Some Selected Abstracts:

1.

Ahn H, Li CS, Wang W. Sickle cell hepatopathy: clinical presentation, treatment, and outcome in pediatric and adult patients. : Pediatr Blood Cancer. 2005 Aug;45(2):184-90

Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA.

BACKGROUND: Standard diagnostic criteria and therapy are lacking for sickle cell hepatopathy, an uncommon complication of sickle cell disease. Here we propose diagnostic and therapeutic guidelines based on our experience and on reported cases. METHODS: We defined sickle hepatopathy by a total serum bilirubin concentration >13 mg/dl not explained by severe acute hemolysis, viral hepatitis, extrahepatic obstruction, or hepatic sequestration. We reviewed the records of all children with sickle hepatopathy seen at our institution during the past 20 years and the reported cases from the literature. Patients were categorized into two groups based on whether hepatic dysfunction at presentation was mild (Group I) or severe (Group II). RESULTS: Seven patients were identified from our institution and 37 patients from the literature. The 44 patients were evenly divided between the two groups. Group I patients had a significantly lower mean age (11.8 years vs. 24.5 years, P = 0.0001), maximum bilirubin level (36.2 mg/dl vs. 76.8 mg/dl, P = 0.0008), and frequency of treatment with exchange transfusions (P = 0.03). Overall, mortality was 4% in Group I and 64% in Group II (P = 0.0001). Gender and recurrence rate did not differ. Among Group II patients, only two of nine who received exchange transfusion died, whereas 12 of 13 who did not receive exchange transfusion died (P = 0.0015). CONCLUSIONS: Sickle cell hepatopathy is an uncommon complication characterized by extreme hyperbilirubinemia and either mild or severe hepatic dysfunction. Children and adults can present with either form; however, adults have a higher frequency of the severe form. Exchange transfusion may be the only effective management for initial episodes of severe sickle cell hepatopathy.

2.

Papakonstantinou O, Maris TG, Kostaridou S, Ladis V, Vasiliadou A, Gourtsoyiannis NC. Abdominal lymphadenopathy in beta-thalassemia: MRI features and correlation with liver iron overload and posttransfusion chronic hepatitis C. AJR Am J Roentgenol. 2005 Jul;185(1):219-24.

Department of Radiology, MRI Unit, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece.

OBJECTIVE: The objective of our study was to describe the MRI features of abdominal lymphadenopathy in patients with beta-thalassemia major and investigate the relation of abdominal lymphadenopathy with the severity of iron overload and posttransfusion chronic hepatitis C. MATERIALS AND METHODS: Abdominal MRI studies of 60 consecutive patients with beta-thalassemia major, performed for quantification of liver iron overload at a single institution, were retrospectively studied for the presence of lymph nodes and their distribution, size, and number. The signal intensity ratios of liver, spleen, and the largest lymph node to the right paraspinous muscle (L/M, S/M, and LN/M, respectively) were calculated on T1-weighted gradient-echo images. MRI findings for the lymph nodes were compared with the histologically assigned activity level of chronic hepatitis C that was available in 17 patients who had undergone liver biopsy within 1 month of the MRI examination. RESULTS: Hypointense abdominal lymph nodes larger than 7 mm were seen in 19 (32%) of 60 thalassemic patients in perihepatic and paraortic distributions. Lymphadenopathy was related to both the severity of hepatic siderosis, as expressed by the L/M values, and the presence of chronic hepatitis C, given that 18 (95%) of the 19 thalassemic patients with lymphadenopathy had chronic hepatitis C. Moreover, thalassemic patients with a moderate or severe level of hepatic inflammation presented with abdominal lymphadenopathy more frequently than those with mild hepatic inflammation. CONCLUSION: The development of hypointense abdominal lymphadenopathy in patients with beta-thalassemia major who have received multiple transfusions depends both on the severity of liver iron overload and on the presence and the activity level of coexistent chronic hepatitis C.

3.

van Lingen R, Warshow U, Dalton HR, Hussaini SH. Jaundice as a presentation of heart failure. J R Soc Med. 2005 Aug;98(8):357-9.

Cornwall Gastrointestinal Unit, Royal Cornwall Hospital Trust, Truro TR1 3LJ, UK.

On rare occasions the first manifestation of heart disease is jaundice, caused by passive congestion of the liver or acute ischaemic hepatitis. We looked for this presentation retrospectively in 661 patients referred over fifty-six months to a 'jaundice hotline' (rapid access) service. The protocol included a full clinical history, examination and abdominal ultrasound. Those with no evidence of biliary obstruction had a non-invasive liver screen for parenchymal liver disease and those with suspected heart disease had an electrocardiogram, chest X-ray and echocardiogram. 8 patients (1.2%), bilirubin 31-79 micromol/L, mean 46 micromol/L, had a primary cardiac cause for their jaundice. All had dyspnoea, an increased cardiothoracic ratio on chest X-ray and an abnormal electrocardiogram. The jugular venous pressure was raised in the 3 in whom it was recorded. In 6 patients the jaundice was attributed to hepatic congestion and in 2 to ischaemic hepatitis. All patients had severe cardiac dysfunction. Jaundice due to heart disease tends to be mild, and a key feature is breathlessness. The most common mechanism is hepatic venous congestion; ischaemic hepatitis is suggested by a high aminotransferase.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

13312.  Ahn H, Li CS, Wang W. Sickle cell hepatopathy: clinical presentation, treatment, and outcome in pediatric and adult patients. Pediatr Blood Cancer. 2005 Aug;45(2):184-90. Review

13313.  Basar O, Kisacik B, Bozdogan E, Yolcu OF, Ertugrul I, Koklu S. An unusual cause of acalculous cholecystitis during pregnancy: hepatitis A virus. Dig Dis Sci. 2005 Aug;50 (8):1532.

13314.  Blendis L. What are Helicobacter doing in the hepatobiliary system? Gastroenterology. 2005 Aug;129 (2):761-3. Review.

13315.  Davis GL, Lindsay KL. Treatment of chronic hepatitis C infection: one step at a time. Lancet Infect Dis. 2005 Aug;5 (8):524-6.

13316.  Durston S. What you need to know about viral hepatitis. Nursing. 2005 Aug;35(8):36-41; quiz 41-2. Review.

13317.  Fox RI. Sjogren's syndrome. Lancet. 2005 Jul 23-29;366(9482):321-31. Review.

13318.  Papakonstantinou O, Maris TG, Kostaridou S, Ladis V, Vasiliadou A, Gourtsoyiannis NC.  Abdominal lymphadenopathy in beta-thalassemia: MRI features and correlation with liver iron overload and posttransfusion chronic hepatitis C. AJR Am J Roentgenol. 2005 Jul;185(1):219-24.

13319.  Patel K, Zekry A, McHutchison JG. Steatosis and chronic hepatitis C virus infection: mechanisms and significance. Clin Liver Dis. 2005 Aug;9(3):399-410, vi. Review.

