Phylogenetic, virological, and clinical characteristics of genotype C hepatitis B virus with TCC at codon 15 of the precore region

Hepatitis B virus (HBV) with T-1856 of the precore region is always associated with C-1858 (i.e., TCC at nucleotides 1856 to 1858), and it is reported only in genotype C HBV isolates. We aimed to investigate the phylogenetic, virological, and clinical characteristics of HBV isolates bearing TCC at nucleotides 1856 to 1858. We have previously reported on the presence of two major subgroups in genotype C HBV, namely, HBV genotype Cs (Southeast Asia) and HBV genotype Ce (Far East). We have designed a novel 5' nuclease technology based on the nucleotide polymorphism (C or A) at nucleotide 2733 to differentiate the two genotype C HBV subgroups. The mutations at the basal core promoter and precore regions were analyzed by direct sequencing. Among 214 genotype C HBV-infected patients, 31% had TCC, 37% had CCC, 3% had CTC, and 29% had CCT at nucleotides 1856 to 1858. All except one HBV strain with TCC at nucleotides 1856 to 1858 belonged to subgroup Cs, which has been reported only in Hong Kong; Guangzhou, China; and Vietnam. HBV with TCC at nucleotides 1856 to 1858 was associated with the G1898A mutation (64%). Patients infected with HBV harboring TCC had more liver cirrhosis than those infected with HBV harboring CCC (18% versus 5%; P = 0.008), and more of the patients infected with HBV harboring TCC were positive for HBeAg (58% versus 36%; P = 0.01) and had higher median alanine aminotransferase levels (65 IU/liter versus 49 IU/liter; P = 0.006); but similar proportions of patients infected with HBV harboring TCC and those infected with HBV harboring CCT had liver cirrhosis (18% versus 13%; P = 0.43). In summary, we report that HBV with TCC at nucleotides 1856 to 1858 of the precore region might represent a specific HBV strain associated with more aggressive liver disease than other genotype C HBV strains.     

Obesity predisposes to Th17 bias

Obesity is associated with numerous inflammatory conditions including atherosclerosis, autoimmune disease and cancer. Although the precise mechanisms are unknown, obesity‐associated rises in TNF‐α, IL‐6 and TGF‐β are believed to contribute. Here we demonstrate that obesity selectively promotes an expansion of the Th17 T‐cell sublineage, a subset with prominent pro‐inflammatory roles. T‐cells from diet‐induced obese mice expand Th17 cell pools and produce progressively more IL‐17 than lean littermates in an IL‐6‐dependent process. The increased Th17 bias was associated with more pronounced autoimmune disease as confirmed in two disease models, EAE and trinitrobenzene sulfonic acid colitis. In both, diet‐induced obese mice developed more severe early disease and histopathology with increased IL‐17⁺ T‐cell pools in target tissues. The well‐described association of obesity with inflammatory and autoimmune disease is mechanistically linked to a Th17 bias.     

Automatic electronic laboratory-based reporting of notifiable infectious diseases at a large health system

Electronic laboratory-based reporting, developed by the UPMC Health System, Pittsburgh, Pennsylvania, was evaluated to determine if it could be integrated into the conventional paper-based reporting system. We reviewed reports of 10 infectious diseases from 8 UPMC hospitals that reported to the Allegheny County Health Department in southwestern Pennsylvania during January 1-November 26, 2000. Electronic reports were received a median of 4 days earlier than conventional reports. The completeness of reporting was 74% (95% confidence interval [CI] 66% to 81%) for the electronic laboratory-based reporting and 65% (95% CI 57% to 73%) for the conventional paper-based reporting system (p>0.05). Most reports (88%) missed by electronic laboratory-based reporting were caused by using free text. Automatic reporting was more rapid and as complete as conventional reporting. Using standardized coding and minimizing free text usage will increase the completeness of electronic laboratory-based reporting.     

