Management of virus hepatitis.

This review article examines the structure and replication cycle of hepatitis B virus and discusses the natural history of primary infection, the mechanisms of clearance of the virus, and reasons for persistent infection. It concludes with a discussion of what we know about the virus and how it causes hepatitis and the implications for treatment.

http://zeus.colsanitas.com/manual_referencia/archivos/Hepatitis%20B%20Virus%20Infection%20%20Natural%20History%20and%20Clinical%20Consequences.pdf

Hepatitis B Virus Infection — Natural History and Clinical Consequences

Cancer burden in the year 2000. The global picture.

During the last two decades or so, there has been a struggle over the patient's role in medical decision-making that is often characterized as a conflict between autonomy and health, between the values of the patient and the values of the physician. Seeking to curtail physician dominance, many have advocated an ideal of greater patient control.',' Others question this ideal because it fails to acknowledge the potentially imbalanced nature of this interaction when one party is sick and searching for security, and when judgments entail the interpretation of technical information.14 Still others are trying to delineate a more mutual relationship.5,6 This struggle shapes the expectations of physicians and patients as well as the ethical and legal standards for the physician's duties, informed consent, and medical malpractice. This struggle forces us to ask, What should be the ideal physician-patient relationship? We shall outline four models of the physicianpatient interaction, emphasizing the different understandings of (1) the goals of the physicianpatient interaction, (2) the physician's obligations, (3) the role of patient values, and (4) the conception of patient autonomy. To elaborate the abstract description of these four models, we shall indicate the types of response the models might suggest in a clinical situation. Third, we shall also indicate how these models inform the current debate about the ideal physician-patient relationship. Finally, we shall evaluate these models and recommend one as the preferred model. As outlined, the models are Weberian ideal types. They may not describe any particular physician-patient interactions but highlight, free from complicating details, different visions of the essential characteristics of the physician-patient interaction. 7 Consequently, they do not embody minimum ethical or legal standards, but rather constitute regulative ideals that are "higher than the law" but not "above the law."' THE PATERNALISTIC MODEL First is the paternalistic model, sometimes called the parental 9 or priestly model. In this model, the physician-patient interaction ensures that patients receive the interventions that best promote their health and well-being. To this end, physicians use their skills to determine the patient's medical condition and his or her stage in the disease process and to identify the medical tests and treatments most likely to restore the patient's health or ameliorate pain. Then the physician presents the patient with selected information that will encourage the patient to consent to the intervention the physician considers best. At the extreme, the physician authoritatively informs the patient when the intervention will be initiated. The paternalistic model assumes that there are shared objective criteria for determining what is best. Hence the physician can discern what is in the patient's best interest with limited patient participation. Ultimately, it is assumed that the patient will be thankful for decisions made by the physician even if he or she would not agree to them at the time." In the tension

/pdf/four-models-of-the-physician-patient-relationship-1lsj945ktz.pdf

Four Models of the Physician-Patient Relationship

Comparative surface feature analyses of the VP1 sequences of hepatitis A virus (HAV) and poliovirus type 1 allowed an alignment of the two sequences and an identification of probable HAV neutralization antigenic sites. A synthetic peptide containing the HAV-specific amino acid sequence of one of these sites induced anti-HAV-neutralizing antibodies. It is concluded that a structural homology exists between the two viruses, despite minimal primary sequence conservation.

Induction of hepatitis A virus-neutralizing antibody by a virus-specific synthetic peptide.

The identification of two types of infectious hepatitis with distinctive clinical, epidemiological, and immunological features provided an explanation for the occurrence of second attacks of the disease. One type resembled classical infectious hepatitis (IH); it was characterized by an incubation period of 30 to 38 days, a relatively short period of abnormal serum transaminase activity (3 to 19 days), a consistently abnormal thymol turbidity, and a high degree of contagion. The other type resembled serum hepatitis (SH); it was characterized by a longer incubation period (41 to 108 days), a longer period of abnormal transaminase activity (35 to 200 days) and a relatively normal thymol turbidity. Contrary to commonly accepted concepts, the SH type was moderately contagious. Patients with IH type were later proved to be immune to the same type. Patients with the SH type were not immune to the IH type infection.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=393593&pdfFileName=jama_252_3_023.pdf

Infectious hepatitis. Evidence for two distinctive clinical, epidemiological, and immunological types of infection.

Tests for the presence of Australia or hepatitisassociated antigen (HAA) and antibody (anti-HAA) were performed on more than 25,000 serum specimens from more than 700 patients with viral hepatitis. Hepatitisassociated antigen was consistently present in sera from patients with MS-2 strain of serum hepatitis (SH); it was not present in MS-1, infectious hepatitis (IH). Hepatitis-associated antigen was detected earlier after a parenteral exposure to SH than after an oral exposure. Antigen appeared two weeks to two months before onset of jaundice; it was transient in 65% of patients, but persisted for four months to 13 years in 35% of children. The average incubation period of IH (MS-1) was essentially the same following an oral or parenteral exposure (32 to 33 days); in SH (MS-2) it was 65 days after parenteral exposure and 98 days after oral exposure. Gamma-globulin consistently neutralized the infectivity of IH (MS-1) serum; in most cases it did not neutralize the infectivity of SH (MS-2) serum.

https://jamanetwork.com/journals/jama/articlepdf/354057/jama_212_6_005.pdf

Viral Hepatitis: New Light on an Old Disease

surprisingly poor quality; the author admits freely (p. 38) that the purpose of his taking photographs was \". . . the best way for me to create an aura of respectability.\" The pictures are poorly composed, badly focused, and quite uninteresting. The text which accompanies them becomes comical at times in its overinterpretation, as in his description of \"an altogether private look\" given by a new mother to her husband. The picture in question shows the woman's blurry profile and her husband cropped off at the shoulders (pp. 70-71). There are many other books available with excellent photographs and less turgid writing. But there would still be a justification for this book if it were the honest exploration of a man's emotional feelings about childbirth and fatherhood, in which case one would expect to hear about the emotions connected with personal experience. Remarkably, the author is not writing about the birth of his own children, though he mentions just in passing that he has three children of his own. Rather, he diligently records his own feelings about being at the births of three infants whose parents do not know him well but allow him to be present. His decision to do this project came, apparently, as a result of his artistic difficulties with his \"Cycle of Life\" sculpture. The situation seems somewhat irrelevant. The writing is wholly subjective, even self-indulgent, and the few opinions expressed, on the use of drugs during labor, silver nitrate treatment for infants' eyes, and the separation of mother and infant after birth, are confused and misinformed. The fact that some combination of these practices occurred with each birth compromises his advocacy of \"natural\" childbirth considerably. In short, this book does not succeed at all and should not be recommended. There are too many other visually satisfying and informative books available on the new practice of childbirth.

Relation of Australia-SH antigen to the willowbrook MS-2 strain.

Viral hepatitis, type B (MS-2-strain). Further observations on natural history and prevention.

https://www.amjmed.com/article/0002-9343(62)90161-4/pdf

Joan P. Giles

Papers

Infectious hepatitis. Evidence for two distinctive clinical, epidemiological, and immunological types of infection.

Viral Hepatitis: New Light on an Old Disease

Relation of Australia-SH antigen to the willowbrook MS-2 strain.

Viral hepatitis, type B (MS-2-strain). Further observations on natural history and prevention.

The natural history of infectious hepatitis