Non-A,Non-B hepatitis; Factors involved in progression to chronicity

A cross-sectional, longitudinal study was undertaken on a group of acute non-A, non-B hepatitis patients, as well as on a control group of hepatitis B patients, in order to assess both the prevalence of the most important factors favoring infection, and the relevance of these factors in promoting evolution towards chronic liver disease. Exposures to unknown risk factors were present in 47.4% of acute non-A, non-B infections, followed by blood transfusions (17.9%), sporadic exposures (17.9%) and drug addiction (16.6%). Unknown as well as sporadic exposures showed a greater prevalence in control population if compared to non-A, non-B cases, while drug addiction was equally represented in the two groups, and blood transfusion nearly absent from control group. The risk of evolution to chronic liver disease was about 13 times greater in non-A, non-B group than in controls, with the greatest risk for drug addicts and the lowest for patients with unknown exposures. Among patients with known exposures, the lowest risk of chronic hepatitis was observed in post-transfusion and in sporadic cases, while the greatest was observed in drug addicts.Corresponding author.     

男性慢性胃炎患者人格特征初探

本文采用卡氏十六种人格因素量表，对纤维胃十二肠镜和活体组织病理检查确诊，剔除可能影响调查的疾患之后的５６例慢性胃炎患者做了测查，结果与中国男性成人常模对照，提示男性慢性胃炎患者的主要人格特征有：严谨、保守、忧郁、紧张、顺从、依赖、有焦虑倾向，非内向个性，不属于心理不健康人群，而与消化性溃疡个性特征有所不同，但是，矫治其人格缺损及属必要。     

Establishment of chronic hepatitis C virus infection:Translational evasion of oxidative defence

Hepatitis C virus(HCV)causes a clinically important disease affecting 3%of the world population.HCV is a single-stranded,positive-sense RNA virus belonging to the genus Hepacivirus within the Flaviviridae family.The virus establishes a chronic infection in the face of an active host oxidative defence,thus adaptation to oxidative stress is key to virus survival.Being a small RNA virus with a limited genomic capacity,we speculate that HCV deploys a different strategy to evade host oxidative defence.Instead of counteracting oxidative stress,it utilizes oxidative stress to facilitate its own survival.Translation is the first step in the replication of a plus strand RNA virus so it would make sense if the virus can exploit the host oxidative defence in facilitating this very first step.This is particularly true when HCV utilizes an internal ribosome entry site element in translation,which is distinctive from that of cap-dependent translation of the vast majority of cellular genes,thus allowing selective translation of genes under conditions when global protein synthesis is compromised.Indeed,we were the first to show that HCV translation was stimulated by an important prooxidant-hydrogen peroxide in hepatocytes,suggesting that HCV is able to adapt to and utilize the host antiviral response to facilitate its own translation thus allowing the virus to thrive under oxidative stress condition to establish chronicity.Understanding how HCV translation is regulated under oxidative stress condition will advance our knowledge on how HCV establishes chronicity.As chronicity is the initiator step in disease progression this will eventually lead to a better understanding of pathogenicity,which is particularly relevant to the development of anti-virals and improved treatments of HCV patients using anti-oxidants.     

Cronicidad,envejecimiento y multimorbilidadChronicity,ageing and multimorbidity

Thanks to highly active antiretroviral therapy (HAART), HIV-related mortality has been drastically reduced and HIV infection has become a chronic disease. The HIV-infected population is ageing prematurely. Despite good immunovirological control, HIV causes chronic inflammation and accelerated immunosenes-cence. This clinically manifests as an increased prevalence of age-related comorbidity and frailty occurring earlier than in the general population. The heterogeneity of older HIV-infected adults highlights the rele-vance of identifying those who are at risk of poor health, and frailty may be an effective indicator. The rela-tionship between ageing, HIV infection, antiretroviral treatment, comorbidities and frailty still needs to be clarified. Elderly HIV-infected adults are complex patients who require a specific, global and multidisci-plinary approach.     

