High prevalence of anti-hepatitis delta virus antibody in chronic liver disease in Somalia.

We have assessed the prevalence of hepatitis delta virus (HDV) infection in people with histologically proven chronic liver disease living in Somalia. Among 104 patients studied (14 with chronic persistent hepatitis, 74 with chronic active hepatitis, and 16 with active cirrhosis), 52 were positive for hepatitis B surface antigen; of these, 26 (50%) carried anti-delta antibodies. HDV infection was detected more frequently in sera from hepatitis B e antigen (HBeAg) negative patients (60.9%) than in HBeAg positive patients (9.1%). Using the dot-blot hybridization technique, serum hepatitis B virus deoxyribonucleic acid was revealed in 73.1% of patients without HDV infection, while it was detected in only 7.7% of anti-delta positive patients. It is concluded that HDV is strongly associated with chronic liver disease in Somalia.     

Hepatitis C virus transmission in family members of Egyptian patients with HCV related chronic liver disease

Hepatitis C virus (HCV) infection in Egypt has become a major public health problem. In the present study, sexual and intrafamilial transmission of HCV infection were assessed in the family members of 200 Egyptian patients (index patients) with HCV-RNA positive and biopsy ascertained chronic hepatitis C. Index patients were 139 men (mean age 55+/-11 years) and 61 women (mean age 48+/-8 years). Family members consisted of 200 spouses; 139 women (mean age 45+/-12 years) and 61 men (mean age 58+/-9 years); and 355 children (183 males and 172 females, mean age 11.8+/-10 years). All the family members were tested for the presence of antibodies to HCV in their sera. Thereafter, HCV-RNA detection by PCR and HCV serotype determination were performed in antibody positive contacts. Hepatitis C virus antibodies were detected in 28 (14%) spouses, all of them were also positive for HCV-RNA. Hepatitis C virus serotypes were identical in HCV seropositive patient-spouse pairs (Serotype 4). None of the 355 children involved in this study showed HCV antibodies in their sera. No significant difference was found between the prevalence of male-to-female and female-to-male transmission of HCV. A highly significant association was found between both the age of the spouse and the duration of marriage to index patient and HCV seropositivity in spouses. Moreover, HCV seropositivity in spouses was significantly related to increased serum ALT and HCV-RNA levels, histological severity of chronic hepatitis C and to a history of dental care, as a risk factor for HCV acquisition, in index patients. It was concluded that spouses of patients with HCV viremia and chronic liver disease have an increased risk for acquiring HCV, while intrafamilial acquisition of HCV in non sexual contacts seems to be rare. The authors suggest that spouses of HCV viraemic patients should be followed routinely for markers of HCV infection and liver disease.     

The treatment of chronic hepatitis C virus infection in children

A 9-year-old boy, a 15-year-old boy, and a 6-year-old girl were infected with chronic hepatitis C virus (HCV). They had no physical complaints and a virus genotype that was favourable to treatment with peginterferon-alpha and ribavirin. The younger boy and the girl had liver fibrosis and were treated for 6 months; the virus was eradicated from the boy's plasma and the fibrosis diminished, while the girl's plasma virus was again present shortly after the end of treatment. In the older boy with no fibrosis, treatment was temporarily suspended due to behaviour problems. HCV infection is a frequent cause of chronic hepatitis in children. A better understanding of its natural history, improvements in the efficacy of treatment, and more favourable outcomes seen in children compared with adults have gradually changed the consideration to treat children with chronic HCV infection over the last 10 years. The decision whether or not to treat depends primarily on the degree of liver damage, virus genotype, and the psychological condition and motivation of the patient. Screening patients at risk for chronic HCV infection and careful follow-up for liver damage in those with HCV infection have become even more important given the new insights regarding treatment.     

Anthropometric evaluation of children with chronic liver disease

To characterize type and age distribution of malnutrition and to determine the usefulness of anthropometric indices in children with chronic liver disease (CLD), 56 children (aged 1 mo-10 y) with CLD underwent anthropometric evaluation when they were clinically stable. Mean-height Z score was depressed, whereas mean-weight Z score was closer to normal and mean-weight/height Z score was normal in patients with extrahepatic biliary atresia, idiopathic neonatal hepatitis, and other liver disorders. Patients with arteriohepatic dysplasia showed more severe depression of all three variables. In all patients, triceps skinfold (TSF) thickness Z scores were significantly more depressed than were weight/height Z scores. Depressions of midarm-circumference and midarm-muscle-area Z scores were intermediate. Mean-head-circumference Z score was depressed in children aged less than 24 mo. We conclude that acute (wasting) and chronic (stunting) malnutrition are common in childhood CLD and that weight/height values underestimate the degree of acute malnutrition compared with TSF thickness, most likely because of the inflated patient weight caused by organomegaly.     

