HEPATITIS 

Selected abstracts:

1.                Adams PC, Passmore L, Chakrabarti S, Reboussin DM, Acton RT, Barton JC, McLaren GD, Eckfeldt JH, Dawkins FW, Gordeuk VR, Harris EL, Leiendecker-Foster C, Gossman E, Sholinsky P; Hemochromatosis and Iron Overload Screening Study Research Investigators.  Liver diseases in the hemochromatosis and iron overload screening study. Clin Gastroenterol Hepatol. 2006 Jul;4(7):918-23; quiz 807.

Department of Medicine, University Hospital, 339 Windermere Road, London, Ontario, Canada N6A 5A5. padams@uwo.ca

BACKGROUND AND AIMS: The Hemochromatosis and Iron Overload Screening (HEIRS) Study screened 101,168 primary care participants for iron overload with serum transferrin saturation (TS), ferritin, and C282Y and H63D mutations of the HFE gene. METHODS: All C282Y homozygotes and participants with an increased TS (>45% women, >50% men) and serum ferritin level (> 200 microg/L women, >300 microg/L men) were recalled for a clinical history and physical examination, and blood tests including alanine transaminase (ALT) and aspartate transaminase levels. Hepatitis B surface antigen and anti-hepatitis C virus were measured if the ALT level was increased (>31 IU/L in women, >40 IU/L in men). RESULTS: In the group of participants selected to return for clinical examination because of increased TS and ferritin levels, ALT increases and anti-hepatitis C virus were found in 95 of 284 (33%) African Americans, 50 of 466 (11%) Asian and Pacific Islanders, 21 of 120 (18%) Hispanics, and 40 of 477 (8.4%) Caucasians. ALT increases and hepatitis B surface antigen were detected in 24 of 466 (5%) Asian and Pacific Islanders, 10 of 284 (3.5%) African Americans, 3 of 120 (2.5%) Hispanics, and 2 of 477 (.42%) Caucasians. Of 86 liver biopsy specimens obtained for clinical purposes, 53 were reviewed by a single study pathologist. Liver fibrosis (stage 3 or 4) was present in 2 of 11 (18.2%) C282Y homozygotes that underwent central review and 2 of 302 (.66%) C282Y homozygotes attending the clinical examination. CONCLUSIONS: Screening for iron overload with ferritin and TS detects persons with viral hepatitis and other types of liver disease. A minimum of .66% C282Y homozygotes have liver fibrosis.

 2.              Kumar P. Physician documentation of neonatal risk assessment for perinatal infections. J Pediatr. 2006 Aug;149(2):265-7.

Department of Pediatrics, Northwestern Memorial Hospital and Children's Memorial Hospital, Northwestern University, Chicago, Illinois, USA. p-kumar@northwestern.edu

Charts of newborn infants were reviewed for documentation of maternal risk factors and prenatal screening test results. Physician documentation was incomplete in most infants. Nearly half of all infants were discharged without documentation regarding maternal status of hepatitis B, syphilis, and group B streptococcus. These lapses in newborn assessment have a potential for significant medical errors.

 3.                 Tsai N. Diagnosis and management of chronic hepatitis B in the primary care setting. Diagnosis and management of chronic hepatitis B in the primary care setting. Postgrad Med. 2006 Jul-Aug;119(2):28-36.

Division of Gastroenterology, John A Burns School of Medicine, Honolulu, Hawaii 96817, USA. naoky@hawaii.edu

Chronic hepatitis B is a complex disease for which there are an increasing number of approved treatment options. Clinicians who strive to keep up to date on the diagnosis and treatment of hepatitis B will be in the best position to meet the challenge of managing patients with this serious infection. 

4.                Yang Y, Sujan S, Sun F, Zhang Y, Jiang Y, Song J, Qin J, Wu X. Acute metabolic crisis induced by vaccination in seven Chinese patients. Acute metabolic crisis induced by vaccination in seven Chinese patients.

Department of Pediatrics, Peking University First Hospital, Beijing, China. yanlingy@vip.sina.com
Seven Chinese patients (5 males and 2 females) with vaccination-induced acute metabolic crisis were reported. Only one male with 21-hydroxylase deficiency had been diagnosed before vaccination. In the remaining six patients, the preexisting diagnoses were not confirmed before the vaccination. Acute metabolic crisis occurred in seven patients between 3 and 12 hours after the administration of Japanese encephalitis, diphtheria, and tetanus toxoids and acellular pertussis, hepatitis B, or measles vaccines. Patients 1 and 2 displayed acute adrenal insufficiencies at the ages of 5 years and 3 months, respectively. Patient 3 had presented with mild motor retardation previously. Patients 4 to 7 were previously healthy, but suffered from fever, seizures, coma, acidosis, and hypoglycemia after being vaccinated. Glutaric aciduria type 1 was evident in case 4. Leigh syndromes were present in Patients 5, 6, and 7. They all died from respiratory failure before 2 years of age. Symmetric foci, cystic cavitations with neuronal loss, and vascular proliferation were observed by postmortem examination. Among the seven patients, although the vaccines were not the primary cause of the acute metabolic crisis, the severe acute episodes occurred coincidentally.

