Anti-HBc of IgM-class,HBeAg and anti-HBe in acute and chronic hepatitis B

ABSTRACT— The presence and persistence of IgM antibody against hepatitis B core antigen (anti-HBc IgM) and the correlation with other HBV markers were studied in 42 patients, all of whom had acute HBsAg-positive hepatitis but whose subsequent diseases differed. All patients initially had anti-HBc IgM. In 13 out of 15 patients with uncomplicated acute hepatitis, anti-HBc IgM disappeared within 6 months after onset of the disease. In five out of 12 patients, who in spite of transient HBsAg developed chronic liver disease, the anti-HBc IgM persisted for more than 2 years. Among 15 patients with persistent HBsAg, anti-HBc IgM was present from 7 months to more than 8 years. Seroconversion from HBeAg to anti-HBe was observed in seven patients and in five of these anti-HBc IgM disappeared during the follow-up period. These results indicate that anti-HBc IgM can be used as a serological marker of recent or ongoing HBV infection.     

Acute non-A, non-B hepatitis--clinical, epidemiological and histological characteristics

Among 73 consecutive patients with biopsy documented acute non-toxic hepatitis, half of the patients (49%) had acute type B hepatitis, while 27 patients (37%) had acute type A infection. One patient had a significant rise in antibodies against cytomegalovirus. The remaining 10 patients (14%) fulfilled the criteria of hepatitis type non-A, non-B. The main type of exposure for hepatitis A was visit to endemic hepatitis areas (41%), and for type B it was drug addiction (46%). Half of the patients with hepatitis non-A, non-B had no known hepatitis exposure while some had visited endemic hepatitis areas or were drug addicts. The patients with non-A, non-B hepatitis had significantly less biochemical changes as compared to the patients with hepatitis B. In contrast, the histological findings showed the greatest activity in the biopsies from patients with hepatitis B and non-A, non-B. Follow-up liver biopsies in half of the patients with non-A, non-B hepatitis showed no signs of chronic active liver disease. It is concluded that hepatitis type non-A, non-B is a significant problem in Denmark.     

Increased prevalence of cytomegalovirus antibodies in homosexual men with syphilis: relation to sexual behaviour

Serum samples from 146 homosexual males, 40 heterosexual males and 51 females with at least one episode of syphilis were tested for the presence of IgG and IgM antibodies against cytomegalovirus (CMV IgG and CMV IgM). 100 blood donors served as a control group. CMV IgG was present in 95% of homosexual men compared with 68% of heterosexual men (p less than 0.001) and 73% of females (p less than 0.001) with past or present syphilis. CMV IgM was found in 43-68% of the venereal patients and with the highest percentage in homosexual men. Only 7% of blood donors had CMV IgM. It is concluded that CMV infection may be regarded as a venereal disease.     

The use of health-care resources in obesity-hypoventilation syndrome

OBJECTIVE: To document health-care utilization (ie, physician claims and hospitalizations) in patients with obesity-hypoventilation syndrome (OHS), for 5 years prior to the diagnosis and for 2 years after the diagnosis and initiation of treatment. DESIGN: Retrospective observational cohort study. SETTING: University-based sleep disorders center in Manitoba, Canada. Patients and control subjects: Twenty OHS patients (mean [+/- SD] age, 52.7 +/- 9.5 years; body mass index [BMI], 47.3 +/- 11.0 kg/m(2); PaCO(2), 59.7 +/- 13.8 mm Hg; PaO(2), 51.6 +/- 12.4 mm Hg) were matched to two sets of control subjects. First, each case was matched to 15 general population control subjects (GPCs) by age, gender, and geographic location, and, second, each case was matched to a single obese control subject (OBC) who was matched using the same criteria as for the GPCs, plus the measurement of BMI. Measurements and results: In the 5 years before diagnosis, the 20 OHS patients had (mean +/- SE) 11.2 +/- 1.8 physician visits per patient per year vs 5.7 +/- 0.8 (p < 0.01) visits for OBCs and 4.5 +/- 0.4 (p < 0.001) visits for GPCs. OHS patients generated higher fees, $623 +/- 96 per patient per year for the 5 years prior to diagnosis compared to $252 +/- 34 (p < 0.001) for OBCs and $236 +/- 25 (p < 0.001) for GPCs. OHS patients were much more likely to be hospitalized than were subjects in either control group in the 5 years prior to diagnosis (odds ratio [OR] vs GPCs, 8.6) (95% confidence interval [CI], 5.9 to 12.7); OR vs OBCs, 4.9 (95% CI, 2.3 to 10.1). In the 2 years after diagnosis and the initiation of treatment (usually continuous positive airway pressure or bilevel positive airway pressure), there was a significant linear reduction in physician fees. In the 2 years after the initiation of treatment, there was a 68.4% decrease in days hospitalized per year (5 years before treatment, 7.9 days per patient per year; after 2 years of treatment, 2.5 days per patient per year [p = 0.01]). CONCLUSIONS: OHS patients are heavy users of health care for several years prior to evaluation and treatment of their sleep breathing disorder; there is a substantial reduction in days hospitalized once the diagnosis is made and treatment is instituted.     

