Hepatitis: Urbánek P

Husa P, Plísek S, Sperl J, Urbánek P, Galský J, Hůlek P, Kümpel P, Nemecek V, Volfová M, Anonymous00254. · Klinika infekcnich chorob Lékarské fakulty MU a FN Brno, pracoviste Bohunice, prednosta. · Klin Mikrobiol Infekc Lek. · Pubmed #18459234 No free full text.

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Husa P, Plísek S, Sperl J, Urbánek P, Galský J, Hůlek P, Kümpel P, Nemecek V, Volfová M, Anonymous00156. · Klinika infekcních chorob Lékarské fakulty MU a FN Brno, pracoviste Bohunice. · Vnitr Lek. · Pubmed #18277633 No free full text.

Abstract: Chronic hepatitis B is one of the world's most common infectious diseases. In the Czech Republic it has a prevalence of 0.56%. Antiviral therapy for chronic hepatitis B demonstrably increases quality of life and where indication criteria are met and standard therapeutic procedures are followed, it is clearly cheaper than treatment for the complications of advanced cirrhosis of the liver or hepatocellular carcinoma. At the time of issuing of this recommendation, 4 medicines were classified for the treatment of chronic hepatitis B in the Czech Republic--pegylated interferon (IFN) alpha-2a, conventional IFN alpha, lamivudine (LAM) and adefovir dipivoxil (ADV). In a number of other developed states, entecavir (ETV) and telbivudine (LdT) have also been approved for treatment. The most effective treatment available at present is pegylated IFN alpha-2a, which should be the medication of first choice for initial treatment of hepatitis B, HBeAg positive and negative forms, provided that there are no contraindications for IFN alpha treatment. Conventional (standard, classical) IFN alpha can also be used, though clinical studies have shown it to be less effective than pegylated IFN alpha-2a. The main advantage of interferon compared to other commercially available medications is its relatively shorter and more clearly defined treatment period, the high probability of permanent suppression of virus replication and seroconversion of HBeAg/anti-HBe (in HBeAg positive forms of the illness) and the non-creation of mutant strains of HBV resistant to IFN in the course of treatment. If there are contraindications for IFN alpha (pegylated or conventional) or it is ineffective or poorly tolerated, ADV, ETV, LAM or LdT can be used. LAM and LdT treatments are often accompanied by the appearance of mutant strains of HBV, that are resistant to lamivudine or LdT and therefore they are not preferred.

Urbánek P. · No affiliation provided · Vnitr Lek. · Pubmed #12931432 No free full text.

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Urbánek P, Husa P, Galský J, Sperl J, Kümpel P, Nemecek V, Plísek S, Volfová M. · Interni klinika 1. LF UK a UVN, Praha. · Cas Lek Cesk. · Pubmed #18630184 No free full text.

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Urbánek P, Brůha R, Marecek Z, Petrtýl J. · IV. interní klinika 1. LF UK a VFN. Praha. · Cas Lek Cesk. · Pubmed #15981988 No free full text.

Abstract: The article reviews basic information on the epidemiology, origin, diagnostics and therapy of hepatitis C viral infection. Virus of the hepatitis C was identified in 1989. The most frequent transmission pathway till 1992 was the reception of blood derivatives, after that year, when transfusion centres started to use detection sets to prove anti-HCV antibodies, the incidence of post-transfusion hepatitis C dropped almost to zero. The most common route of transmission at present is the intravenous toxicomany, and significant participation represents the medical care. The basic serological marker of HCV infection is the presence of anti-HCV antibodies. Those antibodies signify markers of the human contact with the virus; they need not automatically mean the encounter of infection. More often it is contrariwise--because the C viral hepatitis develops the chronic stadium up in 85%, the anti-HVC positivity signifies usually the active form of infection. To prove the active form of infection it is necessary to identify viral nucleic acids in the serum of the examined patient. The standard therapy of the chronic form of the C viral hepatitis is at present a combination of pegylated interpherons alpha and ribavirin. Such form of therapy can result the permanent elimination of the virus in about 60% of cases. In the C viral hepatitis neither the specific pre-exposition nor post-exposition prophylaxis is available. The only prevention of the transmission of infection is the avoidance of any risk factor of transmission, namely in the medical care.

