1) The study compared standard immunoassay screening tests for hepatitis B and C viruses to nucleic acid amplification testing (NAT) in blood donors in Mexico.
2) In 94,806 blood donors screened by immunoassay over 75 months, hepatitis B surface antigen was detected in 219 donors (0.23%) and anti-HCV antibodies in 922 donors (0.97%).
3) In an exploratory NAT screening of 100 additional donors, hepatitis B virus DNA was detected in one donor (1%) and hepatitis C virus RNA in another donor (1%), though both tested negative by immunoassay.
Plasma levels of circulating nucleic acids (CNAs) were significantly higher in patients with Plasmodium vivax malaria compared to healthy donors. CNAs levels strongly correlated with clinical markers of malaria morbidity, including fever and thrombocytopenia. Higher CNAs levels were also associated with a more severe clinical presentation based on a scoring system. These findings suggest that CNAs have potential as sensitive biomarkers for assessing severity of P. vivax malaria infections.
International standards for screening blood donations require testing for hepatitis B, hepatitis C, HIV, syphilis, and malaria. While screening has improved blood safety, risks remain as new infectious agents may emerge and current tests have window periods where early infections are not detected. In Pakistan, screening is not uniform across centers and some use substandard methods, like pooling donor samples, which increases transmission risk. Future directions include fully implementing standard screening tests, minimizing residual risks through new tests, encouraging healthy volunteer donors, and increasing awareness of transfusion risks.
This document describes a study examining hepatitis C virus (HCV) core antigen expression in liver tissue samples from liver transplant patients with either severe or mild recurrent HCV infection post-transplant. Liver samples were analyzed from 12 transplant recipients (6 with severe cholestatic hepatitis and 6 with mild recurrence) at three time points: pre-transplant, early post-transplant, and late post-transplant. HCV core antigen staining was stronger in the severe group, especially in explant samples. Serum HCV RNA levels were also higher in the severe group. The results suggest that strong HCV staining in explant samples may predict more severe recurrent disease post-transplant.
BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxuryicsp
- Screening of blood donations for transfusion has greatly reduced but not eliminated the risk of transmitting infections like HIV, HBV, and HCV due to the window period between exposure and detection.
- While developed countries widely use sensitive nucleic acid tests (NAT) to screen for viral RNA, most developing countries still lack adequate policies, funding, and infrastructure for comprehensive screening.
- Adding tests for hepatitis B core antibody (Anti-HBc) and NAT screening could further reduce residual transmission risks of HBV and HCV in Pakistan, but developing robust transfusion services and legislation is required first.
1) The study found that the Plasmodium yoelii malaria parasite preferentially infects young red blood cells (RBCs) that express high levels of CD47.
2) Mice lacking CD47 (CD47-/- mice) were highly resistant to P. yoelii infection and developed a 9.3-fold lower peak parasitemia compared to wild-type mice.
3) Macrophages from CD47-/- mice were more effective at phagocytizing parasitized RBCs during acute infection, when parasitemia was rapidly rising, suggesting CD47 helps the parasite evade immune clearance.
This document provides an overview of hepatitis A-E viruses. Hepatitis A virus is transmitted through the fecal-oral route and does not cause chronic infection. Hepatitis B virus can cause chronic infection and is transmitted through blood and bodily fluids. Hepatitis C virus is transmitted through blood exposure and often causes chronic infection leading to complications like cirrhosis and liver cancer. The viruses are classified into genotypes with different geographical distributions and disease outcomes. Laboratory tests are used to diagnose acute and chronic viral hepatitis infections.
The document discusses screening and testing for infectious agents like hepatitis B, hepatitis C, and HIV. It describes the window period as the time between initial infection and when diagnostic tests can reliably detect the infection. For HIV, the window period may be up to 3 months depending on the test, but newer RNA tests can detect HIV within 12-16 days. For hepatitis B, the window period refers to the time between disappearing surface antigen and appearing antibodies, or between infection and appearing surface antigen. During this time, only IgM core antibodies may be detectable. The document also discusses various assays used in screening and testing like ELISA, EIA, RIA.
Testing Donor For Anti HbcIgM to Enhance Blood Safetyiosrjce
This study tested 2,488 blood donors in India for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody IgM (Anti-HbcIgM) to enhance blood safety. 1.29% of donors tested positive for HBsAg and 0.6% tested positive for only Anti-HbcIgM. A total of 1.89% showed evidence of hepatitis B infection. Testing only for HBsAg is not sufficient for eliminating HBV due to window periods and occult infections. The study recommends including Anti-HbcIgM screening in addition to HBsAg to further reduce transfusion-associated HBV infections in India.
Plasma levels of circulating nucleic acids (CNAs) were significantly higher in patients with Plasmodium vivax malaria compared to healthy donors. CNAs levels strongly correlated with clinical markers of malaria morbidity, including fever and thrombocytopenia. Higher CNAs levels were also associated with a more severe clinical presentation based on a scoring system. These findings suggest that CNAs have potential as sensitive biomarkers for assessing severity of P. vivax malaria infections.
International standards for screening blood donations require testing for hepatitis B, hepatitis C, HIV, syphilis, and malaria. While screening has improved blood safety, risks remain as new infectious agents may emerge and current tests have window periods where early infections are not detected. In Pakistan, screening is not uniform across centers and some use substandard methods, like pooling donor samples, which increases transmission risk. Future directions include fully implementing standard screening tests, minimizing residual risks through new tests, encouraging healthy volunteer donors, and increasing awareness of transfusion risks.
This document describes a study examining hepatitis C virus (HCV) core antigen expression in liver tissue samples from liver transplant patients with either severe or mild recurrent HCV infection post-transplant. Liver samples were analyzed from 12 transplant recipients (6 with severe cholestatic hepatitis and 6 with mild recurrence) at three time points: pre-transplant, early post-transplant, and late post-transplant. HCV core antigen staining was stronger in the severe group, especially in explant samples. Serum HCV RNA levels were also higher in the severe group. The results suggest that strong HCV staining in explant samples may predict more severe recurrent disease post-transplant.
BLOOD SCREENING :AntiHBc and NAT-Necessity or Luxuryicsp
- Screening of blood donations for transfusion has greatly reduced but not eliminated the risk of transmitting infections like HIV, HBV, and HCV due to the window period between exposure and detection.
- While developed countries widely use sensitive nucleic acid tests (NAT) to screen for viral RNA, most developing countries still lack adequate policies, funding, and infrastructure for comprehensive screening.
- Adding tests for hepatitis B core antibody (Anti-HBc) and NAT screening could further reduce residual transmission risks of HBV and HCV in Pakistan, but developing robust transfusion services and legislation is required first.
1) The study found that the Plasmodium yoelii malaria parasite preferentially infects young red blood cells (RBCs) that express high levels of CD47.
2) Mice lacking CD47 (CD47-/- mice) were highly resistant to P. yoelii infection and developed a 9.3-fold lower peak parasitemia compared to wild-type mice.
3) Macrophages from CD47-/- mice were more effective at phagocytizing parasitized RBCs during acute infection, when parasitemia was rapidly rising, suggesting CD47 helps the parasite evade immune clearance.
This document provides an overview of hepatitis A-E viruses. Hepatitis A virus is transmitted through the fecal-oral route and does not cause chronic infection. Hepatitis B virus can cause chronic infection and is transmitted through blood and bodily fluids. Hepatitis C virus is transmitted through blood exposure and often causes chronic infection leading to complications like cirrhosis and liver cancer. The viruses are classified into genotypes with different geographical distributions and disease outcomes. Laboratory tests are used to diagnose acute and chronic viral hepatitis infections.
The document discusses screening and testing for infectious agents like hepatitis B, hepatitis C, and HIV. It describes the window period as the time between initial infection and when diagnostic tests can reliably detect the infection. For HIV, the window period may be up to 3 months depending on the test, but newer RNA tests can detect HIV within 12-16 days. For hepatitis B, the window period refers to the time between disappearing surface antigen and appearing antibodies, or between infection and appearing surface antigen. During this time, only IgM core antibodies may be detectable. The document also discusses various assays used in screening and testing like ELISA, EIA, RIA.
Testing Donor For Anti HbcIgM to Enhance Blood Safetyiosrjce
This study tested 2,488 blood donors in India for hepatitis B surface antigen (HBsAg) and hepatitis B core antibody IgM (Anti-HbcIgM) to enhance blood safety. 1.29% of donors tested positive for HBsAg and 0.6% tested positive for only Anti-HbcIgM. A total of 1.89% showed evidence of hepatitis B infection. Testing only for HBsAg is not sufficient for eliminating HBV due to window periods and occult infections. The study recommends including Anti-HbcIgM screening in addition to HBsAg to further reduce transfusion-associated HBV infections in India.
