American family physician
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American family physician · Nov 2010
ReviewCaring for pregnant women and newborns with hepatitis B or C.
Family physicians encounter diagnostic and treatment issues when caring for pregnant women with hepatitis B or C and their newborns. When hepatitis B virus is perinatally acquired, an infant has approximately a 90 percent chance of becoming a chronic carrier and, when chronically infected, has a 15 to 25 percent risk of dying in adulthood from cirrhosis or liver cancer. However, early identification and prophylaxis is 85 to 95 percent effective in reducing the acquisition of perinatal infection. ⋯ Infants of mothers who are positive for hepatitis B surface antigen should receive hepatitis B immune globulin and hepatitis B vaccination within 12 hours of birth, and other infants should receive hepatitis B vaccination before hospital dis- charge. There are no effective measures for preventing perinatal hepatitis C transmission, but transmission rates are less than 10 percent. Perinatally acquired hepatitis C can be diagnosed by detecting hepatitis C virus RNA on two separate occasions between two and six months of age, or by detecting hepatitis C virus antibodies after 15 months of age.
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American family physician · Nov 2010
ReviewHuman papillomavirus: clinical manifestations and prevention.
Human papillomaviruses cause the most common sexually transmitted infection in the world and are responsible for nearly all cases of cervical cancer. Genital human papillomavirus infection can be divided into low-risk infections (causing genital warts) and high-risk infections (causing cervical intraepithelial neoplasia, and cervical and other cancers). Exposure to human papilloma- virus typically produces a sexually transmitted infection that may progress to a clinically apparent process, such as genital warts and cervical intraepithelial neoplasia lesions of the lower genital tract. ⋯ Risk factors for persistent infection include multiple sex partners, sex at an early age, history of sexually transmitted infections, and smoking. Condom use is only partially protective against human papillomavirus infection. The two human papillomavirus vaccines are most effective if given to girls before the onset of sexual activity.
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Microcytosis is typically an incidental finding in asymptomatic patients who received a complete blood count for other reasons. The condition is defined as a mean corpuscular volume of less than 80 µm3 (80 fL) in adults. The most common causes of microcytosis are iron deficiency anemia and thalassemia trait. ⋯ If the serum ferritin level is not initially low, further evaluation should include total iron-binding capacity, transferrin saturation level, serum iron level, and possibly hemoglobin electrophoresis. Anemia of chronic disease is suggested with low iron levels and decreased total iron-binding capacity. Patients with beta-thalassemia trait usually have elevated levels of hemoglobin A2.
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Nongenital herpes simplex virus type 1 is a common infection usually transmitted during childhood via nonsexual contact. Most of these infections involve the oral mucosa or lips (herpes labialis). The diagnosis of an infection with herpes simplex virus type 1 is usually made by the appearance of the lesions (grouped vesicles or ulcers on an erythematous base) and patient history. ⋯ Oral acyclovir, valacyclovir, and famciclovir are effective in treating acute recurrence of herpes labialis (cold sores). Recurrences of herpes labialis may be diminished with daily oral acyclovir or valacyclovir. Topical acyclovir, penciclovir, and docosanol are optional treatments for recurrent herpes labialis, but they are less effective than oral treatment.