Predictive Factors of Clinical Outcome in Patients with Diffuse Proliferative Lupus Nephritis Treated Early by Intravenous Methylprednisolone Pulse Therapy

Background. Diffuse proliferative lupus nephritis (DPLN) is associated with significant morbidity and mortality unless aggressive immunosuppressive therapy is initiated early in the course of the disease. It has been observed that with steroid pulse therapy, some patients with DPLN enter clinical remission while others do not. The factors predictive of clinical remission with steroid pulse therapy in these patients has not yet been elucidated. Methods. The authors retrospectively reviewed the records of 52 consecutive patients of DPLN treated by steroid pulse therapy in order to compare the characteristics of patients in the clinical remission group and those in the non-remission group. Clinical remission was defined as a serum creatinine level of ≤1.2 mg/dL, negative or trace proteinuria, and the observation of ≤1–4 red blood cells / high-power field in a routine urine examination. The 52 patients were divided into the clinical remission group (n?=?29) and the non-remission group (n?=?23), and also into subcategories of DPLN, namely, the IV-G group (n?=?28) and the IV-S (n?=?24). The characteristics of the patients were then compared between the two respective groups to identify factors that might be significantly related to clinical remission using Mann-Whitney's U test and the Cox proportional hazards model. Results. In regard to the clinical and immunological characteristics of the patients, except for a significant difference in the serum albumin level, there were no significant differences in any of the parameters examined, including blood pressure, degree of proteinuria, and serum creatinine, between the remission group and non-remission group. Added to that, in the non-remission group, the pretreatment period was significantly longer than in the remission group. In relation to the histological characteristics, the Chronicity Index (CI) and severity of interstitial fibrosis were significantly higher (p?=?0.021) in the non-remission group than in the remission group. The result of the Cox proportional hazards analysis revealed that the serum albumin, pretreatment period, CI, and severity of interstitial fibrosis were strongly related to the clinical outcome, whereas the results of the multivariate Cox proportional hazards analysis revealed only a weak correlation between the CI and the outcome. Conclusion. It was concluded that the diagnosis should be performed early and the pretreatment period should be shortened before treatment. Also, an aggressive therapeutic intervention should be initiated early, before chronic renal injury becomes established, to increase the likelihood of remission in patients with DPLN.     

Effects of multidisciplinary pain treatment can be predicted without elaborate questionnaires

Purpose

Low back pain is one of the most common and expensive diseases of Western societies. Psychosocial factors such as low social status, depression, or work dissatisfaction are known to promote chronicity of low back pain. With a multidisciplinary approach, better outcomes can be achieved than with purely biomedical treatment. Optimal patient selection for multidisciplinary therapy reduces costs and labour. This study investigated whether elaborated questionnaires exceed simple items in predicting multimodal therapy success.

Methods

In this prospective longitudinal clinical study, 330 patients were followed up for six months after multidisciplinary therapy. We applied the patient questionnaire Heidelberg Short Early Risk Assessment Questionnaire for the Prediction of Chronicity in Low Back Pain (HKF-R10) that is approved and established for predicting chronicity in patients with acute low back pain to forecast the therapeutic outcome. Outcome criteria were QOL, pain reduction and back to work.

Results

With regard to outcome criteria, the HKF-R10 was unable to anticipate therapeutic success, but education level, depression, best pain condition, and helplessness predicted therapy success with an 80 % probability for QOL improvement.

Conclusions

It is not necessary to confront patients with an extensive and complicated questionnaire to predict the outcome of multidisciplinary therapy. In fact, assessing a few specific items allows better and easier prognosis estimation.     

Methodological features of quantitative studies on medication adherence in older patients with chronic morbidity: A systematic review

ObjectivesThe growing number of chronic, multimorbid older adults encourages healthcare systems to cope with polypharmacy and non-adherence. However, methodology on how to provide effective interventions to enhance medication adherence is still object of debate.MethodsTo describe methodological features of quantitative studies concerning older adults’ medication adherence, by means of a PRISMA systematic review (Scopus, PubMed, Medline). A specific focus was devoted to theoretical models and to the ABC Taxonomy model, as stated by the EMERGE guidelines.Results55 papers were included. Most of the studies were conducted using randomized control trials (63.6%) and focused on a single disease only (72.7%). Most of the interventions were provided by a single professional figure (70.9%). Medication adherence was mainly evaluated by means of questionnaires (61.8%) and by clinical records (30.9%). Sixteen studies considered a theoretical model in the intervention framework. The Initiation phase (ABC Taxonomy) was the most neglected.ConclusionsFuture studies upon medication adherence should account real-life challenges such as multimorbidity, polypharmacy and interdisciplinarity, analyzing adherence as a complex, holistic process.Practice implicationsTheoretical models may be useful to enhance the soundness of the results, to ease their comparability, to calibrate tailored strategies and to plan patient-centered interventions.     

