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Update on entecavir in the management of severe forms of Hepatitis B

Update on entecavir in the management of severe forms of Hepatitis B

Abstract: Despite the effective management of most cases of hepatitis B virus (HBV) infection, there is still much room for improvement in the treatment of more severe cases of hepatitis B, such as those occurring in patients with decompensated cirrhosis, in transplanted subjects, and in patients with exacerbations of HBV infection. Among the treatments currently approved for the therapy of hepatitis B, entecavir determines a rapid suppression of viral load. This drug is also associated with a high genetic barrier and an overall favorable safety profile. This review provides an overview of recent evidence related to the use of entecavir in the management of the most severe forms of hepatitis B. The results obtained for this drug in real-life clinical practice are also reviewed.
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Severe forms of fibromyalgia with acute exacerbation of pain: costs, comorbidities, and length of stay in inpatient care

Severe forms of fibromyalgia with acute exacerbation of pain: costs, comorbidities, and length of stay in inpatient care

Background and purpose: As a disease of the musculoskeletal system, fibromyalgia is becom- ing increasingly important, because of the direct and indirect costs to health systems. The purpose of this study of health economics was to obtain information about staff costs differentiated by service provider, and staff and material costs of the nonmedical infrastructure in inpatient care. Patients and methods: This study looked at 263 patients who received interdisciplinary inpa- tient treatment for severe forms of fibromyalgia with acute exacerbation of pain between 2011 and 2014. Standardized cost accounting and an analysis of additional diagnoses were performed. Results: The average cost per patient was €3,725.84, with staff and material costs of the nonmedi- cal infrastructure and staff costs of doctors and nurses accounting for the highest proportions of the costs. Each fibromyalgia patient had an average of 6.1 additional diagnoses.
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Common interleukin 6promoter variants associate with the more severe forms of distal interphalangeal osteoarthritis

Common interleukin 6promoter variants associate with the more severe forms of distal interphalangeal osteoarthritis

The present study showed an association between certain promoter genotypes of IL-6 and the more severe outcomes of DIP OA, namely symmetrical and symptomatic DIP OA. IL-6 is one of the most important mediators of inflammatory reactions in humans. At least 50 SNPs and five common haplotypes have been identified so far in the IL-6 gene, and the genetic variations, especially within the non-coding promoter sequence, have been shown to have a powerful influence on the expression of the gene [26-28]. Pain and inflammation symptoms are known to be related to IL-6, and it was recently reported by Oen and coworkers that the promoter genotype - 174GG has a positive correlation with pain in juvenile rheuma- toid arthritis [19].
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Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

ABSTRACT. Clinical history and inappropriate insulin secretion during hypoglycemic episodes permit the diag- nosis of hyperinsulinism. We report 2 cases of factitious hyperinsulinism leading to partial pancreatectomy. Case 1 was an 8-year-old girl who presented with severe hy- poglycemia and elevated insulin and C-peptide levels. Catheterization of pancreatic veins was performed to lo- calize the excess insulin secretion. Insulinoma was sus- pected, and partial pancreatectomy was performed. Ten days after surgery, severe hypoglycemia recurred with severely elevated plasma insulin levels ( ⴛ 100) but very low C-peptide plasma levels, suggesting factitious hyper- insulinemia. Hypoglycemic episodes before surgery were provoked by oral sulfonamides; postoperative epi- sodes were caused by parenteral insulin. Falsified pre- scriptions for sulfonamides and insulin by the mother, a nurse, were found. Case 2 was a 6-month-old girl who presented with seizures and hypoglycemia but had a symptom-free interval of many months afterward. At 2 years of age, repeated hypoglycemic seizures and ele- vated insulin plasma levels suggested congenital hyper- insulinism. C-peptide plasma level, measured once, was normal, but blood sampling was performed 15 minutes after a hypoglycemic episode. Partial pancreatectomy was performed. Two weeks after surgery, hypoglycemic seizures recurred, and the patient was admitted for pan- creatic vein catheterization. This investigation was per- formed during hypoglycemia and revealed high insulin levels and undetectable C-peptide levels, suggesting fac- titious hypoglycemia. Insulin/C-peptide ratio analysis is crucial to assess factitious hypoglycemia, although sul- fonamide-induced hypoglycemia is not thereby detected. One percent (2 of 250) of all cases of hyperinsulinemic hypoglycemia in our unit have been identified as Munchausen syndrome by proxy. Atypical disease his- tory should raise the question of factitious hypo- glycemia. Pediatrics 2005;116:e145–e148. URL: www. pediatrics.org/cgi/doi/10.1542/peds.2004-2331; hyperinsu- linemia, partial pancreatectomy, Munchausen syndrome by proxy, factitious hypoglycemia.
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HCV Extrahepatic Events: Cryoglobulinemic Syndrome – A Case Report in an Over-70-Year Old Patient

