Age-specific seroprevalence of anti-hepatitis a antibody among 1-30 years old population of savadkuh, mazandaran, iran with literature review

Background

To determine age-specific seroprevalence rates of hepatitis A virus (HAV) immunoglobulin G (IgG) antibody in Savadkuh district, Mazandaran province, north of Iran, as well as to compare the collected data with earlier seroprevalence studies in the region and Iran in order to draw a proper epidemiological pattern for HAV infection in the country.

Objectives

This study aimed to assess an age-specific HAV seroprevalence among 1- to 30-yearold people in Savadkuh, a less developed district of Mazandaran province, north of Iran.

Patients and Methods

The study participants were 984 subjects who aged from one to 30 years and were residents of rural and urban areas of Savadkuh. They were selected using cluster sampling method and divided into five age groups: 1-2.9 (316 cases), 3-6.9 (254 cases), 7-10.9 (201 cases), 11-17.9 (115 cases), and 18-30 (98 cases). Anti-HAV antibody was measured by ELISA method. Seroprevalence rates among different age groups and their relationship to residency, educational levels of parents, water supply, and waste water disposal system was analyzed using chi-squared test.

Results

Overall seroprevalence rate was 19.20 % with no significant difference between rural and urban residents. The seroprevalence rates increased significantly with age: from 5.7 % in age group 1-2.9 year to 34.8 % in adolescents, and to 68.4 % among young adults (P < 0.0001); regardless of significant differences in educational levels among parents of residents in two areas it did not affect seroprevalence rates. Findings of this study and reviewing other reports from the region and the country suggest an epidemiological shift towards lower rates of anti-HAV antibody seroprevalence.

Conclusions

It appears that anti-HAV antibody seroprevalence rate has been declining among Iranians and thereby more children would be susceptible to this infection. This would necessitate revising current strategies of preventative measures in Mazandaran and Iran.     

Effect of sodium caprate on the intestinal absorption of two modified antisense oligonucleotides in pigs.

Sodium caprate, a medium chain fatty acid, is known to enhance the transport of drugs across the intestinal mucosa in cell culture systems and small animal species. The aim of the present study was to evaluate the effect of this enhancer on the oral absorption of two chemically modified antisense oligonucleotides ISIS 2503 (phosphorothioate) and ISIS 104838 (methoxyethyl modified phosphorothioate) using an intra-intestinal catheterised pig model. Sodium caprate at doses 25, 50 and 100 mg/kg was effective in enhancing systemic delivery of both antisense chemistries. At all enhancer doses, the absorption of both chemistries was rapid (T(max) 10 min) and short lived (plasma levels fell below detection by 2 h following administration). The pharmacokinetic parameters (AUC, C(max), T(max)) of both chemistries were unchanged with the increase in the permeation enhancer dose. The oral bioavailability with methoxyethyl modified phosphorothioate (ISIS 104838) was higher relative to unmodified phosphorothioate. Sodium caprate was rapidly absorbed following intra-intestinal administration (T(max) approximately 7 min regardless of the dose) and its pharmacokinetics were linear with dose. All tested formulations were well tolerated by the animals and no abnormal histopathological findings were observed following histological evaluation of intestinal tissues from pigs exposed to multi-dose administration of sodium caprate. It is concluded that sodium caprate can improve the oral delivery of antisense oligonucleotides in pigs and that its membrane-permeation effect is rapid, short-lived and dose independent.     

Oral bioavailability and multiple dose tolerability of an antisense oligonucleotide tablet formulated with sodium caprate

In vivo study was performed to determine the tolerability and pharmacokinetics of ISIS 104838, a phosphorothioate antisense oligonucleotide targetting human tumour necrosis factor alpha (TNF-alpha) mRNA, following multi-dose administration via intravenous and oral routes. Oral tablet formulations of ISIS 104838 were pre-formulated with the permeation enhancer, sodium caprate, in an enteric-coated solid dosage form. The average plasma bioavailability of ISIS 104838 was 1.4% relative to IV. The tissue distribution profile was similar following both routes of administration, with highest concentrations observed in the kidney followed by the liver, lymph nodes and spleen. Plasma bioavailability underestimated the tissue accumulation of ISIS 104838 observed 1 day after the last dose. Mean systemic tissue bioavailability ranged from 2.0 to 4.3%, relative to IV tissues, and was dependent on tissue type. No marked differences were noted in the pharmacokinetic parameters following multi-dosing either via intravenous or oral routes. All formulations administered were well tolerated. This paper reports the first evaluation of solid oral dosage forms comprising sodium caprate and an antisense oligonucleotide. Furthermore, this study demonstrates the oral delivery of ISIS 104838 from solid oral dose formulations, with the achievement of comparable tissue concentrations of the oligonucleotide to that of the intravenous treatment.     

Is lymph node dissection necessary for staging while undergoing nephrectomy in patients with renal cell carcinoma?