1. Chronic HCV infection can lead to increased mortality from both hepatic and extrahepatic diseases such as liver cancer, cardiovascular disease, and kidney disease.
2. HCV infection is associated with a variety of autoimmune manifestations and lymphoproliferative disorders, most notably mixed cryoglobulinemia vasculitis.
3. Treatment of HCV infection with direct-acting antivirals or pegylated interferon/ribavirin can result in remission of extrahepatic manifestations by achieving sustained virological response.
This study compared the diagnostic performance of non-isotopic in situ hybridization (NISH) and dot-blot hybridization for detecting human papillomavirus (HPV) in cervical samples. Cervical samples from 122 patients were tested using both methods. NISH detected HPV in 33.3% of samples while dot-blot detected HPV in 12.4% of samples. NISH was more sensitive at detecting HPV even in samples with koilocytosis (abnormal cells indicative of HPV infection), detecting HPV in 90% of these samples compared to 40% for dot-blot. The study concluded that NISH is a more sensitive screening tool for detecting HPV infection in cervical samples than dot-bl
Evidence for antigen-driven TCRβ chain convergence in the melanoma-infiltrati...Thermo Fisher Scientific
T cell convergence refers to the phenomenon whereby antigen-driven selection enriches for T cell receptors (TCRs) having a shared antigen specificity but different amino acid or
nucleotide sequence. T cell recruitment and expansion within the tumor microenvironment (TME) may be directed by responses to tumor neoantigen, suggesting that elevated T
cell convergence could be a general feature of the tumor infiltrating T cell repertoire. Here we use the Ion AmpliSeq™ Immune Repertoire Assay Plus – TCRβ to evaluate evidence
for T cell convergence within melanoma tumor biopsy research samples from a set of 63 subjects plus peripheral blood leukocytes (PBL) from four healthy subjects. We find that the melanoma TME is highly enriched for convergent TCRs compared to healthy donor peripheral blood. We discuss the potential use of TCR convergence as a liquid biopsy compatible predictive biomarker for immunotherapy response.
This document provides a history of the discovery of hepatitis B virus (HBV). HBV was originally identified in the 1960s and associated with serum hepatitis. It was found to be a unique DNA virus that replicates via reverse transcription of an RNA intermediate. Several related hepatitis viruses were later discovered in other species. These viruses were classified in the Hepadnaviridae family based on their small genomes and novel replication strategy. HBV itself exists as different genotypes that tend to have distinct geographic distributions. The structure of the HBV virion is described, consisting of an inner core containing the viral DNA, surrounded by envelope proteins that are acquired from host cells.
This document discusses the implementation of nucleic acid testing (NAT) in blood banks to improve transfusion safety. It notes that NAT screening can reduce the risk of transmitting infections like HIV and HCV during the "window period" between exposure and detection by standard serological tests. While NAT provides benefits, it also has challenges like high costs, complexity, and potential for false positives. The document reviews various NAT technologies used in blood banks and strategies for sample pooling to make high-throughput screening feasible. It examines the impact of NAT for different viruses based on their virological characteristics and window periods. Overall NAT screening has become a standard practice due to public pressure despite the technical and economic hurdles involved.
Infective endocarditis is a life-threatening disease caused by bacterial infection of the endothelium and cardiac valves, either native or prosthetic. In the present work the role of the new microbiological techniques (techniques of detection and amplification of the subunit 16 ribosomal sRNA by means of the chain reaction of the polymerase in blood or tissue, fluorescent in situ hybridization, and matrix-assisted laser is reviewed desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the diagnosis of infective endocarditis.
2013-Pierce-Accurate Detection and Quantification of the Fish Viral(2)Ji-Youn Yeo
This document describes the development of a new two-color fluorometric real-time PCR assay to detect and quantify the fish pathogen Viral Hemorrhagic Septicemia virus (VHSv) more accurately than previous methods. The new assay uses internal standards and FAM- and Quasar-labeled probes to detect the VHSv nucleoprotein gene and a fish reference gene in separate fluorescent channels. Testing on field-caught and laboratory-infected fish samples demonstrated the assay could reliably detect as few as 6 VHSv molecules and quantify the virus over a seven order of magnitude range, making it more sensitive and accurate than traditional cell culture and previous PCR-based methods. The assay provides a rapid, inexpensive and highly
1) HBV is a partially double-stranded DNA virus that was discovered in the 1960s and can cause both acute and chronic hepatitis B infections.
2) It is transmitted through bodily fluids and can be diagnosed through serological and molecular testing for antigens and antibodies.
3) Vaccination provides effective immunization against HBV infection and treatment options for chronic infection include immunomodulators and nucleoside/nucleotide analogs.
This document provides an outline for a presentation on HCV genotyping methods. It discusses the morphology and characteristics of HCV, its history and structure. It describes the six genotypes of HCV and their geographical distribution. It also discusses mutants of HCV, clinical importance of genotypes, laboratory diagnosis, and different methods for genotyping including direct sequencing, RFLP typing of the 5'UTR, and line probe assay (LiPA). The advantages of LiPA include it being easy, less time consuming and capable of reliably genotyping HCV RNA directly from clinical samples.
This study evaluated presepsin (sCD14-ST) as a biomarker for diagnosing bacterial infection in cerebrospinal fluid (CSF) samples from children with suspected bacterial meningitis or ventriculitis who had external ventricular drains. The study found that presepsin levels in CSF had good diagnostic accuracy for bacterial infection, superior to other biomarkers like leukocyte count and proteins. Presepsin levels were significantly higher in children who were clinically confirmed to have ventriculitis compared to those without meningitis or ventriculitis. Using broad-range PCR in addition to culture improved detection of bacteria in CSF samples. The results suggest presepsin could help diagnose meningitis and ventricul
This study investigated the role of HCV NS5A protein transcriptional activation in viral replication and the impact of NS5A cleavage and nuclear localization. The researchers analyzed NS5A variants isolated from a chronically infected patient. They found that variants with different transcriptional activities in yeast also demonstrated varying replication efficiencies in a subgenomic replicon system. Further, the C-terminal fragment of NS5A was found to localize to the nucleus, requiring a functional nuclear localization signal and cellular caspase activity. Nuclear localization of NS5A was necessary for efficient viral replication. NS5A in the nucleus bound to host cell promoters of genes important for replication, inducing their transcription - demonstrating a new mechanism by which HCV modulates its cellular environment to
Quantification of Donor/Recipient Chimerism in Leukemia Samples by Digital PCRThermo Fisher Scientific
Digital PCR (dPCR) and quantitative PCR (qPCR) methods were compared for their ability to detect mixed chimerism and predict relapse in leukemia patients after stem cell transplantation. Research results showed that dPCR using the QuantStudioTM 3D Digital PCR System produced similar results to qPCR when recipient DNA levels were above 1%, but was more sensitive for detecting lower levels of 0.2% or less. dPCR was able to detect increasing recipient chimerism earlier than qPCR in some samples, potentially allowing for earlier prediction of relapse. The false positive rate for dPCR was close to the 0.01% level considered full donor chimerism.
This document discusses hepatitis C recurrence after liver transplantation. It notes that hepatitis C recurrence is a major issue, accounting for two-thirds of graft loss. Five years post-transplant, 30% of patients have cirrhosis of the graft. The document examines factors that influence recurrence like fibrosis stage and viral load at one year post-transplant. It also discusses using antiviral treatment before and after transplant to improve outcomes.
Krista's Presentation at the 2019 SFAF Meeting Krista Ternus
This study aims to evaluate pathogen transmission rates under various simulated healthcare conditions using both traditional culturing and culture-independent metagenomic methods. Researchers designed experiments to directly and indirectly transmit pathogens between surfaces and hands at different concentrations, with and without washing. Preliminary results found direct transmission was more efficient than indirect transmission, and washing reduced transmission most on cotton. Further bioinformatics analysis will characterize detection limits and identify pathogen genes.
The document discusses hepatitis B virus (HBV) infection and pathogenesis. It begins with epidemiological data on HBV infection in France, including incidence rates, transmission routes, and risk factors. It then covers the virology of HBV, including its genome, replication cycle in hepatocytes, and animal models. The role of HBV in liver cancer (hepatocellular carcinoma) development is described. The pathophysiology and immunopathology of chronic HBV infection are discussed, focusing on the immune-mediated injury to hepatocytes and role of cytokines.
