Hepatitis: India

Parsad D, Gupta S, Anonymous00015. · Department of Dermatology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. · Indian J Dermatol Venereol Leprol. · Pubmed #18688102 links to  free full text

Abstract: Vitiligo surgery is an effective method of treatment for selected, resistant vitiligo patches in patients with vitiligo. PHYSICIAN'S QUALIFICATIONS: The physician performing vitiligo surgery should have completed postgraduate training in dermatology which included training in vitiligo surgery. If the center for postgraduation does not provide education and training in cutaneous surgery, the training may be obtained at the surgical table (hands-on) under the supervision of an appropriately trained and experienced dermatosurgeon at a center that routinely performs the procedure. Training may also be obtained in dedicated workshops. In addition to the surgical techniques, training should include local anesthesia and emergency resuscitation and care. FACILITY: Vitiligo surgery can be performed safely in an outpatient day care dermatosurgical facility. The day care theater should be equipped with facilities for monitoring and handling emergencies. A plan for handling emergencies should be in place, with which all nursing staff should be familiar. Vitiligo grafting for extensive areas may need general anesthesia and full operation theater facility in a hospital setting and the presence of an anesthetist is recommended in such cases. INDICATIONS FOR VITILIGO SURGERY: Surgery is indicated for stable vitiligo that does not respond to medical treatment. While there is no consensus on definitive parameters for stability, the Task Force suggests the absence of progression of disease for the past one year as a definition of stability. Test grafting may be performed in doubtful cases to detect stability. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form elaborating the procedure and possible complications should be signed by the patient. The patient should be informed of the nature of the disease and that the determination of stability is only a vague guide. The consent form should specifically state the limitations of the procedure, about the possible future progression of disease and whether more procedures will be needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures and one-to-one discussions. The need for concomitant medical therapy should be emphasized and the patient should understand that proper results take time (a few months to a year). Preoperative laboratory studies include hemogram including platelet counts, bleeding and clotting time (or prothrombin and activated partial thromboplastin time), and blood chemistry profile. Screening for antibodies for hepatitis B surface antigen and HIV is recommended depending on individual requirements. ANESTHESIA: Lignocaine (2%) with or without adrenaline is generally used for anesthesia; infiltration and nerve block anesthesia are adequate in most cases. General anesthesia may be needed in patients with extensive lesions. POSTOPERATIVE CARE: Proper postoperative immobilization and care are very important to obtain satisfactory results.

John TJ. · Department of Peediatrics, Christian Medical College and Hospital, Vellore 632 004, India. · Indian Pediatr. · Pubmed #10740304 No free full text.

This publication has no abstract.

Tyagi P, Madan K. · Department of Gastroenterology, GB Pant Hospital, New Delhi. · Trop Gastroenterol. · Pubmed #19323086 No free full text.

Abstract: It is clear that the major indication for the use of hematopoietic growth factors in hepatology is to counteract the adverse effects of interferons (neutropenia and thrombocytopenia) and ribavirin (hemolytic anaemia) during the treatment of hepatitis C infection. This is important because the probability of SVR depends on proper adherence to therapy (at least 80% of the requisite dose maintained for at least 80% of the requisite duration) and proper adherence can only be achieved if the side effects are reduced to a minimum. Even though the studies have demonstrated beyond doubt that the use of hematopoietic growth factors does indeed reduce the incidence and severity of these adverse effects and helps the patients to complete the course of therapy, the data on improvement of SVR is still limited. There is only one study of darbepoetin and filgrastim showing the beneficial effect on SVR. Even among the hematological side effects, possibly the only significant effect which limits the use of optimal HCV therapy is the hemolytic anaemia induced by ribavirin. The other two main side effects, i.e. neutropenia and thrombocytopenia are not clinically problematic. The use of such growth factors would be particularly effective if patients who have advanced liver disease or cirrhosis are able to receive adequate anti-viral therapy as has been demonstrated in the study of eltrombopag among HCV cirrhotics. Apart from this, other indications of G-CSF or GM-CSF use are still in the experimental stage. So, as of now, apart from erythropoietic factors, the role played by other hematopoietic growth factors in hepatology is limited. But future research, especially in the areas of immunotherapy of liver cancers and stem cell therapy for endstage liver disease, is surely going to give these factors their due place in hepatology.

