losartan-potassium and Hepatitis--Viral--Human

The emergence of the acquired immunodeficiency syndrome (AIDS) has fueled concerns of both physicians and their patients about safety of blood transfusions. Although AIDS has generated the most fear, the risk today is extremely remote (1/60.000 units of blood). The risk of transmitting infectious disease by homologous transfusion is decreasing, as more donor screening and testing measures are implemented. The blood supply is safer that at any time, but small transfusion risks exist. The most common problems associated with transfusions are temporary: one in 100-300 recipients will experience fever or rash. The biggest problem is a mismatch of the well-known ABO blood groups and once in every 100-400.000 transfusions the hemolytic reaction is fatal. Viral hepatitis is another serious and important risk. At present hepatitis seems to strike between 1 and 3 percent of transfusion recipients. Most, if not all, of transfusion-associated hepatitis cases are caused by hepatitis C virus. Cytomegalovirus can cause primary infection, reactivation or reinfection by transfusion. Immunosuppressed patients are more likely to develop more severe disease. Epstein-Barr virus does not seem to cause significant post-transfusion disease. Bacterial or protozoal infections are an infrequently encountered adverse effect of transfusion. However, some clinical cases document the potential hazard of blood components as a vector for bacteria or protozoa. Homologous blood transfusion down-regulates some immune functions. Host defences against malignancy and infection may in some instances be severely compromised by transfusions of homologous blood.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acquired Immunodeficiency Syndrome; Adult; Blood Donors; Blood Transfusion, Autologous; Deamino Arginine Vasopressin; Epoprostenol; Erythropoietin; Female; Graft vs Host Disease; Hemodilution; Hepatitis, Viral, Human; Humans; Infant, Newborn; Infections; Male; Pregnancy; Prognosis; Protozoan Infections; Risk Factors; Transfusion Reaction

Topics: Adolescent; Adult; Anemia; Erythropoietin; Female; Flaviviridae; Hepatitis, Viral, Human; Humans; Kidney Failure, Chronic; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

Patients receiving maintenance hemodialysis (HD) present with hemostatic abnormalities, which may be aggravated by comorbid conditions, especially liver disease. The factors that influence plasma levels of thrombomodulin (TM), an initiator of the anticoagulant protein C pathway, and those of tissue factor (TF), which triggers the extrinsic coagulation pathway, were assessed. In 63 HD patients, TM and TF levels were higher than those in healthy controls. In bivariate analysis, TF positively correlated with TM, and both were directly associated with the presence of viral hepatitis B or C marker, serum liver enzymes, use of erythropoietin therapy, hemoglobin levels, and duration of HD therapy, and inversely correlated with body mass index. TF was also positively associated with plasma von Willebrand factor (vWF) antigen, and inversely associated with activated partial thromboplastin time. In multivariate analysis, increased vWF, alanine aminotransferase, and use of erythropoietin independently predicted both TF and TM levels. HD patients with vWF and ALT levels lower than middle, and not treated with erythropoietin had normal TF but increased TM concentrations compared with levels in healthy controls. Increased plasma levels of TM and TF in patients on maintenance HD are surrogates of vascular endothelial injury. Liver disease and use of erythropoietin treatment are also important determinants of these markers, and should be considered in further studies.

Topics: Adult; Aged; Aged, 80 and over; Analysis of Variance; Biomarkers; Case-Control Studies; Clinical Enzyme Tests; Cross-Sectional Studies; Endothelium, Vascular; Erythropoietin; Female; Hepatitis, Viral, Human; Humans; Liver Diseases; Male; Middle Aged; Prevalence; Renal Dialysis; Thrombomodulin; Thromboplastin; von Willebrand Factor