A reduction in chronic hepatitis B virus infection prevalence among children in Vietnam demonstrates the importance of vaccination

Background

Vietnam has high endemic hepatitis B virus infection with >8% of adults estimated to have chronic infection. Hepatitis B vaccine was first introduced in the national childhood immunization program in 1997 in high-risk areas, expanded nationwide in 2002, and included birth dose vaccination in 2003. This survey aimed to assess the impact of Vietnam's vaccination programme by estimating the prevalence of hepatitis B surface antigen (HBsAg) among children born during 2000–2008.

Methods

This nationally representative cross-sectional survey sampled children based on a stratified three-stage cluster design. Demographic and vaccination data were collected along with a whole blood specimen that was collected and interpreted in the field with a point-of-care HBsAg test.

Results

A total of 6,949 children were included in the survey analyses. The overall HBsAg prevalence among surveyed children was 2.70% (95% confidence interval (CI): 2.20–3.30). However, HBsAg prevalence was significantly higher among children born in 2000–2003 (3.64%) compared to children born 2007–2008 (1.64%) (prevalence ratio (PR: 2.22, CI 1.55–3.18)). Among all children included in the survey, unadjusted HBsAg prevalence among children with ≥3 doses of hepatitis B vaccine including a birth dose (1.75%) was significantly lower than among children with ≥3 doses of hepatitis B vaccine but lacked a birth dose (2.98%) (PR: 1.71, CI: 1.00–2.91) and significantly lower than among unvaccinated children (3.47%) (PR: 1.99, CI: 1.15–3.45). Infants receiving hepatitis B vaccine >7 days after birth had significantly higher HBsAg prevalence (3.20%) than those vaccinated 0-1 day after birth (1.52%) (PR: 2.09, CI: 1.27–3.46).

Conclusion

Childhood chronic HBV infection prevalence has been markedly reduced in Vietnam due to vaccination. Further strengthening of timely birth dose vaccination will be important for reducing chronic HBV infection prevalence of under 5 children to <1%, a national and Western Pacific regional hepatitis B control goal.     

Search for hepatitis delta virus (HDV) infection in hepatitis C patients in north-eastern Poland. Comparison with anti-HDV prevalence in chronic hepatitis B

Hepatitis C virus and hepatitis D virus have been shown to suppress HBsAg synthesis. Thus it is possible that HDV infection occurs despite the lack of detectable HBsAg. The aim of our study was to (a) determine the prevalence of HDV infection in patients with chronic hepatitis C (b) compare it with the prevalence of HDV infection in HBsAg positive patients with hepatitis B. The study group consisted of 51 chronic hepatitis C patients, 30 HIV infected drug addicts (27 of them were also positive for anti-HCV) and 102 hepatitis B patients. The participants were tested for anti-HDV, anti-HCV and HBsAg. All anti-HCV positive patients were negative for anti-HDV. Four individuals with anti-HDV belonged to hepatitis B group and constituted 3.9% of all HBsAg positive subjects. We conclude that (a) there is currently no evidence of HDV infection among HCV infected patients in our region (b) hepatitis delta infection is rare in north-eastern Poland.     

儿童病毒感染与川崎病发病及冠状动脉病变的相关性

目的：探究病毒感染与川崎病（ KD）发病及冠状动脉病变的相关性。方法选取KD儿童105例为KD组,同期选取发热性疾病但非KD患儿210例为非KD组。对两组患儿的病毒感染情况进行比较,并行超声心动图检查,比较两组儿童冠状动脉病变情况。结果两组患儿中病毒感染232例,其中,KD组感染96例,占91．43％,非KD组感染136例,占64．76％。两组EB病毒感染率比较,KD组患儿明显高于非KD组患儿,差异具有统计学意义（χ2＝32．874,P＜0．001）;呼吸道合胞病毒、副流感病毒、流感病毒、腺病毒、单纯疱疹病毒、冠状病毒感染率两组比较,差异均无统计学差异（均P＞0．05）。分别将KD组和非KD组分为感染组与未感染组,其中KD组中感染组患儿冠状动脉损伤率最高,为46．55％（43／96）,显著高于KD组的未感染组（11．11％）,差异均具有统计学意义（确切概率法得出P＝0．04）,亦高于非KD组的感染组（7．59％）和未感染组（8．22％）,差异均具有统计学意义（χ2值分别为42．45、27．41,均P＜0．001）;而KD组中未感染组（11．11％）、非KD组的感染组（7．95％）和未感染组（8．11％）比较差异无统计学意义（P＞0．05）。结论患儿病毒感染与KD发病有关,且病毒感染的KD患儿更易发生冠状动脉病变。     