BK virus has become a serious issue in hematopoietic stem cell transplantation recipients, commonly manifesting as hemorrhagic cystitis, which can last from a matter of days to months and, if severe enough, may result in death. Patients with BK virus-associated hemorrhagic cystitis often experience poor quality of life, severe pain and discomfort, and prolonged hospitalizations. Despite numerous advances in stem cell transplantation methods, BK virus-associated hemorrhagic cystitis is difficult to control and treatment options are few. This ppt provides an overview of BK virus along with risk factors, current treatment modalities
Chronic Hepatitis C Virus Infection and Carcinoma Cervix – Report of a Case ...Apollo Hospitals
We report a case of a 54 year old woman with carcinoma cervix and chronic hepatitic C infection. Hepatitis C Virus was isolated from the malignant cervical tissue which caused Chronic Hepatitis and may have had a direct role in the development and pathogenesis of cervical cancer.
1) BK virus is a polyomavirus that commonly infects humans and usually causes asymptomatic infection during childhood. However, in immunosuppressed transplant patients it can reactivate and cause polyomavirus-associated nephropathy (PVAN).
2) The primary treatment for PVAN is reduction of immunosuppression to allow the immune system to control viral replication. Additional treatments like cidofovir and leflunomide have not been proven effective.
3) While reduction of immunosuppression can control the virus and prevent graft loss in many cases, PVAN remains a significant problem after transplantation and may contribute to longer term allograft dysfunction. Improved antiviral therapies are still needed.
Nucliec Acid Testing in Blood and solid organ Donor Screening by dr umairDr. Umair Manghrio
The document discusses the importance of molecular diagnostic (NAT) testing in screening blood and organ donors. NAT testing can detect early infections like HIV, HBV, and HCV before antibody tests through the detection of viral nucleic acids. This helps shorten the window period and improves the safety of blood and organ donations. While NAT cannot completely close the window, it provides benefits by detecting infections at lower viral loads than antibody tests alone. Proper donor screening through medical history, examination, and accurate laboratory testing including NAT is crucial to ensure the health of donors and the safety of blood/organ recipients.
The clinical application development and validation of cell free dna assays -...Candy Smellie
What is the impact of assay failure in your laboratory and how do you monitor for it?
In cancer patients, cell-free DNA carries tumour-related genetic alterations that are relevant to cancer development, disease progression and response to therapy.
Cell-free DNA detection allows:
Early detection
Frequent sampling
Monitoring of disease progression
Measure response to therapy
Detection of resistance mutation
Non-invasive diagnostic tool development
This document discusses various MySQL functions including date functions, string functions, and group concatenation functions. It provides examples of using functions like DATE_FORMAT, DATEDIFF, CONCAT, CONCAT_WS, UPPER, LOWER and GROUP_CONCAT on tables in the sakila sample database. Functions are demonstrated to format dates, calculate date differences, concatenate strings, convert case and group multiple values.
1. Chronic HCV infection can lead to increased mortality from both hepatic and extrahepatic diseases such as liver cancer, cardiovascular disease, and kidney disease.
2. HCV infection is associated with a variety of autoimmune manifestations and lymphoproliferative disorders, most notably mixed cryoglobulinemia vasculitis.
3. Treatment of HCV infection with direct-acting antivirals or pegylated interferon/ribavirin can result in remission of extrahepatic manifestations by achieving sustained virological response.
This study compared the diagnostic performance of non-isotopic in situ hybridization (NISH) and dot-blot hybridization for detecting human papillomavirus (HPV) in cervical samples. Cervical samples from 122 patients were tested using both methods. NISH detected HPV in 33.3% of samples while dot-blot detected HPV in 12.4% of samples. NISH was more sensitive at detecting HPV even in samples with koilocytosis (abnormal cells indicative of HPV infection), detecting HPV in 90% of these samples compared to 40% for dot-blot. The study concluded that NISH is a more sensitive screening tool for detecting HPV infection in cervical samples than dot-bl
Evidence for antigen-driven TCRβ chain convergence in the melanoma-infiltrati...Thermo Fisher Scientific
T cell convergence refers to the phenomenon whereby antigen-driven selection enriches for T cell receptors (TCRs) having a shared antigen specificity but different amino acid or
nucleotide sequence. T cell recruitment and expansion within the tumor microenvironment (TME) may be directed by responses to tumor neoantigen, suggesting that elevated T
cell convergence could be a general feature of the tumor infiltrating T cell repertoire. Here we use the Ion AmpliSeq™ Immune Repertoire Assay Plus – TCRβ to evaluate evidence
for T cell convergence within melanoma tumor biopsy research samples from a set of 63 subjects plus peripheral blood leukocytes (PBL) from four healthy subjects. We find that the melanoma TME is highly enriched for convergent TCRs compared to healthy donor peripheral blood. We discuss the potential use of TCR convergence as a liquid biopsy compatible predictive biomarker for immunotherapy response.
This document provides a history of the discovery of hepatitis B virus (HBV). HBV was originally identified in the 1960s and associated with serum hepatitis. It was found to be a unique DNA virus that replicates via reverse transcription of an RNA intermediate. Several related hepatitis viruses were later discovered in other species. These viruses were classified in the Hepadnaviridae family based on their small genomes and novel replication strategy. HBV itself exists as different genotypes that tend to have distinct geographic distributions. The structure of the HBV virion is described, consisting of an inner core containing the viral DNA, surrounded by envelope proteins that are acquired from host cells.
This document discusses the implementation of nucleic acid testing (NAT) in blood banks to improve transfusion safety. It notes that NAT screening can reduce the risk of transmitting infections like HIV and HCV during the "window period" between exposure and detection by standard serological tests. While NAT provides benefits, it also has challenges like high costs, complexity, and potential for false positives. The document reviews various NAT technologies used in blood banks and strategies for sample pooling to make high-throughput screening feasible. It examines the impact of NAT for different viruses based on their virological characteristics and window periods. Overall NAT screening has become a standard practice due to public pressure despite the technical and economic hurdles involved.
Infective endocarditis is a life-threatening disease caused by bacterial infection of the endothelium and cardiac valves, either native or prosthetic. In the present work the role of the new microbiological techniques (techniques of detection and amplification of the subunit 16 ribosomal sRNA by means of the chain reaction of the polymerase in blood or tissue, fluorescent in situ hybridization, and matrix-assisted laser is reviewed desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS) in the diagnosis of infective endocarditis.
2013-Pierce-Accurate Detection and Quantification of the Fish Viral(2)Ji-Youn Yeo
This document describes the development of a new two-color fluorometric real-time PCR assay to detect and quantify the fish pathogen Viral Hemorrhagic Septicemia virus (VHSv) more accurately than previous methods. The new assay uses internal standards and FAM- and Quasar-labeled probes to detect the VHSv nucleoprotein gene and a fish reference gene in separate fluorescent channels. Testing on field-caught and laboratory-infected fish samples demonstrated the assay could reliably detect as few as 6 VHSv molecules and quantify the virus over a seven order of magnitude range, making it more sensitive and accurate than traditional cell culture and previous PCR-based methods. The assay provides a rapid, inexpensive and highly
1) HBV is a partially double-stranded DNA virus that was discovered in the 1960s and can cause both acute and chronic hepatitis B infections.
2) It is transmitted through bodily fluids and can be diagnosed through serological and molecular testing for antigens and antibodies.
3) Vaccination provides effective immunization against HBV infection and treatment options for chronic infection include immunomodulators and nucleoside/nucleotide analogs.
This document provides an outline for a presentation on HCV genotyping methods. It discusses the morphology and characteristics of HCV, its history and structure. It describes the six genotypes of HCV and their geographical distribution. It also discusses mutants of HCV, clinical importance of genotypes, laboratory diagnosis, and different methods for genotyping including direct sequencing, RFLP typing of the 5'UTR, and line probe assay (LiPA). The advantages of LiPA include it being easy, less time consuming and capable of reliably genotyping HCV RNA directly from clinical samples.
This study evaluated presepsin (sCD14-ST) as a biomarker for diagnosing bacterial infection in cerebrospinal fluid (CSF) samples from children with suspected bacterial meningitis or ventriculitis who had external ventricular drains. The study found that presepsin levels in CSF had good diagnostic accuracy for bacterial infection, superior to other biomarkers like leukocyte count and proteins. Presepsin levels were significantly higher in children who were clinically confirmed to have ventriculitis compared to those without meningitis or ventriculitis. Using broad-range PCR in addition to culture improved detection of bacteria in CSF samples. The results suggest presepsin could help diagnose meningitis and ventricul
This study investigated the role of HCV NS5A protein transcriptional activation in viral replication and the impact of NS5A cleavage and nuclear localization. The researchers analyzed NS5A variants isolated from a chronically infected patient. They found that variants with different transcriptional activities in yeast also demonstrated varying replication efficiencies in a subgenomic replicon system. Further, the C-terminal fragment of NS5A was found to localize to the nucleus, requiring a functional nuclear localization signal and cellular caspase activity. Nuclear localization of NS5A was necessary for efficient viral replication. NS5A in the nucleus bound to host cell promoters of genes important for replication, inducing their transcription - demonstrating a new mechanism by which HCV modulates its cellular environment to
Quantification of Donor/Recipient Chimerism in Leukemia Samples by Digital PCRThermo Fisher Scientific
Digital PCR (dPCR) and quantitative PCR (qPCR) methods were compared for their ability to detect mixed chimerism and predict relapse in leukemia patients after stem cell transplantation. Research results showed that dPCR using the QuantStudioTM 3D Digital PCR System produced similar results to qPCR when recipient DNA levels were above 1%, but was more sensitive for detecting lower levels of 0.2% or less. dPCR was able to detect increasing recipient chimerism earlier than qPCR in some samples, potentially allowing for earlier prediction of relapse. The false positive rate for dPCR was close to the 0.01% level considered full donor chimerism.
