloped, linear, double-stranded DNA viruses infecting a wide variety of animals. There are three subfamilies based on biological characteristics: alphaherpesvirinae, betaherpesvirinae, and gammaherpesvirinae. [NIH] Histocompatibility: The degree of antigenic similarity between the tissues of different individuals, which determines the acceptance or rejection of allografts. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Housekeeping: The care and management of property. [NIH] Humoral: Of, relating to, proceeding from, or involving a bodily humour now often used of endocrine factors as opposed to neural or somatic. [EU] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hybridomas: Cells artificially created by fusion of activated lymphocytes with neoplastic cells. The resulting hybrid cells are cloned and produce pure or "monoclonal" antibodies or T-cell products, identical to those produced by the immunologically competent parent, and continually grow and divide as the neoplastic parent. [NIH] Hyperpigmentation: Excessive pigmentation of the skin, usually as a result of increased melanization of the epidermis rather than as a result of an increased number of melanocytes. Etiology is varied and the condition may arise from exposure to light, chemicals or other substances, or from a primary metabolic imbalance. [NIH] Hypertension: Persistently high arterial blood pressure. Various criteria for its threshold have been suggested, ranging from 140 mm. Hg systolic and 90 mm. Hg diastolic to as high as 200 mm. Hg systolic and 110 mm. Hg diastolic. Hypertension may have no known cause (essential or idiopathic h.) or be associated with other primary diseases (secondary h.). [EU] Immunity: The condition of being immune; the protection against infectious disease conferred either by the immune response generated by immunization or previous infection or by other nonimmunologic factors (innate i.). [EU] Immunoassay: Immunochemical assay or detection of a substance by serologic or immunologic methods. Usually the substance being studied serves as antigen both in antibody production and in measurement of antibody by the test substance. [NIH]
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Immunochemistry: Field of chemistry that pertains to immunological phenomena and the study of chemical reactions related to antigen stimulation of tissues. It includes physicochemical interactions between antigens and antibodies. [NIH] Incubation: The development of an infectious disease from the entrance of the pathogen to the appearance of clinical symptoms. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Infusion: The therapeutic introduction of a fluid other than blood, as saline solution, solution, into a vein. [EU] Inhalation: The drawing of air or other substances into the lungs. [EU] Interferons: Proteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation of normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. [NIH] Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Intravenous: Within a vein or veins. [EU] Invasive: 1. having the quality of invasiveness. 2. involving puncture or incision of the skin or insertion of an instrument or foreign material into the body; said of diagnostic techniques. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]
Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Jaundice:
A clinical manifestation of hyperbilirubinemia, consisting of
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deposition of bile pigments in the skin, resulting in a yellowish staining of the skin and mucous membranes. [NIH] Lamivudine: A reverse transcriptase inhibitor and zalcitabine analog in which a sulfur atom replaces the 3' carbon of the pentose ring. It is used to treat HIV disease. [NIH] Lentinan: Polysaccharide isolated from the edible mushroom Lentinus edodes. The exact composition is unknown. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Leucine: An essential branched-chain amino acid important for hemoglobin formation. [NIH] Lipid: Any of a heterogeneous group of flats and fatlike substances characterized by being water-insoluble and being extractable by nonpolar (or fat) solvents such as alcohol, ether, chloroform, benzene, etc. All contain as a major constituent aliphatic hydrocarbons. The lipids, which are easily stored in the body, serve as a source of fuel, are an important constituent of cell structure, and serve other biological functions. Lipids may be considered to include fatty acids, neutral fats, waxes, and steroids. Compound lipids comprise the glycolipids, lipoproteins, and phospholipids. [EU] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Liposome: A spherical particle in an aqueous medium, formed by a lipid bilayer enclosing an aqueous compartment. [EU] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Lymphocytic: Pertaining to, characterized by, or of the nature of lymphocytes. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Malaise: A vague feeling of bodily discomfort. [EU] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Malignant: Tending to become progressively worse and to result in death. Having the properties of anaplasia, invasion, and metastasis; said of tumours. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a
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substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Melanoma: A tumour arising from the melanocytic system of the skin and other organs. When used alone the term refers to malignant melanoma. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Metabolite: process. [EU]