Mathur P, Arora NK. · Indian Council of Medical Research, New Delhi, India. · Indian J Med Res. · Pubmed #19246792 links to  free full text

Abstract: With improvement in economic and living conditions of the communities, the age of acquiring hepatitis A virus (HAV) infection is shifting from early childhood to adolescence and young adulthood. Such epidemiological shift leads to an increased incidence of symptomatic HAV infection, including heightened risk of liver failure. Data from India indicate that the population is no longer homogeneous for its HAV exposure profile. Occasional outbreaks of HAV and higher proportions of symptomatic cases are reported amongst older children and adults from different regions of the country. However, the heterogeneous exposure to HAV defies widespread use of the vaccine. The challenge is to recognize the susceptible pockets and take pre-emptive steps. In regions with rapid improvement in living standards and environmental hygiene, there is a need for regular surveillance through structured protocols that are able to identify early signs of epidemiological shift. This review discusses relevant issues and concerns to influence decision making for HAV vaccination in such transition societies.

Mukhopadhyaya A. · Department of Gastrointestinal Sciences, Christian Medical College, Vellore 632 004, India. · J Biosci. · Pubmed #19208972 links to  free full text

Abstract: Hepatitis C is an emerging infection in India and an important pathogen causing liver disease in India.The high risk of chronicity of this blood-borne infection and its association with hepatocellular carcinoma underscores its public health importance. Blood transfusion and unsafe therapeutic interventions by infected needles are two preventable modalities of spread of hepatitis C infection. In addition, risk factor modification by reducing the number of intravenous drug users will help curtail the prevalence of this infection. This review summarizes the extent, nature and implications of this relatively new pathogen in causing disease in India.

Chandra V, Taneja S, Kalia M, Jameel S. · Virology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), New Delhi 110 067, India. · J Biosci. · Pubmed #19208971 links to  free full text

Abstract: The hepatitis E virus (HEV) is a small RNA virus and the etiological agent for hepatitis E, a form of acute viral hepatitis. The virus has a feco-oral transmission cycle and is transmitted through environmental contamination, mainly through drinking water. Recent studies on the isolation of HEV-like viruses from animal species also suggest zoonotic transfer of the virus. The absence of small animal models of infection and efficient cell culture systems has precluded virological studies on the replication cycle and pathogenesis of HEV. A vaccine against HEV has undergone successful clinical testing and diagnostic tests are available. This review describes HEV epidemiology, clinical presentation, pathogenesis, molecular virology and the host response to HEV infection. The focus is on published literature in the past decade.

Kumar R, Singla V, Kacharya S. · Department of Gastrenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi-110029, India. · Trop Gastroenterol. · Pubmed #19115605 No free full text.

