Chronic hepatitis B in pregnant women: Current trends and approaches

Chronic hepatitis B(CHB)is a significant public health problem worldwide.The aim of the present review is to summarize the actual trends in the management of CHB in pregnant women.The prevalence of hepatitis B virus(HBV)infection in pregnant women is usually comparable to that in the general population in the corresponding geographic area.All women have to be screened for hepatitis B surface antigen(HBsAg)during pregnancy.Additional examinations of pregnant women with CHB may include maternal hepatitis B e antigen,HBV viral load,alanine aminotransferase level,and HBsAg level.The management of pregnancy depends on the phase of the HBV infection,which has to be determined before pregnancy.In women of childbearing age with CHB,antiviral therapy can pursue two main goals:Treatment of active CHB,and vertical transmission prevention.During pregnancy,tenofovir is the drug of choice in both cases.A combination of hepatitis B immunoglobulin and vaccine against hepatitis B should be administered within the first 12 h to all infants born to mothers with CHB.In such cases,there are no contraindications to breastfeeding.

Pay attention to the rehabilitation of cancer patients—Excerpts of the 2013 NCCN Guidelines for Survivorship

For some survivors, the consequences of cancer are minimal; these patients can return to a normal life after the completion of treatment. In fact, a majority of cancer survivors report being in good general health and experience good to excellent quality of life. A recent review suggests that at least 50% of survivors suffer from some late effects of cancer treatment. The most common problems in cancer survivors are depression, pain, and fatigue. The guidelines suggest the following standards for survivorship care:(1) prevention of new and recurrent cancers and other late effects;(2) surveillance for cancer spread, recurrence, or second cancers;(3) assessment of late psychosocial and medical effects;(4) intervention for consequences of cancer and treatment(eg, medical problems, symptoms, psychologic distress, financial and social concerns); and(5) coordination of care between primary care providers and specialists to ensure that all of the survivor's health needs are met. The NCCN Survivorship Panel hopes that these guidelines can help both oncologic and primary health care professionals lessen the burden left on survivors by their cancer experience so they can transition back to a rewarding life.