This document discusses hepatitis C recurrence after liver transplantation. It notes that hepatitis C recurrence is a major issue, accounting for two-thirds of graft loss. Five years post-transplant, 30% of patients have cirrhosis of the graft. The document examines factors that influence recurrence like fibrosis stage and viral load at one year post-transplant. It also discusses using antiviral treatment before and after transplant to improve outcomes.
Krista's Presentation at the 2019 SFAF Meeting Krista Ternus
This study aims to evaluate pathogen transmission rates under various simulated healthcare conditions using both traditional culturing and culture-independent metagenomic methods. Researchers designed experiments to directly and indirectly transmit pathogens between surfaces and hands at different concentrations, with and without washing. Preliminary results found direct transmission was more efficient than indirect transmission, and washing reduced transmission most on cotton. Further bioinformatics analysis will characterize detection limits and identify pathogen genes.
The document discusses hepatitis B virus (HBV) infection and pathogenesis. It begins with epidemiological data on HBV infection in France, including incidence rates, transmission routes, and risk factors. It then covers the virology of HBV, including its genome, replication cycle in hepatocytes, and animal models. The role of HBV in liver cancer (hepatocellular carcinoma) development is described. The pathophysiology and immunopathology of chronic HBV infection are discussed, focusing on the immune-mediated injury to hepatocytes and role of cytokines.
BK virus has become a serious issue in hematopoietic stem cell transplantation recipients, commonly manifesting as hemorrhagic cystitis, which can last from a matter of days to months and, if severe enough, may result in death. Patients with BK virus-associated hemorrhagic cystitis often experience poor quality of life, severe pain and discomfort, and prolonged hospitalizations. Despite numerous advances in stem cell transplantation methods, BK virus-associated hemorrhagic cystitis is difficult to control and treatment options are few. This ppt provides an overview of BK virus along with risk factors, current treatment modalities
Chronic Hepatitis C Virus Infection and Carcinoma Cervix – Report of a Case ...Apollo Hospitals
We report a case of a 54 year old woman with carcinoma cervix and chronic hepatitic C infection. Hepatitis C Virus was isolated from the malignant cervical tissue which caused Chronic Hepatitis and may have had a direct role in the development and pathogenesis of cervical cancer.
1) BK virus is a polyomavirus that commonly infects humans and usually causes asymptomatic infection during childhood. However, in immunosuppressed transplant patients it can reactivate and cause polyomavirus-associated nephropathy (PVAN).
2) The primary treatment for PVAN is reduction of immunosuppression to allow the immune system to control viral replication. Additional treatments like cidofovir and leflunomide have not been proven effective.
3) While reduction of immunosuppression can control the virus and prevent graft loss in many cases, PVAN remains a significant problem after transplantation and may contribute to longer term allograft dysfunction. Improved antiviral therapies are still needed.
Nucliec Acid Testing in Blood and solid organ Donor Screening by dr umairDr. Umair Manghrio
The document discusses the importance of molecular diagnostic (NAT) testing in screening blood and organ donors. NAT testing can detect early infections like HIV, HBV, and HCV before antibody tests through the detection of viral nucleic acids. This helps shorten the window period and improves the safety of blood and organ donations. While NAT cannot completely close the window, it provides benefits by detecting infections at lower viral loads than antibody tests alone. Proper donor screening through medical history, examination, and accurate laboratory testing including NAT is crucial to ensure the health of donors and the safety of blood/organ recipients.
The clinical application development and validation of cell free dna assays -...Candy Smellie
What is the impact of assay failure in your laboratory and how do you monitor for it?
In cancer patients, cell-free DNA carries tumour-related genetic alterations that are relevant to cancer development, disease progression and response to therapy.
Cell-free DNA detection allows:
Early detection
Frequent sampling
Monitoring of disease progression
Measure response to therapy
Detection of resistance mutation
Non-invasive diagnostic tool development
This document discusses various MySQL functions including date functions, string functions, and group concatenation functions. It provides examples of using functions like DATE_FORMAT, DATEDIFF, CONCAT, CONCAT_WS, UPPER, LOWER and GROUP_CONCAT on tables in the sakila sample database. Functions are demonstrated to format dates, calculate date differences, concatenate strings, convert case and group multiple values.
This case report describes a 63-year-old woman with idiopathic hypertrophic cranial pachymeningitis (IHCP) who was successfully treated with weekly subcutaneous methotrexate. IHCP is a rare disorder characterized by diffuse thickening of the dura mater, mostly associated with inflammation. The patient's symptoms initially improved with steroids but later worsened. MRI showed thickening of the dura and brain abnormalities. Treatment with weekly subcutaneous methotrexate led to complete clinical and radiological remission within 6 months, with minimal side effects. This is the first reported case of using low-dose methotrexate to successfully treat IHCP.
This document presents a framework for developing knowledge-based optimization support systems for flexible manufacturing systems (FMS). It proposes an ontology-based semantic foundation to provide a shared knowledge base for various design tools and applications to interact with. An example FMS use case is described that integrates device, process, product and resource domain ontologies to populate the semantic model with runtime process data. A framework is outlined that uses reasoning engines and SPARQL queries to provide optimal scheduling support to applications based on the ontology model. Future work involves further implementing the optimization algorithms and testing the framework.
The Business Service Center (BSC) was created to efficiently deliver exceptional services to UNT System institutions. It consolidated many business functions from the campuses. As of September 2011, the BSC provided 176 services, employing 132 staff who previously worked across campuses. Key services included payroll, human resources, purchasing and payments. The BSC aimed to treat customers as partners through regular communication, process improvements and training. Immediate next steps were finalizing the BSC location and staff transfer, and developing training for the new service model.
Monitoring Parkinson's symptoms - Sara Riggare Ernesto Ramirez
The document lists various symptoms associated with Parkinson's disease under categories such as end-of-dose akinesia, "on"-"off" phenomenon, peak-dose dyskinesia, freezing, tremors, rigidity, postural disturbances, cognition issues, sleep disorders, mental health symptoms, pain, and digestive system problems. It emphasizes that Parkinson's causes both physical and mental symptoms that can fluctuate and discusses the importance of monitoring the condition.
Find over 1,000's of fantastic Branded Merchandise products available at our specialist branded merchandise sourcing division. For anything branded with your logo or design, CALL: 0800 822 4056 or EMAIL: enquiries@branded-merchandise.com TODAY!
Experience sampling of my stress - Ulrich AtzErnesto Ramirez
This document discusses three methods for measuring stress: experience sampling using smartphone surveys, the day reconstruction method using daily diaries, and heart rate. It provides examples of user interfaces for experience sampling and explains the day reconstruction method. While biophysical measures like heart rate can indicate stress, simpler methods like experience sampling and day reconstruction that avoid devices may be better. The best method depends on the person, and studies should plan for enough observations over 3-4 weeks. Keeping the measurement method simple is advised.
1) The actor for the magazine cover will be a sixth form student to make photography easier, while bands will be used inside.
2) Photographs will be taken at the student's school for simplicity, with a plain background sought to look professional.
3) Props may include a green screen to ensure a plain background, or a guitar if a solo artist is on the cover instead of a band.
Online learning involves students and instructors being in different physical locations and using technology to access course materials, interact with each other, and receive support. It has been referred to using various terms but generally implies distance learning through electronic means. Web-enhanced courses supplement traditional in-person classes without reducing meeting times, while hybrid courses combine both online and in-class elements. Fully online courses take place entirely on the internet without physical class meetings. Asynchronous learning is non-simultaneous communication using tools like email and forums, while synchronous learning involves real-time interaction such as videoconferencing and chat.
Universitas Gadjah Mada (UGM) is the oldest university in Indonesia located in Yogyakarta. UGM engages in many sustainable development activities on campus including operating a green bicycle program, developing an electric vehicle, constructing a Wisdom Park, holding an annual Green Week and International Day of Peace, and operating an international student summer program called DREaM. These activities promote environmental protection, community engagement, and education around sustainability issues.
