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Abstract

Hepatitis B virus (HBV) is a small-enveloped DNA virus that belongs to the Hepadnaviridae family, representing the second greatest cause of chronic viral hepatitis worldwide (1). Despite decades of vaccination, HBV infection is still a major global burden, with 257 million persons chronically infected and approximately 880,000 deaths per year (2). Chronic hepatitis B (CHB) is the result of an acute, unresolved infection that induces an immune-mediated liver damage followed by fibrotic tissue deposition leading overtime to a complete alteration of the hepatic architecture toward cirrhosis and its complications, such as liver failure and hepatocellular carcinoma (HCC) (3, 4).Remarkable advances have been made in the setting of CHB treatment (5). In particular, the development of new molecular biology techniques in association with an ever deeper understanding of the different phases of HBV infection and primarily the introduction of nucleos(t)ide analogs (NAs) are the main features that may lead to the virological cure in the near term and the functional cure in the long-term follow-up (6).This review discusses the current available drugs and treatment guidelines for CHB therapy focusing on telbivudine (LtD), a thymidine analog that has demonstrated unique features that make the abovementioned drug still valid even in the era of new powerful anti-viral agents. HBV Virology and Replication CycleHBV structure Hepatitis B virus structure consists of an outer envelope made of three viral surface proteins named preS1 (large), preS2 (middle), and S (small), which correspond to the serologic HBsantigen (HBsAg), and an inner nucleocapsid formed by core proteins, which correspond to HBcore-antigen (HBcAg) (7). Within the nucleocapsid is present the full-length HBV genome as a partially double-stranded relaxed circular (rc) DNA linked to the viral polymerase protein by a phosphotyrosine bond (8). The genome has an extremely compact organization displaying four partially overlapped major open reading frames (ORFs): the preS/S that encodes the three viral surface proteins, the pre-core/core that encodes both the nucleocapsid core protein and the non-structural core protein known as the e-antigen (HBeAg); the polymerase ORF that encodes the viral polymerase; and the X ORF that encodes the regulatory X protein that is essential for viral replication (9). Chronic Hepatitis B Treatment: Current Perspectives on TelbivudineHepatitis B virus (HBV) is the primary cause of chronic viral hepatitis worldwide. Currently, there are 5 oral nucleos(t)ide analogs (NAs) approved for chronic hepatitis B (CHB) treatment and include lamivudine, adefovir, telbivudine (LtD), entecavir (ETV), and tenofovir disoproxil fumarate (TDF). ETV and TDF are those with higher anti-viral efficacy and lower resistance rates, whereas LtD shows similar efficacy but has a higher risk for viral resistance in long-term monotherapy. However, LtD carries several advantages that must be considered and are worthy of discussion. Compared to other NAs, LtD showed a poten...

Are the Menstrual Characteristics Similar in Adolescent and Adult Women with Cerebral Palsy?

“…A comparison of demographic and menstruation characteristics of adolescent and adult CP groups is shown in table II. The median age of adolescent CP groups was 16.5 (11)(12)(13)(14)(15)(16)(17)(18) years and adult CP groups were 23.5 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) years. The median age of the adult CP group was higher than the adolescent group (p>0.05).…”

“…LEVEL 1 Walks without limitations LEVEL 2 Walks with limitations LEVEL 3 Walks using a hand-held mobility device LEVEL 4 Self-mobility with limitations; may use powered mobility LEVEL 5 Transported in a manual wheelchair A self-report questionnaire based on the relevant literature was used to assess information regarding the menstrual status of adolescent and adult women with CP. Items from valid questionnaires used in other research on menstruation disorders were utilized to construct the questionnaire (7,(11)(12)(13). These items investigated the use of menstrual suppression treatment, age of menarche, presence of dysmenorrhea, length of menstruation, number of pads used on the heaviest day of menstruation, the total number of pads, pain onset time, pain duration, pain medicine during menstruation, number of drugs, use of pain relief methods, absence from school or work, number of days absent from school, whether they got treatment.…”