13320.  Rosmawati M. Aetiology and classification of acute liver failure. Med J Malaysia. 2005 Jul;60 Suppl B:125-6.

13321.  Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver Dis. 2005 Aug;9(3):383-98, vi. Review.

13322.  van Lingen R, Warshow U, Dalton HR, Hussaini SH. Jaundice as a presentation of heart failure. J R Soc Med. 2005 Aug;98(8):357-9.

Pathogenesis:

13323.  Darabi K. Proton-pump-inhibitor-induced hepatitis. South Med J. 2005 Aug;98(8):844-5.

13324.  Ferreiro MC, Dios PD, Scully C. Transmission of hepatitis C virus by saliva? Oral Dis. 2005 Jul;11(4):230-5. Review.

13325.  Fountain FF, Tolley E, Chrisman CR, Self TH. Isoniazid hepatotoxicity associated with treatment of latent tuberculosis infection: a 7-year evaluation from a public health tuberculosis clinic. Chest. 2005 Jul;128(1):116-23.

Therapy:

13326.   Whelan J.   First clinical data on RNAi. Drug Discov Today. 2005 Aug 1;10(15):1014-5.

13327.  Worley D. Ordinary strangers. Mr. Clean, Lady Goodwill, and other folks at TPAN's needle exchange. Posit Aware. 2005 Jul-Aug;16(4):38-40.

Back

Some Selected Abstracts:

1.

1.                   Eisen D, Carrozzo M, Bagan Sebastian JV, Thongprasom K. Number V Oral lichen planus: clinical features and management. Oral Dis. 2005 Nov;11(6):338-49.

Dermatology Research Associates, Cincinnati, OH 45230, USA. drore@eos.net

Oral lichen planus (OLP) is a relatively common chronic inflammatory disorder affecting stratified squamous epithelia. Whereas in the majority of instances, cutaneous lesions of lichen planus (LP) are self-limiting and cause itching, oral lesions in OLP are chronic, rarely undergo spontaneous remission, are potentially premalignant and are often a source of morbidity. Current data suggest that OLP is a T cell-mediated autoimmune disease in which auto-cytotoxic CD8+ T cells trigger apoptosis of oral epithelial cells. The characteristic clinical aspects of OLP may be sufficient to make a correct diagnosis if there are classic skin lesions present. An oral biopsy with histopathologic study is recommended to confirm the clinical diagnosis and mainly to exclude dysplasia and malignancy. The most commonly employed and useful agents for the treatment of lichen planus (LP) are topical corticosteroids but other newer agents are available.

2.

1.                   Fontana RJ, Shakil AO, Greenson JK, Boyd I, Lee WM. Acute liver failure due to amoxicillin and amoxicillin/clavulanate. Dig Dis Sci. 2005 Oct;50(10):1785-90.

Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, Michigan 48109-0362, USA. rfontana@umich.edu

The aim of our study is to report upon the presentation of two patients with life-threatening acute liver failure (ALF) due to amoxicillin and amoxicillin/clavulanate. A 59-year-old, Caucasian male presented with ALF 34 days after receiving amoxicillin/clavulanate. Despite aggressive supportive care, he died on hospital day 10. A 42-year-old, Caucasian female presented with ALF 21 days after receiving amoxicillin. She underwent successful liver transplantation on hospital day 19. In both cases, all competing causes of ALF had been excluded, liver pathology was consistent with drug-induced hepatitis, and cases were deemed "definite/ highly probable" using causality assessment. Amongst 14 prior ALF/death cases due to amoxicillin / clavulanate, the mean age (62 years), male predominance (57%), and mean delay from drug cessation to presentation (17 days) is similar to what has been reported in patients with self-limited cholestatic hepatitis. Acute liver failure is a rare manifestation of amoxicillin and amoxicillin/clavulanate hepatotoxicity with no obvious clinical features at presentation portending a poor prognosis. Early transfer of patients with severe drug-induced hepatotoxicity (i.e., encephalopathy or coagulopathy) to a transplant center is recommended due to their poor likelihood of recovery.

3.

1.                   Omenaca F, Garcia-Sicilia J, Garcia-Corbeira P, Boceta R, Romero A, Lopez G, Dal-Re R. Response of preterm newborns to immunization with a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio and Haemophilus influenzae type b vaccine: first experiences and solutions to a serious and sensitive issue. Pediatrics. 2005 Dec;116(6):1292-8.

Department of Neonatology, La Paz Hospital, Madrid, Spain.

OBJECTIVE: Preterm infants are at increased risk from infections and should be vaccinated at the usual chronological age. The aim of the study was to evaluate the immunogenicity and reactogenicity of a hexavalent diphtheria-tetanus-acellular pertussis-hepatitis B virus-inactivated polio and Haemophilus influenzae type b (DTPa-HBV-IPV/Hib) vaccine in preterm infants. METHODS: In a comparative trial, 94 preterm infants between 24 and 36 weeks (mean +/- SD gestational age: 31.05 +/- 3.45 weeks; mean birth weight: 1420 +/- 600 g) and a control group of 92 full-term infants were enrolled to receive 3 doses of a DTPa-HBV-IPV/Hib vaccine at 2, 4, and 6 months. Immunogenicity was assessed in serum samples that were taken before and 4 weeks after primary vaccination. Evaluation of reactogenicity was based on diary cards. RESULTS: All preterm (n = 93) and full-term (n = 89) infants who were included in the immunogenicity analysis had seroprotective titers to diphtheria; tetanus; and polio virus types 1, 2, and 3. The immune response to the Hib and hepatitis B components was lower in preterm than in full-term infants: 92.5% versus 97.8% and 93.4% versus 95.2%, respectively. Vaccine response rates for pertussis antigens were >98.9% in both study groups. Although most geometric mean titers were lower in preterm infants, titers were similar for pertussis, a major threat for premature infants. The vaccine was well tolerated, and there were no differences in reactogenicity between groups. Some extremely immature infants experienced transient cardiorespiratory events within the 72 hours after the first vaccination with no clinical repercussion. CONCLUSIONS: Preterm infants who were immunized with the hexavalent DTPa-HBV-IPV/Hib vaccine at 2, 4, and 6 months displayed good immune response to all antigens. The availability of this vaccine greatly facilitates the vaccination of premature infants.

4.

1.                   Slavin DE, Schlichting CL, Freston JW. Rating the severity of the medical consequences of drug-induced liver injury. Regul Toxicol Pharmacol. 2005 Nov;43(2):134-40.

Pfizer Global Research and Development, Pfizer Inc., Sandwich, CT13 9NJ, England, UK.