Abstract: Individuals at risk of HIV are concomitantly at risk of acquiring parenterally or sexually transmitted viruses, including HBV and HCV. After the introduction of highly active antiretroviral therapy (ART), liver disease has emerged as a major cause of morbidity and mortality in HIV-infected persons. HBV, HCV and HIV share common routes of transmission, but the differential efficiency of these viruses to the types of exposures underlies difference in their prevalence by geographic region. Coinfection alters the natural history of each of these viruses in a peculiar way; furthermore coinfection with viral hepatitis may complicate the delivery of ART by increasing the risk of drug-related hepatoxicity and impacting the selection of specific agents (e.g., those dually active against HIV and HBV). The treatment of HBV in HIV co-infection is complex because the drug(s) used is/are associated with drug-resistance, cross-resistance, hepatotoxicity and suboptimal response. The aim is to achieve long-term sustained viral (HBV) suppression. HBV should be treated in coinfected patients with elevated HBV DNA or significant hepatic fibrosis (Metavir score = A2 or F2). The HBV DNA threshold for initiation of HBV treatment should be lower than in patients with HBV monoinfection. Anti HBV therapy should also be considered in those receiving ART irrespective of viral load and fibrosis, in order to prevent hepatitis of immune reconstitution. Selection of drug(s) depends on whether coinfected patients require treatment of only HBV or both HBV and HIV. In patients requiring only HBV treatment, drugs with dual antiviral activity should not be used in order to avoid early HIV resistance. When both HIV and HBV meet criteria for the treatment, agents with dual activity should be included in the anti-retroviral regimen. Treatment should be monitored by measuring the ALT and HBV DNA levels 3 to 6 monthly. The required duration of HBV treatment in coinfected induviduals is not known and may possibly be life long. Every coinfected person with compensated chronic HCV should be considered for HCV treatment. However, treatment should be avoided in decompensated cirrhosis and in the presence of active opportunistic infection. In patients with CD4 counts <200 cells/il and/or plasma HIV-RNA above 100,000 copies/mI, it may be better to consider anti HIV treatment before HCV treatment. The standard treatment in coinfected patients is pegylated interferon alfa-2a (Pegasys) or -2b (Peg-Intron) plus ribavirin for 48 weeks. Several studies have shown an overall sustained vwal response rate of 14% to 29% in genotype 1 and 53% to 73% in genotypes 2 and 3. The other concern with treatment is drug interaction with anti retroviral drugs necessitating avoidance of certain drugs from ART regimen. The coinfected persons with decompensated liver cirrhosis should not be denied HAART and should be evaluated for liver transplantation. Finally, management of patients not responding to standared therapy is not known.

Datta S. · ICMR Virus Unit Kolkata, Infectious Diseases & Beleghata General Hospital Campus, 57 Dr, Suresh Chandra Banerjee Road, Kolkata 700010, India. · Virol J. · Pubmed #19099581 links to  free full text

Abstract: Hepatitis B virus (HBV) is one of the major global public health problems. In India, HBsAg prevalence among general population ranges from 2% to 8%, placing India in intermediate HBV endemicity zone and the number of HBV carriers is estimated to be 50 million, forming the second largest global pool of chronic HBV infections. India is a vast country, comprised of multiracial communities with wide variations in ethnicity and cultural patterns, which is attributable to its geographical location, gene influx due to invasion and/or anthropological migrations in the past. Moreover, recent increase in trade, trafficking and use of illicit drugs has also considerably influenced the epidemiology of HBV, specifically in the eastern and north eastern parts of India. However, data on the molecular epidemiology of HBV in India is scanty. HBV genotypes A and D have been well documented from different parts of mainland India. Interestingly, in addition to genotypes A and D, genotype C having high nucleotide similarity with south East Asian subgenotype Cs/C1 strain, have been detected exclusively from eastern Indian HBV carriers, suggesting a recent introduction. Thus, compared to other parts of India, the molecular epidemiology of HBV is naturally distinct in eastern India. Very recently, taking the advantage of circulation of three distinct HBV genotypes within the population of eastern India, different aspects of HBV molecular epidemiology was studied that revealed very interesting results. In this study, the clinical significance of HBV genotypes, core promoter and precore mutations, possible routes of introduction of HBV genotype C in eastern India, the clinical implications of x gene variability, prevalence of the AFB1 induced p53 gene codon 249 mutation, the transmission potentiality of HBV among asymptomatic/inactive or occult HBV carriers and the genetic variability of HBV persisting in the PBL was investigated. In this manuscript, the information available on the molecular epidemiology of HBV in India has been reviewed and the results of studies among the eastern Indian population have been summarised.

Irshad M, Khushboo I, Singh S, Singh S. · Clinical Biochemistry Division, Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India. · Int Rev Immunol. · Pubmed #19065353 No free full text.

