UMLS:C0019158 - FACTA Search

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Query: UMLS:C0019158 (hepatitis)
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There has been significant concern that the dental curriculum and system of clinical education, in particular, is not designed to take advantage of the explosion in knowledge in biomedical science and its application to the health of the public. Although there are some examples of innovations in dental education on a global scale that have the capacity to increase the assimilation of basic and clinical knowledge, most of the dental education models are mired in the traditional '2 + 2' approach to education. This can be seen in North America and the European '2 + 3' model or the stomatological '4 + 2' approach. In each of these systems, the basic and behavioural science courses continue to be perceived as hurdles over which students must leap in order to reach the clinical programmes where there is little opportunity to use basic science information to advance patient care and treatment. Examples of issues that are not well represented include: innovations in imaging; diagnosis; bio-materials; science-based approaches to clinical practice; novel approaches to therapeutics; interactions between the oral, dental and craniofacial complex and systemic health and disorders; the role of oral infections and systemic disease; the increasing appreciation of chronic diseases and disorders such as osteoporosis and diabetes that affect oral tissues; the promise of bioengineering, tissue engineering and biomimetics; the potential use of saliva as a diagnostic tool; the understanding of oral complications of cancer treatment; the treatments of HIV/AIDS diseases and hepatitis; the use of dental and dental hygiene staff on health-care teams to deal with issues such as birth defects, orofacial trauma, head and neck cancer, chronic pain management and so on. There seems to be an excessive emphasis on restorative dentistry and, to a lesser extent, on the more biological approaches to diagnosis, prevention and therapeutics. This continued lack of integration of basic and clinical sciences in the curriculum continues to foster a dental workforce that is highly technically competent to provide specific clinical services but poorly equipped to evaluate and implement new biological approaches to diagnosis, therapeutics and intervention. Unfortunately, after many attempts by organized dental symposia aimed at the integration of basic and clinical sciences, there has been little discernible curricular change. It appears that there is an opportunity through this global congress to identify the best practices in the various global curricula that could change this paradigm in dental education and lead us toward the education of a more scientifically orientated practitioner-one who can take advantage of innovations in new and emerging technologies in their application to patient care. It is the challenge of this section to try to ascertain the best method or methods by which dental education promotes research to the dental student and what research represents in terms of critical thinking and evidence-based approaches to dental education and clinical practice.
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PMID:1.4 Research and the dental student. 1239 Feb 58

Bone quality by quantitative ultrasound and fracture rate were assessed in 135 (64 males) children and adolescents aged 3-21 y with bone and mineral disorders such as chronic anticonvulsants or glucocorticoids treatment, juvenile rheumatoid arthritis, celiac disease, paucity of intrahepatic bile ducts, autoimmune hepatitis, genetic diseases, idiopathic juvenile osteoporosis, disuse osteoporosis, beta-thalassemia major, survivors of acute lymphoblastic leukemia, liver transplantation, calcium deficiency, and nutritional or X-linked hypophosphatemic rickets. Amplitude-dependent speed of sound through the distal end of the first phalangeal diaphysis of the last four fingers of the hand was measured by an ultrasound device. In the majority of patients cortical area to total area ratio by metacarpal radiogrammetry (n = 120) and lumbar bone mineral density (BMD) by dual-energy x-ray absorptiometry (n = 99) were also assessed. In patients with X-linked hypophosphatemic rickets radial BMD by single-photon absorptiometry instead of lumbar BMD was measured. Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMDarea, or lumbar BMD corrected for bone sizes estimated by a mathematical model (BMDvolume), as well as mean values of radial BMD in patients with X-linked hypophosphatemic rickets, expressed as z score, were significantly reduced (p < 0.0001) in comparison with their reference values (-1.7 +/- 1.0, -2.0 +/- 0.9, -3.0 +/- 1.3, -1.9 +/- 1.0, -2.7 +/- 0.7, respectively). A positive relationship was found between amplitude-dependent speed of sound and cortical area to total area ratio (r = 0.90, p < 0.0001), lumbar BMDarea (r = 0.62, p < 0.0001), or lumbar BMDvolume (r = 0.66, p < 0.0001). Fifty-two patients (38.5%) had suffered fractures in the 6 mo preceding the bone measurements, the radial distal metaphysis being the most frequent fracture site (28.8%). Mean values of amplitude-dependent speed of sound, cortical area to total area ratio, lumbar BMDarea, or lumbar BMDvolume, expressed as z score, of fractured patients were significantly lower (p < 0.0001) than those of fracture-free patients (-2.2 +/- 1.0 and -1.4 +/- 0.8, -2.6 +/- 0.9 and -1.7 +/- 0.7, -3.5 +/- 1.2 and -2.5 +/- 1.0, -2.5 +/- 1.0 and -1.3 +/- 0.7, respectively). Phalangeal quantitative ultrasound may be a useful method to assess bone quality and fracture risk in children and adolescents with bone and mineral disorders.
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PMID:Assessment of bone quality by quantitative ultrasound of proximal phalanges of the hand and fracture rate in children and adolescents with bone and mineral disorders. 1270 Mar 67

The levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) peak in human in their twenties, then decrease gradually with age. The physiological importance of DHEA was not clear until recent research reports showing that DHEA has beneficial effects on preventing diabetes, malignancy, inflammation, osteoporosis, and collagen disease. We summarize our results concerning diabetes, hepatitis, and colon cancer. In 1982, Coleman et al. [Diabetes 31 (1982) 830] reported that DHEA decreased hyperglycemia in diabetic db/db mice, which become insulin resistant. We measured hepatic gluconeogenic enzymes in an attempt to elucidate the mechanical mechanism of DHEA action. The activity and gene expression of hepatic gluconeogenic enzyme such as glucose-6-phosphatase (G6Pase) was increased in db/db mice despite hyperinsulinemia compared to control db/+m mice. DHEA, like troglitazone, decreased these levels in db/db mice. We also showed that DHEA improved the insulin resistance caused by aging or obesity using the glucose clamp technique in another animal model. In humans, the serum DHEA concentration was shown to be associated with hyperinsulinemia in diabetes. It also became clear that DHEA increased insulin secretion in old-aged db/db mice. DHEA increases not only insulin sensitivity due to the effects in the liver and muscle, but also insulin secretion. As an effect of DHEA on T-cell mediated hepatitis induced by concanavalin A (ConA), DHEA reduced hepatic injury by inhibiting several inflammatory mediators and apoptosis. As an effect of DHEA on carcinogenesis, DHEA would be a potential chemopreventative agent against colon cancer because it decreases the number of azoxymethane (AOM) induced aberrant crypt foci, which is a possible precursor to adenoma and cancer in a murine model.Thus, since DHEA has many beneficial effects experimentally, we should consider administration of DHEA in the future, and common mechanisms among these actions of DHEA should be elucidated in further studies.
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PMID:Prevention of diabetes, hepatic injury, and colon cancer with dehydroepiandrosterone. 1294 37

Patients affected with chronic hepatitis are prone to alterations in bone metabolism, osteoporosis and osteopoenia being the most common manifestations. Bone mineral densitometry is the method of choice for assessing bone mass; nevertheless, this is a static parameter whereas biochemical markers of bone remodelling reveal the dynamics of bone resorption and formation. With this study we used bone mineral densitometry and biochemical markers to evaluate bone metabolism in a group of male patients with chronic C virus hepatitis and in a group of healthy males. In the hepatitis group 56% of the patients proved osteopoenic or osteoporotic and bone depletion increased as the histological score of the disease increased. Crosslaps are a parameter of osteoclastic activity: their measurement showed alterations in all the age groups of the hepatitis patients studied, which goes to show that there is intense bone remodelling in these individuals due mainly to osteoclastic resorption. Hepatitis C is a risk factor for bone depletion: we believe that when this type of hepatitis is diagnosed it is useful to assess bone metabolism with bone mineral densitometry and with the crosslaps assay.
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PMID:[Alterations of bone metabolism in patients with chronic C virus hepatitis]. 1588 78