Risk analysis in drug development aims to allow for clear decisions showing whether or not the benefit of an intervention outweighs the risk. One of the difficulties in doing this in a repeatable and clear way is the problem of comparing different adverse events, as seriousness is often subjective. Using drug-induced liver injury as our model, we show that clinical, laboratory, and histological manifestations of liver reactions can be ranked by experienced hepatologists and these rankings can be used to rank the consequences of drug-induced side effects as a continuum. This risk ranked information could be transformed to standardized scores (z score) and the risks displayed by standard techniques; adverse events can then be compared with effects from other drugs and possibly with the consequences due to untreated disease or natural occurrences. As a risk is a function of both the seriousness of the event and the probability of its occurrence, risk can therefore be displayed in terms of probability and hazard to further ease communication. We propose that risk management of drugs in development would be improved, especially in terms of risk communication, if the hazard were ranked by means of a common scale and displayed in graphic form against the likelihood of occurrence.

5.

  3         Ward JI, Cherry JD, Chang SJ, Partridge S, Lee H, Treanor J, Greenberg DP, Keitel W, Barenkamp S, Bernstein DI, Edelman R, Edwards K; APERT Study Group. Efficacy of an acellular pertussis vaccine among adolescents and adults. N Engl J Med. 2005 Oct 13;353(15):1555-63.

UCLA Center for Vaccine Research, Research and Education Institute, Harbor-UCLA Medical Center, David Geffen School of Medicine, UCLA, Torrance, Calif 90502, USA.

BACKGROUND: Pertussis immunization of adults may be necessary to improve the control of a rising burden of disease and infection. This trial of an acellular pertussis vaccine among adolescents and adults evaluated the incidence of pertussis, vaccine safety, immunogenicity, and protective efficacy. METHODS: Bordetella pertussis infections and illnesses were prospectively assessed in 2781 healthy subjects between the ages of 15 and 65 years who were enrolled in a national multicenter, randomized, double-blind trial of an acellular pertussis vaccine. Subjects received either a dose of a tricomponent acellular pertussis vaccine or a hepatitis A vaccine (control) and were monitored for 2.5 years for illnesses with cough that lasted for more than 5 days. Each illness was evaluated with use of a nasopharyngeal aspirate for culture and polymerase -chain-reaction assay, and serum samples from patients in both acute and convalescent stages of illness were analyzed for changes in antibodies to nine B. pertussis antigens. RESULTS: Of the 2781 subjects, 1391 received the acellular pertussis vaccine and 1390 received the control vaccine. The groups had similar ages and demographic characteristics, and the median duration of follow-up was 22 months. The acellular pertussis vaccine was safe and immunogenic. There were 2672 prolonged illnesses with cough, but the incidence of this nonspecific outcome did not vary between the groups, even when stratified according to age, season, and duration of cough. On the basis of the primary pertussis case definition, vaccine protection was 92 percent (95 percent confidence interval, 32 to 99 percent). Among unimmunized controls with illness, 0.7 percent to 5.7 percent had B. pertussis infection, and the percentage increased with the duration of cough. On the basis of other case definitions, the incidence of pertussis in the controls ranged from 370 to 450 cases per 100,000 person-years. CONCLUSIONS: The acellular pertussis vaccine was protective among adolescents and adults, and its routine use might reduce the overall disease burden and transmission to children. Copyright 2005 Massachusetts Medical Society.

6.

1.                   Yeo MS, Bond LM, Sawyer SM. Health risk screening in adolescents: room for improvement in a tertiary inpatient setting. Med J Aust. 2005 Oct 17;183(8):427-9.

Centre for Adolescent Health, Royal Children's Hospital, 2 Gatehouse St, Melbourne, VIC 3052. Michele.Yeo@mcri.edu.au

OBJECTIVE: To determine the extent to which comprehensive health screening of adolescents was undertaken in a tertiary inpatient setting. DESIGN AND SETTING: Retrospective review of 100 consecutive medical records of 13-18-year-old adolescents admitted to The Royal Children's Hospital, Melbourne (first 20 consecutive admissions in 2001 to each of five units--general medicine, adolescent medicine, specialty medicine, general surgery, and specialty surgery). MAIN OUTCOME MEASURES: Documentation of screening for biomedical (height, weight, pubertal staging, and hepatitis B vaccination) and psychosocial concerns (HEADSS framework categorised into four screening levels--none, incomplete, adequate, thorough). Risks identified and actions taken. RESULTS: Weight was recorded for 98 patients, height for 17, pubertal staging for 12, and hepatitis B vaccination status for nine. Documentation of psychosocial screening was absent from 62 charts, inadequate in 29, thorough in three, and complete in seven charts. Adolescent medicine inpatients were more likely than patients in other units to have any screening of psychosocial risk recorded and more likely to be thoroughly screened (P < 0.005). Screening was more often documented for less sensitive issues (eg, home, tobacco) than higher risk behaviours (eg, illicit drug use) (P = 0.013). When screening identified risks, appropriate action was undertaken in most cases. CONCLUSIONS: This study highlights deficiencies in comprehensive health screening in adolescents admitted to a tertiary children's hospital. These results support the development of more consistent approaches to screening adolescent inpatients.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

13850.   Bae SH, Yoon SK, Choi JY, Jang JW, Cho SH, Yang JM, Han NI, Ahn BM,  hung KW, Sun HS. Timing of lamivudine administration according to Child class in patients with decompensated cirrhosis. J Gastroenterol Hepatol. 2005 Oct;20(10):1527-32.

13851.  Balasubramanian S, Prosser CC, Ransibrahmanakul K, Rossaro L, Bourgeois JA.   Treatment of hepatitis B and C co-infection in schizoaffective disorder. QJM. 2005 Oct;98(10):774-5.

13852.  Barnett ED. Immunizations and infectious disease screening for internationally adopted children. Pediatr Clin North Am. 2005 Oct;52(5):1287-309, vi. Review.

13853.  Coban S, Ceydilek B, Ekiz F, Erden E, Soykan I. Levofloxacin-induced acute fulminant hepatic failure in a patient with chronic hepatitis B infection. Ann Pharmacother. 2005 Oct;39(10):1737-40. 

13854.   Forrest EH.   Prognostic evaluation of alcoholic hepatitis. J Hepatol. 2005 Oct;43(4):738-9.

13855.  Guntupalli SR, Steingrub J. Hepatic disease and pregnancy: an overview of diagnosis and management. Crit Care Med. 2005 Oct;33(10 Suppl):S332-9. Review.

13856.   Iguchi Y, Ohmoto K, Wada H, Yamamoto S. Drug-induced megaloblastic anemia. Dig Dis Sci. 2005 Oct;50(10):1778-9.

13857.   Karnad DR, Guntupalli KK. Neurologic disorders in pregnancy. Crit Care Med. 2005 Oct;33(10 Suppl):S362-71. Review.

13858.   Keeffe EB. Chronic hepatitis C: management of treatment failures. Clin Gastroenterol Hepatol. 2005 Oct;3(10 Suppl 2):S102-5. Review.

13859.   Li XM, Ma L, Yang YB, Shi ZJ, Zhou SS. [Prognostic factors of fulminant hepatitis in pregnancy.]. Chin Med J (Engl). 2005 Oct 20;118(20):1754-7.