Abstract: The present manuscript represents an updated review on different aspects of immunology involved during hepatitis C virus infection in human beings. This includes a brief mention of HCV structure, presentation of viral components to host immune system, and ensuing immune response and immunopathogenesis occurring during HCV infection. The present article also highlights immunodiagnosis of HCV infection and the current status of immunotherapy available for HCV eradication. Its envelope protein, E2, is the primary mediator of virus attachment and cell entry. CD81 molecule on cell surface acts as a major receptor for viral entry into the host cells. Mature dendritic cells play an important role in presenting viral antigen, activate T-cells, and initiate anti-viral immune response. Relative T-cell populations and release of different cytokines from activated T-cells ultimately determine the clearance or persistence of HCV viremia through cellular and humoral immune responses. Natural killer (NK) cells constitute the first line of host defense against invading viruses by recruiting virus-specific T-cells and inducing antiviral immunity in liver. Diagnosis of acute or chronic hepatitis C virus (HCV) infection is established by serological assays for presence of antibodies against different sets of viral proteins during varied periods post infection. An effective immunotherapy and vaccine against HCV is still awaited.

Girish C, Pradhan SC. · Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605 006, India. · Fundam Clin Pharmacol. · Pubmed #19049667 No free full text.

Abstract: The use of herbal drugs for the treatment of liver diseases has a long tradition in many eastern countries. The easy accessibility without the need for laborious pharmaceutical synthesis has drawn increased attention towards herbal medicines. Few herbal preparations exist as standardized extracts with major known ingredients or even as pure compounds. Some of the herbals, which show promising activity, are ellagic acid for antifibrotic treatment, phyllanthin for treating chronic hepatitis B, glycyrrhizin to treat chronic viral hepatitis and picroliv for liver regeneration. These compounds, which have proven antioxidant, antiviral or anticarcinogenic properties, can serve as primary compounds for further development as hepatoprotective drugs. This review provides the chemistry, pharmacology and future aspects of picroliv, ellagic acid and curcumin with focus on hepatoprotective properties. These phytochemicals may prove to be very useful in the treatment of hepatotoxicity induced by viral agents, toxic drugs and plant poisons. The high safety profile may be an added advantage. However, poor bioavailability and temperature and light sensitivity can reduce the efficacy of drugs like curcumin. In future, the derivatives or new combinations of these drugs may prove to be useful.

Dwivedi M, Misra SP, Misra V, Waikhom RK, Bhatnagar M. · Department of Gastroenterology, Moti Lal Nehru Medical College, University of Allahabad, Allahabad, Uttar Pradesh, India. · Natl Med J India. · Pubmed #19004143 No free full text.

Abstract: Hepatitis B virus infection continues to be a major global health problem with an estimated 350 million carriers. The response to available treatment modalities is not impressive. The advent of RNA Interference--a phenomenon of sequence-specific degradation of RNAs mediated by double-stranded RNA--holds promise as a potential therapy for chronic hepatitis B virus infection. Synthetic preparations of short RNA (21-23 bp long) can be used to mediate this process of gene silencing with a lower immune response. The duration of suppression can be further increased by using a vector delivery system. Small interfering RNA (siRNA) has several advantages over conventional therapy, which include fewer side-effects, a lower chance of developing escape mutants and non-requirement of viral replication for its action. A potent knockdown of the gene of interest with high sequence specificity makes RNA interference a powerful tool that has shown antiviral effect against hepatitis B virus. However, the 'off-target effect', i.e. suppression of genes other than the intended target, poor siRNA stability, inefficient cellular uptake, widespread biodistribution and non-specific effects need to be overcome. The problem of long-term toxicity of siRNA should be addressed and an ideal vector delivery system needs to be designed before it can be put to clinical use.

Anand AC, Puri P. · Army Hospital R & R, New Delhi, India. · Trop Gastroenterol. · Pubmed #18972765 No free full text.

Abstract: Rapid evolution and development in the treatment strategy of chronic hepatitis B (CHB) has taken place in the last decade. Six agents have been so far approved by the FDA for the management of HBV infection including two parenteral drugs (interferon alpha2b and pegylated interferon alpha-2a) and four oral nucleotide/nucleosides (lamivudine, adefovir dipivoxil, entecavir, and telbivudine). The two parenteral drugs have significant side effects and limited rates of HBeAg seroconversion. Lamivudine and Adefovir have been plagued by significant levels of drug resistance.The newer drugs entecavir and telbivudine have been in focus recently with claims of increased potency, with low side effects and lesser drug resistance. While these new drugs are definitely a welcome addition to the family of antiviral drugs against HBV, they are not necessarily a cure for all the evils of their predecessors.