Roundtable on Bioterrorism Detection: Information System–based Surveillance

During the 2001 AMIA Annual Symposium, the Anesthesia, Critical Care, and Emergency Medicine Working Group hosted the Roundtable on Bioterrorism Detection. Sixty-four people attended the roundtable discussion, during which several researchers discussed public health surveillance systems designed to enhance early detection of bioterrorism events. These systems make secondary use of existing clinical, laboratory, paramedical, and pharmacy data or facilitate electronic case reporting by clinicians. This paper combines case reports of six existing systems with discussion of some common techniques and approaches. The purpose of the roundtable discussion was to foster communication among researchers and promote progress by 1) sharing information about systems, including origins, current capabilities, stages of deployment, and architectures; 2) sharing lessons learned during the development and implementation of systems; and 3) exploring cooperation projects, including the sharing of software and data. A mailing list server for these ongoing efforts may be found at http://bt.cirg.washington.edu.Bioterrorism has quickly become a new and frightening part of life in America. A host of potential agents, with varying degrees of virulence and a confusing array of nonspecific symptoms, are now household words. The field of medical and public health informatics has long concerned itself with developing methods to represent, store, and analyze data that describe the complexities of individual and population-based health.¹ Now, informatics tools such as knowledge representation, controlled vocabularies, heterogeneous databases, security and confidentiality, clinical decision support, data mining, and data visualization are being applied with a new urgency to the task of early detection of intentional outbreaks of disease.In November 2001, as part of the activities of the Anesthesia, Critical Care, and Emergency Medicine Working Group, investigators from several research groups took part in the “Roundtable on Bioterrorism Detection” at the AMIA Annual Symposium. The session was subtitled “Information System–based Sentinel Surveillance.” These researchers, and others, are developing public health surveillance systems that make secondary use of data gathered during normal clinical workflow or that facilitate electronic case reporting by clinicians. These surveillance strategies are intended to enhance early detection of changes in the health of the community. This paper combines brief case reports of a number of existing systems with a discussion of some commonly employed techniques and approaches.Several bioterrorism-related posters and papers were presented at the Symposium.^2–7 A handful of systems, all in active development, are currently deployed. The utility of these systems in detecting bioterrorism events is unproven, and it is hoped that their full capabilities will never need to be tested directly. However, the value of monitoring and aggregating disease indicators across a population is clear, if intuitive, and such surveillance has a strong precedent in public health practice.^8–10There are strategies for indirectly measuring the performance of these systems and for improving their diagnostic accuracy and timeliness, even in the absence of bioterrorism cases. These strategies include measuring the accuracy of detection of components of case definitions, as opposed to detection of outbreaks. Other strategies involve the detection of surrogate diseases, such as influenza, whose symptoms are similar to the initial symptoms of inhalational anthrax. Espino et al.⁴ showed a 44percent sensitivity and 97percent specificity in detection of cases of acute respiratory illness, a common symptom prodrome of many illnesses spread by bio-aerosol agents. A companion study³ showed that time–series analysis of such cases in a population could detect an outbreak of influenza. McClung et al.¹¹ found relatively similar sensitivity and specificity (37 and 97percent, respectively) in a system detecting asthma visits, based on chief complaint on presentation to an emergency room.A number of federal and other agencies have funded the work on these surveillance systems. These include the Centers for Disease Control and Prevention (CDC), through State Bioterrorism Preparedness grants, the Health Alert Network program, and cooperative agreements; the Agency for Healthcare Research and Quality (AHRQ); the Defense Advanced Research Projects Agency (DARPA); the National Library of Medicine (NLM), both directly though grant funding and indirectly through support of NLM Fellowships in Informatics and Integrated Advanced Information Management System sites; and by state and local public health agencies using CDC and other funds.     

A study of the STD/AIDS related attitudes and behaviors of men who have sex with men in Hong Kong

A random population based study was carried out to understand HIV-related attitudes and behaviors and self-reported sexually transmitted diseases (STDs) among men who have had sex with men (MSM) in Hong Kong. A special computerized telephone survey method was used and 85 MSM were identified (from a total sample of 2,074 men), 47.1% of whom had at least one male sex partner in the past 6 months. Among these 85 MSM, 29.4% had multiple partners and 37.5% had had anal sex in the last 6 months (67% of them were inconsistent condom users). MSM were more likely to have contracted at least one STD in the last 6 months (10.6%) and were less likely to perceive susceptibility for contracting HIV (62.4%) than those other respondents who visited a female sex worker (FSW) in the past 6 months (4.3% and 43%, respectively). About 45% of the MSM did not perceive condom use to be efficacious for HIV prevention (vs. 30% for male clients of FSW). The study is limited by its small number; however, it suggests that MSM in Hong Kong may be at high risk of contracting HIV. Prevention programs should attempt to change attitudes (e.g., perceived efficacy of condom use, perceived susceptibility, awareness of risk involved, etc.) as well as behaviors. The feasibility for establishing a behavioral surveillance system for this population was demonstrated.     

Digital subtraction in gadolinium-enhanced MR imaging of the brain: a method to reduce contrast dosage

The aim of the study was to investigate the feasibility of using digital subtraction in contrast-enhanced MR imaging of the brain to reduce the MR contrast dosage without jeopardizing patient care. Fifty-two patients with intracranial lesions, either intra-axial or extra-axial, detected by computerized tomography were selected for contrast-enhanced MR imaging with half-dose and full-dose of gadopentetate dimeglumine. The half-dose unsubtracted, full-dose unsubtracted, and half-dose subtracted MR images were visually assessed by counting the number of enhancing brain lesions in the images and quantitatively analyzed by computing their lesion contrast-to-background ratios (CBR). The visual conspicuity of the half-dose subtracted MR images was comparable to that of the full-dose unsubtracted MR images ( p>0.05), whereas the CBR of the half-dose subtracted images was approximately two to three times higher than that of the full-dose unsubtracted images. The half-dose subtracted T1-weighted spin-echo images might be able to replace the conventional standard-dose T1-weighted spin-echo images in MR imaging of the brain.     

Botulinum toxin A as treatment for drooling saliva in PD

The authors evaluated intraparotid injections of botulinum toxin A in reducing salivary secretions and drooling in nine patients with PD. There was a marked objective reduction in secretion, and two thirds of the patients had subjective improvement in drooling. No side effects were observed. The authors conclude that botulinum toxin A promises to be a simple and effective treatment for the common problem of drooling saliva in chronic neurologic disease.     

Burkitt's lymphoma presenting as mandibular swelling--report of a case and review of publications

Burkitt's lymphoma in a 4-year-old Chinese boy presented with acute mandibular swelling but no associated systemic disturbance. A review of published reports shows that the diagnosis should be suspected in jaw lesions with no obvious cause.