Increased serum hepatocyte growth factor (HGF) level is a part of the counter-system against tissue damage and predicts mortality in maintenance haemodialysis (HD) patients. We studied which of the common co-morbid and clinical conditions, and surrogates of metabolic disorders or specific organ damage determine HGF levels in these subjects.. In 86 patients, pre-dialysis serum HGF, soluble endothelial markers--such as thrombomodulin (TM), von Willebrand factor and plasminogen activator inhibitor-1--and hepatitis B and C markers were measured by ELISAs. Inflammatory reactants such as C-reactive protein (CRP), alpha(1)-antitrypsin, alpha(1) acid-glycoprotein, and immunoglobulin M and G were assayed by nephelometry, and lipoprotein(a) was determined by ELISA. Cardiovascular disease (CVD) was identified on a clinical basis.. Serum HGF was directly associated with the presence of viral hepatitis, alanine aminotransferase and TM levels, time on HD, the presence of CVD, CRP and alpha(1)-antitrypsin levels, use of unfractionated heparin (UFH) (vs enoxaparin) during HD, dose of UFH, use of recombinant erythropoietin (rHuEpo) treatment, and Kt/V. In 36 patients not treated with rHuEpo, HGF directly correlated with haemoglobin, but not with endogenous Epo levels. There was no association between HGF and the other endothelial and inflammatory markers, gender, age, smoking, cause of renal failure, body mass index, normalized protein catabolic rate, dialysate buffers, dialysers, blood pressure, antihypertensive treatment, leukocyte and platelet counts, albumin, fibrinogen, lipoprotein(a), markers of iron and calcium-phosphorus metabolism, or metabolic acidosis. Positive viral hepatitis markers, prevalent CVD and rHuEpo treatment (in descending order of significance) were independent predictors of high HGF level. In another 20 HD patients, a 4-week course of rHuEpo treatment resulted in a significant 17% increase in circulating HGF levels.. Serum HGF levels in HD patients are determined by inflammatory conditions such as viral hepatitis and CVD, increase in response to rHuEpo treatment, and may be influenced by type and dose of heparin used during HD procedures.

Topics: Adolescent; Adult; Aged; Anticoagulants; Cardiovascular Diseases; Erythropoietin; Female; Heparin; Hepatitis, Viral, Human; Hepatocyte Growth Factor; Humans; Male; Middle Aged; Recombinant Proteins; Renal Dialysis

Although the majority of patients with end stage renal failure have anemia, some have relative erythrocytosis. Patients treated with continuous ambulatory peritoneal dialysis (CAPD) having relative erythrocytosis were studied in order to determine the factors that would be responsible.. Nine out of 89 CAPD patients (10%) were identified as having relative erythrocytosis. Age-, sex- and duration of disease-matched eight patients undergoing CAPD were taken as control. Beside factors of etiologies of renal failure, smoking, renal cysts, viral hepatitides, residual renal function, the adequacy of CAPD, nutritional status, hypertension, serum levels of erythropoietin, IL-1, IL-6, TNF-, and IGF-1 levels were also investigated.. Relative erythrocytosis occurred most often in diabetic and amyloidosis patients. None of the parameters studied were found to be significantly different between groups. During 2-year follow-up, although statistically non-significant, patients having relative erythrocytosis seemed to have higher mortality rate due to vascular complications.. No single factor seemed to explain erythrocytosis in patients undergoing CAPD. Being diabetic or with amyloidosis may increase the risk.

Topics: Adult; Amyloidosis; Antigens, CD; Diabetes Complications; Erythropoietin; Female; Hepatitis, Viral, Human; Humans; Hypertension; Insulin-Like Growth Factor I; Interleukin-1; Interleukin-6; Kidney; Kidney Diseases, Cystic; Kidney Failure, Chronic; Male; Peritoneal Dialysis, Continuous Ambulatory; Polycythemia; Receptors, Tumor Necrosis Factor; Receptors, Tumor Necrosis Factor, Type I; Risk Factors; Smoking

The relationship between aplastic anemia and viral hepatitis is well recognized, and such patients usually have a high mortality. We successfully treated a case of aplastic anemia following living-related orthotopic liver transplantation (LROLT) for non-A, non-B, non-C hepatitis. A 2-yr-old boy with fulminant hepatic failure from non-A, non-B, non-C hepatitis received LROLT. Before transplantation, he had pancytopenia which was probably hepatitis associated, and viral suppression was suspected after bone marrow (BM) biopsy. After the transplantation, he developed progressive pancytopenia and a diagnosis of aplastic anemia was made via BM biopsy. With immunosuppressant agents (cyclosporine, methylprednisolone), cytokine therapy (granulocyte-colony stimulating factor (G-CSF), macrophage-colony stimulating factor (M-CSF), recombinant human erythropoietin (rhEPO)) was effectual and the patient recovered from pancytopenia. He was discharged from the hospital 57 d after the liver transplantation and remains well 1 yr after LROLT. Combined cytokine therapy with high doses of G-CSF, M-CSF and rhEPO appeared to be effective in the treatment of aplastic anemia following liver transplantation for non-A, non-B, non-C hepatitis. Since M-CSF activates macrophages, it may have contributed to the graft rejection. Careful consideration should be given to the use of high-dose M-CSF in liver transplant patients.