Prevalence and duration of PTSD in survivors 6 years after a natural disaster

The present study aimed to examine the prevalence of posttraumatic stress disorder (PTSD) in survivors with low levels of risk factors for PTSD. The sample included 142 adults (58% women, 54% university education, 93% employed/students/retired) on vacation in Southeast Asia during the 2004 Indian Ocean disaster. Semi-structured clinical interviews (SCID-I) were performed after 6 years including PTSD, depression, specific phobia, and alcohol abuse. The 6-year prevalence of PTSD was 11.3% and the current prevalence was 4.2%, with onset mainly within 1 month and remission within 3 years post-disaster. Suicidal ideation and comorbidity were common in PTSD cases. Lifetime prevalence of depression was 19%, specific phobia 7%, and alcohol abuse 4%. The findings suggest elevated levels of PTSD but not other disorders as compared with general population samples, but still lower levels than other disaster samples. Despite benign circumstances, however, the course and burden of PTSD were comparable to similar studies.     

Cyclosporin A therapy for severe Henoch-Schönlein nephritis with nephrotic syndrome

To evaluate the efficacy of cyclosporin A (CyA) for treating severe Henoch-Schönlein nephritis (HSN), seven patients with nephrotic syndrome, aged 3.9–13.8 years (mean 6.5 years), were analyzed retrospectively. Mean follow-up times were 5.5 years (range 2–9 years). All underwent renal biopsy before treatment, and follow-up renal biopsy was performed in six of the seven patients. All patients improved, with 24-h protein declining from a mean of 9.2 g/m²/day (range 1.5–16 g/m²/day) to 0.3 g/m²/day (range 0.03–1.2 g/m²/day) (p=0.016) and serum albumin increasing from a mean of 2.1 g/dl (range 1.5–2.4 g/dl) to 4.6 g/dl (range 3.5–5.3 g/dl) (p=0.016) after CyA therapy. The activity index decreased significantly at the second renal biopsies obtained at a mean interval of 11.7 months after the first (6.4±3.3 vs 3.5±1.2, p=0.042, respectively), while the chronicity index and the tubulointerstitial scores did not change. On the immunofluorescent findings at the second biopsies, the degree of deposits of immunoglobulins such as IgA, IgM, C3, and fibrinogen decreased in five of the six patients. Although this case series is without controls, our study suggests that CyA may be beneficial to a subset of HSN patients with nephrotic syndrome.     

White matter hyperintensities and chronicity of depression

OBJECTIVE: White matter hyperintensities (WMHs) on T(2)-weighted magnetic resonance imaging (MRI) of the brain are associated with advanced age and late-life depression. Most investigations predominantly found these lesions in frontal lobe and basal ganglia supporting the hypothesis of a fronto-striatal dysfunction in depression. A prospective study was undertaken to investigate the association between extent of WMHs and clinical outcome in elderly depressed patients. METHODS: Thirty-one non-demented depressed subjects underwent a 1.5 T cranial MRI scan. The MRI scans were analysed in consensus by two experienced radiologists. Each MRI scan was assessed for presence and extent of WMHs, which are differentiated in periventricular hyperintensities (PVHs) and deep white matter hyperintensities (DWMHs). A total of 21 patients of the original cohort of 31 patients were re-assessed 5 years after baseline assessment. We ascertained the severity of depressive symptoms, the longitudinal course of depression, the cognitive decline and the global assessment of functioning at follow-up visit. RESULTS: (1) Subjects with greater extent of WMHs had a significant higher Hamilton Depression Rating Scale (HAM-D) score, (2) had more severe longitudinal courses of depression (3) and had a lower Mini-Mental State Examination (MMSE) score. CONCLUSIONS: WMHs on MRI are associated with poorer outcome in elderly depressed subjects. Further studies are needed to evaluate WHMs as prognostic factor for an appropriate treatment decision-making.