Doppler ultrasound is used to evaluate portal hypertension by examining blood flow patterns, velocities, and waveforms in vessels like the portal vein, hepatic veins, and inferior vena cava. Abnormal flow patterns include hepatofugal, bidirectional, and static flow rather than the normal hepatopedal flow. Doppler indices and waveforms provide information about resistance to blood flow. Careful analysis of these Doppler ultrasound findings helps assess the underlying causes and severity of portal hypertension.
The document provides illustrated lesson notes for teaching drawing fundamentals to students ages 9-14. Lesson One introduces elementary perspective by having students divide a page into quarters and construct light lines connecting to left and right vanishing points, creating the illusion of depth on a two-dimensional page by copying the teacher's lines. Students then practice constructing vertical lines and joining them to the vanishing points to build up rows of buildings, and learn basic shading techniques. The goal is to promote confidence by having students reproduce illustrated examples while learning core perspective and construction skills.
This study examined risk factors for HCV infection and severity of liver disease in 86 Mexican women reactive for anti-HCV antibodies. Surgery (80%) and blood transfusions before 1993 (58%) were main risk factors, with 52% having both. The most common reasons for surgery and transfusion were obstetric/gynecologic (74% and 68%). 64% were HCV RNA positive. Age and history of transfusion before 1993 predicted cirrhosis. Anti-HCV levels correlated with time since transfusion but not age. HBV co-infection rate was low (5%) and did not influence severity.
This document describes a study that aimed to generate a clinical prediction rule to predict hepatitis C viremia using both clinical and serologic data from 114 hepatitis C virus-seropositive patients. The researchers identified independent predictors of hepatitis C viremia using logistic regression. They found that a ratio of the immunoassay signal strength of the sample to the cutoff value (S/CO) greater than 15 had the best performance at detecting cases with viremia. A rule combining a history of blood transfusion before 1993 and S/CO greater than 15 had the highest accuracy, positive predictive value, and positive likelihood ratio for predicting viremia in all patients. This clinical rule performed even better for predicting viremia in asymptomatic patients
This systematic review analyzed 22 studies involving over 825,000 people in Mexico to determine the prevalence of hepatitis C virus (HCV) infection. The studies tested asymptomatic low-risk populations, mainly blood donors, for anti-HCV antibodies between 1993-2005. The weighted mean prevalence of anti-HCV was 0.37%, and most studies reported a prevalence below 1%. Blood transfusion was the main risk factor reported. Genotype 1 was the most prevalent among those with confirmed HCV infection, with subtype 1b being the most common. The review concludes that HCV prevalence in Mexico may be lower than previous estimates of 1%, and calls for a nationwide study to better determine the epidemiology of HCV in the country.
Prevalence of anti-HCV Antibodies Among Healthy Asymptomatic Indian Blood Don...Apollo Hospitals
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections account for a bulk of acute and chronic liver diseases world-wide. Since, both the viruses share similar risk factors and modes of transmission, a combined HBV and HCV infection is frequently encountered especially in the HBV endemic areas. Until lately anti-HBc antibodies were considered as surrogate marker for HCV infection. But with the development of advanced tests for HCV detection the role of anti-HBc in this regard stands uncertain.
Akram et al-2018-journal_of_viral_hepatitisDr.Arifa Akram
Detection of Hepatitis B Virus DNA among Chronic and potential Occult HBV patients in resource‐limited settings by Loop‐Mediated Isothermal Amplification assay
This study examined clonal B cells from patients with hepatitis C virus (HCV) associated mixed cryoglobulinemia (MC). Despite being fundamentally involved in MC pathogenesis, transcriptional profiling revealed these B cells have features of anergy and apoptosis rather than neoplastic transformation. Phenotypically, a large proportion of the patients' clonal B cells were CD21low memory B cells, which typically exhibit decreased activation and increased anergy. Functionally, the CD21low subset showed impaired calcium signaling and failed to efficiently differentiate into antibody-secreting plasmablasts, suggesting anergy. The down-regulation of activation pathways in many of the patients' expanded B cells may attenuate overstimulation from persistent
Pak Us Science And Technology Grant Project E Ditedabbas491
This document outlines a proposed collaborative project between researchers at NUST in Pakistan and UCSD in the US to study Hepatitis B virus (HBV) genotypes and their association with Hepatocellular Carcinoma (HCC) in Pakistan. The objectives are to characterize HBV genotypes, identify virus mutations that increase risk of HCC, and study the role of cellular editing enzymes and HBx protein. The project will involve sample collection from hospitals, genotyping, sequencing, and in vitro studies over 3 years. The researchers have facilities and expertise to conduct molecular and clinical analyses of HBV in Pakistan where genotype D is prevalent and HBV infection is a major health problem.
This document discusses several methods for diagnosing infections based on detecting DNA and RNA, including polymerase chain reaction (PCR) and real-time PCR. It provides details on PCR, describing how it exponentially amplifies DNA or RNA sequences. It also explains that real-time PCR can detect results more rapidly and sensitively than conventional PCR. The document outlines several applications of these molecular diagnostic techniques for specific infections.
Lombardi et al: XMRV/CFS Inflammatory Signaturedegarden
This document summarizes a study that identified a signature of 10 cytokines and chemokines that can correctly identify patients with chronic fatigue syndrome (CFS) associated with xenotropic murine leukemia virus-related virus (XMRV) infection. The study used Luminex multi-analyte profiling to measure cytokine and chemokine levels in the plasma of 118 CFS patients who tested positive for XMRV, compared to 138 healthy controls. Analysis identified a cytokine/chemokine signature that diagnosed XMRV-associated CFS with 93% specificity and 96% sensitivity. This signature provides immunological evidence for the role of XMRV in CFS pathology and the associated inflammatory response.
This study evaluated a new method called ViraStim to stimulate and detect replication-competent HIV from patient blood samples. Whole blood from 31 HIV-positive patients was collected into tubes with and without ViraStim activation. Viral loads and cellular reservoirs were then measured and compared between the two tube types. Results showed that 6-8 out of 10 patients, depending on their initial viral load, had at least a 0.5 log increase in viral replication after ViraStim activation. Sequencing of 7 matched samples also revealed additional drug resistance mutations in 3 patients following ViraStim. This new method therefore has potential to better inform treatment by more accurately detecting antiviral resistance in HIV reservoirs.
This document describes a study that aimed to develop a blood-based long noncoding RNA (lncRNA) signature for the early detection of gastric cancer (GC). The study used a 3-phase approach involving over 2000 patients. In the discovery phase, they identified an lncRNA (GClnc1) that was upregulated in both GC tissue and circulating extracellular vesicles (EVs) and showed good diagnostic performance for early-stage GC. In validation phases using multiple cohorts, GClnc1 detected in EVs maintained high diagnostic accuracy for early-stage GC. GClnc1 levels also robustly distinguished early-stage GC from pre-cancerous lesions and GC with negative traditional biomarkers. The signature showed GC specificity
The relationship between the molecular epidemiology of hepatitis c and the be...Alexander Decker
This study examined the molecular epidemiology and prevalence of hepatitis C virus (HCV) infection in Jordan. Researchers tested 1929 patients for HCV antibodies between 2010-2011. A total of 149 patients (9%) tested positive, with the infection being twice as common in males compared to females. The most common causes of infection were blood transfusion (68%), kidney dialysis (17%), addiction treatment centers (6%), and unknown causes (9%). HCV RNA detection and genotyping was performed on positive samples. The results suggest blood transfusion is a major route of HCV transmission in Jordan and screening of blood donors has helped reduce prevalence over time.
Prevalence & factors associated with hepatitis c virus seropositivity in ...Anjum Hashmi MPH
This study aimed to determine the prevalence of hepatitis C virus (HCV) in females in Islamabad, Pakistan and identify associated risk factors. The researchers surveyed 252 females and found that 24.6% tested positive for HCV antibodies. Logistic regression identified receiving a blood transfusion, undergoing dental procedures, and dilation and curettage as significantly associated with HCV positivity. The high prevalence of HCV in this population highlights the need for improved healthcare practices and public education on prevention and control.
Hepatitis-B and C in Sickle Cell Hemoglobinopathies of Western Odisha, Indiainventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
This study aimed to develop an unbiased RNA profiling approach for the early detection of colorectal cancer (CRC) and advanced adenomas (AA) using blood samples. The researchers combined a literature review with microarray analysis of circulating RNA purified from plasma to identify RNA biomarker panels. They tested the panels on two cohorts, detecting CRC with 75% sensitivity and 93% specificity using an 8-gene panel, and detecting AA with 60% sensitivity and 87% specificity using a 2-gene panel. The study demonstrates the feasibility of unbiased molecular diagnosis of CRC and AA from blood and introduces circulating RNA profiling as a potential non-invasive screening approach.