13860.   Lindsey N, Reif JS, Bachand A, Seys SA. Behavior modification following a diagnosis of hepatitis C infection. Am J Health Behav. 2005 Nov-Dec;29(6):  512-9.

13861.   Lopez-Medrano F, Lizasoain M, Aguado JM. A fractured diagnosis. N Engl J Med. 2005 Oct 20;353(16):1747; author reply 1747.

13862.   Miyake Y, Sakaguchi K, Iwasaki Y, Ikeda H, Makino Y, Kobashi H, Araki Y, Ando M, Kita K, Shiratori Y. New prognostic scoring model for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. Transplantation. 2005 Oct 15;80(7):930-6.

13863.   Mohanty SR. Extrahepatic manifestations of hepatitis C. South Med J. 2005 Oct;98(10):967-9.

13864.   Sherman M.  Predicting survival in hepatitis B. Gut. 2005 Nov;54(11):1521-3. Review.

13865.   Slowik MK, Jhaveri R. Hepatitis B and C viruses in infants and young children. Semin Pediatr Infect Dis. 2005 Oct;16(4):296-305. Review.

13866.   Weyer P, Cummings OW, Knox KS. A 49-year-old woman with hepatitis, confusion, and abnormal chest radiograph findings. Chest. 2005 Oct;128(4):3076-7, 3078-9.

13867.   Zalavras CG, Gupta N, Patzakis MJ, Holtom PD. Microbiology of osteomyelitis in patients infected with the human immunodeficiency virus. Clin Orthop Relat Res. 2005 Oct;439:97-100. 

Pathogenesis:

13868.     Erdem I, Cicekler N, Mert D, Yucesoy-Dede B, Ozyurek S, Goktas P. A case report of acute hepatitis due to brucellosis. Int J Infect Dis. 2005 Nov;9(6):349-50.  .

13869.   Griffith R, Tengnah C. Public health 2: Criminal liability for spreading disease. Br J Community Nurs. 2005 Oct;10(10):475-8. Review.

13870.   Kopka A. Anesthetist to patient transmission of hepatitis C virus associated with non exposure-prone procedures. J Med Virol. 2005 Dec;77(4):500; discussion 501.

13871.   Milazzo L. Hepatitis A associated with green onions. N Engl J Med. 2005 Nov 24;353(21):2300-1.

13872.  Yang PM, Chen DS. Images in clinical medicine. Caput medusae. N Engl J Med. 2005 Nov 24;353(21):e19.

Vaccines:

13873.     Charatan F. US panel recommends young children receive hepatitis A vaccination. BMJ. 2005 Nov 12;331(7525):1102.

13874.   Connor BA. Hepatitis A vaccine in the last-minute traveler. Am J Med. 2005 Oct;118 Suppl 10A:58S-62S. Review.

13875.   Davis JP.  Experience with hepatitis A and B vaccines. Am J Med. 2005 Oct;118 Suppl 10A:7S-15S. Review. 

13876.  Gall SA. Expanding the use of hepatitis vaccines in obstetrics and gynecology. Am J Med. 2005 Oct;118 Suppl 10A:96S-99S. Review.

13877.   Peterson DC, Palevsky SL. Office-based approach to the implementation of a hepatitis immunization program. Am J Med. 2005 Oct;118 Suppl 10A:90S-9S5. Review.

13878.   Woo EJ, Ball R, Braun MM. Fatal syncope-related fall after immunization. Arch Pediatr Adolesc Med. 2005 Nov;159(11):1083.

13879.   Zanetti AR, Mariano A, Romano L, D'Amelio R, Chironna M, Coppola RC,  uccia M, Mangione R, Marrone F, Negrone FS, Parlato A, Zamparo E, Zotti C, Stroffolini T, Mele A; Study Group. Long-term immunogenicity of hepatitis B vaccination and policy for booster: an Italian multicentre study. Lancet. 2005 Oct 15-21;366(9494):1379-84.

13880 .     Dhiman RK, Chawla YK. Herbal medicines for liver diseases. Dig Dis Sci. 2005 Oct;50(10):1807-12. Review.

13881.   Hardie J. Harsh advice? Br Dent J. 2005 Oct 22;199(8):483-4.

13882.   Larkin M. In hurricanes' aftermath, keeping infection under control. Lancet Infect Dis. 2005 Nov;5(11):673.

13883.  Peterson GM, Naunton M. Valproate: a simple chemical with so much to offer. J Clin Pharm Ther. 2005 Oct;30(5):417-21. Review.

13884.  Seed CR, Kiely P, Keller AJ. Residual risk of transfusion transmitted human immunodeficiency virus, hepatitis B virus, hepatitis C virus and human T lymphotrophic virus. Intern Med J. 2005 Oct;35(10):592-8.

Back

Some Selected Abstracts:

1.

Autoimmune liver disease in children presents predominantly as autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC). These diagnoses must be considered in patients who have acute and chronic hepatitis, particularly when an extrahepatic autoimmune disorder is present. In AIH, the timely and sustained control of liver inflammation is critical to improve the short- and long-term outcomes. No effective treatment for PSC has been identified to date, but supportive care, careful attention to complications and associated nonhepatic diseases, and liver transplantation significantly improve the long-term outcome.
 

2.

Vaccines are one of the most important and effective tools for protecting the health of the public and family physicians are instrumental in insuring that vaccine recommendations are implemented. With the development of new vaccines come increasingly complex recommendations. Staying current is challenging. This column describes the most recent changes to the immunization schedules made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC).
 

3.

Toxic epidermal necrolysis (TEN) is the most severe and potentially life-threatening cutaneous reaction associated with lamotrigine. The risk of developing TEN during lamotrigine therapy is low and previously reported cases most involved epileptic patients. However, the risk of TEN with combination lamotrigine and valproate is greater than with monotherapy. We present here the emergence of TEN in a 32-year-old bipolAR woman who was concomitantly treated with lamotrigine and valproate. The patient developed high fever, pharyngitis, cervical lymphadenopathy, mucosal sloughing, generalized
erythematous eruptions and more than 40% epidermal detachment of the total body surface area (TBSA) after we added lamotrigine to her medications of valproate and trazodone. The patient's illness course was protracted and accompanied with hepatitis, pneumonitis and hematologic abnormalities. In the beginning of her illness course, our patient did not respond to antihistamine treatment. However, she made a full recovery without any sequela after she had received systemic corticosteroid and intensive resuscitation. Our case suggests that early use of systemic corticosteroid might be beneficial in treating TEN patients, if there is not any clinical contraindication.
 

4.

