Racial/ethnic disparities in the prevalence and awareness of Hepatitis B virus infection and immunity in the United States

Hepatitis B virus (HBV) infection in the United States is the most common among Asians followed by non‐Hispanic blacks. However, there have been few studies that describe HBV infection and immunity by racial group. Our study aimed to assess racial/ethnic disparities in the prevalence and awareness of HBV infection and immunity using nationally representative data. In the National Health and Nutrition Examination Survey 2011‐2014, 14 722 persons had HBV serology testing. We estimated the prevalence of HBV infection, past exposure, and immunity by selected characteristics and calculated adjusted odds ratios using survey‐weighted generalized logistic regression. Awareness of infection and vaccination history was also investigated. The overall prevalence of chronic HBV infection, past exposure and vaccine‐induced immunity was 0.34% [95%CI 0.24‐0.43], 4.30% [95%CI 3.80‐4.81], and 24.4% [95%CI 23.4‐25.4], respectively. The prevalence of chronic infection was 2.74% [95% CI 1.72‐3.76] in Asians, 0.64% [95% CI 0.35‐0.92] in non‐Hispanic blacks, and 0.15% [95% CI 0.06‐0.24] in non‐Asian, non‐blacks. Only 26.2% of those with chronic infection were aware of their infection. The prevalence of the past exposure was 21.5% [95%CI 19.3‐23.7] in Asians, 8.92% [95%CI 7.84‐9.99] in non‐Hispanic blacks, 2.05% [95%CI 1.49‐2.63] in non‐Hispanic whites and 4.47% [95%CI 3.25‐5.70] in Hispanics. Prevalence of vaccine‐induced immunity by each race was 34.1% [95%CI: 32.0‐36.2] in Asians, 25.5% [95%CI: 24.0‐27.0] in non‐Hispanic blacks, 24.0% [95%CI: 22.6‐25.4] in non‐Hispanic whites and 22.2% [95%CI: 21.3‐23.3] in Hispanics. There are considerable racial/ethnic disparities in HBV infection, exposure and immunity. More active and sophisticated healthcare policies on HBV management may be warranted.     

Consensus Bundle on Severe Hypertension During Pregnancy and the Postpartum Period

Complications arising from hypertensive disorders of pregnancy are among the leading causes of preventable severe maternal morbidity and mortality. Timely and appropriate treatment has the potential to significantly reduce hypertension‐related complications. To assist health care providers in achieving this goal, this patient safety bundle provides guidance to coordinate and standardize the care provided to women with severe hypertension during pregnancy and the postpartum period. This is one of several patient safety bundles developed by multidisciplinary work groups of the National Partnership for Maternal Safety under the guidance of the Council on Patient Safety in Women's Health Care. These safety bundles outline critical clinical practices that should be implemented in every maternity care setting. Similar to other bundles that have been developed and promoted by the Partnership, the hypertension safety bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. Although the bundle components may be adapted to meet the resources available in individual facilities, standardization within an institution is strongly encouraged. This commentary provides information to assist with bundle implementation.     

Echocardiogram-gated multislice spiral CT in functionally univentricular heart following long-lasting Waterston-Cooley anastomosis

Waterston-Cooley anastomosis may be carried out in patients with tricuspid atresia to provide pulmonary perfusion. It is associated with several complications, including preferential blood flow to the right lung, hypoplasia of the left pulmonary artery, obstruction of the anatomosis or rupture of pulmonary aneurysms. We study a patient with thrombosis in the pulmonary arteries following surgical construction of a Waterston shunt in childhood. Imaging findings and clinical symptoms are discussed with emphasis on echocardiogram-gated multislice spiral CT.     

Salivary receptors for the proline-rich protein-binding and lectin-like adhesins of oral actinomyces and streptococci

Colonization of the tooth surface by actinomyces and viridans group streptococci involves the attachment of these bacteria to adsorbed salivary components of the acquired enamel pellicle. The hypothesis that this attachment depends on specific adhesins has now been assessed from the binding of bacteria with well-defined adhesive properties to blots of SDS-PAGE-separated parotid and submandibular-sublingual (SM-SL) saliva. Streptococcus sanguis and type 2 fimbriated Actinomyces naeslundii, which bound terminal sialic acid and Galbeta1-3GalNAc, respectively, recognized only a few SM-SL salivary components, primarily MG2. In contrast, type 1 fimbriated A. naeslundii and S. gordonii, which bound purified proline-rich proteins (PRPs), recognized several other components from both SM-SL and parotid saliva. Significantly, bacteria that lacked PRP-binding and the lectin-like activities detected by binding to MG2 failed to bind any immobilized salivary component. These findings suggest the involvement of specific adhesins in bacterial recognition of many adsorbed salivary proteins and glycoproteins.     