This document provides information about transfusion-associated hepatitis and hepatitis viruses. It discusses the various types of hepatitis viruses (A-E), their modes of transmission, clinical manifestations, and molecular and serological markers. It outlines the risks of post-transfusion hepatitis B and C, current blood screening algorithms and markers used (HBsAg, anti-HBc, HCV antibody, NAT). Geographic prevalence of HBV and HCV are shown. The document concludes with donor notification and eligibility policies based on screening results.
A 45-year-old woman presents with fatigue, weakness, loss of appetite, and abnormal liver function tests. Laboratory results show elevated AST, ALT, bilirubin levels and positive tests for HCV antibody and RNA. A liver biopsy revealed severe inflammation and bridging fibrosis. The patient is diagnosed with chronic hepatitis C virus infection based on her history of blood transfusion, symptoms, laboratory abnormalities and biopsy findings. The best course of action is to treat her HCV infection with antiviral therapy to reduce liver damage and prevent progression to cirrhosis.
The document summarizes information about several hepatitis viruses including HAV, HBV, HCV, HDV, and HEV. It provides details on their geographical distribution, modes of transmission, clinical presentation, natural history, and markers used to diagnose infection. Highlights include that HBV is a major cause of liver cancer and cirrhosis worldwide, with 400 million chronic carriers. Chronic HBV infection progression can lead to complications like liver failure, cancer, and death if left untreated.
This document discusses chronic hepatitis B infection. It covers the epidemiology of chronic hepatitis B, including that approximately 400 million people are chronically infected worldwide. It also discusses the hepatitis B virus particle, noting it has a 3.2 kb DNA genome that encodes four overlapping genes. Regarding diagnosis, it emphasizes the importance of optimal HBV screening and diagnosis using markers such as HBsAg, HBeAg, anti-HBe and HBV DNA levels.
Similar to 2. viral hepatitis in blood bank hospital civil (20)
Mortalidad asociada al diagnóstico de síndrome de Guillain-Barré en adultos i...Erwin Chiquete, MD, PhD
Mortality associated with a diagnosis of Guillain-Barré syndrome in adults of Mexican health institutions
Introduction. Guillain-Barré syndrome (GBS) is a neurological emergency representing the main cause of flaccid paralysis
around the world, affecting all age groups. Little is known about the essential epidemiology of GBS in most Latin American
countries.
Aim. To determine the mortality associated with the diagnosis of GBS in hospital discharges during 2010 in hospitals of
the Ministry of Health, Mexico.
Patients and methods. We analyzed the database of hospital discharges of institutions pertaining to the Ministry of
Health. Study cases were identified by the code G61.0 of the International Classification of Diseases, 10th revision (ICD-10).
We excluded records of patients younger than 18 years and patients without complete demographic information.
Results. During the year 2010 there were 2,634,339 discharges from hospitals of the Ministry of Health. We identified a
total of 467 hospitalizations due to GBS in adults (median age: 41 years; 62.1% male) from 121 health institutions of the
32 Republic States. The highest frequency of GBS hospitalizations occurred during summer and fall. The median hospital
stay was 8 days. The hospital mortality rate was 10.5%. The probability of death was directly associated with age, without
a particular trend regarding gender, hospital care or state.
Conclusions. In 2010 GBS hospital mortality in this part of the Mexican health system was higher than that reported in
contemporary studies. A seasonal association was observed regarding the frequency of hospitalizations for GBS.
Key words. Climate. Epidemiology. Guillain-Barré syndrome. Mortality. Mexico.
Rogelio Domínguez-Moreno, Paulina Tolosa-Tort, Anais Patiño-Tamez, Alejandra Quintero-Bauman,
Deisy K. Collado-Frías, María G. Miranda-Rodríguez, Obet J. Canela-Calderón, Pablo Hurtado-Valadez,
Raúl de Gante-Castro, Karoll M. Ortiz-Guillén, Bruno Estañol-Vidal, Horacio Sentíes-Madrid,
Guillermo García-Ramos, Carlos Cantú-Brito, José Luis Ruiz-Sandoval, Erwin Chiquete
Seroepidemiology of Toxoplasma gondii infection in drivers involved in road t...Erwin Chiquete, MD, PhD
Background: The prevalence of toxoplasmosis in the general population of Guadalajara, Mexico, is around 32%.
Toxoplasmosis can cause ocular lesions and slowing of reaction reflexes. Latent toxoplasmosis has been related
with traffic accidents. We aimed to assess the prevalence of anti-Toxoplasma gondii antibodies and visual
impairments related with traffic accidents in drivers from the metropolitan Guadalajara.
Methods: We prospectively evaluated the prevalence of IgG and IgM anti-T. gondii antibodies in 159 individuals
involved in traffic accidents, and in 164 control drivers never involved in accidents. Cases of toxoplasmosis
reactivation or acute infection were detected by PCR in a subset of 71 drivers studied for the presence of T. gondii
DNA in blood samples. Ophthalmologic examinations were performed in drivers with IgG anti-T. gondii antibodies
in search of ocular toxoplasmosis.
Results: Fifty-four (34%) traffic accident drivers and 59 (36%) controls were positive to IgG anti-T. gondii antibodies
(p = 0.70). Among the 113 seropositive participants, mean anti-T. gondii IgG antibodies titers were higher in traffic
accident drivers than in controls (237.9 ± 308.5 IU/ml vs. 122.9 ± 112.7 IU/ml, respectively; p = 0.01 by Student’s t
test, p = 0.037 by Mann–Whitney U test). In multivariate analyses, anti-T. gondii IgG antibody titers were consistently
associated with an increased risk of traffic accidents, whereas age showed an inverse association. The presence of
IgM-anti-T. gondii antibodies was found in three (1.9%) subjects among traffic accident drives, and in two (1.2%)
controls. Three (4.2%) samples were positive for the presence of T. gondii DNA, all among seropositive individuals.
No signs of ocular toxoplasmosis were found in the entire cohort. Moreover, no other ocular conditions were found
to be associated with the risk of traffic accidents in a multivariate analysis.
Conclusions: Anti-T. gondii antibody titers are associated with the risk of traffic accidents. We could not determine
any association of ocular toxoplasmosis with traffic accidents. Our results warrant further analyses in order to clarify
the link between toxoplasmosis and traffic accidents.
Tiempo de llegada hospitalaria y pronóstico funcional después deun infarto ce...Erwin Chiquete, MD, PhD
Introducción: La información sobre el tiempo de llegada hospitalaria después de un infartocerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca infor-mación en naciones emergentes. Nos propusimos identificar los factores que influyen en eltiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después delictus.Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer RegistroMexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de lossíntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escalamodificada de Rankin a los 30 días, 3, 6 y 12 meses.Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%)en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatíaisquémica y ser migra˜noso; en < 3 h: edad 40-69 a˜nos, antecedente familiar de hipertensión,antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospitalprivado; en < 6 h: antecedente familiar de hipertensión, ser migra˜noso, ictus previo, cardiopatíaisquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunary alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegadaen < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicacionesintrahospitalarias.
Comportamiento del barorreflejo en pacientes con síncope vasovagal durante el...Erwin Chiquete, MD, PhD
Caroline Malamud-Kessler, Bruno Estañol-Vidal, Óscar Infante-Vázquez, Miguel Campos-Sánchez,
Erwin Chiquete
Introducción. El síncope mediado neuralmente, también conocido como síncope vasovagal, se define como la pérdida
súbita y transitoria del estado de alerta como consecuencia de un descenso brusco y profundo de la presión arterial.
Objetivo. Conocer las diferencias de los parámetros hemodinámicos que median el barorreflejo durante el ortostatismo
activo en pacientes con diagnóstico clínico de síncope vasovagal y sujetos sanos.
Sujetos y métodos. Estudio transversal, observacional y comparativo. Se incluyeron 20 pacientes con diagnóstico de síncope
neuralmente mediado y 30 controles, a los que se les practicó la prueba de ortostatismo activo y se les registró por
finometría la presión arterial sistólica (PAS) y la frecuencia cardíaca (intervalo entre latidos) de manera continua (latido a
latido) y no invasiva.
Resultados. Los pacientes con síncope presentaron una PAS basal con una media significativamente mayor que la de los
sanos. Las magnitudes medidas desde la PAS basal demostraron una diferencia significativa, que era de menor valor en el
grupo de los controles. No se demostraron diferencias entre grupos en la caída de la PAS desde el primer pico, recuperación
de la PAS desde la sima o en las latencias medidas en la frecuencia cardíaca.
