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Jūrmala, Latvia

Lim T.R.,University of Birmingham | Tan B.H.,Digestive Diseases Center | Mutimer D.J.,University of Birmingham
International Journal of Antimicrobial Agents | Year: 2014

Chronic hepatitis C virus (HCV) infection is a major public health burden associated with significant morbidity and mortality. The approval of telaprevir and boceprevir for use with interferon and ribavirin in chronic HCV infection significantly increased viral eradication but has been accompanied by increased adverse events and therefore inferior clinical tolerance. Newer classes of antiviral agents, such as directly acting antiviral and host-targeting agents, offer a combination of drugs without the need for interferon and can achieve better response rates with a shorter duration of treatment. This offers an exciting prospect in the new era of antiviral treatment for HCV infection. © 2013 Elsevier B.V. and the International Society of Chemotherapy.

Khuroo M.S.,Digestive Diseases Center
Virus Research | Year: 2011

Hepatitis E was first recognised during an epidemic of hepatitis, which occurred in Kashmir Valley in 1978. The epidemic involved an estimated 52,000 cases of icteric hepatitis with 1700 deaths. The disease had unique clinical and epidemiological features. The epidemic was water-borne with highly compressed epidemic curve. Following the epidemic, secondary waves of hepatitis did not occur. Clinical profile was characterized by cholestasis in around 20% of patients. The disease predominantly occurred in young adults. There was increased incidence and severity of the disease in pregnant women. A subset of patients had distinctive liver histology with bile plugs in the canaliculi and formation of pseudo-ductules by hepatocytes around the bile plugs. All surviving patients had self limiting disease. Sera lacked serological markers of acute hepatitis A and hepatitis B. Based on these data, the possibility of another human hepatitis virus distinct from post-transfusion non-A, non-B hepatitis was postulated. Balayan et al. (1983) successfully transmitted the disease into himself by oral administration of pooled stool extracts of 9 patients from a non-A, non-B hepatitis outbreak which had occurred in a Soviet military camp located in Afghanistan. Reyes et al. (1990) cloned and sequenced hepatitis E virus genome. Over the years, hepatitis E was identified as a major health problem in developing countries with unsafe water supplies and poor sanitary disposal. Data from sero-surveys forced re-evaluation of the epidemiology of hepatitis E and gave an indirect indication to vocationally acquired HEV infections in industrialized countries. Soon, autochthonous hepatitis E was recognised as a clinical problem in such countries. Several animal species especially domestic swine, wild boar and wild deer were found to be reservoirs of hepatitis E virus genotype 3 & 4 in these countries. Human infections occur through intake of uncooked or undercooked meat of the infected animals and pig livers or sausages made from these livers and sold in supermarkets. Chronic hepatitis E resulting in rapidly progressive liver cirrhosis and end stage liver disease was described in organ transplant patients and those with other immunodeficiency states from many European countries. Two recombinant hepatitis E virus vaccines have successfully undergone phase 3 trials. © 2011 Elsevier B.V.

Kyaw M.H.,Royal Infirmary | Mayberry J.F.,Digestive Diseases Center
Journal of Clinical Gastroenterology | Year: 2011

Fructose exists in food naturally or as a sweetening additive. It has been thought that fructose malabsorption may cause the gastrointestinal symptoms seen in patients with irritable bowel syndrome. However, fructose malabsorption is still poorly understood, and clinicians are still uncertain of its role. This review attempts to clarify the relation between fructose malabsorption and symptoms in normal individuals and patients with irritable bowel syndrome. The main problem lies in the diagnosis. First, there is no definite cut off value for the breath tests. Second, we are unsure of the normal absorptive capacity of fructose in normal individuals. Normal individuals will have a degree of fructose malabsorption with or without symptoms depending on the dose of fructose used. From earlier studies, 25 g of fructose seems to be the cut-off dose to investigate fructose malabsorption, with a positive breath test at this dose suggesting abnormally low capacity to absorb fructose. This low level may be difficult to exclude from the daily diet, resulting in symptoms of fructose malabsorption. © 2010 by Lippincott Williams & Wilkins.

Goddard A.F.,Digestive Diseases Center | Badreldin R.,James Paget Hospital | Pritchard D.M.,University of Liverpool | Walker M.M.,Imperial College London | Warren B.,John Radcliffe Hospital
Gut | Year: 2010

Background: Gastric polyps are important as some have malignant potential. If such polyps are left untreated, gastric cancer may result. The malignant potential depends on the histological type of the polyp. The literature base is relatively weak and any recommendations made must be viewed in light of this. Definition: Gastric polyps are sessile or pedunculated lesions that originate in the gastric epithelium or submucosa and protrude into the stomach lumen. Malignant potential: Depending on histological type, some gastric polyps (adenomas and hyperplastic polyps) have malignant potential and are precursors of early gastric cancer. They may also indicate an increased risk of intestinal or extra-intestinal malignancy.

This paper will explore the development of medical education in the Soviet Union, its underlying principles and the subsequent migration of this format into the countries of the Soviet Bloc following World War II. The impact of Perestroika and the collapse of the Warsaw Pact on university training and medical education in particular will be reviewed. The need for external funding as a factor in the emergence of English Parallel courses in Hungary, Czechoslovakia and subsequently in other countries will also be considered. © The Author(s) 2013.

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