Contraception is Health Promotion

Contraception can be considered a means of health promotion because when women control the timing of their childbearing, they, together with their health care providers, can ensure that they are healthy before conception, thereby minimizing risk of complications of pregnancy and childbirth. Ensuring that women have accessible and affordable contraceptive services takes on a new urgency in the current context of rising rates of maternal morbidity and mortality in the United States.     

Early laryngeal inhalation injury and its correlation with late sequelae

OBJECTIVE: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. STUDY DESIGN: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. METHODS: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. RESULTS: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. CONCLUSION: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness.     

Adenosine and its derivatives control human monocyte differentiation into highly accessory cells versus macrophages

Human peripheral blood monocytes have been found to undergo a transitory state of high accessory activity before they fully become macrophages. Time kinetics were done to follow this accessory potential. Studying the regulation of accessory activity, we have found that monocyte-derived accessory cells (m-AC) pass through two phases of development, which both are adversely controlled by cyclic nucleotides. Phase I is positively correlated by intracellular cAMP increase and can be arrested by adenosine 3';5' cyclic monophosphate (cAMP) and synergystic agents. In addition to cAMP, non-cyclic adenine nucleotides and adenosine also mimic all cAMP effects. This behavior is explained by the known presence of surface 5' nucleotidase and adenosine receptor, which in turn leads to activation of adenylate cyclase. At phase II serum is required to convert m-AC into macrophages. In the absence of serum, cells were arrested in the m-AC state. Adenine nucleotides effectively counteract the serum induction leading to the development of m-AC even in the presence of serum. Monocyte/macrophage markers such as Fc receptors and non-specific esterase strictly correlate negatively with the expression of accessory activity. Morphologically, the appearance of veils positively correlates with all experimental situations of high accessory activity. Therefore, it is evident that serum contains regulatory factors that strongly modify the accessory potency of the m-AC via the cyclic nucleotide system, thus presenting a potent immunoregulatory principle at the beginning of the immune cascade.     

Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization: the NHANES I Epidemiologic Followup Study. First National Health and Nutrition Examination Survey.

PURPOSE: Gastroesophageal reflux disease is an important and increasingly common condition. Both overweight and high fat food consumption have been implicated as causes of reflux disease. We examined the relationship of overweight, high dietary fat intake, and other factors with reflux disease hospitalization. METHODS: We studied participants in the first National Health and Nutrition Examination Survey, a population-based sample examined in 1971-75 and followed through 1992-93. Persons with a physician-diagnosed hiatal hernia at baseline or reflux disease hospitalization within the first five years of study were excluded. A second analysis included follow-up of 9851 participants free of reflux disease in 1982-84. Ninety-six percent of the baseline cohort were recontacted. Reflux disease cases were persons hospitalized with a diagnosis of esophagitis or uncomplicated hiatal hernia. Hazard rate ratios for reflux disease hospitalization according to body mass index (BMI) (kg/m2), total daily servings of high fat foods and other factors were calculated using Cox proportional hazards analysis. RESULTS: A total of 12,349 persons were followed for a median of 18.5 years (range 5.0-22.1). Cumulative incidence of reflux disease hospitalization was 5.2% at 20 years. Multivariate survival analysis revealed higher reflux disease hospitalization rates with higher BMI (5 kg/m2) [hazard ratio (HR) = 1.22, 95% confidence interval (CI) = 1.13-1.32]. No relationship was found between higher fat intake and reflux disease hospitalization. Other factors associated with reflux disease hospitalization included age, low recreational activity, and history of doctor-diagnosed arthritis. CONCLUSIONS: Overweight, but not high dietary fat intake, increases risk of gastroesophageal reflux disease hospitalization.