Svára F, Urbánek P, Sulková S. · Interní oddĕlení Strahov 1. lékarské fakulty UK a Vseobecné fakultní nemocnice, Praha. · Vnitr Lek. · Pubmed #15635869 No free full text.

Abstract: After cardiovascular diseases and bacterial infections viral hepatitis is the most frequent disease which complicates haemodialyzation treatment of patients with chronic renal failure. Substitution of renal function is for these patients a life saving procedure. It is, however, complicated treatment associated with various risks of acute and chronic complications. The prevalence of parenterally transmitted viral hepatitis in the population of haemodialyzed patients is by far higher than the prevalence of these diseases in the general population. There are several reasons for this condition. In addition to the character of this treatment there is also the fact that for reasons of immunodeficiency the course proper of infetious hepatitis in haemodialyzed patients is markedly more often terminated by development of the chronic state of the disease with permanent viraemia. These patients become a possible source of infection of the other patients and possibly also the staff of haemodialyzation centres. Vaccination against viral hepatitis B reduces the risk of transmission of the disease. However a large proportion of patients is enlisted in the haemodialyzation programme acutely without the possibility of previous vaccination. Some patients who are vaccinated during the predialyzation period do not respond by antibody formation. Viral hepatitis complicates or makes it impossible in some cases to include the patient in the transplantation programme. The prevalence of viral hepatitis in patients in the haemodialyzation programme was significantly reduced despite all mentioned facts. During the last three years a certain stagnation of this positive trend was recorded. New therapeutic possibilities (the use of interferon and new antiviral properations--analogues of nucleoside bases) offer a chance of a further decrease of the number of these serious diseases.

Urbánek P, Marecek Z. · I. interní klinika VFN a 1. LF UK. · Ceska Gynekol. · Pubmed #11732237 No free full text.

Abstract: OBJECTIVE: Diagnostic methods of hepatitis C-virus. SUBJECT: A review article. SETTING: 1st Internal Clinic, General Faculty Hospital in Prague, 1st Medical Faculty, Charles University. SUBJECT AND METHOD: Hepatitis C virus infection importance is increasing during the last few years, in concordance with this fact therapeutical options are being developed very rapidly, too. Majority of cases of HCV infection has a silent clinical course for a long time and patients are often diagnosed in the late stage of liver disease. This is the reason why the diagnosis should be established as early as possible. Gynecologist can be the first person who can observe the symptoms of the infection and therefore he may become the key person in the diagnostic process. CONCLUSION: The basic facts about the diagnostic methods and clinical course of the disease are mentioned in this review. The differences in clinical course of HCV infection in pregnancy and the vertical transmission is discussed in details.

Urbánek P, Tesar V, Procházková-Francisci E, Lachmanová J, Marecek Z, Svobodník A. · Department of Internal Medicine IV, Charles University School of Medicine I, Prague, Czech Republic. · Blood Purif. · Pubmed #15258445 No free full text.

Abstract: BACKGROUND: Acute and early diagnosed hepatitis C virus (HCV) infections are rare diagnoses. Patients on regular dialysis treatment (RDT) are at risk of acquiring HCV infection. AIMS OF THE STUDY: (1) To determine the efficacy and safety of two-phase induction treatment of acute and early diagnosed HCV infections in patients on RDT, and (2) to establish the importance of serum HCV RNA testing at defined time points of treatment for the prediction of the therapeutic effect. THERAPEUTIC PROTOCOL: Antiviral treatment consisted of two different phases: phase A therapy was interferon (IFN)-alpha 2b 10 million units (MU) s.c. administered daily for 21 days followed by phase B with IFN-alpha 2b 3 MU s.c. administered 3 times weekly for 12 weeks. RESULTS: (1) Efficacy of the treatment: A sustained virological response (SVR) was achieved in a total of 13/18 patients (72%). Safety: We did not observe any serious side effects of the treatment. The most pronounced side effect was the myelosuppression caused by IFN-alpha. (2) SVR prediction: Patients with negative serum HCV RNA at day 6 achieve SVR more frequently than those with positive HCV RNA at day 6 (p = 0.074). CONCLUSIONS: Treatment of acute and early diagnosed HCV infections in hemodialyzed patients is much more effective than treatment of chronic infection. Even relatively high doses of IFN at the beginning of therapy (10 MU daily) are tolerated well by the patients.