INTRODUCTION: Tuberculosis continues to be a major cause of morbidity and mortality worldwide. Currently available drugs are effective for treatment of the disease or latent infection, but may cause serious adverse effects. METHODS: The authors reviewed the literature for side effects of five first-line antituberculous medications (isoniazid, rifampin, pyrazinamide, ethambutol and streptomycin). Incidence of the major side effects were compiled with particular attention to the incidence of isoniazid hepatotoxicity. RESULTS: Hepatotoxicity to isoniazid is a serious problem. Although overall incidence may be decreasing, incidence averaged 9.2 per 1000 patients who were compliant, in multiple studies, with a case fatality rate of 4.7%. The incidence is higher with increasing age . Other serious adverse effects include dermatological, gastrointestinal, hypersensitivity, neurological, haematological and renal reactions. They can lead to drug  discontinuation (in up to 10% of patients) or even more serious morbidity or mortality. CONCLUSIONS: Side effects to antituberculosis drugs are common, and include hepatitis, cutaneous reactions, gastrointestinal intolerance, haematological reactions and renal failure. These adverse effects must be recognised early, to reduce associated morbidity and mortality.
 

5.

Massive ascites and hepatorenal syndrome (HRS) are frequent complications of liver cirrhosis.Thus, effective therapy is of great clinical importance. This concise review provides an update of recent advances and new developments. Therapeutic paracentesis can be safely performed even in patients with severe coagulopathy. Selected patients with a refractory or recurrent ascites are good candidates for non-surgical portosystemic shunts (TIPS) and may have a survival benefit and improvement of quality of life. Novel pharmaceutical agents mobilizing free water (aquaretics) are currently under test for the therapeutic potential in patients with ascites. Prophylaxis of hepatorenal syndrome in patients with spontaneous bacterial peritonitis is recommended and should be considered in patients with alcoholic hepatitis. Liver transplantation is the best therapeutic option with long-term survival benefit for patients with HRS. To bridge the time until transplantation, TIPS or Terlipressin and albumin are goodoptions. Albumin dialysis can not be recommended outside prospective trials.
 

6.

OBJECTIVE: To evaluate the effects of hepatitis B vaccine and immunoglobulin in newborn infants of mothers positive for hepatitis B surface antigen. DESIGN: Systematic review and meta-analysis of randomised clinical trials. DATA SOURCES: Electronic databases and hand searches. REVIEW METHODS: Randomised clinical trials were assessed for methodological quality. Meta-analysis was undertaken on three outcomes: the relative risks of hepatitis B occurrence, antibody levels to hepatitis B surface antigen, and adverse events. RESULTS: 29 andomised clinical trials were identified, five of which were considered high quality. Only three trials reported inclusion of mothers negative for hepatitis B e antigen. Compared with placebo or no intervention, vaccination reduced the occurrence of hepatitis B (relative risk 0.28, 95% confidence interval 0.20 to 0.40; four trials). No significant difference in hepatitis B occurrence was found between recombinant vaccine and plasma derived vaccine (1.00, 0.71 to 1.42; four trials) and between high dose versus low dose vaccine (plasma derived vaccine 0.97, 0.55 to 1.68, three trials; recombinant vaccine 0.78, 0.31 to 1.94, one trial). Compared with placebo or no intervention, hepatitis B immunoglobulin or the combination of plasma derived vaccine and hepatitis B immunoglobulin reduced hepatitis B occurrence (immunoglobulin 0.50, 0.41 to 0.60, one trial; vaccine and immunoglobulin 0.08, 0.03 to 0.17, three trials). Compared with vaccine alone, vaccine plus hepatitis B immunoglobulin reduced hepatitis B occurrence (0.54, 0.41 to 0.73; 10 trials). Hepatitis B vaccine and hepatitis B immunoglobulin seem safe, but few trials reported adverse events. CONCLUSION: Hepatitis B vaccine, hepatitis B immunoglobulin, and vaccine plus immunoglobulin prevent hepatitis B occurrence in newborn infants of mothers positive for hepatitis B surface antigen.
 

7.

OBJECTIVE: To report a case of drug-induced hepatitis associated with low-dose venlafaxine. CASE SUMMARY: A 60-year-old white woman receiving venlafaxine 75 mg daily for vasomotor symptoms presented after one month of therapy with nonspecific complaints,including abdominal pain. A series of diagnostic and laboratory tests revealed anenlarged liver and elevated alanine aminotransferase (ALT) up to 372 U/L, aspartate aminotransferase (AST) up to 99 U/L, gamma-glutamyltransferase (GGT) up to 962 U/L, and alkaline phosphatase up to 758 U/L. All potential hepatotoxic medications were discontinued. Within one week after stopping venlafaxine, her liver function test results showed marked improvement. Almost 4 weeks after discontinuing therapy, venlafaxine 37.5 mg was reinitiated. Her ALT, AST, GGT, and alkaline phosphatase again increased to 269, 49, 256, and 263 U/L, respectively, 6 days after resuming therapy. Upon discontinuation of venlafaxine, her liver function abnormalities resolved. DISCUSSION: This case is significant due to the severity of symptoms and consequent liver function test results involved in diagnosing drug-induced hepatitis. It is also remarkable because of the hepatotoxicity that occurred initially and on rechallenge with low-dose venlafaxine. The hepatotoxic effects of venlafaxine have been characterized as rare and idiosyncratic. The Naranjo probability scale revealed that the adverse drug event was probable. CONCLUSIONS: Venlafaxine therapy can lead to drug-induced hepatitis, even when used at low doses. Clinicians should be aware of this possible adverse effect of venlafaxine therapy and monitor patients closely after initiation of therapy.
 

8.

BACKGROUND: Male sex workers are at risk of blood borne viruses but may have limited access to sexual health services, including vaccination. We explore factors associated with hepatitis B vaccination uptake among male sex workers in London METHODS: Follow up study of men attending the Working Men's Project, a specialist health project for men who sellsex, between 1994 and 2003. RESULTS: At baseline 797 men were screened for hepatitis B;308 were not eligible for vaccination because of past or current infection (155, 19.4%) orprevious vaccination 153 (19.2%). Of the 489 men eligible for a full course of vaccination 292(59.8%) completed the course. Completion rates fell over time: men recruited up to 1999were more likely to complete the course than those recruited more recently (177/259, 68.3% compared with 115/229, 50.2%, OR 2.14, 95% CI 1.48 to 3.09). CONCLUSION: This specialist service achieved a high rate of vaccine completion in theearly years, but the decline is a concern. It may reflect wider availability of vaccination elsewhere and a more mobile population of sex workers. Shorter courses may achieve a higher completion.
 

9.