Objective: The essential treatment for patients with renal cell carcinoma is nephrectomy. As no lymph node dissection (LND) could be performed in the majority of these patients, healthy staging could not be carried out. In this study, we investigated the impact of LND during nephrectomy on patient survival. Methods: A total of 181 patients—58 (32%) were female and 123 (68%) were male—were included in the study. Median follow-up period was 48 months. The patients were separated into 4 groups according to their stage during diagnosis; group 1 (T1–3N0M0), group 2 (T1–3NXM0), group 3 (T1–3N1M0), and group 4 (T1–4N0/XM1). The disease-free survival of nonmetastatic patients and the overall survival of all groups were calculated. Results: Mean age was 58.4 ± 12.0 years. Median survival for Group 1 could not be reached. Median survival was 89 months in Group 2, 50 months in Group 3, and 39 months in Group 4 (P <0.001). There was no statistically significant difference between the N1 and M1 groups (P = 0.297). For the NX patient group without LND, median survival was 89 months, which is worse than the N0 group and better than the N1 group (P = 0.002). Conclusions: Our study presumes that the patients without LND are not staged sufficiently, NX patients have worse survival rates when compared with N0 patients, node-positive patients have poor survival rates as do the metastatic patients, and it should be defined as TNM stage4.     

Implicit and Explicit Associations with Erotic Stimuli in Women with and Without Sexual Problems

Conceptual models of sexual functioning have suggested a major role for implicit cognitive processing in sexual functioning. The present study aimed to investigate implicit and explicit cognition in sexual functioning in women. Gynecological patients with (N = 38) and without self-reported sexual problems (N = 41) were compared. Participants performed two Single-Target Implicit Association Tests (ST-IAT), measuring the implicit association of visual erotic stimuli with attributes representing, respectively, valence and motivation. Participants also rated the erotic pictures that were shown in the ST-IATs on the dimensions of valence, attractiveness, and sexual excitement, to assess their explicit associations with these erotic stimuli. Participants completed the Female Sexual Functioning Index and the Female Sexual Distress Scale for continuous measures of sexual functioning, and the Hospital Anxiety and Depression Scale to assess depressive symptoms. Compared to nonsymptomatic women, women with sexual problems were found to show more negative implicit associations of erotic stimuli with wanting (implicit sexual motivation). Across both groups, stronger implicit associations of erotic stimuli with wanting predicted higher level of sexual functioning. More positive explicit ratings of erotic stimuli predicted lower level of sexual distress across both groups.     

Comparison of intravenous methylprednisolone therapy vs. oral methylprednisolone therapy in patients with Graves' ophthalmopathy

A prospective, randomised and single blind clinical trial was designed to compare intravenous methylprednisolone pulse (IVGC) with oral methylprednisolone (OGC) monotherapy in terms of effectiveness and tolerability in Graves' ophthalmopathy (GO). Fifty-two consecutive patients with untreated, moderately severe and active GO were randomly treated with either IVGC or OGC therapy for 12 weeks. IVGC therapy achieved a more rapid and significant improvement than OGC therapy according to clinical activity score (p < 0.01), proptosis (p < 0.038), lid width (p < 0.0001), extraocular muscle changes (p < 0.02), optic neuropathy. (p < 0.001), intraocular pressure (p < 0.04), visual acuity (p < 0.03), quality of life (p < 0.0001) and treatment response (p < 0.001). Diplopia was significantly improved in two groups but there was no difference between them (p < 0.6). Heavy smokers indicated alteration of ophthalmic signs with increased thyroid stimulating hormone (TSH)-receptor antibody during the therapy. In conclusion, IVGC therapy was more effective and better tolerated than OGC therapy in the management of GO.     

Relationship between vertebral artery blood flow in different head positions and vertigo

Objective: To identify the vertebral artery blood flow in different head positions in patients with positional vertigo with no specific diagnosis.

Methods: Patients with history of vestibular symptoms associated with changes in head position were enrolled into the study. Healthy volunteers were evaluated as control group. Doppler ultrasonography examination of the cervical segment of the vertebral arteries was performed under three different head positions: (i) supine position, (ii) head hyperextended and rotated to the right side and (iii) head hyperextended and rotated to the left side.

Results: In the study group, right and left vertebral artery blood flow was significantly lower in the ipsilateral hyperextended position compared to standard supine position (respectively p?=?.014; p?=?.001), but did not differ significantly when compared between the standard supine and contralateral hyperextended positions (respectively?=?.959; p?=?.669). In the control group, left and right vertebral artery blood flow did not differ significantly when the head was hyperextended to the right or left sides compared to standard supine position (p?>?.05).

Conclusions: Our data demonstrated that the etiology of vestibular complaints in patients with undiagnosed positional vertigo might be related to impairment in vertebral artery blood flow according to head positions.     

Which imaging modality in cochlear implant candidates?

European Archives of Oto-Rhino-Laryngology - There is no guideline or consensus on preoperative radiologic imaging modality despite the fact that it has a vital importance in appropriate candidacy...