Gupta A, Chawla Y. · Department of Hepatology Postgraduate Institute of Medical Education & Research Chandigarh 160 012, India. · Indian J Med Res. · Pubmed #18820351 links to  free full text

This publication has no abstract.

Khuroo MS, Khuroo MS. · Digestive Disease Centre, Dr Khuroo's Medical Clinic, Srinagar, India. · Curr Opin Infect Dis. · Pubmed #18725805 No free full text.

Abstract: PURPOSE OF REVIEW: Hepatitis E is an emerging infectious disease. This review will focus on recent advances in the zoonotic transmission, global distribution and control of hepatitis E. RECENT FINDINGS: Hepatitis E virus infection is known to cause waterborne epidemics and sporadic infections in developing countries. Recently, there have been several reports on zoonotic foodborne autochthonous infections of hepatitis E in developed countries. Hepatitis E typically causes self-limited acute infection. Recent reports have documented hepatitis E virus causing chronic hepatitis and cirrhosis in patients after solid organ transplantation. High incidence and severity of hepatitis E in pregnant women have been re-confirmed. The reason for high mortality in pregnant women remains ill understood. A recombinant hepatitis E vaccine has been evaluated in a phase 2, randomized, placebo-controlled trial in Nepal and was found to be well tolerated and efficacious. SUMMARY: There has been considerable advance in understanding the epidemiology of hepatitis E virus infections in western countries. The occurrence of chronic hepatitis in organ transplant recipients opens a new chapter in hepatitis E epidemiology. The report on an efficacious and well tolerated recombinant vaccine gives hope for control of the disease in the near future.

Mathew JL, El Dib R, Mathew PJ, Boxall EH, Brok J. · Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medial Education and Research (PGIMER), Chandigarh, India, 160012. · Cochrane Database Syst Rev. · Pubmed #18677780 No free full text.

Abstract: BACKGROUND: The benefits and harms of hepatitis B vaccination in persons not previously exposed to hepatitis B infection or with unknown exposure status have not been established. OBJECTIVES: To assess the benefits and harms of hepatitis B vaccination in people not previously exposed to hepatitis B infection or with unknown exposure status. SEARCH STRATEGY: Trials were identified from The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS,Science Citation Index Expanded (last search, March 2007). Additionally, we contacted experts and vaccine manufacturers, and read through reference lists for eligible trials. SELECTION CRITERIA: Randomised clinical trials comparing hepatitis B vaccine versus placebo, no intervention, or another vaccine in persons not previously exposed to hepatitis B (HBsAg negative) or with unknown exposure status. DATA COLLECTION AND ANALYSIS: The primary outcome was hepatitis B infection (detecting HBsAg, HBeAg, HBV DNA, or anti-HBc). Secondary outcomes were lack of sero-protection, antibody titre, clinical complications, adverse events, lack of compliance, and cost-effectiveness. Dichotomous outcomes were reported as relative risk (RR) with 95% confidence interval (CI), using intention-to-treat analysis assuming an unfavourable event for missing data. Sensitivity analyses based on methodological quality (risk of bias), available data analysis, intention-to-treat analysis assuming a favourable event for missing data, best-case scenario, and worst-case scenario were conducted. MAIN RESULTS: Twelve trials were eligible. All had high risk of bias and reporting was inconsistent. Hepatitis B vaccine did not show a clear effect on the risk of developing HBsAg (RR 0.96, 95% CI 0.89 to 1.03, 4 trials, 1230 participants) and anti-HBc (RR 0.81, 95% CI 0.61 to 1.07; 4 trials, 1230 participants, random-effects) when data were analysed using intention-to-treat analysis assuming an unfavourable event for missing data. Analysis based on data of available participants showed reduced risk of developing HBsAg (RR 0.12, 95% CI 0.03 to 0.44, 4 trials, 576 participants) and anti-HBc (RR 0.36, 95% CI 0.17 to 0.76, 4 trials, 576 participants, random-effects). Intention-to-treat analysis assuming favourable outcome for missing data showed similar reduction in risk. Hepatitis B vaccination had an unclear effect on the risk of lacking protective antibody levels (RR 0.57, 95% CI 0.26 to 1.27, 3 trials, 1210 participants, random-effects). Development of adverse events was sparsely reported. AUTHORS' CONCLUSIONS: In people not previously exposed to hepatitis B, vaccination has unclear effect on the risk of developing infection, as compared to no vaccination. The risk of lacking protective antibody levels as well as serious and non-serious adverse events appear comparable among recipients and non-recipients of hepatitis B vaccine.