OBJECTIVES: In 1998 the World Health Organization (WHO) recommended the inclusion of Haemophilus influenza type B (Hib) conjugate vaccines in infant immunization programs, whenever in accordance with national priorities. GlaxoSmithKline Biologicals has developed a new pentavalent combined diphtheria-tetanus-whole cell pertussis-hepatitis B/Hib (DTPw-HB/Hib) vaccine containing 5 microg of polyribosylribitol phosphate (PRP), and we assessed the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with this new vaccine compared with a reference regimen consisting of the licensed DTPw-HB (Tritanrix) and Hib (Hiberix) vaccines given as simultaneous concomitant injections. METHODS: We performed a randomized, double-blind study from September 1998 to August 1999 to establish the immunogenicity and reactogenicity of primary and booster vaccination of healthy children with the new pentavalent combined DTPw-HB/Hib vaccine given as a single injection, compared with the reference regimen. RESULTS: Both vaccination regimens elicited excellent immune responses, with all subjects in both groups achieving seroprotective anti-PRP antibody concentrations of > or = 0.15 microg/mL one month after primary vaccination. The combined DTPw-HB/Hib vaccine was non-inferior to the licensed vaccines in terms of seroprotection/seropositivity/vaccin response rates for all antigen components. Persistence of antibodies against all study vaccine antigens up to the time of booster vaccination was comparable between groups, and a marked increase of all antibody concentrations was observed after the booster
dose. Both vaccine regimens were similar in terms of their overall reactogenicity profiles. CONCLUSIONS: Our results indicate that the new DTPw-HB/Hib pentavalent  combination vaccine provides an efficient and reliable way of implementing WHO recommendations for controlling hepatitis B and Hib infections on a worldwide basis.
 

10.

A full-term, healthy female newborn was delivered via cesarean section because the labor did not adequately progress. The mother, age 33 years and of Asian ancestry, had a significant medical and obstetrical history: chronic hepatitis B carrier without cirrhosis, cutaneous lupus erythematosus (positive anti-Ro and anti-La antibodies), and a positive group B streptococcal recto-vaginal culture at 35 weeks' gestation. The mother received 4 doses of intravenou ampicillin during labor. The infant's initial hospital course was complicated by a transient and otherwise asymptomatic bradycardia. An electrocardiogram (ECG) confirmed a heart rate of 96 with normal interval parameters, but there were
changes suggestive of left ventricular hypertrophy. An echocardiogram was normal. Follow- up office visits for common newborn feeding problems demonstrated consistent weight gain and normal vital signs, including heart rate and facial milia. However, by age 4 weeks an erythematous eruption extending from the frontal scalp and forehead to the cheek area had developed. What is the differential diagnosis? What tests should be done to make the diagnosis?
 

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

14353.  Wong T, Lee SS. Hepatitis C: a review for primary care physicians. CMAJ. 2006 Feb 28;174(5):649-59. Review.

Vaccines:

14362.   Terney D, Beniczky S, Barsi P, Kondakor I, Perenyi J, Faludi B, Szapper M, Vecsei L. Multiple sclerosis after hepatitis B vaccination in a 16-year-old patient. Chin Med J (Engl). 2006 Jan 5;119(1):77-9.

14370.  Wu CH, Wang QH, Tian GS, Xu XY, Yu YY, Wang GQ. Clinical features of the overlap syndrome of autoimmune hepatitis and primary biliary cirrhosis: retrospective study. Chin Med J (Engl). 2006 Feb 5;119(3):238-41.

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 April 2006

Some selected abstract:

1

Azad N, Rojanasakul Y. Vaccine delivery--current trends and future. Curr Drug Deliv. 2006 Apr;3(2):137-46. Review.
West Virginia University, School of Pharmacy, Department of Pharmaceutical Sciences, Morgantown, WV 26506, USA.Since its discovery in 1796 by Edward Jenner, vaccines have been an integral aspect of therapeutics, combating a number of infectious diseases with remarkable success. In recent years, due to rapid advances in proteomics, genomics, biotechnology and immunology and the plethora of knowledge amassed in related fields, it is fair to expect vaccine development to progress at an exponential pace. However, as we march on into the 21st century, we are still struggling in our efforts to eradicate fatal diseases such as AIDS, malaria and hepatitis C due, in part, to the absence of effective vaccines against these diseases. Vaccine development faces major challenges both technologically and economically. Newer vaccines that are stable, economical, require fewer doses and can be administered using needle free systems are a worldwide priority. An ideal theoretical vaccine may not be cogent unless formulated and delivered aptly. Delivery of vaccines via oral, intranasal, transcutaneous and intradermal routes will decrease the risk of needle-borne diseases and may eliminate the need for trained personnel and sterile equipment. Crucial to the success of a vaccine is the delivery strategy that is to be employed. Currently, various techniques involving DNA vaccines, adjuvants, microparticles and transgenic plants are being developed and evaluated. Although, no major breakthrough is in prospect, these systems have potential and will take immunization to a new technological level. This review will focus on the current development of some novel vaccine delivery systems and will explore the non-parenteral routes of vaccine administration.
 

2

Brent RL. Risks and benefits of immunizing pregnant women: the risk of doing nothing. Reprod Toxicol. 2006 May;21(4):383-9.
Laboratory of Clinical and Environmental Teratology, Alfred I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, DE 19899, USA. rbrent@nemours.org
The medical, social and legal risks of immunizing pregnant women are obstacles preventing the initiation of programs to immunize women for their protection and for their infant's protection. Recent projects devoted to vaccine development have focused on protecting newborns and infants. But there are many other reasons for developing or utilizing vaccines before or during pregnancy, beyond the protection of the newborn. Besides the usual reasons for utilizing immunizations to protect the mother and the neonate, the threat of bio-terrorism adds a new dimension to the necessity for addressing this issue. The potential advantages for thinking about vaccinating pregnant women include an array of possible programs associated with risks and benefits. The immunization of pregnant women or women of reproductive age has multiple purposes: to protect the mother, to protect the newborn and infant and to prevent diseases and complications of pregnancy. (1) Preparation of vaccines against infectious agents that are known to result in reproductive pathology and congenital malformation if the infection of the mother occurs during pregnancy. (2) To utilize vaccines used routinely to protect the non-pregnant population, for administration during pregnancy, i.e., influenza, tetanus and other vaccines. Should these vaccines and other routinely used vaccines for children and non-pregnant adults be administered to women during pregnancy if they are medically indicated? (3) Utilization of vaccines to protect women from diseases to which they are susceptible because of pregnancy (poliomyelitis, hepatitis). (4) Utilization of vaccines for use before or during pregnancy, primarily to protect the newborn and infant via maternal transplacental antibodies, i.e., GBD (group B streptococcus). (5) The prevention of intrauterine infection that has been alleged to initiate premature labor. (6) The preparation of a vaccine for use before or during pregnancy to protect both the mother and the neonate, i.e., botulism toxin vaccine. The regulatory agencies and the vaccine producers will need a great deal of objective scientific advice and support and it is the scientific community's responsibility to provide that support. If the scientific and medical community ignores the opportunity to develop vaccines that could reduce the occurrence of reproductive and developmental problems, then we can be accused of acquiescing to the "risk of doing nothing."
 