The potential hepatotoxicity of herbal remedies is usually ignored in daily life. One such compound, Boh-Gol-Zhee (in Chinese, Bu Ku Zi), appeared to be associated with the occurrence of acute cholestatic hepatic injury in the following case. Some alternative medicine therapists claim that Psoralea corylifolia is effective for the treatment of osteoporosis. We observed a case of acute cholestatic hepatitis associated with the use of the seeds of Psoralea corylifolia in amounts over 10 times the usual dose in a postmenopausal woman. Liver biopsy showed zone three necroses, degenerating cells, cholestasis, and infiltrations with inflammatory cells. This case stresses the need to warn of the potential hepatotoxicity of the seed of Psoralea corylifolia, especially in a large dose.
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PMID:A case of acute cholestatic hepatitis associated with the seeds of Psoralea corylifolia (Boh-Gol-Zhee). 1625 43

The life expectancy of patients with thalassemia major has significantly increased in recent years, as reported by several groups in different countries. However, complications are still frequent and affect the patients' quality of life. In a recent study from the United Kingdom, it was found that 50% of the patients had died before age 35. At that age, 65% of the patients from an Italian long-term study were still alive. Heart disease is responsible for more than half of the deaths. The prevalence of complications in Italian patients born after 1970 includes heart failure in 7%, hypogonadism in 55%, hypothyroidism in 11%, and diabetes in 6%. Similar data were reported in patients from the United States. In the Italian study, lower ferritin levels were associated with a lower probability of experiencing heart failure and with prolonged survival. Osteoporosis and osteopenia are common and affect virtually all patients. Hepatitis C virus antibodies are present in 85% of multitransfused Italian patients, 23% of patients in the United Kingdom, 35% in the United States, 34% in France, and 21% in India. Hepatocellular carcinoma can complicate the course of hepatitis. A survey of Italian centers has identified 23 such cases in patients with a thalassemia syndrome. In conclusion, rates of survival and complication-free survival continue to improve, due to better treatment strategies. New complications are appearing in long-term survivors. Iron overload of the heart remains the main cause of morbidity and mortality.
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PMID:Survival and complications in thalassemia. 1633 50

Arthropathies and joint deformities in patients with severe hemophilia result in prolonged immobilization, reduced physical activity, and predispose them for osteoporosis. This can lead to an increasing tendency of bone fragility and fractures in patients after trivial trauma. The aim of this study was to find out (i) the prevalence of osteoporosis in hemophilia patients and (ii) the association of osteoporosis with hemophilic arthropathy and related restricted physical activity. In this case-control study, 50 consecutive severe hemophilia patients aged between 20 and 50 years were evaluated for osteoporosis with measurement of bone mass density (BMD) by a DEXA scan and values were compared with that of 50 sex matched normal healthy controls. Major joints of the limbs were evaluated to determine the extent of joint damage and related disability. Forty-two patients had severe hemophilia A and 8 patients severe hemophilia B (efficient factor activity < 0.01 U/ml). BMD values (gms/cm(2)) of lumbar spine and left hip of the patients were significantly lower than that of controls (0.825 vs. 0.939; P < 0.0001 and 0.725 vs. 0.938; P < 0.0001, respectively). The incidence of osteoporosis (T score: -2.5 or more) was significantly higher in hemophiliacs. Incidence of fractures in adult life was also significantly higher in hemophiliacs compared to controls (12% vs. 0%). There was statistically significant correlation between joint evaluation scores and BMD of hip, but not with that of the lumbar spine. There was no correlation between Hepatitis-C virus status and BMD of any site. This shows that development of osteoporosis is a significant problem in patients with severe hemophilia in this country. Hence appropriate preventive measures such as early treatment and adequate mobilization, exercises, encouragement to participate in sporting activities, early assessment of bone density, and administration of anti-osteoporotic therapy is recommended.
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PMID:Osteoporosis in young haemophiliacs from western India. 1727 14