Wilczek H, Urbánek P. · III. interní klinika 1. LF UK a VFN, Praha. · Cas Lek Cesk. · Pubmed #12841128 No free full text.

Abstract: BACKGROUND: The survey of viral infections in the liver investigated by means of serological markers of hepatitis A, B and C in drug addicts on methadone maintenance treatment is important for the next procedures. The goal of this study was to assign profile of the viral liver infections in patients on the methadone maintenance treatment. In selected persons hepatological examination or treatment are urgent. METHODS AND RESULTS: In 154 patients, 127 men and 27 women (mean age 28.5 years, variation from 21 to 49 years) serological markers detecting hepatitis A, B and C were evaluated. CONCLUSIONS: In 72% of patients a contact with hepatitis B and/or hepatitis C was identified. 67.6% of patients represented a high-risk group and hepatological care or treatment was necessary. Only 7% were serologicaly completely negative in all tested parameters.

Amaraa R, Marecková H, Urbánek P, Fuciková T. · Institute of Microbiology and Clinical Immunology, Department of Internal Medicine, 1st Medical Faculty, Charles University, 121 11 Prague, Czechia. · Folia Microbiol (Praha). · Pubmed #12630325 No free full text.

Abstract: The phenotype of intrahepatic (IHL) and peripheral blood lymphocytes (PBL) was determined, and the production of cytokines by T lymphocytes analyzed in patients with chronic hepatitis C (CHC). Three-color fluorescence-activated cytometric analysis was done for 36 patients with untreated CHC. The percentage of peripheral blood memory T cells was higher in patients with CHC than in healthy controls (all data in %, significant at p < 0.001; 74.6 +/- 2.7 vs. 58.3 +/- 4.5), and a greater proportion of them were observed in the intrahepatic compartment (IHL-94.2 +/- 2.8 vs. PBL-74.6 +/- 2.7). There was a higher percentage of peripheral blood T helper 1 lymphocytes expressing IFN-gamma (IFN-gamma/IL-4) in these patients (4.6 +/- 0.7 vs. control-2.2 +/- 0.5). The expression of CXCR3 chemokine receptors on peripheral blood T helper cells was also high compared with the control (39.8 +/- 4.8 vs. 26.8 +/- 2.5) and a large percentage of T cells expressing CXCR3 or CCR5 chemokine receptors was observed in hepatitis C virus (HCV)-infected liver (CXCR3: IHL vs. PBL-74.9 +/- 5.7 vs. 39.8 +/- 4.8; CCR5: IHL vs. PBL-65.9 +/- 5.9 vs. 19.1 +/- 2.1). The intrahepatic compartment contains a greater proportion of activated cytotoxic T lymphocytes (CTL) and natural killer-T (NK-T) cells than peripheral blood (CTL: IHL vs. PBL-69.5 +/- 3.2 vs. 59.9 +/- 3.1; NK-T: IHL vs. PBL-10.6 +/- 2.5 vs. PBL: 3.99 +/- 0.5). The data suggest that in HCV-infected subjects, memory TH1 lymphocytes, activated CTL and NK-T cells compartmentalize in liver tissue and could play an important role in pathogenesis of chronic hepatitis.