Any substance produced by metabolism or by a metabolic
Metastasis: 1. the transfer of disease from one organ or part to another not directly connected with it. It may be due either to the transfer of pathogenic microorganisms (e.g., tubercle bacilli) or to transfer of cells, as in malignant tumours. The capacity to metastasize is a characteristic of all malignant tumours. 2. Pl. metastases. A growth of pathogenic microorganisms or of abnormal cells distant from the site primarily involved by the morbid process. [EU] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Misoprostol: A synthetic analog of natural prostaglandin E1. It produces a dose-related inhibition of gastric acid and pepsin secretion, and enhances mucosal resistance to injury. It is an effective anti-ulcer agent and also has oxytocic properties. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monocytes: Large, phagocytic mononuclear leukocytes produced in the vertebrate bone marrow and released into the blood; contain a large, oval or somewhat indented nucleus surrounded by voluminous cytoplasm and numerous organelles. [NIH] Morphogenesis: The development of the form of an organ, part of the body, or organism. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mutagenesis: Process of generating genetic mutations. It may occur spontaneously or be induced by mutagens. [NIH] Nasal: Pertaining to the nose. [EU] Nausea: An unpleasant sensation, vaguely referred to the epigastrium and abdomen, and often culminating in vomiting. [EU] Necrosis: The sum of the morphological changes indicative of cell death and caused by the progressive degradative action of enzymes; it may affect groups of cells or part of a structure or an organ. [EU] Neomycin:
Antibiotic complex produced by Streptomyces fradiae. It is
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composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neonatal: Pertaining to the first four weeks after birth. [EU] Neoplasms: New abnormal growth of tissue. Malignant neoplasms show a greater degree of anaplasia and have the properties of invasion and metastasis, compared to benign neoplasms. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nucleocapsid: A protein-nucleic acid complex which forms part or all of a virion. It consists of a capsid plus enclosed nucleic acid. Depending on the virus, the nucleocapsid may correspond to a naked core or be surrounded by a membranous envelope. [NIH] Occult: Obscure; concealed from observation, difficult to understand. [EU] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Opiate: A remedy containing or derived from opium; also any drug that induces sleep. [EU] Oral: Pertaining to the mouth, taken through or applied in the mouth, as an oral medication or an oral thermometer. [EU] Osteoporosis: Reduction in the amount of bone mass, leading to fractures after minimal trauma. [EU] Pancreas: An organ behind the lower part of the stomach that is about the size of a hand. It makes insulin so that the body can use glucose (sugar) for energy. It also makes enzymes that help the body digest food. Spread all over the pancreas are areas called the islets of Langerhans. The cells in these areas each have a special purpose. The alpha cells make glucagon, which raises the level of glucose in the blood; the beta cells make insulin; the delta cells make somatostatin. There are also the PP cells and the D1 cells, about which little is known. [NIH] Pancreatitis: Inflammation (pain, tenderness) of the pancreas; it can make the pancreas stop working. It is caused by drinking too much alcohol, by disease in the gallbladder, or by a virus. [NIH]
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Panniculitis: An inflammatory reaction of the subcutaneous fat, which may involve the connective tissue septa between the fat lobes, the septa lobules and vessels, or the fat lobules, characterized by the development of single or multiple cutaneous nodules. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Pathogen: Any disease-producing microorganism. [EU] Pathologic: 1. indicative of or caused by a morbid condition. 2. pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Percutaneous: Performed through the skin, as injection of radiopacque material in radiological examination, or the removal of tissue for biopsy accomplished by a needle. [EU] Perinatal: Pertaining to or occurring in the period shortly before and after birth; variously defined as beginning with completion of the twentieth to twenty-eighth week of gestation and ending 7 to 28 days after birth. [EU] Peritonitis: Inflammation of the peritoneum; a condition marked by exudations in the peritoneum of serum, fibrin, cells, and pus. It is attended by abdominal pain and tenderness, constipation, vomiting, and moderate fever. [EU] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacokinetics: The action of drugs in the body over a period of time, including the processes of absorption, distribution, localization in tissues, biotransformation, and excretion. [EU] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phosphorylation: The introduction of a phosphoryl group into a compound through the formation of an ester bond between the compound and a phosphorus moiety. [NIH] Plasmapheresis: Procedure whereby plasma is separated and extracted from anticoagulated whole blood and the red cells retransfused to the donor.
