Antibodies to hepatitis E virus among several populations in Greece: increased prevalence in an hemodialysis unit

BACKGROUND: Hepatitis E virus (HEV) has been found to be the causative agent of enterically transmitted non-A, non-B hepatitis in tropical and subtropical countries. Several investigators, however, have indicated that HEV could be endemic in Europe, albeit at a low prevalence. STUDY DESIGN AND METHODS: The purpose of this study was to estimate the prevalence of anti-HEV in various populations in northwestern Greece (Epirus region). Healthy blood donors (2636), refugees from southern Albania (350), children (165), injecting drug users (IDUs) (65), multiply transfused patients (62), patients with chronic viral hepatitis (75), and chronic hemodialysis patients (149) were investigated for anti-HEV by enzyme immunoassay and confirmatory Western blot assay. In addition, 380 consecutive healthy blood donors and 62 hemodialysis patients from a neighboring area (Agrinion, Greece) were investigated. RESULTS: A very low presence of anti-HEV antibody was found among healthy blood donors from Epirus (0.23%) and Agrinion (0.53%). Anti-HEV was not detected in children, IDUs, or multiply transfused patients. In contrast, a low but significant prevalence of anti-HEV was found among refugees (4.85%), patients with chronic viral hepatitis (5.3%), and hemodialysis patients from Epirus (1.34%), as compared with healthy blood donors from Epirus: p < 0.0001, p < 0.00001, and p < 0.10, respectively. A high prevalence (9.7%) of anti- HEV was revealed in patients at the hemodialysis unit of the General Hospital of Agrinion (p < 0.00005, compared to healthy blood donors from Agrinion). No significant association was found between anti-HEV positivity and the age or sex of donors, the duration of hemodialysis, positivity for hepatitis B or C virus infection markers, history of hepatitis, increased alanine aminotransferase, renal transplantation, a history of transfusion, or the number of units transfused. CONCLUSION: This study demonstrated a high prevalence of anti-HEV in a separate hemodialysis unit, without an association with the known routes of transmission of blood-borne viruses. This observation suggests that a still-undefined intra-unit factor or other factors are associated with HEV transmission.     

Physical activity and depressive symptoms among Norwegian adults aged 20-50

ABSTRACT Introduction: To analyze the association between physical activity (PA) and occurrence of depressive symptoms in The Nord‐Trøndelag Health Survey (HUNT 1 1984–1986, HUNT 2 1995–1997). Methods: In this prospective follow‐up study, we studied men and women who were 21–40 years old in HUNT 1, and participated in HUNT 2. The sample consisted of 3,353 women and 3,308 men. We used logistic regression and calculated odds ratios (OR) to assess the association between physical activity and depression (Hospital Anxiety and Depression Scale depression subscale [HADS‐D]). Confounding was addressed by excluding those with relevant health conditions and adjustment. Results: Among women 272 (8.1%) and among men 293 (8.9%) scored higher than 8 on the HADS‐D scale. We found a higher mean on HADS‐D in men and women who were inactive. Men participating in low PA had significantly lower scores on depression (OR=0.63, confidence interval [CI]=0.43–0.93, p=.02) than inactive men. Women participating in medium PA had significantly lower scores on depression (OR=0.69, CI=0.49–0.97, p=.03) than inactive women. Conclusions: Young men and women who exercised were less likely to have a high depression score, compared with inactive people. Our prospective, observational study included a large population and indicated some significant associations between physical activity and depression.     

Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III)

