Viral hepatitis clinical presentation

Inactivation and Removal of Viruses. In developing methods of plasma fractionation, the possibiHty of transmitting infection from human vimses present in the starting plasma pool has been recognized (4,5). Consequentiy, studies of product stabiHty encompass investigation of heat treatment of products in both solution (100) and dried (101) states to estabHsh vimcidal procedures that could be appHed to the final product. Salts of fatty acid anions, such as sodium caprylate [1984-06-17, and the acetyl derivative of the amino acid tryptophan, sodium acetyl-tryptophanate [87-32-17, are capable of stabilizing albumin solutions to 60°C for 10 hours (100) this procedure prevents the transmission of viral hepatitis (102,103). The degree of protein stabilization obtained (104) and the safety of the product in clinical practice have been confirmed (105,106). The procedure has also been shown to inactivate the human immunodeficiency vims (HIV) (107). 

The data about fields of application of Silics in clinics for treatment for infectious diseases are presented in Table 4. From Table 4 it is evident that the field of application of Silics is rather large and covers both intestinal infections and toxicoses which victimize infants, as well as viral hepatitis, and botulism. It is appropriate to mention here that inclusion of Silics into the complex treatment of patients suffering from salmonellosis, dysentery, and intestinal toxicoses accelerates normalization of clinic manifestations of these diseases by a factor of two and more. In the case of botulism the normalization of symptoms characteristic of lesions of the nervous system is shortened by almost 4 days. If intestinal infections are not severe, Silics can be recommended as a single therapeutic agent. In the case of a considerable diarrheal syndrome it is more expedient to use it together with rehydration substances. Inclusion of Silics into a complex of therapeutic agents for patients suffering from viral hepatitis substantially accelerates recovery rates of patients, so that their normal level of bilirubin and activity of alanine aminotranspherase are recovered within shorter periods of time. 

Both autoimmune and viral hepatitis, which could present with a similar clinical picture to patient 1, are contraindications to the use of POCs as they could worsen the clinical course. 

Those forms of acute viral hepatitis that have a normal clinical course also present discrete quantities of bile to be found as intraepithelial drops and intercellular cylinders or deposits in the stellate cells. These findings cannot be confirmed biochemically. A cholestatic course of disease is occasionally witnessed with a marked increase in alkaline phosphatase, particularly in older patients and in women. It is mostly accompanied by jaundice. The... 

If cholestasis is not present, the additional application of ursodeoxycholic acid (UDCA) is worth considering because of its pharmacological properties and lack of side effects or interactions. Initial results on the treatment of chronic hepatitis with UDCA were reported by F. IcHiDA (1961), T. Nakahara et al. (1975) and K. Miyaji (1976). (s. p. 705) In 1988 our study group also noted obvious and permanent effects of UDCA on the course of disease in terms of clinical and laboratory indices in severe acute viral hepatitis B. (s. p. 437) Such observations were confirmed by A. Jorge in 1993. Owing to the multiple mechanisms of action of UDCA, in particular its immunomodulatory effect, adjuvant therapeutic efficacy can be anticipated in autoimmune hepatitis, as reported by P. Janowitz et al. in 1996. In autoimmune-associated chronic hepatitis C, UDCA proved to be a successful therapeutic agent (K. Nakamura et al., 1999). 

GZ (23) is known to decrease elevated plasma levels of AST and ALT in various liver diseases. Thus it has been widely used for the treatment of chronic liver diseases (chronic viral hepatitis) in Japan for several years [82]. However, the mechanism of its transaminase-lowering action is not fully understood. Some studies suggested that the decrease of transaminase levels by GZ in patients with chronic viral hepatitis is mediated in part by inhibition of immune-mediated cytotoxicity against hepatocytes [83]. GZ (23) was shown to inhibit the cytotoxicity of CTL against antigen-presenting cells and also to suppress TNF-a induced cytotoxicity in the TNF-a sensitive cell line in vitro. A clinical study reported the use of GZ to bring about an improvement of hepatitis after liver transplantation performed for cirrhosis secondary to hepatitis B complicated by a small hepatocellular carcinoma [84],... 

In addition to inhibition of HIV viral attachment, the dendrimers also inhibit adsorption of certain enveloped viruses such as herpes simplex virus 2 (HSV) [250] and respiratory syncytial virus (RSV) [251,252] in cell culture at very low concentrations (0.1 to 1 Mg/ml)- In recent work, PAMAM and poly(lysine) dendrimers were also shown to inhibit human cytomegalovirus (HCMV), Ebola Virus, Hepatitis B virus (HBV), Influenza A and B, Epstein Barr virus (EbV), Adeno- and Rhino-viruses [245]. Several of these surface functionalized dendrimers are presently entering clinical studies as dendrimer-based antiviral nanodrugs. 

---