Telbivudine in the treatment of chronic hepatitis B

Treatment of chronic hepatitis B with oral nucleos(t)ide analogs is evolving rapidly with newer compounds gaining approval. Recently, the US FDA and European Medicines Agency (EMEA) have approved telbivudine, a potent anti-hepatitis B virus (HBV)-specific agent with a hitherto excellent safety profile. This review focuses on the efficacy of this agent in chronic hepatitis B compared with lamivudine, evaluated clinically in Phase II and a large Phase III study. Monitoring of the virologic response under treatment with sensitive HBV-DNA assays has been applied, aiming at increasing efficacy and reducing HBV resistance. The results are critically presented and the evolving concept of effective long-term telbivudine and other nucleos(t)ide analog therapy, predicted by the extent of suppression of HBV replication at week 24, are analyzed and discussed.     

The association of infectious agents and schizophrenia

Abstract

Objectives. The influence of infectious agents on the pathogenesis of psychiatric disorders has been discussed for decades. Pre- and postnatal infections are risk factors for schizophrenia. This may be explained by chronic infections or an altered immune status. However most of the studies have only focused on one single pathogen and not on the impact of different infectious agents. We investigated the association between schizophrenia and various neurotophic infectious agents. Methods. A total of 31 schizophrenic patients and 30 healthy matched individuals were included. Antibody titres of cytomegalovirus, herpes simplex virus, Epstein-Barr virus, mycoplasma, chlamydia and toxoplasma were evaluated. For statistical analysis we used Fisher's exact and Wilcoxon test. Results. Significantly elevated positive antibody titres within schizophrenic patients were found only for Chlamydia trachomatis (P=0.005) and a trend to significance for herpes simplex virus (P=0.055). Combining the different agents, schizophrenics had a significantly higher rate of positive titres to infectious agents as compared to controls (P=0.04). Conclusions. The higher prevalence of antibodies within schizophrenic patients emphasizes a possible role of infectious agents in the pathogenesis of schizophrenia. Our data indicates that not one specific agent might be responsible for schizophrenic symptoms but the resulting immune response in the central nervous system.     

神经内科患者发生下呼吸道感染的危险因素分析

目的 了解医院神经内科患者下呼吸道感染发生率及引起下呼吸道感染的危险因素,为临床预防和控制医院感染提供参考.方法 对1348例神经内科住院患者临床资料进行逐份查阅,回顾性分析患者医院感染情况及引起感染的危险因素.结果 调查病历1348份,其中发生医院感染132例,医院感染率9.79％,感染部位分布:下呼吸道感染41例、上呼吸道感染35例、泌尿道25例、胃肠道14例、皮肤软组织6例、五官4例、其他7例,分别占26.52％、31.06％、18.94％、10.61％、4.55％、3.03％、5.30％；患者年龄、性别、患病季节、基础疾病、烟酒史、意识状态、住院时间、预防使用抗菌药物、气管切开、气管插管、机械通气及留置导尿均是导致神经内科发生下呼吸道感染的危险因素(P＜0.05)；主要病原菌依次为铜绿假单胞菌、肺炎克雷伯菌、大肠埃希菌、鲍氏不动杆菌、肠球菌属及凝固酶阴性葡萄球菌,分别占21.74％、19.57％、17.39％、13.04％、10.87％、8.70％.结论 针对引起的下呼吸道感染的危险因素进行预防与控制,对降低下呼吸道感染具有重要意义.     

Reactive arthritis after pharyngeal infection: report of two siblings

Abstract

?In this report we describe the cases of two siblings with reactive arthritis (ReA) induced by pharyngeal infections. The patients were a man and his sister living with their parents. He developed arthritis in August 1997, and his younger sister developed similar symptoms in September 1998. Their disease conditions were both severe and required hospitalization. Their conditions improved with the administration of nonsteroidal anti-inflammatory drugs together with antibiotics, and both fully recovered within 1–2 weeks. Rheumatic fever was ruled out since streptococcal infections were not demonstrated with antistreptolysin O (ASO) or antistreptokinase (ASK) titers, or with pharyngeal culture. The sister suffered from a rash which was similar to erythema nodosum on her lower extremities, but neither chorea nor carditis was observed. Both human leukocyte antigen (HLA) typing analyses revealed positive results for HLA-B40 and -B39 for the brother and sister, respectively. Both HLA-B40 and -B39 are considered to be related to HLA-B27-negative ReA, most likely poststreptococcal reactive arthritis (PSRA). Therefore, the two patients were tentatively diagnosed as suffering from PSRA.     

21所医院微生物室感染控制支持能力现状调查

目的 了解德州市二级及二级以上医院微生物室对感染管理工作的专业支持能力.方法 对德州市11个县市区,21所二级及二级以上医院进行现场检查及问卷调查.结果 全市17所医院设立了微生物室,12所医院参加了省级室间质量控制,5所医院既未参加室内质控也未开展室间质控；近95.0％的医院未落实三级报告等检验规程.结论 微生物室基本专业水平较低下,感染控制支持能力较差,制约了感染控制工作的深入开展；微生物室人员知识理念陈旧,亟待提高微生物学及医院感染管理知识技能.     

Survey on hospital‐acquired urinary tract infection in neurological intensive care unit

This study aimed to explore the causes, incidence, and risk factors of urinary tract infection patients in neurological intensive care unit (ICU). Patients (n = 916) admitted to the neurological ICU from January 2005 to December 2010 were retrospectively surveyed for urinary tract infections. There were 246 patients in neurological ICU who were diagnosed with hospital‐acquired urinary tract infection during that period of time (26.9%). Forty‐three cases were upper urinary tract infection, and 203 cases were lower urinary tract infection. The top three strains were Escherichia coli, Enterococcus faecalis, and Klebsiella pneumoniae. Older age (UTI rate, 22.6%), female patients (21.7%), hospital stay for more than 7 days (16.7%), diabetes (11.7%), and catheterization (21.1%) were the risk factors for hospital‐acquired urinary tract infection. There is a high incidence of nosocomial urinary tract infection in the neurological intensive care unit. Active prevention program and surveillance need to be carried out in neurological ICU, especially in those with risk factors.     

Body Mass Index and CD4+ T-Lymphocyte Recovery in HIV-Infected Men with Viral Suppression on Antiretroviral Therapy

Abstract

Purpose: To better characterize the relationship between body mass index (BMI) and CD4+ T-lymphocyte recovery in HIV disease.Methods: We analyzed the association between baseline BMI and CD4+ T-lymphocyte increases, as well as the association between BMI and immune activation (CD38 and HLA-DR co-expression on CD4+ and CD8+ T-lymphocytes), in male HIV-infected patients who achieved viral suppression on antiretroviral therapy (ART).Results: Baseline BMI predicted change in CD4+ T-lymphocyte count at weeks 96 ( P = .03, n = 461) and 144 ( P = .005, n = 357) but not at week 48 ( P = .38, n = 558). Relative to men with a normal BMI, overweight and obese men had increases at week 144 that were 35 and 113 cells/ mm³ higher, respectively, while underweight men had CD4+ T-lymphocyte increases that were 94 cells/mm³ lower. No significant correlations between baseline BMI and cellular immune activation were seen.Conclusions: BMI predicts CD4+ T-lymphocyte gains in men started on ART.