Nosocomial outbreak of hepatitis B virus infection in a pediatric hematology and oncology unit in South Africa: Epidemiological investigation and measures to prevent further transmission

Background

Hospital‐acquired hepatitis B virus (HBV) infection has been well described and continues to occur worldwide. Recent nosocomial outbreaks have been linked to unsafe injection practices, use of multi‐dose vials, and poor staff compliance with standard precautions. This report describes a nosocomial outbreak that occurred in a pediatric hematology and oncology unit of a large academic hospital, the epidemiological investigation of the outbreak, and preventive measures implemented to limit further in‐hospital transmission.

Methods

Outbreak investigation including contact tracing and HBV screening were initially carried out on all patients seen by the unit during the same period as the first three cases. Routine screening for the entire patient population of the unit was initiated in February 2013 when it was realized that numerous patients may have been exposed.

Results

Forty‐nine cases of HBV infection were confirmed in 408 patients tested between July 2011 and October 2013. Phylogenetic analysis of the HBV preC/C gene nucleotide sequences revealed that all tested outbreak strains clustered together. Most (67%) patients were HBeAg positive. The cause of transmission could not be established. Preventive measures targeted three proposed routes. HBV screening and vaccination protocols were started in the unit.

Conclusions

The high number of HBeAg positive patients, together with suspected lapses in infection prevention and control measures, are believed to have played a major role in the transmission. Measures implemented to prevent further in‐hospital transmission were successful. On‐going HBV screening and vaccination programs in pediatric hematology and oncology units should become standard of care. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.     

LetterEvidence of Association between FKBP1B and Thyroid Autoimmune Disorders in a Large Tunisian Family

FKBP1B belongs to immunophilins superfamily and functions as a cytosolic receptor protein of FK506. The role of FKBP1B in the immunosuppressive pathway of FK506 is well established. Previously, we reported a strong evidence of linkage between D2S171 microsatellite marker (located in vicinity of FKBP1B gene) and susceptibility to autoimmune thyroid diseases (AITDs). In this study, we report linkage disequilibrium between the dimorphism (C/T) in the 3′ untranslated region (3′ UTR) of FKBP1B gene and susceptibility to AITDs.

DNAs were extracted from a large Tunisian family affected with Graves' disease (GD) and Hashimoto's thyroiditis (HT) and analysed by PCR–RFLP using DraIII restriction enzyme. Our results showed an excess of transmission of the allele C from heterozygous parents to affected offspring (transmission disequilibrium test (TDT)=4.76; p=0.012). This suggests a linkage disequilibrium of 3′ UTR (C/T) SNP with AITDs. Moreover, The FBAT analysis gives a significant association with the C allele under the recessive model (χ²=5.50; p=0.018). These results support the involvement of FKBP1B gene in the genetic susceptibility to the AITDs development in the studied family.     

Effect of Internet Therapeutic Intervention on A1C Levels in Patients With Type 2 Diabetes Treated With Insulin

OBJECTIVE

To assess the effect of an Internet-based glucose monitoring system (IBGMS) on A1C levels in patients with type 2 diabetes treated with insulin.

RESEARCH DESIGN AND METHODS

This trial involved 50 patients randomly assigned to receive either conventional treatment alone or with additional follow-up through an IBGMS for 6 months. Patients randomized to the intervention group uploaded blood glucose readings every 2 weeks to a secure Web site for review and receipt of feedback from their endocrinologist. A1C and laboratory test results were collected at 0, 3, and 6 months.

RESULTS

The baseline parameters were not significantly different. Over a 6-month follow-up, A1C dropped from 8.8 to 7.6% (P < 0.001) in the intervention group compared with 8.5 to 8.4% (P = 0.51) in the control group.

CONCLUSIONS

The use of IBGMS significantly improved A1C levels in patients with type 2 diabetes treated with insulin.In the management of diabetes, self-monitoring of blood glucose (SMBG) is performed as an adjunct to A1C measurements in order to assess and modify treatment (1–3); however, it often requires healthcare professionals to help interpret the results to refine treatment (4–6). The Internet provides a readily accessible platform for communication and remote health monitoring (7). In this study, we evaluated whether the use of an IBGMS would improve the outcome of treatment for patients with type 2 diabetes.     