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Plasmapheresis is also employed for therapeutic use. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Porphyria: A pathological state in man and some lower animals that is often due to genetic factors, is characterized by abnormalities of porphyrin metabolism, and results in the excretion of large quantities of porphyrins in the urine and in extreme sensitivity to light. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Preclinical: Before a disease becomes clinically recognizable. [EU] Prednisone: A synthetic anti-inflammatory glucocorticoid derived from cortisone. It is biologically inert and converted to prednisolone in the liver. [NIH]
Prenatal: Existing or occurring before birth, with reference to the fetus. [EU] Prevalence: The number of people in a given group or population who are reported to have a disease. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Protease: Proteinase (= any enzyme that catalyses the splitting of interior peptide bonds in a protein). [EU] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH]
Prothrombin Time: Measurement of clotting time of plasma recalcified in the presence of excess tissue thromboplastin. Factors measured are fibrinogen, prothrombin, and factors V, VII, and X. It is used for monitoring anticoagulant therapy with coumarins. [NIH] Pruritus: Itching skin; may be a symptom of diabetes. [NIH] Psychiatric: Pertaining to or within the purview of psychiatry. [EU] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also
Glossary 321
psychophysiologic. [EU] Pyoderma: Any purulent skin disease. Called also pyodermia. [EU] Reactivation: The restoration of activity to something that has been inactivated. [EU] Reagent: A substance employed to produce a chemical reaction so as to detect, measure, produce, etc., other substances. [EU] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Recombinant: 1. a cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflux: A backward or return flow. [EU] Refractory: Not readily yielding to treatment. [EU] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU]
Reinfection: A second infection by the same pathogenic agent, or a second infection of an organ such as the kidney by a different pathogenic agent. [EU] Resection: Excision of a portion or all of an organ or other structure. [EU] Retinoids: Derivatives of vitamin A. Used clinically in the treatment of severe cystic acne, psoriasis, and other disorders of keratinization. Their possible use in the prophylaxis and treatment of cancer is being actively explored. [NIH] Ribavirin: 1-beta-D-Ribofuranosyl-1H-1,2,4-triazole-3-carboxamide. A nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both RNA and DNA viruses. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Ribose: A pentose active in biological systems usually in its D-form. [NIH] Rotavirus: A genus of reoviridae, causing acute gastroenteritis in birds and mammals, including humans. Transmission is horizontal and by environmental contamination. [NIH] Saccharomyces:
A
genus
of
ascomycetous fungi
of the
family
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Saccharomycetaceae, order saccharomycetales. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salmonella: A genus of gram-negative, facultatively anaerobic, rod-shaped bacteria that utilizes citrate as a sole carbon source. It is pathogenic for humans, causing enteric fevers, gastroenteritis, and bacteremia. Food poisoning is the most common clinical manifestation. Organisms within this genus are separated on the basis of antigenic characteristics, sugar fermentation patterns, and bacteriophage susceptibility. [NIH] Sanitation: The development and establishment of environmental conditions favorable to the health of the public. [NIH] Sarcoma: A tumour made up of a substance like the embryonic connective tissue; tissue composed of closely packed cells embedded in a fibrillar or homogeneous substance. Sarcomas are often highly malignant. [EU] Sedative: 1. allaying activity and excitement. 2. an agent that allays excitement. [EU] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Serine: A non-essential amino acid occurring in natural form as the Lisomer. It is synthesized from glycine or threonine. It is involved in the biosynthesis of purines, pyrimidines, and other amino acids. [NIH] Seroconversion: The change of a serologic test from negative to positive, indicating the development of antibodies in response to infection or immunization. [EU] Serology: The study of serum, especially of antigen-antibody reactions in vitro. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Silymarin: A mixture of flavonoids extracted from seeds of the milk thistle, Silybum marianum. It consists primarily of three isomers: silicristin, silidianin, and silybin, its major component. Silymarin displays antioxidant