Murhekar MV, Murhekar KM, Sehgal SC. · National Institute of Epidemiology (ICMR), Chennai, Tamilnadu, India. · Trans R Soc Trop Med Hyg. · Pubmed #18565560 No free full text.

Abstract: The Andaman and Nicobar Islands, Union Territory of India, are home to six primitive tribes, namely the Great Andamanese, Onges, Jarawas and Sentinelese (Negrito race), and the Shompens and Nicobarese (Mongoloid race). These tribes account for about 8% of the island's population and the Nicobarese constitute >95% of the tribal population. Hepatitis B virus (HBV) infection is highly endemic among them with the prevalence of hepatitis B surface antigen (HBsAg) ranging from 23% among the Nicobarese to 66% among the Jarawas. The high HBsAg prevalence among pregnant mothers (20.5%), a linear increase in the age-specific rates of HBV exposure and the presence of HBsAg-positive individuals in every family suggested a combination of perinatal and horizontal transmission among the Nicobarese. Molecular studies of HBV isolates from the Onges, Nicobarese and Great Andamanese indicated a predominance of genotype D and there was a close similarity between these isolates and isolates from mainland India, suggesting that HBV may have been introduced from mainland India. In contrast, genotype C predominated among the Jarawas, with isolates similar to strains from Southeast Asian countries. Due to its high prevalence, hepatitis B vaccine is included in the childhood vaccination programme in these islands. It might be worth considering a pilot screening programme for chronic HBV patients to detect hepatocellular carcinoma.

Shankar EM, Solomon SS, Vignesh R, Murugavel KG, Sundaram M, Solomon S, Balakrishnan P, Kumarasamy N. · YRG Centre for AIDS Research and Education (YRG CARE), Voluntary Health Services Hospital Campus, IT Corridor, Taramani, Chennai 600 113, India. · Trans R Soc Trop Med Hyg. · Pubmed #18513775 No free full text.

Abstract: The GB virus (GBV)/hepatitis G virus is a member of the Flaviviridae family and belongs to the hepatitis group of viruses transmitted parenterally, common among intravenous drug users. The strong association between GBV and HIV infection suggests that the two viruses may share similar epidemiological and transmission features. GBV infection is widely believed to prolong HIV disease progression as well as decreasing the HIV viral load and increasing the CD4(+) T-cell level. GBV-driven anti-E2 antibodies have been shown to inhibit HIV replication in vitro. Preliminary studies also suggest that GBV infection of peripheral blood mononuclear cells leads to increased production of beta-chemokines, which may explain the in vitro inhibitory effects and warrants further studies. With sufficient knowledge of resistance patterns studied in tropical south India, researchers are now keen to study the competitive interactions between GBV-induced chemokines and HIV ligands to bind CCR5.

Kumar M, Sarin SK. · Department of Gastroenterology, G.B. Pant Hospital, Affiliated to the University of Delhi, New Delhi, India. · Aliment Pharmacol Ther. · Pubmed #18373730 No free full text.