HCV Extrahepatic Events: Cryoglobulinemic Syndrome – A Case Report in an Over-70-Year Old Patient

The B-lymphocyte proliferation was first described by Meltzer and Franklin in 1966 [4]; it is a syndrome characterized by the triad purpura, weakness and arthralgias, involving organ damage such as nephropathy and peripheral neuropathy. However, it has been shown that the amount of circulating cryoglobulins weakly correlates with the severity of clinical manifestations and not rarely it is exclusively a laboratory concern [5]. To this purpose it is possible to distinguish a condition characterized solely by the presence of serum cryoglobulins, cryoglobulinemic syndrome, with a wide range of clinical events and eventually both mild or paucisymptomatic frameworks (purpuric lesions, occasional arthralgias) and severe forms, with rapidly progressive renal impairment [1,3].
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Premature ovarian failure

Premature ovarian failure

The symptoms can vary considerably from patient to patient and the disorder may occur abruptly or spontane- ously or it may develop gradually over several years. The most severe forms of hypergonadotropic ovarian failure present with absent pubertal development and primary amenorrhea [2,21]. The clinical picture is characterized by absent menarche and pubertal delay results in absent sex- ual maturation and reduced growth velocity. In the female, pubertal delay is defined as the absence of mam- mary and pubic hair development and menarche at 13 years. Moderate hirsutism may be seen due to the action of androgens originating from adrenals.
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High Resolution MRI Evaluation of Neonatal Brachial Plexus Palsy: A Promising Alternative to Traditional CT Myelography

High Resolution MRI Evaluation of Neonatal Brachial Plexus Palsy: A Promising Alternative to Traditional CT Myelography

NBPP occurs with an incidence of up to 3 per 1000 live births.1 The most severe forms of injury result from complete axonal disruption neurotmesis or severe axonotmesis, either at the le[r]

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The Italian Public Policies Frame on Prostitution and the Practical Overlapping with Trafficking: an Inevitable Condition?

The Italian Public Policies Frame on Prostitution and the Practical Overlapping with Trafficking: an Inevitable Condition?

Although it is easy to agree with the idea that general social tolerance or a lack of public awareness on trafficking and the other severe forms of exploitation can create a permissive environment for certain crimes, nevertheless, all the questions related to prostitution in itself remain unsolved. Moreover, as revealed in important analysis produced during the last years by many scholars (Kempadoo and Doezema 1998; Perry et al. 2014) it is clear that decriminalize people in prostitution can protect the rights of this target of migrant women in a more effective way. But the problem, in terms of public policies, is represented by the fact that trafficking in human beings and measures on prostitution should not be overlapped and confused. It highlights the need to ensure that the complexities behind both these phenomena are addressed, for example avoiding invisibility of people, their disempowered and stigmatization.
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Genetic and environmental components of female depression as a function of the severity of the disorder

Genetic and environmental components of female depression as a function of the severity of the disorder

In view of the weakness of the classical twin analysis to reject the AE model in favor of the ADE model, and the fact that this study is lim- ited in power, it is important to replicate these estimates using a larger sample. If it is confirmed that severe forms of female depression are largely associated with the additive genetic component and the more moderate forms with a dominance deviation component plus a larger random environmental variance, then this has implications for the design of GWAS and linkage surveys. Such surveys should be sex spe- cific and recruit those with the severest, more heritable, forms of the disability in order to attempt to detect significant homozygotic genetic loci. In this context, a recent large- scale study, named CONVERGE, has recruited some 5,000 Chinese women with recurrent major depression in order to reduce such heterogeneity and to identify specific genes through whole- genome sequencing (CONVERGE Consortium, 2015).
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Prevention of Human Trafficking for Social Workers

Prevention of Human Trafficking for Social Workers

(7) Whether the government of the country vigorously investigates, prosecutes, convicts, and sentences public officials, including diplomats and soldiers, who participate in or facilitate severe forms of trafficking in persons, including nationals of the country who are deployed abroad as part of a diplomatic, peacekeeping, or other similar mission who engage in or facilitate severe forms of trafficking in persons or exploit victims of such trafficking, and takes all appropriate measures against officials who condone such trafficking. A government’s failure to appropriately address public allegations against such public officials, especially once such officials have returned to their home countries, shall be considered inaction under these criteria. After reasonable requests from the Department of State for data regarding such investigations, prosecutions, convictions, and sentences, a government which does not provide such data consistent with its resources shall be presumed not to have vigorously investigated, prosecuted, convicted, or sentenced such acts. During the periods prior to the annual report submitted on June 1, 2004, and June 1, 2005, and the periods afterwards until September 30 of each such year, the Secretary of State may disregard the presumption contained in the preceding sentence if the government has provided some data to the Department of State regarding such acts and the Secretary has determined that the government is making a good faith effort to collect such data.
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Prognosis of Acute Renal Failure of the Child during Severe Malaria in Niamey Niger