Glossary 323
and membrane stabilizing activity. It protects various tissues and organs against chemical injury, and shows potential as an antihepatoxic agent. [NIH] Sizofiran: A beta-D-glucan obtained from the Aphyllophoral fungus Schizophyllum commune. It is used as an immunoadjuvant in the treatment of neoplasms, especially tumors found in the stomach. [NIH] Smiling: A facial expression which may denote feelings of pleasure, affection, amusement, etc. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Splenomegaly: Enlargement of the spleen. [EU] Spores: The reproductive elements of lower organisms, such as protozoa, fungi, and cryptogamic plants. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Superinfection: A new infection complicating the course of antimicrobial therapy of an existing infectious process, and resulting from invasion by bacteria or fungi resistant to the drug(s) in use. It may occur at the site of the original infection or at a remote site. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tetanus: A disease caused by tetanospasmin, a powerful protein toxin produced by clostridium tetani. Tetanus usually occurs after an acute injury,
324 Hepatitis B
such as a puncture wound or laceration. Generalized tetanus, the most common form, is characterized by tetanic muscular contractions and hyperreflexia. Localized tetanus presents itself as a mild condition with manifestations restricted to muscles near the wound. It may progress to the generalized form. [NIH] Thimerosal: A topical antiseptic used on skin and mucous membranes. It is also used as a preservative in pharmaceuticals. [NIH] Threonine: An essential amino acid occurring naturally in the L-form, which is the active form. It is found in eggs, milk, gelatin, and other proteins. [NIH]
Thymosin: Thymosin. A family of heat-stable, polypeptide hormones secreted by the thymus gland. Their biological activities include lymphocytopoiesis, restoration of immunological competence and enhancement of expression of T-cell characteristics and function. They have therapeutic potential in patients having primary or secondary immunodeficiency diseases, cancer or diseases related to aging. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Titre: The quantity of a substance required to produce a reaction with a given volume of another substance, or the amount of one substance required to correspond with a given amount of another substance. [EU] Tolerance: 1. the ability to endure unusually large doses of a drug or toxin. 2. acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU]
Topical: Pertaining to a particular surface area, as a topical anti-infective applied to a certain area of the skin and affecting only the area to which it is applied. [EU] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Toxoids: Preparations of pathogenic organisms or their derivatives made nontoxic and intended for active immunologic prophylaxis. They include deactivated toxins. [NIH] Transaminase: Aminotransferase (= a subclass of enzymes of the transferase
Glossary 325
class that catalyse the transfer of an amino group from a donor (generally an amino acid) to an acceptor (generally 2-keto acid). Most of these enzymes are pyridoxal-phosphate-proteins. [EU] Transfusion: The introduction of whole blood or blood component directly into the blood stream. [EU] Transplantation: The grafting of tissues taken from the patient's own body or from another. [EU] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of mycobacterium. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ulcer: A break in the skin; a deep sore. People with diabetes may get ulcers from minor scrapes on the feet or legs, from cuts that heal slowly, or from the rubbing of shoes that do not fit well. Ulcers can become infected. [NIH] Urinalysis: Examination of urine by chemical, physical, or microscopic means. Routine urinalysis usually includes performing chemical screening tests, determining specific gravity, observing any unusual color or odor, screening for bacteriuria, and examining the sediment microscopically. [NIH] Urology: A surgical specialty concerned with the study, diagnosis, and treatment of diseases of the urinary tract in both sexes and the genital tract in the male. It includes the specialty of andrology which addresses both male genital diseases and male infertility. [NIH] Vaccination: The introduction of vaccine into the body for the purpose of inducing immunity. Coined originally to apply to the injection of smallpox vaccine, the term has come to mean any immunizing procedure in which vaccine is injected. [EU] Vaccine: A suspension of attenuated or killed microorganisms (bacteria, viruses, or rickettsiae), administered for the prevention, amelioration or treatment of infectious diseases. [EU] Vaccinia: The cutaneous and sometimes systemic reactions associated with vaccination with smallpox vaccine. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Valine: A branched-chain essential amino acid that has stimulant activity. It promotes muscle growth and tissue repair. It is a precursor in the penicillin biosynthetic pathway. [NIH] Varicella: Chicken pox. [EU] Vascular:
Pertaining to blood vessels or indicative of a copious blood
326 Hepatitis B
supply. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Viremia: The presence of viruses in the blood. [NIH] Viruses: Minute infectious agents whose genomes are composed of DNA or RNA, but not both. They are characterized by a lack of independent metabolism and the inability to replicate outside living host cells. [NIH] Withdrawal: 1. a pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) a substancespecific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Zalcitabine: A dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. This modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. The compound is a potent inhibitor of HIV replication at low concentrations, acting as a chain-terminator of viral DNA by binding to reverse transcriptase. Its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy. [NIH]
General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·
Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna
·
Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg, M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna
·
A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna
Glossary 327
·
Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna
·
Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna
·
Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618
·
Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna
·
Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna
·
Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna
·
Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna
328 Hepatitis B
INDEX A Abdomen .................22, 32, 209, 317, 323 Abdominal.....18, 38, 39, 53, 55, 132, 137, 171, 172, 308, 319 Aberrant.................................................94 Acetaminophen......................................22 Acyclovir ..............................................135 Adjuvant...............119, 164, 191, 247, 249 Alanine.....................................79, 84, 245 Alimentary......................................70, 319 Alkaline ................................................271 Alopecia.................................................78 Anal .....................................17, 18, 22, 76 Anorexia ................................................18 Antibiotic ........................32, 276, 308, 323 Antibodies.......68, 83, 106, 113, 121, 125, 134, 139, 143, 148, 251, 277, 308, 312, 314, 315, 322 Antibody......60, 69, 88, 90, 108, 114, 115, 122, 125, 146, 149, 159, 186, 251, 252, 253, 254, 255, 310, 314, 317, 322 Antigens......55, 68, 85, 93, 125, 130, 131, 138, 142, 143, 146, 271, 277, 308, 315, 321 Antimicrobial ................................125, 323 Antioxidant...................................125, 322 Antiviral .....22, 57, 58, 61, 71, 89, 91, 120, 130, 133, 134, 136, 142, 145, 148, 162, 164, 251, 276, 307, 308, 321 Aphidicolin ...........................................272 Ascites .........................................153, 154 Assay.....................79, 119, 122, 255, 314 Asymptomatic ..............143, 146, 195, 250 B Bacteria ..31, 32, 123, 125, 140, 171, 172, 266, 309, 312, 313, 317, 322, 323, 325 Biliary...............................36, 38, 153, 154 Bilirubin ..................................................79 Biochemical .....................79, 92, 122, 313 Biopsy..13, 55, 56, 58, 172, 195, 304, 319 Buccal ....................................78, 121, 309 C Campylobacter ....................................169 Carbohydrate.......................122, 268, 313 Carnitine ................................................56 Causal .................................................196 Causality..............................................245 Chemotherapy .....111, 119, 120, 248, 256 Cholangitis...........................................153 Cholesterol ..................................266, 268 Colitis .............................................78, 153