Role of auriculotherapy in smoking cessation. Personal experience

Smoking is one of the main causes of poor health and early death. In line with the 1999 law which aims at reducing smoking, we have tested auriculotherapy as an aid for giving up smoking. We tried this treatment on 39 people who wanted to give up smoking. After two months of treatment, 15 people (38.5%) had given up completely and 24 people had reduced their smoking by more than half. Auriculotherapy is an useful aid for giving up smoking. It is easy and painless, has no secondary effects and it is economic.     

Étude en Microscopie électronique de la Spermiogénèse et du Spermatozoïde dePhyllobothrium gracile Weld, 1855 (Cestoda,Tetraphyllidea, Phyllobothriidae)

Résumé La spermiogénèse et al structure du spermatozoïde dePhyllobothrium gracile Weld, 1855 sont étudiées en microscopie électronique.La spermiogénèse est caractérisée par les stades successifs suivants: (1) formation de la zone de différenciation et apparition d'une structure intercentriolaire flanquée de deux corps basaux. (2) formation d'une expansion cytoplasmique et d'un seul flagelle. (3) rabattement du flagelle et fusion avec l'expansion cytoplasmique. (4) migration du noyau jusqu'à l'extrémité antérieure du spermatozoïde en voie de différenciation.Le spermatozoïde filiforme, à un seul axonème, contient du glycogène mais est dépourvu de mitochondrie. II montre, à l'extrémité opposée au noyau, une structure hélicoïdale, d'origine golgienne, formant en coupe transversale, un corps en crête.Par ces résultats, il est prouvé que le spermatozoïde à un axonème des Phyllobothriidae dérive du type primitif à deux axonèmes par avortement, au cours de la spermiogénèse, d'un des deux corps basaux.L'orientation du spermatozoïde et la position du corps en crête par rapport au noyau sont discutées.

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The spermiogenesis and spermatozoon ultrastructure ofPhyllobothrium gracile weld, 1855 studied by electron microscopy

Summary The spermiogenesis is characterized by the following steps: (1) Formation of the differentiation zone and appearance of an intercentriolar body with two basal bodies. (2) Formation of a cytoplasmic expansion and induction of only one flagellum. (3) Rotation of the flagellum and its fusion with the cytoplasmic expansion. (4) Nucleus migration towards the anterior part of the differentiating spermatozoon.The only one-axonemed threadlike spermatozoon contains glycogen but lacks mitochondria. On the opposite side of the nucleus there is an helicoidal structure derived from the Golgi body and looking like a crested body in cross-sections.From these results it is proved that the one-axonemed Phyllobothriidae spermatozoon is derived from a more primitive two axonemed spermatozoon by abortion of one of the two basal bodies formed during spermiogenesis.The spermatozoon orientation and the crested body position with regard to the nucleus are discussed.

     

Being differently the same: the mediation of identity tensions in the sharing of illness experiences

The sharing of experiences between patients has become increasingly privileged as a source of knowledge and support in contemporary healthcare. Despite this, relatively little is known about the processes whereby people's experiences become, or fail to become, valued as sources of health-related knowledge in different contexts. Through a secondary analysis of 87 interviews conducted between 2006 and 2008 in the UK with people affected by motor neurone disease (46 interviews) and Parkinson's disease (41 interviews), we explore the identity work involved in turning other people's experiences into 'experiential knowledge' that can be shared between patients. Of particular interest is how the turning of others' experiences into knowledge is presupposed by negotiating a particular type of identity tension - what, drawing on the work of Paul Ricoeur (2003) on metaphor, we refer to as 'being differently the same'. We examine the way in which people living with motor neurone disease and Parkinson's disease spoke of managing this tension as part of the process of accessing and valuing other patients' experiences, both epistemologically and emotionally. Instead of treating others' experiences as a pre-given source of knowledge, we emphasise how experience comes to be embodied and articulated through different media - bodies, speech, text, and images. Moreover, we suggest that paying closer attention to these media provides opportunities for enhancing our understanding of how people with different chronic and/or terminal illnesses use or do not use different forms of peer support - and in particular online ones - as a source of health-related experiential knowledge. Some of the implications of this are discussed in the specific context of people diagnosed with incurable neurodegenerative conditions characterised by visible physical deterioration and associated emotional distress.