Smoking among nurses in Turkey: comparison with other countries

The purpose of this study was to obtain baseline information on smoking among nurses. An attempt was made to contact, in person, all 301 nurses working for the university hospital in Sivas, Turkey, and when contacted they were asked to complete an anonymous questionnaire. Each unit of the hospital was visited three times, and 239 (79%) nurses were reached who all completed the questionnaire. Of the 239 respondents, 107 (45%) were current smokers, reflecting a substantially higher prevalence compared to that among the adult female population. The quit ratio was 22.5%. Of 127 ever-smoker nurses who responded to the related item, 90% started smoking during or after nursing education. This pattern of smoking initiation was different from the pattern in developed countries where nurses had already started smoking before beginning that training. Nurses with a high school education had a significantly higher prevalence of ever-smoking. Most respondents frequently or sometimes saw doctors smoking in rooms for nurses and in rooms for doctors in inpatient services. In-depth qualitative studies are needed to determine the reasons for the different smoking-initiation pattern.     

The prevalence of TT virus and GB virus C/hepatitis G virus infection in individuals with raised liver enzymes but without HBV or HCV infection in Taiwan

The prevalence of TT virus (TTV) and GB virus-C/hepatitis G virus (GBV-C/HGV) infection and the association with raised liver function tests in 546 Taiwanese with negative HBsAg, anti-HCV and HCV RNA was elucidated. They were tested for serum alanine aminotransferase (ALT), GBV-C/HGV RNA, anti-envelope protein 2 antibody (anti-E2) and TTV DNA. Direct sequencing and phylogenetic analyses were performed on 58 isolates for TTV genotype determination. The prevalence of TTV DNA, GBV-C/HGV RNA, anti-E2 and over all GBV-C/HGV exposure was 24.9, 3.4, 8.2 and 11.1%, respectively. Using uni- and multi-variate analyses, male gender and TTV viremia were associated significantly with raised ALT values. Sixty-nine percent of TTV isolates were deduced to be TTV genotype 1 and they had significantly lower mean age than genotype non-1 isolates. In the population, raised ALT may be related to male gender and be attributable to TTV infection but not to GBV-C/HGV among individuals with no evidence of current HBV and HCV infection. TTV genotype 1 is the most prevalent genotype and associated with younger age.     

Impact of respiratory virus infection in patients with chronic chest disease.

This study investigated the morbidity associated with respiratory virus infections in patients with well-documented chest disease, and the risk of transmission between close contacts. Patients informed the study team if they were exposed to a family member or colleague with a cold. Patients and symptomatic index cases recorded respiratory symptoms during the study period. Acute nasopharyngeal swabs and paired sera were obtained for viral diagnosis. Twenty-five (43%) of 58 recorded exposures resulted in a symptomatic illness and 16 (28%) patients developed lower respiratory tract symptoms. Sixteen (64%) of the 25 symptomatic patients contacted their general practitioner, 14 (56%) received antibiotics and 4 (16%) were hospitalized. Mean duration of illness was 10.6 days in symptomatic patients and 5.7 days in their corresponding index cases (P < 0.005). Mean symptom scores were 100.6 in symptomatic patients and 62.2 in index cases (P < 0.01). Respiratory viruses were identified in 19 (33%) episodes. Rhinovirus, coronavirus and respiratory syncytial virus infections were all associated with lower respiratory tract exacerbations. Respiratory tract symptoms following exposure to a cold were comparatively severe in these patients with chronic chest disease. This group of patients might gain particular benefit from the introduction of effective vaccines or antiviral therapy.     

EB病毒系列检测在小儿EBV感染疾病诊断中的意义

目的 探讨EB病毒系列抗体5项(EBNA-1-IgG、EBV-EA-D-IgG、EBV-CA-IgM、EBV-CA-IgG、EBV-CA-IgG亲合力)检测在小儿EBV感染相关疾病诊断中的临床应用价值.方法 采用固相酶联免疫吸附法检测129例EB病毒感染患儿血清样本中的EB病毒系列抗体,并对其检测结果进行统计学分析.结果 单纯检测EBV-CA-IgM阳性患儿48例,阴性81例,阳性率为37.2%.利用EB系列5项检测,在EBV-CA-IgM阳性组中,除提示为EB病毒感染外,还可分别提示为感染急性期、早期、晚期、复发期和慢性期各阶段;在EBV-CA-IgM阴性组中,也可提示为感染早期、晚期和曾经感染期,但发现阴性组中有12.4%的感染期患儿被漏诊.结论 EB病毒系列抗体检测能根据EB病毒感染不同时期的抗体水平,确定感染各期别,可减少漏诊,提早治疗,且检测方法简单,值得在小儿EBV感染相关疾病诊断中推广使用.     