Prognosis of Acute Renal Failure of the Child during Severe Malaria in Niamey Niger

Malaria is the most common parasitic disease in the world. It represents a major public health problem, especially in tropical and subtropical countries [1]. About 500 million people worldwide have malaria each year. It is responsible for 1 to 3 million deaths a year [1]. Children and women pay the highest price for the dis- ease. More than two-thirds (70%) of deaths from malaria occur in the under-5 age group. Severe forms are the most lethal of the disease [1] [2]. Acute renal failure is one of the most serious complications. In malaria-endemic areas, acute renal failure (ARF) occurs in 40% of severe forms of malaria in adults and is linked to 75% of deaths, especially when extra-renal cleansing is not available [3]. In children, studies of ARF during malaria are limited. In an Indian study [4], the incidence of ARF during malaria ranged from 13% to 17.8%. In a Con- golese series [5], the incidence of ARI in severe forms of malaria was 23.06% with an intra-hospital mortality of 12.6%. In Niger, according to the estimates of the national malaria control program, 770,000 cases were recorded in 2015. It is responsible for 50% of deaths in children under 5 years of age [6]. We have no published studies on ARI and severe childhood malaria in Niger. The main ob- jective of our study is to evaluate the prognosis of ARI during severe malaria in children.
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Human Trafficking: What is the Role of the Health Care Provider?

Human Trafficking: What is the Role of the Health Care Provider?

The TVPA created the trafficking “T-visa” that allows victims of severe forms of trafficking to live, receive services, and work legally in the United States for up[r]

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SOCIAL PANIC DISORDER AND ITS IMPACTS

SOCIAL PANIC DISORDER AND ITS IMPACTS

Abstract: Panic disorder has been increasingly focused on health services and the media, where it affects young people aged 20-40. The incidence of these disorders affects 22% of the adult world population. Of these, 2.8% are grouped in severe disorders (schizophrenia, manic-depressive psychosis and severe forms of depression, panic syndrome and obsessive-compulsive disorder) in adults (Stuart, Laraia, 2002). This study aims to identify the risk factors for the development of Panic Disorder (PD), through the literature consulted; analyze the authors' discourse and provide health professionals with the necessary subsidies for prevention and early intervention in the presence of possible signs and symptoms of PD. This is a bibliographic study carried out in libraries, the internet, scientific technical books and monographs. The results evidenced that in Brazil there is still no research that shows the real incidence of people affected with this syndrome. It is hoped that this discourse can guide the work of health professionals - specifically nurses - in the development of the syndrome and provide the means for adequate care directed at the patients and their families.
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Eosinophilia at the Time of Respiratory Syncytial Virus Bronchiolitis Predicts Childhood Reactive Airway Disease

Eosinophilia at the Time of Respiratory Syncytial Virus Bronchiolitis Predicts Childhood Reactive Airway Disease

time of initial LRI were associated with wheezing persisting to 6 years of age, but not with wheezing that ceased at 3 years of age. Therefore, the findings of the present study confirm those of Martinez and colleagues and extend them in several ways. First, only approximately two thirds of the subjects of the study by Martinez et al were diagnosed with bron- chiolitis at the time of first LRI. Other subjects had an initial diagnosis of croup (10%–12%), pneumonia (4%– 8%), bronchitis (6%–10%), or other respiratory conditions (3.5%–7%). Second, the study by Martinez et al did not determine whether eosinophilia was related to a family history of atopy or to gender. Third, their subjects were seen as outpatients and had a variety of viral agents identified as the cause of their initial LRI episodes. The subjects in the present study all had bronchiolitis attributable to RSV infec- tion as the initial respiratory illness, and all were hospitalized. Therefore, the association of eosino- philia and persistent wheezing holds even in those infants with more severe forms of bronchiolitis, in which persistent airway damage as a result of the infection itself was perhaps more likely to occur.
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The swain-langley and McCoy blood group polymorphisms of complement receptor 1: role in severe plasmodium falciparum malaria

The swain-langley and McCoy blood group polymorphisms of complement receptor 1: role in severe plasmodium falciparum malaria

This case-control study sought to establish any associations between McCb and SI2 and severe forms of malaria (cerebral malaria and severe malarial anaemia). 03) than individuals with th[r]

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Domestic violence and violence against children in Ghana 2015