Conclusiones. La PAS basal y la caída de la PAS medida desde la basal en posición supina fue mayor en los pacientes con
síncope mediado neuralmente que en los sujetos sanos. La magnitud de la elevación de la frecuencia cardíaca tuvo una
tendencia a ser mayor en el grupo de pacientes en comparación con el grupo control. Esto sugiere una hiperactividad
simpática en los pacientes con síncope
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura...Erwin Chiquete, MD, PhD
Delírium en adultos que reciben cuidados paliativos: revisión de laliteratura con un enfoque sistemáticoSofía Sánchez-Romána, Cristina Beltrán Zavalab, Argelia Lara Solaresby ErwinChiquetea,∗
El delírium en pacientes que reciben cuidados paliativos es frecuente y constituyeun importante reto de diagnóstico y tratamiento. Nuestro objetivo fue realizar en 2 fases unanálisis bibliométrico de la evidencia científica reciente (2007 a 2012) sobre diagnóstico y tra-tamiento del delírium en adultos en cuidados paliativos. En la fase 1 (estudios descriptivos yrevisiones narrativas) se identificaron 133 artículos relevantes: 73 trataron el tema del delíriumde forma secundaria y en 60 artículos como tema principal. Sin embargo, solo se identificaron4 estudios observacionales prospectivos en los que el delírium fue central. De 135 artículos iden-tificados en la fase 2 (ensayos clínicos o estudios descriptivos sobre tratamiento del delírium enpacientes paliativos), solo 3 fueron sobre prevención o tratamiento: 2 estudios retrospectivosy un ensayo clínico sobre prevención multicomponente en pacientes con cáncer. Gran parte dela literatura reciente corresponde a revisiones que hablan de estudios realizados hace másde una década en pacientes diferentes a los que reciben cuidados paliativos. En conclusión, laevidencia científica reciente sobre el delírium en cuidados paliativos es escasa y subóptima.Urgen estudios prospectivos que se enfoquen específicamente en esta población altamentevulnerable.
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
José L. Ruiz-Sandoval, Guadalupe Ramírez-Guzmán,
Erwin Chiquete and Ángel Vargas-Sánchez
A 45-year-old garbage collector was referred to our department
with a history of tonic-clonic seizures and risky
sexual behavior (anilingus). A neurological examination was
normal. Contrast-enhanced cranial CT showed calcified lesions
and viable parasites compatible with a diagnosis of
massive non-encephalitic neurocysticercosis. Oral metallic
implants impeded performing brain MRI. Hepatitis and HIV
serologies were negative. The patient was discharged with
steroids and an anticonvulsant. Delayed cysticidal therapy
was planned; however, albendazole therapy was immediately
initiated in another hospital, which led to brain edema, uncontrolled
seizures, rostrocaudal deterioration and death.
Cestoda infections are rare in developed countries (1). In
contrast, neurocysticercosis is a leading cause of adult-onset
epilepsy in Latin America. Massive infections are classified
as encephalitic or non-encephalitic (2). In patients with the
encephalitic presentation, cysticidal drugs can cause extensive
parasite lysis and aggravate brain inflammation (2). In
patients with non-encephalitic massive neurocysticercosis,
cysticidal therapy is usually considered; (2) however, rapid
initiation of antiparasitic medications can launch an encephalitic
process.
Cost of care according to disease-modifying therapy in Mexicans with relapsin...Erwin Chiquete, MD, PhD
Miguel A. Macı´as-Islas • Isaac F. Soria-Cedillo • Merced Velazquez-Quintana •
Victor M. Rivera • Vero´nica I. Baca-Muro • Edith A. Lemus-Carmona • Erwin Chiquete
Limited data exist on the costs of care of
patients with multiple sclerosis (MS) in low- to middleincome
nations. The purpose of this study was to describe
the economic burden associated with care of Mexican
patients with relapsing-remitting MS in a representative
sample of the largest institution of the Mexican public
healthcare system. We analysed individual data of 492
patients (67 % women) with relapsing-remitting MS registered
from January 2009 to February 2011 at the Mexican
Social Security Institute. Direct costs were measured about
the use of diagnostic tests, disease-modifying therapies
(DMTs), symptoms control, medical consultations,
relapses, intensive care and rehabilitation. Four groups
were defined according to DMT alternatives: (1) interferon
beta (IFNb)-1a, 6 million units (MU); (2) IFNb-1a, 12MU;
(3) IFNb-1b, 8MU; and (4) glatiramer acetate. All patients
received DMTs for at least 1 year. The most frequently
used DMT was glatiramer acetate (45.5 %), followed by
IFNb-1a 12MU (22.6 %), IFNb-1b 8MU (20.7 %), and
IFNb-1a 6MU (11.2 %). The mean cost of a specialised
medical consultation was €74.90 (US $107.00). A single
relapse had a mean total cost of €2,505.97 (US $3,579.96).
No differences were found in annualised relapse rates and
costs of relapses according to DMT. However, a significant
difference was observed in total annual costs according to
treatment groups (glatiramer acetate being the most
expensive), mainly due to differences in unitary costs of
alternatives. From the public institutional perspective,
when equipotent DMTs are used in patients with comparable
characteristics, the costs of DMTs largely determine
the total expenses associated with care of patients with
relapsing-remitting MS in a middle-income country.
Blood pressure at hospital admission and outcome after primary intracerebral ...Erwin Chiquete, MD, PhD
Introduction: The importance of the admission blood pressure (BP) for intracerebral
hemorrhage (ICH) outcome is not completely clear. Our objective was to
analyze the clinical impact of BP at hospital arrival in patients with primary ICH.
Material and methods: We studied 316 patients (50% women, mean age:
64 years, 75% with hypertension history) with acute primary ICH. The first BP reading
at admission was evaluated for its association with neuroimaging findings
and outcome. A Cox proportional hazards model and Kaplan-Meier analyses
were constructed to evaluate factors associated with in-hospital mortality.
Results: Intraventricular irruption occurred in 52% of cases. A high frequency
of third ventricle extension was observed in patients with BP readings in the
upper quartiles of the distribution (systolic, diastolic, or mean arterial pressure).
Blood pressure readings did not correlate with hematoma volumes. In-hospital
case fatality rate was 46% (63% among those with ventricular irruption). Systolic
BP (SBP) > 190 mm Hg was independently associated with in-hospital mortality
in supratentorial (n = 285) ICH (hazard ratio: 1.19, 95% confidence interval:
1.02-1.38, for the highest vs. the lowest quartile) even after adjustment for
known strong predictors (age, ICH volume, Glasgow coma scale and ventricular
extension). Blood pressure was not significantly associated with ventricular
extension or outcome in patients with infratentorial ICH.
Conclusions: A high BP on admission is associated with an increased risk of
intraventricular extension and early mortality in patients with supratentorial
ICH. However, a significant proportion of patients with high BP readings without
ventricular irruption still have an increased risk of death.
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Erwin Chiquete, MD, PhD
34. Chiquete E, Ochoa-Guzmán A, García-Lamas L, Anaya-Gómez F, Gutiérrez-Manjarrez JI, Sánchez-Orozco LV, Godínez-Gutiérrez SA, Maldonado M, Román S, Panduro A. Hepatitis C virus infection and type 2 diabetes mellitus in Mexican patients. Rev Med Inst Mex Seguro Soc. 2012;50(5):481-6. [PMID: 23282259]
Atherothrombotic Disease, Traditional Risk Factors, and 4-Year Mortality in a...Erwin Chiquete, MD, PhD
Erwin Chiquete, MD, PhD
Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This
epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated
factors associated with 4-year all-cause mortality in a Latin American population at high risk.
Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and
cardiovascular mortality in this Latin American cohort.
Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic
atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued
Health registry.
Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease,
and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%),
hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension
(89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality
steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients
with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with
cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality
were congestive heart failure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular
disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were
associated with a reduced risk.
Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin
José L. Ruiz-Sandoval, Erwin Chiquete,
Lucía E. Álvarez-Palazuelos, Miguel
A. Andrade-Ramos & Luis R. Rodríguez-
Rubio
Osmotic demyelination syndrome (ODS) is the
damage over the central nervous system caused by several
electrolytes, metabolic and toxic disorders. We aimed to
describe cases of unusual forms of ODS. In a 9-year period,
25 consecutive patients with ODS (15 men; mean age
42 years) were registered in our referral institution, among
them, four (16 %) with atypical neuroimaging findings
were abstracted for this communication. None of them
presented cardiorespiratory arrest, head trauma, seizures,
neuromyelitis optica spectrum or contact with toxic
chemicals. Case 1 was a 33-year-old alcoholic man without
hypertension or electrolyte imbalance, who presented a
classic central pontine myelinolysis (CPM) and a hemorrhage
within the pons. Case 2 was a 34-year-old alcoholic
man with hypoglycemia and hyponatremia who presented
CPM and diffuse bihemispheric extrapontine myelinolysis
(EPM) after correction of serum sodium. Case 3 was a
52-year-old woman with mild hypokalemia and hyponatremia
(inadequately corrected), who presented a peduncular
and cerebellar EPM. Case 4 was a 67-year-old
woman who had a suicidal attempt with antidepressants
and carbamazepine without impaired consciousness, who
complicated with mild hyponatremia associated with a
classical CPM and a spinal cord EPM. Case 2 died and the
rest remained with variable neurological impairments at
last follow-up visit. With modern neuroimaging, the
so-called atypical forms of ODS may not be as rare as
previously thought; however, they could have a more
adverse outcome than the classical ODS.