Colorectal............................................ 153 Condoms................... 17, 18, 22, 205, 206 Constipation ................................ 172, 319 Cutaneous.. 54, 68, 71, 78, 124, 307, 319, 325 Cytomegalovirus ................................... 62 Cytotoxic ....................... 91, 130, 138, 146 D Decompensation ................. 208, 220, 311 Decontamination ................................. 152 Degenerative ...................... 172, 267, 311 Diarrhea .......................... 12, 22, 169, 266 Dideoxynucleosides............................ 135 Diphtheria.............................................. 59 Disinfection ......................................... 175 Dyspepsia ........................................... 153 E Electroacupuncture............................. 246 Encephalopathy .......................... 153, 154 Endemic ........................................ 92, 208 Endothelium .......................................... 78 Enzyme . 69, 140, 149, 251, 255, 312, 320 Epidemic ............................. 112, 129, 137 Epidemiological............................. 89, 207 Epitopes ...................... 130, 132, 138, 139 Erythema............................................... 78 Exogenous ............................ 99, 121, 312 Extraction ............................................ 119 F Fatigue ...................... 18, 38, 39, 137, 209 Fats ..... 149, 263, 266, 277, 310, 312, 316 Feces .................................................... 19 Fibrosis ......... 31, 145, 208, 250, 254, 310 G Gastrointestinal ...... 68, 78, 122, 153, 154, 165, 169, 308, 312 Genotype .................................... 124, 319 Gluten ................................................. 153 Glycoproteins .......... 93, 95, 100, 122, 313 Glycosylation ........................ 95, 100, 116 H Haematological ................................... 256 Handwashing ........................................ 19 Hematology........................................... 10 Hemorrhage .................................. 78, 153 Hepatic... 4, 113, 114, 143, 153, 154, 165, 170, 208, 248 Hepatocytes .......................... 92, 130, 144 Herpes .................... 46, 62, 148, 307, 313 Histocompatibility................................ 130 Housekeeping ..................................... 197
Index 329
Humoral ...........................86, 97, 130, 246 Hybridization................................271, 272 Hybridomas .........................................134 Hyperpigmentation ................................78 Hypertension .......................................154 I Immunity ......32, 130, 166, 167, 189, 246, 325 Immunization ..20, 29, 40, 70, 84, 90, 106, 117, 119, 125, 134, 139, 160, 166, 167, 177, 194, 195, 212, 272, 314, 322 Immunoassay ......................................251 Immunochemistry ................................272 Incubation ..............................26, 137, 169 Induction ..................................85, 92, 130 Inflammation ...22, 31, 40, 58, 69, 79, 133, 139, 148, 162, 163, 164, 177, 208, 310, 313, 315 Influenza ..............................................142 Infusion ..................................................59 Interferons .............................21, 129, 164 Intermittent...........................................208 Intravenous..........21, 24, 70, 76, 177, 319 Invasive .......................................197, 212 Isoniazid ..............................................187 J Jaundice .....17, 18, 22, 38, 39, 40, 78, 79, 132, 137, 154, 177, 209 L Lamivudine .14, 50, 51, 52, 55, 56, 57, 58, 61, 82, 83, 84, 86, 89, 119, 133, 134, 163, 164, 165, 191 Lesion ..........................121, 123, 312, 316 Leucine ................................................138 Lipid .....................130, 135, 136, 149, 316 Lipophilic..............................................135 Liposome .............................................136 Localization..................114, 124, 272, 319 Lymphocytic.........................................131 Lymphoma.....................70, 120, 248, 316 M Malignant ......31, 70, 71, 78, 93, 121, 248, 309, 315, 316, 317, 322 Melanoma......................................70, 317 Membrane ..114, 125, 133, 142, 204, 317, 323 Metabolite ......................................62, 269 Metastasis ...........................123, 316, 318 Misoprostol ..................................252, 271 Molecular ..10, 91, 93, 125, 158, 160, 202, 214, 216, 321 Monotherapy..........................87, 164, 165 Morphogenesis ....................................103 Mucosa ..........................78, 148, 315, 317 Mutagenesis ..........................................93