Abstract: BACKGROUND: There is a renewed interest in use of combination therapies in treatment-naïve chronic hepatitis B (CHB) because of limitations of monotherapies. AIM: To discuss the current status of combination therapies in treatment-naïve CHB. METHODS: PubMed search was done using 'combination', 'sequential' and 'chronic hepatitis B' as the search terms. RESULTS: The two most popular combination therapies include 'combination of nucleos(t)ide analogues' and 'combination of interferons and nucleos(t)ide analogues'. Combination therapies using two nucleos(t)ide analogues do not lead to higher long-term efficacy. However, addition of a nucleos(t)ide analogue with a good resistance profile to a nucleos(t)ide analogue with a lower genetic barrier to resistance decreases the risk of emergent resistance to the latter. Greater sustained virological, biochemical and seroconversion rates are observed with addition of lamivudine to conventional interferon, but pegylated-interferon monotherapy is equally effective as combination with lamivudine. Again, resistance to lamivudine is lower with its combination with interferons. CONCLUSIONS: The answer to the question whether hepatitis B can be treated better with combination or monotherapy remains largely unknown. Additional trials are warranted of combination therapies of peginterferon and potent nucleos(t)ide analogues or therapies with the combined use of nucleos(t)ide analogues or immunomodulators.

Jayanthi V, Udayakumar N. · Stanley Medical College, Chennai, India. · Minerva Gastroenterol Dietol. · Pubmed #18299670 No free full text.

Abstract: Acute liver failure (ALF) in pregnancy is a common challenging clinical problem both in terms of correct diagnosis and management. Acute viral hepatitis is the most common cause of jaundice in pregnancy. The course of acute viral hepatitis is unaffected by pregnancy, except in patients with hepatitis E (HEV), particularly from endemic countries like India, where ALF carries a high mortality. In both HEV infection and herpes simplex infections, maternal and fetal mortality rates are significantly increased. ALF specific to pregnancy including pre-eclampsia, associated with hemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome, acute fatty liver of pregnancy, and hepatic infarction result in increased maternal and fetal mortality if not recognized and acted on early. Early recognition of possible causes and prompt treatment are crucial for successful outcome of ALF in pregnancy. Treatment involves prompt delivery, whereupon the liver disease quickly reverses. This review article addresses the present understanding of ALF in pregnancy reviewing the common causes of ALF and their management in pregnancy.

Jadhav S, Datla M, Kreeftenberg H, Hendriks J. · Serum Institute of India Limited (SIIL), Pune, India. · Vaccine. · Pubmed #18294742 No free full text.

Abstract: Six years after its establishment, the Developing Countries Vaccine Manufacturers' Network (DCVMN) has become the main representing body for emerging vaccine manufacturers from the developing world. The Network's main strategic priority (increase access to DPT-based combination vaccines containing vaccines against Hepatitis B (HepB) and Haemophilus influenzae type b (Hib)) has now come close to fulfillment due in part to the transfer of conjugation technology from The Netherlands Vaccine Institute (NVI) to various manufacturers of the Network. It is argued that at the international level more push mechanisms for product development involving DCVM are needed, including those promoting access to technology and transfer of technology, know how and technical skills from Organization for Economic Co-operation and Development (OECD) countries to developing countries. At the national level, governments of countries in which DCVMN manufacturers operate should provide more generous funding for all aspects of vaccines and immunization including incentives to manufacturers to develop and import new technologies. These two approaches will contribute to the long-term viability of domestic or regional vaccine manufacturing, which in itself is critical to ensure global equity of access to vaccines.

Amarapurkar DN. · Department of Gastroenterology and Hepatology, Bombay Hospital & Medical Research Centre, Mumbai 400025, India. · World J Gastroenterol. · Pubmed #18069753 links to  free full text

Abstract: Three hundred and fifty million people worldwide are estimated to be chronically infected with hepatitis B virus. 15%-40% of these subjects will develop cirrhosis, liver failure or hepatocellular carcinoma during their life. The treatment of chronic hepatitis B has improved dramatically over the last decade merits to the advent of nucleoside/nucleotide analogues and the use of pegylated interferons. Approved drugs for chronic hepatitis B treatment include: standard interferon-alpha 2b, pegylated interferon-alpha 2a, lamivudine, adefovir dipivoxil, and entecavir. Unfortunately, these agents are not effective in all patients and are associated with distinct side effects. Interferons have numerous side effects and nucleoside or nucleotide analogues, which are well tolerated, need to be used for prolonged periods, even indefinitely. However, prolonged treatment with nucleoside or nucleotide analogues is associated with a high rate of resistance. Telbivudine is a novel, orally administered nucleoside analogue for use in the treatment of chronic hepatitis B. In contrast to other nucleoside analogues, Telbivudine has not been associated with inhibition of mammalian DNA polymerase with mitochondrial toxicity. Telbivudine has demonstrated potent activity against hepatitis B with a significantly higher rate of response and superior viral suppression compared with lamivudine, the standard treatment. Telbivudine has been generally well tolerated, with a low adverse effect profile, and at its effective dose, no dose-limiting toxicity has been observed. Telbivudine is one of the most potent antiviral agents for chronic hepatitis B virus and was approved by the FDA in late 2006.