NHANES III measured serum TSH, total serum T(4), antithyroperoxidase (TPOAb), and antithyroglobulin (TgAb) antibodies from a sample of 17,353 people aged > or =12 yr representing the geographic and ethnic distribution of the U.S. population. These data provide a reference for other studies of these analytes in the U.S. For the 16,533 people who did not report thyroid disease, goiter, or taking thyroid medications (disease-free population), we determined mean concentrations of TSH, T(4), TgAb, and TPOAb. A reference population of 13,344 people was selected from the disease-free population by excluding, in addition, those who were pregnant, taking androgens or estrogens, who had thyroid antibodies, or biochemical hypothyroidism or hyperthyroidism. The influence of demographics on TSH, T(4), and antibodies was examined. Hypothyroidism was found in 4.6% of the U.S. population (0.3% clinical and 4.3% subclinical) and hyperthyroidism in 1.3% (0.5% clinical and 0.7% subclinical). (Subclinical hypothyroidism is used in this paper to mean mild hypothyroidism, the term now preferred by the American Thyroid Association for the laboratory findings described.) For the disease-free population, mean serum TSH was 1.50 (95% confidence interval, 1.46-1.54) mIU/liter, was higher in females than males, and higher in white non-Hispanics (whites) [1.57 (1.52-1.62) mIU/liter] than black non-Hispanics (blacks) [1.18 (1.14-1.21) mIU/liter] (P < 0.001) or Mexican Americans [1.43 (1.40-1.46) mIU/liter] (P < 0.001). TgAb were positive in 10.4 +/- 0.5% and TPOAb, in 11.3 +/- 0.4%; positive antibodies were more prevalent in women than men, increased with age, and TPOAb were less prevalent in blacks (4.5 +/- 0.3%) than in whites (12.3 +/- 0.5%) (P < 0.001). TPOAb were significantly associated with hypo or hyperthyroidism, but TgAb were not. Using the reference population, geometric mean TSH was 1.40 +/- 0.02 mIU/liter and increased with age, and was significantly lower in blacks (1.18 +/- 0.02 mIU/liter) than whites (1.45 +/- 0.02 mIU/liter) (P < 0.001) and Mexican Americans (1.37 +/- 0.02 mIU/liter) (P < 0.001). Arithmetic mean total T(4) was 112.3 +/- 0.7 nmol/liter in the disease-free population and was consistently higher among Mexican Americans in all populations. In the reference population, mean total T(4) in Mexican Americans was (116.3 +/- 0.7 nmol/liter), significantly higher than whites (110.0 +/- 0.8 nmol/liter) or blacks (109.4 +/- 0.8 nmol/liter) (P < 0.0001). The difference persisted in all age groups. In summary, TSH and the prevalence of antithyroid antibodies are greater in females, increase with age, and are greater in whites and Mexican Americans than in blacks. TgAb alone in the absence of TPOAb is not significantly associated with thyroid disease. The lower prevalence of thyroid antibodies and lower TSH concentrations in blacks need more research to relate these findings to clinical status. A large proportion of the U.S. population unknowingly have laboratory evidence of thyroid disease, which supports the usefulness of screening for early detection.     

Uncontrolled hypertension in older patients: markers and associated factors to masked and white-coat effect

Background Hypertension is the main risk factor for cardiovascular diseases, affecting more than half the elderly population. It is essential to know if they have proper control of hypertension. The aim of this study was to identify the associated factors to masked uncontrolled hypertension and false uncontrolled hypertension in older patients. Methods Two-hundred seventy-three individuals (70.1 ± 6.7 years-old) had blood pressure (BP) measured at the office and by ambulatory BP monitoring (ABPM), with the definition of controlled group (C), individuals with high office BP and adequate ABPM, called white-coat effect group (WCE), uncontrolled (UC), and subjects with appropriate office BP and elevated ABPM denominated masked effect group (ME). Age, body mass index, diabetes, pulse pressure (PP) and BP dipping during sleep were evaluated (Kruskal-Wallis test and logistic regression models). Results Age was higher in UC than in C and ME (P < 0.01), and 24-h ABPM PP was lower in C (48 ± 7 mmHg) and WCE (51 ± 6 mmHg) than in UC (67 ± 12 mmHg) and ME (59 ± 8 mmHg) (P < 0.01). Sleep systolic BP dipping was lower in ME than in C (P = 0.03). Female gender was associated with a greater chance of being of ME group, which showed a higher PP and lower BP dipping during sleep. Conclusions In older individuals, office BP measurements did not allow the detection of associated factors that would permit to differentiate WCE from UC group and C from ME group. ABPM favored the identification of a higher PP and a lower BP dipping during sleep in the masked effect and uncontrolled groups.     