Domestic violence and violence against children in Ghana 2015

There is also literature linking individual and household characteristics and dynamics - including intimate partner violence (IPV) - to child abuse and maltreatment (Taylor et al., 2009; Chan, 2011; Holt, Buckley and Whelan, 2008). Past research has established that children whose mothers have been assaulted by their partners are more likely to experience abuse (Jaffe et al., 2008). Corporal punishment has been shown to be an important risk factor of child maltreatment (see Gershoff, 2002, for a discussion and overview on some of this literature), which makes the distinction between child punishment and child abuse in the literature useful. However, studies on child abuse and maltreatment as well as studies aiming to measure the use of child disciplining practices, including (severe) corporal punishment, mostly build on the parent-child conflict tactics scale by Straus et al. (1998) for measuring violence against children. This blurs the distinction between the two concepts and makes it solely dependent on the severity and aim of the violent act. Indeed, as Gershoff (2002) notes, “the majority of child abuse researchers view corporal punishment and potentially abusive techniques as points on a continuum of physical acts toward chil dren” (p. 540).
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Treating pediatric plaque psoriasis: challenges and solutions

Treating pediatric plaque psoriasis: challenges and solutions

The limitations of a safe systemic therapy lead to a distinctly greater role of topical therapy in children even for moderate and some cases of severe psoriasis. Despite advancement in the armamentarium of systemic drugs, including the advent of biologics, topical therapy seems sensible for a vast majority of children with psoriasis. These topical agents are used exclusively or in combination with systemic therapy, depending on the individual’s requirement. Since psoriasis is a chronic inflammatory disease with remissions and exac- erbations, often requiring prolonged therapy, the choice of topical therapy should be made taking into consideration the long-term side effects, with particular reference to steroids, and topical immune-suppressive agents. Higher penetration capacity of children’s skin, due to the altered ratio of skin surface area to body weight, demands further attention while considering topical agents, with particular reference to steroid molecules. The primary goal in the treatment of childhood psoriasis is effective control of disease and not complete clearance. Apart from emollients, corticosteroids and anthralin are the topical agents licensed for use in chil- dren with psoriasis. In case of contemplating other drugs lacking approval, patient and parents must be comprehen- sively informed about all details, including long-term side effects, before the initiation of therapy.
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Thermo-mechanical Analysis of RVLH for APR1400 during a Severe Accident

Thermo-mechanical Analysis of RVLH for APR1400 during a Severe Accident

The SA533B1 data was substituted for creep data of SA-508 in the study. In addition, it was found that the steel ablation at the interface between corium and vessel steel is not only a thermal phenomenon in the METCOR experiments Bechta et al. (2006). Corrosion processes and the formation of eutectics lead to the erosion of the vessel steel at temperatures that are significantly lower than the melting temperature of steel. It called thermo-chemical attack of the corium (corrosion) Sehgal (2012). The reduced wall thickness due to the thermo-chemical effect increases the equivalent stress. As a result, the plastic strain will be increased, and the minimum time to reach 15 % creep strain will be decreased. It comes closer to failure criteria. Thus, further study is recommended to evaluate the structural integrity of the RPV under the severe accident conditions more exactly by considering thermo-chemical attack of the corium and creep properties of SA-508 in the analysis.
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Nuss Procedure and Factor VII Deficiency: A Case Report

Nuss Procedure and Factor VII Deficiency: A Case Report Nesimi Günal 1, Ayşe Anıl Karabulut2 , Meryem Albayrak 3, Koray Dural1 and Berkant Özpolat 1*

therefore treatment strategies are difficult to establish. Clinical history usually gives the best guidance. The largest series in the literature by Benlakhal et al. [7] point on 2 major issues. The first one is; if patients with a positive bleeding history at higher risk of intra- and post-operative hemorrhage and the second one are if the absence of previous bleeding history rules out the subsequent perioperative hemorrhage. For major surgical procedures if FVII:C level is low than 10% replacement therapy is recommended. If greater than 30% no replacement is necessary. If level is between 10%-30% and patient is at pre puberty age group replacement advised. If at post puberty period and clinical bleeding history is present replacement is advised otherwise no replacement is recommended. However other than the severe clinical forms (for which treatment guidelines are well defined), consistent recommendations regarding perioperative replacement management do not exist for mild and asymptomatic Factor VII deficient patients. In another series, Mariani et al evaluated the subjects at clear risk of bleeding and only patients with Factor VIIc levels ≤20% of normal were included. The management of patients during minor surgical interventions and invasive procedures is discussed. They concluded that, for the invasive procedures and for most of the uncomplicated minor surgery procedures,
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A Family of Sculptors from Tyre

A Family of Sculptors from Tyre

Those on the Rhodian monument are almost archaistic in their severe squarish forms (I, M) and restricted serifs. It is hard to believe that only a generation or so sepa[r]

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