Some selected abstract:

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.
 

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."
 

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.
 

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.
 

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.
 

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.
 

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.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.
 

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.
 

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.