中国儿童非酒精性脂肪性肝病患病率的Meta分析

目的 系统评价中国儿童及超重肥胖儿童非酒精性脂肪性肝病(NAFLD)患病率,为儿童及超重肥胖儿童 NAFLD 的流行病学研究和临床防治提供数据基础。方法 计算机检索中国知网、维普网、万方数据知识平台、中国生物医学文献数据库、PubMed、The Cochrane Library、EMbase、Web of Science,收集 2000-2021 年之间的关于中国儿童及超重肥胖儿童 NAFLD 患病率的中英文研究。采用R语言(version 4.0.5)对提取数据进行 Meta 分析,以随机效应模型合并数据,运用漏斗图、Egger's test、Begg's test评估偏倚风险。结果 共纳入 25项研究,其中 8 项研究为儿童NAFLD患病率,17 项研究为超重肥胖儿童 NAFLD 患病率,研究样本量总计 35 300例,其中肥胖儿童样本量为 7 649 例。Meta 分析结果显示,中国儿童 NAFLD 患病率为6.3%(95%CI:4.6%~7.9%),超重肥胖儿童 NAFLD 患病率为40.4%(95%CI:31.5%~49.9%)。亚组分析结果显示,不同性别、研究地区、研究时间的儿童及超重肥胖儿童NAFLD患病率存在差异。结论 我国儿童及超重肥胖儿童 NAFLD 患病率较高,儿童 NAFLD 正逐渐成为我国重大公共卫生问题之一。     

Branched-chain amino acid needs in children with mild-to-moderate chronic cholestatic liver disease

Protein-energy malnutrition is prevalent in children with chronic cholestatic liver disease. Supplementation of branched-chain amino acids (BCAA) in infants and children with chronic liver disease has been associated with significant improvement in growth and nitrogen balance, suggesting that BCAA requirements are increased in chronic liver disease. The goal of the present study was to determine the total BCAA requirement in children with mild-to-moderate chronic cholestatic (MCC) liver disease using indicator amino acid oxidation (IAAO). Total BCAA requirements were determined in 6 children (6.3 +/- 3.7 y, mean +/- SD) with MCC liver disease. Children were randomly assigned to receive 7 graded intakes of total BCAA. Individual BCAA in the test diet were provided in the same proportions as those present in egg protein to minimize the potential interactive effects of individual BCAA on assessment of requirement. The total BCAA requirement was determined by measuring the oxidation of l-[1-13C] Phe to 13CO2 [F13CO2 in micromol/(kg x h)], after a primed, continuous oral administration of the tracer and using a 2-phase linear regression crossover regression analysis. The estimated mean requirement and the upper limit of the 95% CI for total BCAA establishing using the IAAO in children with MCC liver disease were 209 and 272 mg/(kg x d), respectively. Total BCAA estimated average requirements using the IAAO were significantly higher than mean requirements established previously for healthy children (P < 0.05).     

Low prevalence of hepatitis D (delta) virus infection in a nephrology unit in south India.

Fifty-five consecutive patients with end-stage renal disease entering haemodialysis programmes over a two-month period and 48 consecutive recipients of renal allografts during a period of 6 months were investigated for hepatitis B virus (HBV) and hepatitis D virus (delta) infection. HBV markers were present in 25 of the former and 40 of the latter. Of the 65 patients with HBV infection, 12 were not available for delta antibody screening. HBV infection was present for a mean of 2.5 months and 45.3% of those infected had clinical hepatitis; none had fulminant hepatitis. All the patients tested were negative for antidelta antibody. An additional patient on dialysis with delta superinfection and hepatic encephalopathy is also reported.     

Evaluation of new medicines in Spain and comparison with other European countries

ObjectiveTo compare the use of health technology assessment (HTA) as a tool to support pricing and reimbursement (P&R) of new medicines in Spain with England, Sweden, France and Germany.MethodFor each country, the literature is used to identify the purpose and timing of the P&R decision, the HTA and decision-making procedures used to generate evidence, and the criteria used to make decisions.ResultsResults are presented as a summary of the HTA landscape for P&R of new medicines in each country. Comparisons are made between Spain and other countries regarding the procedure and implementation of HTA.ConclusionsBased on these assessments, we made recommendations for how HTA might develop in Spain with the aim of improving governance and efficiency. Spain has made considerable progress in recent years, but still falls short of international standards in terms of independence of the HTA agencies and decision-making committees from political influence and industrial policy, the setting of prices of medicines in relation to health gain, improve the transparency of the process and results of the evaluation, and promote the participation of stakeholders. In common with other countries, Spain needs to clarify the role of cost-effectiveness criteria. Further progress needs to be made to coordinate effort across the various agencies, strengthen technical staff, and ensure equitable access to medicines between regions.