The IFNs exhibit antiviral and antiproliferative effects; in addition, a-IFN is an immunostimulant. The drug does suppress HBV replication in a small proportion of selected children. Twenty-four percent of children 1 year of age and older treated with 3 MU/m2 subcutaneously t.i.w. times 1 week with escalation up to 6 MU/m2 IFN subcutaneously t.i.w for 16 to 24 weeks achieved loss of HBV DNA and HBeAg at 24 weeks of follow-up as opposed to 10% of untreated control patients. The maximum weekly dosage was 10 MU t.i.w. Forty-one percent of the responders lost HBsAg compared with none of the untreated controls. Thirty-five percent of children with a low baseline HBV DNA (< 100 pg/mL) responded compared with 9% with higher levels of HBV DNA. Only 5% of children who had contracted HBV via maternal-fetal transmission achieved a response compared with 31% of those who acquired HBV via other routes. A meta-analysis of 240 children treated with IFN for chronic HBV infection versus untreated controls demonstrated the following odds ratios: (1) increased HBV clearance (2.2), (2) HBeAg clearance (2.2), and (3) ALT normalization (2.3).

IFN is indicated for the treatment of chronic HBV in children 1 year of age or older who have compensated liver disease. Patients should be without a history of hepatic encephalopathy, variceal bleeding, and ascites; should have a normal serum bilirubin and albumin; < 2 seconds prolongation of prothrombin time; white blood cells > 4000/mm3; and platelets > 150,000/mm3.

At baseline prior to therapy, as well as at weeks 1, 2, 4, 8,12, and 16 of therapy, the following tests should be performed:

1. Complete blood count with platelets

2. Aspartate aminotranferase

4. Alkaline phosphatase

5. Total and direct bilirubin

6. Albumin

HBeAg, hepatitis B surface antigen (HbsAg), and HBV DNA should be monitored at the beginning of therapy, at the end of 16 weeks of therapy, as well as at 3 and 6 months after cessation of therapy, because some patients may become virologic responders after discontinuation of therapy. Patients who respond to therapy often develop a flare (transient increase in ALT < 2 times baseline value) 8 to 12 weeks after initiation of therapy (59% of responders versus 35% of nonresponders). IFN can be continued during the flare unless signs of liver failure ensue; patients should be monitored clinically and biochemically every 2 weeks during a flare. Adverse effects include flu-like symptoms, anxiety, depression, anorexia, weight loss, hair loss, bone marrow suppression, thyroid disorders, and auto-antibody induction.

The following dose reduction/stopping rules should be used:

White blood cells

Platelet Granulocytes count

Reduce dose 50% < 1.5 x 109/L < 0.75 x 109/L < 50 x 109/L Permanently < 1.0 x 109/L < 0.5 x 109/L < 25 x 109/L discontinue

Free Yourself from Panic Attacks

Free Yourself from Panic Attacks

With all the stresses and strains of modern living, panic attacks are become a common problem for many people. Panic attacks occur when the pressure we are living under starts to creep up and overwhelm us. Often it's a result of running on the treadmill of life and forgetting to watch the signs and symptoms of the effects of excessive stress on our bodies. Thankfully panic attacks are very treatable. Often it is just a matter of learning to recognize the symptoms and learn simple but effective techniques that help you release yourself from the crippling effects a panic attack can bring.

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