3

Chattopadhyay S, Das BC, Gupta RK, Kar P. Presence of TT virus infection in chronic hepatitis patients from a hospital in New Delhi, India. Indian J med Res 2005, 122(1), 29-33. 
PCR-Hepatitis Laboratory, Department of Medicine, Maulana Azad Medical College, New Delhi, India.
BACKGROUND & OBJECTIVE: The recent discovery of a novel parenterally transmitted, unenveloped, single-stranded DNA virus called TT virus (TTV) in chronic hepatitis patients with unclear pathogenesis throughout the world led us to investigate, its presence in chronic hepatitis patients attending a hospital in New Delhi, India, and to evaluate its role in liver disease. METHODS: TT virus DNA was investigated in serum samples of 70 patients with various types of chronic hepatitis, and 100 healthy subjects from New Delhi, India by nested PCR using the primers that belonged to UTR (A) region of the genome. RESULTS: TTV DNA was detected in 6 of 23 patients (26%) with type B chronic hepatitis, 3 of 20 patients (15%) with type C chronic hepatitis, and 12 of 100 subjects (12%) from healthy control group with normal liver function profile tests. None of the 27 non-B, non-C chronic hepatitis patients had TTV DNA positivity. The prevalence of TTV was significantly higher in type-B chronic hepatitis patients as compared to normal subjects (P< 0.05) but comparable to type C chronic hepatitis patients. The clinical course and biochemical profiles of type B, or type C chronic hepatitis patients co-infected with TTV did not differ significantly from those without TTV infection. INTERPRETATION & CONCLUSION: Interestingly, in chronic hepatitis patients, TTV was always associated with either hepatitis B or C virus indicating a likely parenteral route of transmission. All TTV-positive subjects in healthy control group showed normal clinical and biochemical profiles. Thus, the presence of TTV infection is unlikely to influence the course of chronic hepatitis related to hepatitis B virus (HBV) or hepatitis C virus (HCV) or cause liver diseases in healthy subjects.
 

4

Dunser MW, Baelani I, Ganbold L. A review and analysis of intensive care medicine in the least developed countries. Crit Care Med. 2006 Apr;34(4):1234-42. Review.
Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria.
OBJECTIVE: To give critical care clinicians in Western nations a general overview of intensive care medicine in less developed countries and to stimulate institutional or personal initiatives to improve critical care services in the least developed countries. DATA SOURCE: In-depth PubMed search and personal experience of the authors. DATA SYNTHESIS: In view of the eminent burden of disease, prevalence of critically ill patients in the least developed countries is disproportionately high. Despite fundamental logistic (water, electricity, oxygen supply, medical technical equipment, drugs) and financial limitations, intensive care medicine has become a discipline of its own in most nations. Today, many district and regional hospitals have units where severely ill patients are separately cared for, although major intensive care units are only found in large hospitals of urban or metropolitan areas. High workload, low wages, and a high risk of occupational infections with either the human immunodeficiency virus or a hepatitis virus explain burnout syndromes and low motivation in some health care workers. The four most common admission criteria to intensive care units in least developed countries are postsurgical treatment, infectious diseases, trauma, and peripartum maternal or neonatal complications. Logistic and financial limitations, as well as insufficiencies of supporting disciplines (e.g., laboratories, radiology, surgery), poor general health status of patients, and in many cases delayed presentation of severely sick patients to the intensive care unit, contribute to comparably high mortality rates. CONCLUSION: More studies on the current state of intensive care medicine in least developed countries are needed to provide reasonable aid to improve care of the most severely ill patients in the poorest countries of the world.
 

5

Romero-Gomez M, Otero MA, Sanchez-Munoz D, Ramirez-Arcos M, Larraona JL, Suarez Garcia E, Vargas-Romero J. Acute hepatitis due to Mycoplasma pneumoniae infection without lung involvement in adult patients. J Hepatol. 2006 Apr;44(4):827-8.
Digestive Diseases Unit, Hospital Universitario de Valme, Ctra Cadiz s/n 41014, Sevilla, Spain. mromerog@supercable.es
Mycoplasma pneumoniae has been associated with cholestatic hepatitis in children, while in adults, the lack of liver involvement has been considered as a typical feature of M. pneumoniae infection. Controversial data have been reported about the possibility of liver involvement with M. pneumoniae community-acquired pneumonia. We present two cases of acute hepatitis associated with M. pneumoniae infection without lung involvement.
 

6

Shinefield H, Black S, Thear M, Coury D, Reisinger K, Rothstein E, Xu J, Hartzel J, Evans B, Digilio L, Schodel F, Brown ML, Kuter B; The 013 Study Group for ProQuad.  Safety and immunogenicity of a measles, mumps, rubella and varicella vaccine given with combined Haemophilus influenzae type b conjugate/hepatitis B vaccines and combined diphtheria-tetanus-acellular pertussis vaccines. Pediatr Infect Dis J. 2006 Apr;25(4):287-92.
University of California School of Medicine, San Francisco, USA.
BACKGROUND: A study was conducted to assess administration of a combination measles, mumps, rubella and varicella vaccine (MMRV) with other childhood vaccines. METHODS: In this open, multicenter trial, 1915 healthy children ages 12-15 months were randomized into 3 groups: group 1, MMRV, combined Haemophilus influenzae type b conjugate-hepatitis B vaccines (Hib/HepB) and combined diphtheria-tetanus-acellular pertussis vaccines (DTaP) concomitantly; group 2, MMRV followed by Hib/HepB and DTaP 42 days later; group 3, MMR and varicella vaccine followed by Hib/HepB and DTaP 42 days later. RESULTS: Antibody responses to measles, mumps, rubella, varicella, Hib, HepB, diphtheria and tetanus were similar between groups 1 and 2 (all >95%, except varicella, 89.7% in group 1 and 90.9% in group 2). Pertussis toxin and filamentous hemagglutinin responses were significantly lower in group 1 than in group 2 (group 1, 74.1 and 67.1%; group 2, 90.4 and 86.8%, respectively). An exploratory analysis suggested that the difference in and pertussis toxin and filamentous hemagglutinin responses was likely the result of study design rather than interference among vaccine components because the groups differed in age of receipt of DTaP (group 1, approximately 12 months; group 2, approximately 13.5 months). When the groups were matched for age, sample size was sufficient for comparison only in children > or =13.5 months old. Pertussis toxin and filamentous hemagglutinin responses were similar in these children. The safety profiles for each vaccination regimen were comparable. CONCLUSIONS: The immunogenicity data support concomitant administration of MMRV with Hib/HepB. Limited data from an exploratory analysis indicate that MMRV can be administered concomitantly with DTaP. Concomitant administration of MMRV, Hib/HepB and DTaP is well-tolerated.
 

7

Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect. 2006 Apr;12(4):309-14. Review.
Digestive Diseases Unit, Hospital Universitario de Valme, Ctra Cadiz s/n 41014, Sevilla, Spain. mromerog@supercable.e
Mycoplasma pneumoniae has been associated with cholestatic hepatitis in children, while in adults, the lack of liver involvement has been considered as a typical feature of M. pneumoniae infection. Controversial data have been reported about the possibility of liver involvement with M. pneumoniae community-acquired pneumonia. We present two cases of acute hepatitis associated with M. pneumoniae infection without lung involvement.
 