The use of combined thermal/pressure polyvinylidene fluoride film airflow sensor in polysomnography

Background

The technologies recommended by the American Academy of Sleep Medicine (AASM) to monitor airflow in polysomnography (PSG) include the simultaneous monitoring of two physical variables: air temperature (for thermal airflow) and air pressure (for nasal pressure). To comply with airflow monitoring standards in the sleep lab setting thus often requires the patient to wear two sensors under the nose during testing. We hypothesized that a single combined thermal/pressure sensor using polyvinylidene fluoride (PVDF) film responsive to both airflow temperature and pressure would be effective in documenting abnormal breathing events during sleep.

Methods

Sixty patients undergoing routine PSG testing to rule out obstructive sleep apnea at two different sleep laboratories were asked to wear a third PVDF airflow sensor in addition to the traditional thermal sensor and pressure sensor. Apnea and hypopnea events were scored by the sleep lab technologists using the AASM guidelines (CMS option) using the thermal sensor for apnea and the pressure sensor for hypopnea (scorer 1). The digital PSG data were also forwarded to an outside registered polysomnographic technologist for scoring of respiratory events detected in the PVDF airflow channels (scorer 2).

Results

The Pearson correlation coefficient, r, between apnea and hypopnea indices obtained using the AASM sensors and the combined PVDF sensor was almost unity for the four calculated indices: apnea–hypopnea index (0.990), obstructive apnea index (0.992), hypopnea index (0.958), and central apnea index (1.0). The slope of the four relationships was virtually unity and the coefficient of determination (r ²) was also close to 1. The results of intraclass correlation coefficients (>0.95) and Bland–Altman plots also provide excellent agreement between the combined PVDF sensor and the AASM sensors.

Conclusion

The indices used to calculate apnea severity obtained with the combined PVDF thermal and pressure sensor were equivalent to those obtained using AASM-recommended sensors.     

Injuries in taekwondo.

During the 6th Taekwondo World Championship more than 4 per cent of the competitors were admitted to hospital. The majoirity of the severe injuries were to the head and neck. More padding and a change of rules are recommended.     

Effect of severe gastroesophageal reflux on sleep stage in patients with aperistaltic esophagus

Polysomnography and esophageal pH studies were conducted in 13 patients with an aperistaltic esophagus; seven of these had scleroderma and six were patients treated for achalasia. The percentage total time of pH <4.0 when recumbent exceeded 30% for both groups. There was a total of 51 reflux events for both groups. There were 22 reflux events recorded for both groups that were less than 5 min in length and 29 events greater than 5 min. In 26 of 32 (81%) instances, patients either began awake and went to sleep during a reflux event or did not awake during a reflux event. Only six of 32 (19%) reflux events caused sleep disruption. We conclude that even the severe reflux demonstrated in this subset of patients does not always disrupt sleep. Patients may have severe prolonged reflux and not arouse.This paper was presented in part at the AGA meeting, San Diego, California, 1995.