Aims of treatment for primary sclerosing cholangitis are as follows: prevention of progression of hepatobiliary disease, reduction of symptoms and consequences of cholestasis (pruritus, osteoporosis), and prevention of complications (colorectal cancer, hepatobiliary cancer). Ursodeoxycholic acid (UDCA) improves biliary secretion and laboratory parameters of cholestasis, but its effects on liver histology and survival are not clear. It reduces the incidence of dysplasias and carcinomas of the colon in patients with colitis and possibly has a beneficial effect on the incidence of bile duct carcinomas. At present, UDCA represents the most promising therapeutic option. Immunosuppressive treatment has not been proven to be effective; it appears to be indicated in the overlap syndrome with autoimmune hepatitis but may be harmful in bacterial cholangitis. Bacterial cholangitis is common in patients with dominant stenoses and requires antibiotic treatment. Endoscopic treatment of dominant stenoses improves cholestasis and prolongs survival in comparison to predicted survival. Pruritus represents a problem in some patients, and cholestyramine represents the first-line treatment. If ineffective, opioid antagonists, rifampin, or ondansetron may be tried. For treatment of osteoporosis and osteopenia, calcium and vitamin D supplementation are recommended, and in selected cases, bisphosphonates may be indicated. In patients with severe cholestasis and coagulation defects, parenteral supplementation of vitamin K may be indicated. During treatment, all patients should be regularly screened for colonic and bile duct carcinomas. Patients with cirrhosis of the liver and its complications are treated accordingly, and in end-stage disease, liver transplantation is indicated.
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PMID:Treatment of primary sclerosing cholangitis. 1739 26

Osteoporosis is present often in postmenopausal women. The aim of this retrospective cohort study is to assess the cumulative appearance incidence and predictive factors for bone fracture in postmenopausal women with osteoporosis and chronic liver disease. The patients were 80 postmenopausal women with osteoporosis and chronic liver disease due to hepatitis virus B or C. These patients were given cyclic etidronate therapy within 3 months after diagnosis of osteoporosis (etidronate-group). Another 400 postmenopausal women with osteoporosis and chronic liver disease were selected as controls (control group). Patients in control group were matched 1:5 with etidronate-group for age. Patients in control group were not given any drugs after diagnosis of postmenopausal osteoporosis. The mean observation period was 8.1 years. Four patients in the etidronate-group and 46 in control group developed bone fracture. The 10th year cumulative appearance rates of bone fracture were 4.9% in etidronate-group and 13.8% in control group. Cox regression model showed that the appearance rate of bone fracture decreased with statistical significance in the following cases: (1) patients <65 years (P<0.001), (2) patients with serum albumin level of >or=3.5 g/dl (P=0.003), and (3) patients treated with etidronate (P=0.020). The cumulative survival rate after bone fracture was 82.2% at the second year, and 57.6% at the fifth year. The present study suggests that a serum albumin level of >or=3.5 g/dl and cyclic etidronate treatment reduce the appearance of bone fracture.
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PMID:Prolonged-efficacy of bisphosphonate in postmenopausal women with osteoporosis and chronic liver disease. 1846 28

The XXth century is marked by the substantial increase in human life expectancy. Historically, main reasons for that are four achievements of medicine: (1) improvements in common hygiene, such as waste disposal and water purification which led to the significant reduction of communicable diseases; (2) common recognition of Pasteur's Germ Theory followed by improvements in occupational and personal hygiene as well as introduction of antiseptic and aseptic measures; (3) decrease in childhood mortality due to the discovery and widespread application of vaccination; and (4) the discovery and clinical application of antibiotics. An epidemiological transition took place, i.e. the shift from communicable infectious diseases, as a main cause of morbidity and mortality, to chronic degenerative diseases, mainly considered non-infectious. Experimental evidence has been accumulated on a significant number of microorganisms, including viruses (such as a group of herpes viruses, hepatitis viruses, etc.), bacteria (Chlamydia, Helicobacter, periodontal pathogens, etc.), fungi and parasites, as an underlying reason for many of diseases, such as atherosclerosis, various cancers, type 1 and 2 diabetes, neurodegenerative and some psychiatric diseases, osteoporosis, autoimmune diseases and others. On the other hand, most of these diseases have been traditionally associated with age, together with other "age-related" disorders, such as immune system suppression, thymus involution, pathologic calcification, etc. Taken together, these facts suggest that aging, among others, has infectious origins, and that burden of infections may lead to enhanced senescence and premature death. In fact, infections may serve as a trigger of senescence, presumably via the mechanisms of chronic oxidative stress, low-grade inflammation, telomere shortening, and autoimmune processes due to the molecular mimicry. We believe that next step in human longevity increase can be possible by common appreciation of the role of infections as the main trigger of age-related diseases and disorders, and by efforts to cure and/or eradicate these infections.
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PMID:[Fifth revolution in medicine: on the role of infections in pathogenesis of aging and chronic diseases]. 1882 37

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