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Papatheodoridis G, Thomas HC, Golna C, Bernardi M, Carballo M, Cornberg M, Dalekos G, Degertekin B, Dourakis S, Flisiak R, Goldberg D, Gore C, Goulis I, Hadziyannis S, Kalamitsis G, Kanavos P, Kautz A, Koskinas I, Leite BR, Malliori M, Manolakopoulos S, Matičič M, Papaevangelou V, Pirona A, Prati D, Raptopoulou-Gigi M, Reic T, Robaeys G, Schatz E, Souliotis K, Tountas Y, Wiktor S, Wilson D, Yfantopoulos J, Hatzakis A. Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference. J Viral Hepat 2016; 23 Suppl 1:1-12. [PMID: 26809941 DOI: 10.1111/jvh.12493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 12/26/2022]
Abstract
In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.
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Affiliation(s)
- G Papatheodoridis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - H C Thomas
- Hepatology and Gastroenterology Section, Department of Medicine, Imperial College, London, UK
| | - C Golna
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg
| | - M Bernardi
- Dipartimento di Scienze Mediche e Chirurgiche, University of Bologna, Bologna, Italy
| | - M Carballo
- International Centre for Migration, Health and Development, Geneva, Switzerland
| | - M Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - G Dalekos
- University of Thessaly Medical School, Karditsa, Greece
| | - B Degertekin
- Acibadem University Medical School, Istanbul, Turkey
| | - S Dourakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - R Flisiak
- Medical University of Bialystok, Bialystok, Poland
| | | | - C Gore
- Hepatitis B & C Public Policy Association, Luxembourg, Luxembourg.,World Hepatitis Alliance, The Hepatitis C Trust, London, UK
| | - I Goulis
- Medical School, Aristotle University, Thessaloniki, Greece
| | - S Hadziyannis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - G Kalamitsis
- Hellenic Liver Patient Association "Prometheus", Athens, Greece
| | - P Kanavos
- London School of Economics, London, UK
| | - A Kautz
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - I Koskinas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - B R Leite
- National Parliament, Lisbon, Portugal
| | - M Malliori
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Manolakopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - M Matičič
- Viral Hepatitis Department, Infectious Diseases Clinic, University Medical Centre, Ljubljana, Slovenia
| | - V Papaevangelou
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Pirona
- European Monitoring Center for Drugs and Drug Addiction, Lisbon, Portugal
| | - D Prati
- Alessandro Manzoni Hospital, Lecco, Italy
| | - M Raptopoulou-Gigi
- Hellenic Center for Disease Control and Prevention (HCDCP), Athens, Greece
| | - T Reic
- European Liver Patients Association (ELPA), Sint-Truiden, Belgium
| | - G Robaeys
- Department of Gastroenterology and Hepaatology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - E Schatz
- Correlation Network, Amsterdam, the Netherlands
| | | | - Y Tountas
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - S Wiktor
- World Health Organization, Geneva, Switzerland
| | | | - J Yfantopoulos
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - A Hatzakis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Simsek Z, Ekinci O, Cindoruk M, Karakan T, Degertekin B, Akyol G, Unal S. Fibrinogen storage disease without hypofibrinogenemia associated with estrogen therapy. BMC Gastroenterol 2005; 5:36. [PMID: 16287505 PMCID: PMC1299324 DOI: 10.1186/1471-230x-5-36] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Accepted: 11/15/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cytoplasmic inclusion bodies within hepatocytes may have different etiologies, including the Endoplasmic Reticulum Storage Diseases (ERSDs). ERSD is a pathological condition characterized by abnormal accumulation of proteins destined for secretion in the endoplasmic reticulum of hepatocytes; it may be congenital (primary) or acquired (secondary). Fibrinogen storage disease is a form of ERSD. CASE PRESENTATION We present a case of fibrinogen storage disease secondary to estrogen replacement therapy. Its causal relationship to the drug is shown by histological, immunohistochemical and ultrastructural studies of paired liver biopsies obtained during and after the drug therapy. CONCLUSION The liver biopsies of patients with idiopathic liver enzyme abnormalities should be carefully evaluated for cytoplasmic inclusion bodies and, although rare, fibrinogen deposits.
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Affiliation(s)
- Z Simsek
- Gazi University Faculty of Medicine, Gastroenterology Department, Ankara, Turkey
| | - O Ekinci
- Gazi University Faculty of Medicine, Pathology Department, Ankara, Turkey
| | - M Cindoruk
- Gazi University Faculty of Medicine, Gastroenterology Department, Ankara, Turkey
| | - T Karakan
- Gazi University Faculty of Medicine, Gastroenterology Department, Ankara, Turkey
| | - B Degertekin
- Gazi University Faculty of Medicine, Gastroenterology Department, Ankara, Turkey
| | - G Akyol
- Gazi University Faculty of Medicine, Pathology Department, Ankara, Turkey
| | - S Unal
- Gazi University Faculty of Medicine, Gastroenterology Department, Ankara, Turkey
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Kalkanci A, Tuncer C, Degertekin B, Eren A, Kustimur S, Ilhan MN, Dursun A. Detection ofCandida albicans by culture, serology and PCR in clinical specimens from patients with ulcerative colitis: Re-evaluation of an old hypothesis with a new perspective. Folia Microbiol (Praha) 2005; 50:263-7. [PMID: 16295666 DOI: 10.1007/bf02931575] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The relationship between inflammatory bowel disease and microorganisms was evaluated. The presence of Candida albicans-specific IgM and IgG antibodies in serum samples and the presence of C. albicans in stool and colonal mucosa samples of the patients did not exhibit any significant difference between 21 patients in active stage and 15 patients in remission of ulcerative colitis (UC) (compared with 19 control patients). The invasion of yeast cells to the colonal mucosa was demonstrated by detecting C. albicans DNA using specific PCon1, PCon2, and PspA2 primers in PCR assay. Eighteen of 36 patients (50%) were found to be DNA positive while in 19 controls only 4 (21%) were found to be positive. The presence of DNA in the association of the positive serological reactivity is suggested as an important diagnostic marker of UC.
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Affiliation(s)
- A Kalkanci
- Department of Microbiology, Faculty of Medicine, Gazi University, Ankara, Turkey.
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