Risk Factors for Hepatitis C Virus Antibody Positivity in Blood Donors in a Low-Risk Country

Demographic variables, sexual risk behavior and prevalence of parenteral risk factors were studied in 305 randomly selected donors seronegative for hepatitis C virus, in 170 randomly selected donors reactive on solely enzyme-linked immunosorbent assay (ELISA C-100), in 71 consecutive donors reacting indeterminately according to the second-generation recombinant immunoblot assay (RIBA II) and in 46 consecutive donors found to be positive using the RIBA II. Donors who were positive by RIBA II had significantly more often a risk factor, for example use of intravenous drugs or previous blood transfusion, than donors reacting indeterminately (34 out of 46) (73.9%) versus 14 out of 71 (19.7%, p = 0.0000). Donors reacting indeterminately by RIBA II had one of those risk factors significantly more often than seronegative donors (14 out of 71) (19.7%) versus 23 out of 280 (7.8%, p < 0.005). When donors either positive or indeterminate by RIBA II were compared with donors negative for hepatitis C antibodies, the odds ratio for a possible parenteral source of infection was 7.6 (p = 0.0000). Subjects who had received a poor education (odds ratio 0.3, p < 0.001) or who lived in southern Finland (odds ratio 2.3, p < 0.05) were also at higher risk for being positive or indeterminate in RIBA II. First-time donors were also prone to having antibodies according to RIBA II (odds ratio 2.2, p = 0.1), whereas sexual risk behavior, gender, age, occupational class and type of residential area were not risk factors for hepatitis C antibodies in RIBA.(ABSTRACT TRUNCATED AT 250 WORDS)     

Heart rate reduces when stroke patients are touched . . . And??

McFadden KL, Hernández TD. Cardiovascular benefits of acupressure (Jin Shin) following stroke. Complement Ther Med 2010; 18: 42–8.     

Hypergammaglobulinemia can be associated with a positive direct antiglobulin test, a nonreactive eluate, and no evidence of hemolysis

To determine the cause of a positive direct antiglobulin test (DAT), blood banks routinely perform serologic tests on eluates prepared from DAT-positive red cells. Negative eluates traditionally have been suspected to be associated with drug reactions. This report confirms that the most frequent cause of a positive DAT and a nonreactive eluate is hypergammaglobulinemia. The results of 74 patient samples with positive DATs were analyzed retrospectively. Eluates prepared from the red cells of 54 patients (72.9%) reacted; eluates from 20 patients (27.1%) did not react. This latter group had identical serologic and clinical findings, suggesting that they made up a homogeneous group. In particular, the patients had a positive DAT, a negative indirect antiglobulin test, and a negative eluate; an increased serum concentration of IgG; and no evidence of hemolysis. In a subsequent study, DATs were performed prospectively on red cells from 44 consecutive patients with elevated serum IgG levels. The serum IgG concentration was highest in the three patients whose red cells had a positive DAT. The DAT also became positive in two patients treated with high-dose intravenous gammaglobulin (IV IgG). These studies indicate that a negative eluate from red cells with a positive DAT, a common serologic finding, is often caused by hypergammaglobulinemia. The authors postulate that IgG binds nonspecifically to the red cells because of the hypergammaglobulinemia.     

Fecal calprotectin, MMP-9, and human beta-defensin-2 levels in pediatric inflammatory bowel disease

Purpose

Fecal MMP-9 and human beta-defensin-2 (HBD-2) levels, potential markers of intestinal inflammation, are insufficiently explored in pediatric inflammatory bowel disease (IBD). The aim was to study fecal MMP-9 and HBD-2 in pediatric IBD to compare their performance to calprotectin and to study whether they would provide additional value in categorizing patients according to their disease subtype.

Methods

Fecal calprotectin, MMP-9, and HBD-2 levels were measured with ELISA in 110 pediatric patients with IBD (Crohn’s disease, n?=?68; ulcerative colitis (UC), n?=?27; unclassified, n?=?15; median age, 14). To compare the performance of the fecal markers, the area under the receiver operating characteristics curve (±95 % CI) was used. In addition, the best cut-off values of each measure to differentiate IBD patients and controls (n?=?27 presenting with diarrhea, abdominal pain, and/or anemia) were derived by maximizing sensitivity and specificity.

Results

Of the fecal markers studied, calprotectin performed best for separation of IBD and non-IBD patients with the area under curve (AUC) of 0.944 (95 % CI, 0.907 to 0.981). For MMP-9, AUC was 0.837 (95 % CI, 0.766 to 0.909), the levels being significantly higher in active IBD and in UC compared with Crohn’s disease (p?=?0.0013), but categorization of these patient groups did not take place. HBD-2 did not categorize any of the studied groups.

Conclusions

Calprotectin was the best fecal marker in pediatric IBD, but MMP-9 showed almost comparable performance in UC, suggesting applicability as a surrogate marker of inflammation. Fecal HBD-2 did not bring information to the disease characteristics of pediatric IBD patients.     

Screening for coeliac disease in women with a history of recurrent miscarriage or infertility

Because subclinical coeliac disease may decrease fertility or complicate pregnancy, we screened women with recurrent miscarriage of unknown aetiology (   n = 63  ), unexplained infertility (   n = 47  ) and infertility with a known cause (   n = 82  ), for anti-endomysium antibodies in serum to find undiagnosed coeliac disease. One woman (1.6%) with recurrent miscarriage, another woman (2.1%) with unexplained infertility and one woman (2.0%) in the control group (   n = 51  ), were considered to have coeliac disease. We could not demonstrate a higher frequency of coeliac disease in women with infertility or recurrent miscarriage, but suggest that undiagnosed coeliac disease is common in women.