Venous thromboembolism: a collaborative quality improvement model for practitioners,hospitals, and insurers

Venous thromboembolism (VTE) carries significant morbidity and mortality and affects a large portion of hospitalized patients. VTE prophylaxis is rated by the Agency for Healthcare Research and Quality as the most effective of 79 patient safety practices it assessed in 2001. Since 1997, Blue Cross Blue Shield of Michigan/Blue Care Network (BCBSM/BCN) have partnered with Michigan hospitals and providers in statewide registry-based collaborative quality improvement initiatives (CQI) aimed at improving the safety and quality of surgical and medical care; many of these collaborative have a particular focus on VTE prevention. The CQIs are uniquely structured to catalyze hospitals and practitioners to become self-optimizing. In this review, we describe the model BCBSM/BCN and participating Michigan hospitals have developed to improve the prevention and diagnosis of VTE for patients in the state of Michigan.     

Adhesion of human myeloma-derived cell lines to bone marrow stromal cells stimulates interleukin-6 secretion

Previous studies show that human myeloma-derived cell lines specifically adhere to fibronectin (FN) through very late antigen-4 (VLA-4; alpha 4 beta 1 integrin complex) and RGD-peptide mechanisms, which may contribute to the localization of tumor cells in bone marrow (BM). In these studies, we characterized the adhesion of myeloma- derived cell lines to both normal and myeloma BM stromal cells (BMSCs) and the effect of adhesion on DNA synthesis. Because interleukin-6 (IL- 6) plays an important role in the pathogenesis of multiple myeloma, we also examined the effects of tumor cell adhesion on IL-6 secretion by BMSCs. In 51chromium binding assays, the U266, ARH-77, and IM-9 cell lines showed 52% +/- 12%, 55% +/- 6%, and 47% +/- 7% specific adherence, respectively, to normal BMSCs and 74% +/- 4%, 60% +/- 3%, and 61% +/- 6% specific adherence, respectively, to myeloma BMSCs. In contrast, only 12% to 13% specific binding of HS-Sultan cells to BMSCs was noted. The binding of myeloma cells to BMSCs was partially blocked with anti-beta 1 monoclonal antibody (MoAb), anti-beta 2 integrin MoAb, and excess RGD peptide, suggesting multiple mechanisms for the adhesion of myeloma cell lines to BMSCs. Binding of cell lines to FN or myeloma BMSCs did not affect cell line proliferation; however, adhesion of myeloma cell lines to normal BMSCs decreased DNA synthesis, ie, stimulation indices are 0.1 +/- 0.04, 0.2 +/- 0.1, 0.2 +/- 0.07, and 0.1 +/- 0.06 for the adherent non-IL-6-dependent U266, ARH-77, HS- Sultan, and IM-9 cells, respectively (n = 5, P < .01). In contrast, adherence of IL-6-dependent B9 cells increased their proliferation (stimulation index, 3.2 +/- 0.7). Significant (twofold to eightfold) increases in IL-6 secretion were evident in cell line-adherent (> or = 12 hours) normal and myeloma BMSC cultures. Paraformaldehyde fixation of BMSCs before adhesion completely abrogated IL-6 secretion, suggesting that IL-6 secretion was triggered in BMSCs rather than in cell lines. Partial blocking of cell line adhesion to BMSCs, using anti- beta 1 integrin and anti-beta 2 integrin MoAbs and RGD peptide, also partially blocked the triggering of IL-6 secretion by BMSCs. When cell lines were placed in Transwell inserts and then cultured with either normal or myeloma BMSCs, permitting juxtaposition without cell to cell contact between myeloma cell lines and BMSCs, no increase in IL-6 secretion was observed.(ABSTRACT TRUNCATED AT 400 WORDS)     

Elective re‐intubation to treat complete left lung collapse following Tetralogy of Fallot repair in a very young child

An 18‐month‐old boy weighing 6 kilograms developed complete collapse of left lung following total correction of Tetralogy of Fallot on the next day of extubation. He received extensive chest physiotherapy, along with lung recruitment maneuver by using bubble CPAP, which failed to show any improvement in lung expansion in 2 days. He was then electively intubated on 3rd postoperative day (POD3) for the purpose of suctioning tracheobronchial secretions and maintaining positive airway pressure to open up the left lung. Good results were obtained immediately after intubation, and he was extubated 9 h later. His lung showed complete aeration afterward. He was transferred out of ICU on POD5 and discharged home on POD10.