Amarapurkar DN, Choksi M. · Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India. · Trop Gastroenterol. · Pubmed #18050840 No free full text.

This publication has no abstract.

Gulati S, Maheshwari A. · Maulana Azad Medical College, New Delhi, India. · Trop Med Int Health. · Pubmed #17875019 links to  free full text

Abstract: As the spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. This review compiles descriptions of atypical manifestations of dengue, such as dengue encephalitis, dengue myocarditis, dengue hepatitis and dengue cholecystitis.

Sharma OP, Sharma S, Pattabhi V, Mahato SB, Sharma PD. · Biochemistry Laboratory, Indian Veterinary Research Institute, Regional Station. Kangra Valley, Palampur, India. · Crit Rev Toxicol. · Pubmed #17453937 No free full text.

Abstract: Lantana (Lantana camara Linn) is a noxious weed that grows in many tropical and subtropical parts of the world. Ingestion of lantana foliage by grazing animals causes cholestasis and hepatotoxicity. Both ruminants and nonruminant animals such as guinea pigs, rabbits, and female rats are susceptible to the hepatotoxic action of lantana toxins. The hepatotoxins are pentacyclic triterpenoids called lantadenes. Molecular structure of lantadenes has been determined. Green unripe fruits of the plant are toxic to humans. Lantana spp. exert allelopathic action on the neighboring vegetation. The allelochemicals have been identified as phenolics, with umbelliferone, methylcoumarin, and salicylic acid being the most phytotoxic. In addition to phenolics, a recent report indicates lantadene A and B as more potent allelochemicals. Management of lantana toxicosis in animals is achieved by drenching with activated charcoal and supportive therapy. Recent reports on the bilirubin clearance effect of Chinese herbal tea Yin Zhi Huang (decoction of the plant Yin Chin, Artemisia capillaries, and three other herbs) or its active ingredient 6,7-dimethylesculetin, in jaundice are very exciting and warrant investigations on its, possible, ameliorative effects in lantana intoxicated animals. Research is being conducted on new drug discovery based on natural products in different parts of the lantana plant.

Chakraborty C. · Department of Biotechnology, College of Engineering and Technology, IILM Academy of higher learning, Knowledge Park-II, Greater Noida, (UP), India. · Curr Drug Targets. · Pubmed #17348839 No free full text.

Abstract: In recent years, RNA interference (RNAi) is one of the most important discoveries. RNAi is an evolutionarily conserved mechanism for silencing gene expression by targeted degradation of mRNA. Short double-stranded RNAs, known as small interfering RNAs (siRNA), are incorporated into an RNA-induced silencing complex that directs degradation of RNA containing a homologous sequence. siRNA has been shown to work in mammalian cells, and can inhibit viral infection and control tumor cell growth in vitro. Recently, it has been shown that intravenous injection of siRNA or of plasmids expressing sequences processed to siRNA can protect mice from autoimmune and viral hepatitis. In this review, we have discussed about the discovery of RNAi and siRNA, mechanism of siRNA mediated gene silencing, mediated gene silencing in mammalian cells, vectored delivery of siRNA, pharmaceutical potentiality of siRNA from mice to human. We have also discussed about promise and hurdles of siRNA or RNAi that could provide an exciting new therapeutic modality for treating infection, cancer, neurodegenerative disease, antiviral diseases (like viral hepatitis and HIV-1), huntington's disease, hematological disease, pain research and therapy, sarcoma research and therapy and many other illness in details. It will be a tool for stem cell biology research and now, it is a therapeutic target for gene-silencing.