8

Tam DH, Farber HW. Pulmonary hypertension and beta-thalassemia major: report of a case, its treatment, and a review of the literature. Am J Hematol. 2006 Jun;81(6):443-7.  Evans Medical Foundation, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts 02118, USA
Pulmonary hypertension is a common complication of beta-thalassemia major. We report a case of successful treatment of pulmonary hypertension in a patient with beta-thalassemia major and review the literature on pulmonary hypertension and beta-thalassemia major. A 28-year-old man with beta-thalassemia major, splenectomy, hepatitis C, and hemosiderosis who presented with increasing dyspnea on exertion was diagnosed with pulmonary hypertension. After receiving continuous epoprostenol infusion and desferoxamine, his functional capacity and hemodynamic status improved. To our knowledge, this is the first case of pulmonary hypertension associated with beta-thalassemia treated with continuous epoprostenol infusion and desferoxamine. Epoprostenol, beneficial in the treatment of other types of pulmonary hypertension, may ameliorate the morbidity and mortality of pulmonary hypertension associated with thalassemia.
 

9

Vogiatzi MG, Macklin EA, Fung EB, Vichinsky E, Olivieri N, Kwiatkowski J, Cohen A, Neufeld E, Giardina PJ. Prevalence of fractures among the Thalassemia syndromes in North America. Bone. 2006 Apr;38(4):571-5.
Pediatrics, Weill Medical College of Cornell University, New York, NY, USA.
Historically, fractures are cited as a frequent problem in patients with Thalassemia prior to optimization of transfusion and chelation regimens. The aim of this study was to determine the prevalence of fractures in a contemporary sample of North American patients with Thalassemia. The North American Thalassemia Clinical Research Network (TCRN) database registry was used to gather historical data on 702 patients with common alpha and beta-Thalassemia diagnoses including Thalassemia Major (TM), Intermedia (TI), E/Beta, homozygous alpha Thalassemia (AT), Hemoglobin H disease (HbH) and HbH with Constant Spring (HbH/CS), who consented to a medical record chart review. Bone mineral density (BMD) measurements by DXA were available for review in a subgroup of patients (n = 312). The overall fracture prevalence among all Thalassemia syndromes was 12.1%, equally distributed between females (11.5%) and males (12.7%). Fractures occurred more frequently in TM (16.6%) and TI (12.2%) compared to E/Beta (7.4%) and alpha (2.3%). Prevalence increased with age (2.5% ages 0-10 years, 7.4% ages 11-19 years, 23.2% ages >20 years) and with use of sex hormone replacement therapy (SHRT) (P < 0.01). On average, BMD Z and T scores were 0.85 SD lower among patients with a history of fractures (mean Z/T score -2.78 vs. -1.93, 95% CI for the difference -0.49 to -1.22 SD, P = 0.02). Presence of other endocrinopathies (i.e. hypothyroidism, hypoparathyroidism and diabetes mellitus), anthropometric parameters, heart disease or hepatitis C were not significant independent predictors of fractures. These data indicate that fractures remain a frequent complication among the aging patients with both TM and TI beta-Thalassemia. However, the fracture prevalence has improved compared to published reports from the 1960s to 1970s. In addition, children with Thalassemia appear to have low fracture rates compared to the general population.
 

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:

14714.   Alfire ME, Treem WR. Nonalcoholic fatty liver disease. Pediatr Ann. 2006 Apr;35(4):290-4, 297-9. Review. 

14715.  Bonilla MF, Kaul DR, Saint S, Isada CM, Brotman DJ. Clinical problem-solving. Ring around the diagnosis. N Engl J Med. 2006 May 4;354(18):1937-42.

14716.  Bornstein MM, Kalas L, Lemp S, Altermatt HJ, Rees TD, Buser D. Oral lichen planus and malignant transformation: a retrospective follow-up study of clinical and histopathologic data. Quintessence Int. 2006 Apr;37(4):261-71.

14717.  Cole E, Lynch A, Cugnoni H. Assessment of the patient with acute abdominal pain. Nurs Stand. 2006 May 31-Jun 6;20(38):56-61; quiz 66. 

14718.  Mandal K, Chopra N. Acute transverse myelitis following hepatitis E virus infection. Indian Pediatr. 2006 Apr;43(4):365-6.

14719.  O'Reilly K, Ahmed SF, Murday V, McGrogan P.  Biliary hypoplasia in Williams syndrome. Arch Dis Child. 2006 May;91(5):420-1. 

14720.  van de Veerdonk FL, Schneeberger PM.  Patient with fever and diarrhea. Clin Infect Dis. 2006 Apr 1;42(7):994-5, 1051-2.

Vaccines:

14721.  Capra F, Nicolini N, Franchini M.  Is the periodic repetition of a coagulation check necessary during anti-hepatitis C virus therapy? Gut. 2006 Jun;55(6):902.

14722.  Sharma D, Sibal A. Making a case for hepatitis a vaccination in glucose -6 phosphatedehydrogenase deficient subjects. Indian J Pediat 2005, 72(7), 640.

Therapy:

14723.  Bacon BR.  Assessing evidence from clinical trials in chronic hepatitis C. J Viral Hepat. 2006 May;13 Suppl 1:1-5. Review. 

14724.  Everhart JE.  Alcohol and hepatitis C: do we have a drinking problem? Gastroenterology. 2006 May;130(6):1912-4.

14725.  Fix OK, Peters MG, Davern TJ. Eosinophilic hepatitis caused by lamotrigine. Clin Gastroenterol Hepatol. 2006 Apr;4(4):xxvi.

14726.  Fontana RJ.  Optimizing outcomes in hepatitis C: is treatment beyond 48 weeks ever justified? Gastroenterology. 2006 Apr;130(4):1357-62. Review. 

14727.  Harrison SA. HCV therapy in 2006: down with ALT levels, in with awareness of co-existent metabolic syndrome. J Hepatol. 2006 Apr;44(4):624-6.

14728.  Main J, Thomas H.  Mild hepatitis C: treat or monitor. J Viral Hepat. 2006 May;13(5):289.

14729.  McIntyre K.  Drug-related hepatotoxicity. N Engl J Med. 2006 May 18;354(20):2191-3; author reply 2191-3. 

14730.  Najafi Sani M, Kianifar HR, Kianee A, Khatami G. Effect of oral garlic on arterial oxygen pressure in children with hepatopulmonary syndrome. World J Gastroenterol. 2006 Apr 21;12(15):2427-31. 

14731.  O'Shea R, McCullough AJ.  Steroids or cocktails for alcoholic hepatitis. J Hepatol. 2006 Apr;44(4):633-6.

14732.  Rumi MG, D'Ambrosio R, Aghemo A. The clinical impact of a 24-week treatment course of peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. J Hepatol. 2006 Apr;44(4):825; author reply 825-6. 

14733.  Zuger A.  Guideline watch. HIV treatment guidelines updated. AIDS Clin Care. 2006 Jun;18(6):57.

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