5.                Lin CF, Wan SW, Cheng HJ, Lei HY, Lin YS. Autoimmune pathogenesis in dengue virus infection. Viral Immunol. 2006 Summer;19(2):127-32.

            Department of Microbiology and Immunology, National Cheng Kung University Medical College, Tainan,Taiwan.
The pathogenic mechanisms of dengue hemorrhagic fever and dengue shock syndrome (DHF/DSS) caused by dengue virus (DV) infection remain unresolved. Patients with DHF/DSS are characterized by several manifestations, including severe thrombocytopenia, vascular leakage, and hepatomegaly. In addition to the effect of virus load and virus variation, abnormal immune responses of the host after DV infection may also account for the progression of DHF/DSS. Actually, viral autoimmunity is involved in the pathogenesis of numerous viral infections, such as human immunodeficiency virus, human hepatitis C virus, human cytomegalovirus, herpes simplex virus, Epstein- Barr virus, and DV. In this review, we discuss the implications of autoimmunity in dengue pathogenesis. Antibodies directed against DV nonstructural protein 1 (NS1) showed cross-reactivity with human platelets and endothelial cells, which lead to platelet and endothelial cell damage and inflammatory activation. Based on these findings, we hypothesize that anti-DV NS1 is involved in the pathogenesis of DF and DHF/DSS, and this may provide important information in dengue vaccine development.

Diagnosis, Diagnostics, Immunodiagnosis, Immunodiagnostics:

15025.  Anavekar NS, Mangan TF. 43-year-old man with ear pain, confusion, and agitation. Mayo Clin Proc. 2006 Aug;81(8):1096-9.

15026.  Banerjee S, Rahhal R, Bishop WP. Azathioprine monotherapy for maintenance of remission in pediatric patients with autoimmune hepatitis. J Pediatr Gastroenterol Nutr. 2006 Sep;43(3):353-6. 

15027.  Ebert EC.  Hypoxic liver injury. Mayo Clin Proc. 2006 Sep;81(9):1232-6. Review. 

15028.  Fuhrmann V, Madl C, Mueller C, Holzinger U, Kitzberger R, Funk GC, Schenk P.   Hepatopulmonary syndrome in patients with hypoxic hepatitis. Gastroenterology. 2006 Jul;131(1):69-75.  

15029.  Kelly D.  Viral hepatitis B and C in children. J R Soc Med. 2006 Jul;99(7):353-7. Review.

15030.  Pishvaian AC, Bahrain M, Lewis JH.  Fatal varicella-zoster hepatitis presenting with severe abdominal pain: a case report and review of the literature. Dig Dis Sci. 2006 Jul;51(7):1221-5. Review.

15031.  Pol S, Mallet VO.  Improving anti-hepatitis C virus therapy. Expert Opin Biol Ther. 2006 Sep;6(9):923-33. Review. 

15032.  Polat TB, Urganci N, Yalcin Y, Akdeniz C, Zeybek C, Erdem A, Celebi A.   Evaluation of cardiac function by tissue Doppler imaging in children with chronic hepatitis. J Pediatr Gastroenterol Nutr. 2006 Aug;43(2):222-7. 

15033.  Rosen MJ, Narasimhan M. Critical care of immunocompromised patients: human immunodeficiency virus. Crit Care Med. 2006 Sep;34(9 Suppl):S245-50. Review.

15034.  Swan T.  Living with HIV and hepatitis C. What you need to know, in brief. Posit Aware. 2006 Sep-Oct;17(5):22-3. 

Pathogenesis:

15035.  Sigal SH, Stanca CM, Kontorinis N, Bodian C, Ryan E. Diabetes mellitus is associated with hepatic encephalopathy in patients with HCV cirrhosis. Am J Gastroenterol. 2006 Jul;101(7):1490-6. 

Vaccines:

15036.  Mudur G. Indian association questions plan for hepatitis B immunisation. BMJ. 2006 Sep 23;333(7569):621.

Therapy:

15037.  Chang MH. Hepatitis B virus mutation in children. Indian J Pediatr. 2006 Sep;73(9):803-7. Review. 

15038.  Maggiore G, Caprai S.  Liver involvement in celiac disease. Indian J Pediatr. 2006 Sep;73(9):809-11. Review. 

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