Topics: Anemia, Aplastic; Bone Marrow; Child, Preschool; Drug Therapy, Combination; Erythropoietin; Granulocyte Colony-Stimulating Factor; Hepatitis, Viral, Human; Humans; Immunosuppressive Agents; Liver Transplantation; Living Donors; Macrophage Colony-Stimulating Factor; Male; Recombinant Proteins

In 1980, the first Moroccan hemodialysis center was founded in Casablanca. The number of centers has been increasing since then, to reach 61 centers to wards the of 1996. There are 1800 hemodialysed (males 59%, females 41%) with and average age of 51 +/- 4 years. In about one third of the cases, the cause of the end stage renal failure remains unknown. However, chronic glomerulonephritis comes at the head of known causes (25%), followed by interstitial nephritis (19%). A temporary vascular access (catheter) was necessary in 81% of cases when dialysis has started in emergency in 61% of patients. Infections were the most frequent complications (21%) namely septicaemia (8%) and tuberculosis (7%). The vaccination against hepatitis B virus is done systematically in all the centers, and the number of chronic carriers of HBS Ag is about 7%. Further more, serological C virus is positive in 40% of the hemodialysed patients. Cardio-vascular complications were dominated by percarditis (13%) especially at the beginning of the dialysis. Anaemia remains very frequent and often very important requiring multiple blood transfusions (35%) in the absence of erythropoietin treatment. The death rate, which is very difficult to estimate, is of about 18%. Peritoneal dialysis was used in 50 patients but only four patient continued on peritoneal dialysis therapy. 108 patients were transplanted (23 cases in Morocco, 85 in other countries) with a waiting list of 0 to 12 years. Hemodialysed Moroccan's population is characterised by the high number of unknown causes and the gravity of the admission stage. A renal effort in prophylactic should be performed to avoid certain causes of renal failure.

Topics: Adolescent; Adult; Aged; Ambulatory Care Facilities; Anemia; Cardiovascular Diseases; Carrier State; Catheters, Indwelling; Child; Child, Preschool; Comorbidity; Erythropoietin; Female; Glomerulonephritis; Hepatitis, Viral, Human; Humans; Infant; Infections; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Morocco; Nephritis, Interstitial; Peritoneal Dialysis; Renal Dialysis; Transfusion Reaction; Vaccination

Lisa Capaldini, a physician who treats patients with HIV-related fatigue, discusses symptoms, diagnosis techniques, and treatments of depression, anemia, and various other roots of fatigue in HIV-positive patients. Biochemical depression, caused by abnormal levels of serotonin and norepinephrine in the brain, is easily misdiagnosed or overlooked. Physical and emotional symptoms of depression mirror common effects of HIV such as exhaustion, anger, and irritability. Knowing the history of depression prior to HIV infection, including previous drug abuse and family history of depression, will help to diagnose fatigue. Dr. Capaldini recommends antidepressants provided the condition is properly diagnosed and the side effects are not harmful to the patient. Selective serotonin reuptake inhibitors (SSRI), the most frequently prescribed antidepressants, can cause short term sexual dysfunction. Bupropion and Wellbutrin can be prescribed to avoid this side effect. Psychotherapy can be effective if therapists are familiar with HIV disease and can distinguish between symptoms brought on by behavior, addictive habits, or pre-existing depression. Consideration also must be given to drug interactions, particularly with the antiretrovirals ritonavir and delavirdine, which can cause seizures or disturb cardiac rhythm. Anemia is most noticeable after physical exertion, and symptoms are more evident based on the increased rate that red blood cells move out of the normal range. To determine the course of treatment, physicians need to clarify the cause of anemia. Anemia can be caused by drugs, vitamin deficiencies, or other nutritional problems. Adrenal insufficiency, methemoglobinemia, and malnutrition are also causes of fatigue. Diagnosing fatigue due to hepatitis B or C, rather than HIV, can be achieved by measuring hepatitis levels and observing T cell counts and viral load. Dr. Capaldini suggests that proper diet and exercise prevent fatigue from getting worse.

Topics: Adrenal Insufficiency; Anemia; Anti-HIV Agents; Antidepressive Agents; Depression; Drug Interactions; Erythropoietin; Fatigue; Female; Hepatitis, Viral, Human; HIV Infections; Humans; Male; Methemoglobinemia; Nutrition Disorders

Topics: Anemia, Aplastic; Erythropoietin; Hepatitis, Viral, Human; Humans; Male; Middle Aged; Recombinant Proteins