N Nasal..................................... 78, 148, 315 Nausea............ 18, 22, 38, 39, 40, 79, 209 Necrosis .............................................. 100 Neonatal................................ 38, 129, 256 Neoplasms ............ 78, 123, 125, 318, 323 Neural ................................. 122, 267, 314 Niacin .................................................. 267 Nucleocapsid ...... 85, 123, 130, 133, 138, 139, 146, 147, 318 O Occult.................................................... 79 Oligosaccharides .................................. 93 Opiate ................................................... 95 Oral ...... 17, 18, 32, 62, 78, 89, 171, 247, 309, 318 Overdose ............................................ 267 P Pancreas....................... 78, 124, 154, 318 Pancreatitis ................................... 78, 153 Panniculitis............................................ 78 Parenteral ........................................... 204 Pathogen......................... 31, 92, 161, 315 Pathologic ..................................... 79, 143 Percutaneous...................................... 166 Perinatal...................... 102, 174, 177, 195 Peritonitis .................................... 153, 154 Pharmacist .................................. 228, 235 Pharmacokinetics ................................. 87 Pharmacologic .............................. 32, 324 Phenotype........................... 119, 124, 319 Phosphorylation .................................... 92 Polyethylene ................................. 70, 320 Polypeptide . 122, 139, 147, 149, 314, 324 Porphyria......................................... 36, 78 Potassium ........................................... 268 Preclinical.............................................. 88 Prenatal............................................... 168 Prevalence ... 54, 76, 77, 79, 84, 147, 170, 177, 178, 195, 209 Progressive ................. 123, 137, 145, 317 Proteins.. 69, 93, 122, 126, 139, 141, 143, 172, 192, 266, 268, 310, 313, 314, 324, 325 Pruritus.................................................. 78 Pyoderma.............................................. 78 R Reactivation ........................ 119, 208, 248 Reagent .............................................. 255 Receptor ....................................... 86, 144 Recombinant....... 119, 128, 139, 144, 186 Recurrence ..................................... 83, 89 Reflux.................................................. 153 Regeneration ........................ 31, 133, 310 Reinfection ...................................... 83, 89 Resection ............................................ 155
330 Hepatitis B
Retinoids..............................................272 Riboflavin.............................................266 Ribose .................................................136 Rotavirus .............................................169 S Saccharomyces ...................................271 Salmonella...........................................169 Sanitation...............................................77 Sarcoma ................................................78 Sedative.................................................56 Selenium..............................................268 Semen .............................................11, 20 Seroconversion..............85, 159, 162, 208 Serology ........................................84, 168 Serum .79, 83, 84, 93, 125, 163, 172, 182, 208, 211, 245, 246, 252, 271, 319, 322 Silymarin......................................113, 247 Sizofiran...............................................253 Smiling .................................................176 Species .......126, 137, 148, 149, 169, 171, 172, 246, 309, 312, 323, 325 Spectrum .......................10, 148, 154, 311 Spores ...........................................68, 307 Stomach ...... 12, 122, 124, 125, 312, 318, 323 Surgical....................32, 68, 153, 309, 325 Symptomatic..................................71, 323 Syphilis ..........................................77, 118 Systemic ..........................69, 71, 311, 325
T Tetanus ........................... 59, 71, 205, 324 Thimerosal .......................................... 195 Thymosin .................................... 133, 145 Thyroxine ............................................ 268 Titre..................................................... 211 Tolerance ........................ 62, 86, 163, 324 Topical ................................ 199, 237, 324 Toxicity.................................... 86, 87, 136 Toxicology............................... 10, 91, 203 Toxins ................................. 155, 237, 324 Transaminase ............................... 79, 170 Transfusion ....... 18, 21, 95, 115, 158, 212 Transplantation .... 20, 21, 34, 36, 37, 81, 83, 89, 94, 113, 153, 155, 164, 170, 177, 178 Tuberculosis.................. 88, 199, 205, 315 Tyrosine ................................................ 91 U Ulcer.................................... 123, 153, 317 Urinalysis ...................................... 71, 325 Urology.................................................. 10 V Vaginal ...................................... 17, 18, 20 Valine .................................................. 138 Varicella ................................................ 62 Vascular ................................................ 78 Viremia................................................ 186 W Withdrawal .......................................... 111