Urbánek P, Vedralová J, Marecek Z, Brodanová M, Procházková-Francisci E, Brůha R, Petrtýl J, Kaláb M. · IV. interní klinika 1. lékarské fakulty UK a VFN, Praha. · Vnitr Lek. · Pubmed #12577453 No free full text.

Abstract: INTRODUCTION: The importance of liver biopsy and knowledge of the histological activity of liver les on in chronic hepatitis C virus (HCV) infections is widely discussed recently. There are attempts to find an alternative evaluation which will make it possible to avoid liver biopsy. The crucial question in patients with chronic HCV infection is to differentiate patients with already developed liver cirrhosis from those with chronic hepatitis. OBJECTIVES: 1. To evaluate the impact of the calculation of the discrimination score of liver cirrhosis (DSC) for prediction of liver cirrhosis in the histological assessment. 2. To assess the correlation of prediction of cirrhosis liver based on clinical signs and actual histological verification. 3. To evaluate the frequency of unexpected histological findings not correlating with the clinical picture. GROUP OF PATIENTS: The group was formed by 139 patients. In all patients during the baseline examination the patient's history data were analyzed as well as possible physical signs of liver cirrhosis. In all patients also, based on laboratory values before liver biopsy, the DSC according to Bonacini was calculated. Furthermore agreement between the histological finding of liver cirrhosis and chronic hepatitis with DSC values was assessed. RESULTS: 1. Based on calculation of DSC it is possible to predict accurately the existence of cirrhosis of the liver or chronic hepatitis only in 31% patients. In 69% patients even comprehensive evaluation of the type of DSC is not a sufficient guide for assessment of the hepatic lesion. 2. Even clinical signs of cirrhosis are not a quite reliable guide for its prediction. In 8% patients of our group the histological finding of liver cirrhosis was a surprise and in 3.5% patients cirrhosis of the liver was not confirmed despite the presence of clinical signs. 3. The frequency of other histological findings participating in the development of the hepatic lesion in chronic HCV infection was minimal. In the authors group as such only steatosis and toxic damage of hepatic tissue by alcohol were identified. These findings were, however, suspected already before biopsy. Steatosis can be however considered also a manifestation of HCV infection. CONCLUSION: The results of the trial support the view that liver biopsy is in the majority of cases irreplaceable for evaluation of the severity of the hepatic affection in chronic HCV infection.

Urbánek P, Marecek Z, Brodanová M, Brůha R, Kaláb M, Petrtýl J. · IV. interní klinika 1. LF UK a VFN, Praha. · Cas Lek Cesk. · Pubmed #11977837 No free full text.

Abstract: BACKGROUND: Recent reports from all over the world have repeatedly indicated a change in the incidence of individual risk factors for hepatitis C virus (HCV) infection transmission compared with the pattern in the late 1980s and early 1990s. In the Czech Republic, HCV is very often referred to as an addicts' disease, rare in the general population. To establish the incidence of individual risk factors for HCV infection transmission in a group of patients on follow-up at the Department of Internal Medicine I. General University Hospital in Prague 2. METHODS AND RESULTS: The group of patients included 216 individuals (127 men, 89 women) with documented HCV infection. The mean age of the patients was 40.2 years (10-81 years; SD 14.3). The risk factors were identified on the basis of evaluation of the patient's medical history, and/or their medical records if available. The presence of at least one of the following risk factors was regarded as the source of infection (the figure in brackets gives the incidence of the respective factor in the examined group in percent): blood product transmission (15%), intravenous drug injection (16%), inclusion into a regular dialysis program (12%), profession-related risk of transmission (10%), sexual contact with an infected individual (2%), surgery including dental surgery (14%), invasive examination (6%), and tattooing (1%). No risk factor for infection transmission was identified in 24% of cases. CONCLUSIONS: It has been shown a risk factor for infection transmission can be identified, through careful examination of medical history data, in the Czech population in as much as 76% of cases. An important finding is the fact the infection can be regarded as iatrogenic in as much as 57% of cases. Our data clearly show HCV infection is not exclusively a disease of intravenous drug addicts.