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this
important cardiovascular risk factor should reduce the health burden of ICH.
An Expandable Prosthesis with Dual Cage-and-Plate Function in a Single Device...Erwin Chiquete, MD, PhD
Juan J. Ramı´rez, Erwin Chiquete, Juan J. Ramı´rez, Jr., Ernesto Go´mez-Limo´n, and Juan M. Ramı´rez
An expandable vertebral body prosthesis with dual cage-and-plate function in a single
device (JR prosthesis) was designed to test the hypothesis that this modular system can
provide the biomechanical requirements for immediate and durable spine stabilization
after corpectomy. Cadaver assays were performed with a stainless steal device to test fixation
and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors
(eight metastatic) underwent corpectomy and vertebral body replacement with a titaniummade
JR prosthesis. All patients had neurological deficit, severe pain and spine instability
prior to surgery. Mean pain score before surgery on a visual analog scale decreased from
7.6e3.0 points after operation ( p 5 0.002). All patients achieved at least one grade of
improvement in the Frankel score ( p 5 0.003), excepting the three patients with Frankel
grade A before surgery. Two patients with renal cell carcinoma died during the following
4 days after surgery. The remaining patients attained a painless and stable spine immediately,
which was maintained for long periods (mean follow-up: 25.4 months). No significant
infections or implant failures were registered. A nonfatal case of inferior vena cava
surgical injury was observed (repaired during surgery without further complications). In
conclusion, the JR prosthesis stabilizes the spine immediately after surgery and for the
rest of the patients’ life. To our knowledge, this is the first report on the clinical experience
of any expandable vertebral body prosthesis with dual cage-and-plate function in
a single device.
Expression profile of BRCA1 and BRCA2 genes in premenopausal Mexican women wi...Erwin Chiquete, MD, PhD
Gloria Loredo-Pozos, Erwin Chiquete,
Antonio Oceguera-Villanueva, Arturo Panduro,
Fernando Siller-Lo´pez, Martha E. Ramos-Márquez
Low BRCA1 gene expression is associated with
increased invasiveness and influences the response of
breast carcinoma (BC) to chemotherapeutics. However,
expression of BRCA1 and BRCA2 genes has not been
completely characterized in premenopausal BC. We analyzed
the clinical and immunohistochemical correlates of
BRCA1 and BRCA2 expression in young BC women. We
studied 62 women (mean age 38.8 years) who developed
BC before the age of 45 years. BRCA1 and BRCA2 mRNA
expression was assessed by reverse transcriptase-polymerase
chain reaction (RT-PCR) and that of HER-2 and
p53 proteins by immunohistochemistry. Body mass index
(BMI) C27 (52%) and a declared family history of BC
(26%) were the main risk factors. Ductal infiltrative adenocarcinoma
was found in 86% of the cases (tumor size
[5 cm in 48%). Disease stages I–IV occurred in 2, 40, 55,
and 3%, respectively (73% implicating lymph nodes).
Women aged B35 years (24%) had more family history of
cervical cancer, stage III/IV disease, HER-2 positivity, and
lower BRCA1 expression than older women (P-.05).
BRCA1 and BRCA2 expression correlated in healthy, but
not in tumor tissues (TT). Neither BRCA1 nor BRCA2
expression was associated with tumor histology, differentiation,
nodal metastasis or p53 and HER-2 expression.
After multivariate analysis, only disease stage explained
BRCA1 mRNA levels in the lowest quartile. Premenopausal
BC has aggressive clinical and molecular
characteristics. Low BRCA1 mRNA expression is associated
mainly with younger ages and advanced clinical stage
of premenopausal BC. BRCA2 expression is not associated
with disease severity in young BC women.
The document analyzes the direct costs of treating breast cancer patients at the National Institute of Cancerology in Mexico prior to the introduction of immunotherapy. A total of 633 patients treated in 2004 were studied. The costs were calculated for each stage of care including diagnosis/staging, treatment, follow-up, and palliative care. The average annual cost of treatment per patient increased with each successive stage of disease from $6,219.94 for stage I to $9,917.82 for stage IV. The total direct cost of treating all 633 breast cancer patients in 2004 was calculated to be $5,341,805.37. The study concluded that costs of care increased with more advanced disease stages due in part to late
Este documento presenta el caso de una paciente de 23 años que desarrolló una demencia tres años después de una intoxicación crónica por paradiclorobenceno (PDCB). La paciente había ingerido pequeñas cantidades de desodorante que contenía PDCB durante varios meses y luego intentó suicidarse ingiriendo grandes cantidades. Tres años después presentaba síntomas de demencia mixta corticosubcortical. Las imágenes por resonancia magnética mostraron leucoencefalopatía difusa. El PDCB puede causar desmielinización central y
Spontaneous intracerebral hemorrhage in Mexico: results from a Multicenter Na...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, and the RENAMEVASC investigators
Introduction. Scarce information exists on intracerebral hemorrhage (ICH) in Latin America, and the existent is derived
from single-center registries with non-generalizable conclusions. The aim of this study is to describe the frequency, etiology,
management and outcome of ICH in Mexico.
Patients and methods. We studied consecutive patients with ICH pertaining to the National Multicenter Registry on Cerebrovascular
Disease (RENAMEVASC), conducted in 25 centers from 14 states of Mexico. The Intracerebral Hemorrhage Grading
Scale (ICH-GS) at admission was used to assess prognosis at 30 days follow-up.
Results. Of 2,000 patients with acute cerebrovascular disease registered in RENAMEVASC, 564 (28%) had primary ICH
(53% women; median age: 63 years; interquartile range: 50-75 years). Hypertension (70%), vascular malformations (7%)
and amyloid angiopathy (4%) were the main etiologies. In 10% of cases etiology could not be determined. Main ICH
locations were basal ganglia (50%), lobar (35%) and cerebellum (5%). Irruption into the ventricular system occurred in
43%. Median score of ICH-GS was 8 points: 49% had 5-7 points, 37% had 8-10 points and 15% had 11-13 points. The 30-day
case fatality rate was 30%, and 31% presented severe disability. The 30-day survival was 92% for patients with ICH-GS 5-7
points, whereas it decreased to 27% in patients with ICH-GS 11-13 points.
Conclusions. In Mexico, ICH represents about a third of the forms of acute cerebrovascular disease, and the majority of
patients present severe disability or death at 30 days of follow-up. Hypertension is the main cause; hence, control of this important cardiovascular risk factor should reduce the health burden of ICH.
Hemorragia intracerebral espontánea en México: resultados del Registro Hospit...Erwin Chiquete, MD, PhD
José L. Ruiz-Sandoval, Erwin Chiquete, Alejandra Gárate-Carrillo, Ana Ochoa-Guzmán, Antonio Arauz,
Carolina León-Jiménez, Karina Carrillo-Loza, Luis M. Murillo-Bonilla, Jorge Villarreal-Careaga,
Fernando Barinagarrementería, Carlos Cantú-Brito, investigadores RENAMEVASC
Introducción. Existe poca información respecto a la hemorragia intracerebral (HIC) en América Latina, y la existente ha
sido derivada de registros hospitalarios de un solo centro con conclusiones no generalizables. El objetivo de este estudio
es describir la frecuencia, etiología, manejo y desenlace clínico de la HIC en México.
Pacientes y métodos. Se estudiaron pacientes consecutivos con HIC incluidos en el Registro Nacional Mexicano de Enfermedad
Vascular Cerebral (RENAMEVASC), conducido en 25 centros de 14 estados de la República Mexicana. Se usó la
Intracerebral Hemorrhage Grading Scale (ICH-GS) para estimar el pronóstico a 30 días.
Resultados. De 2.000 pacientes con ictus agudo en el RENAMEVASC, 564 (28%) presentaron HIC espontánea (53% mujeres;
edad media: 63 años; rango intercuartílico: 50-75 años). La hipertensión arterial (70%), las malformaciones vasculares
(7%) y la angiopatía amiloidea (4%) fueron las causas más frecuentes. No se determinó la etiología en el 10% de
los casos. Las localizaciones más frecuentes fueron ganglionar (50%), lobar (35%) y cerebelosa (5%). La irrupción hacia
el sistema ventricular ocurrió en el 43%. La mediana en la escala ICH-GS al ingreso hospitalario fue de 8 puntos: el 49%
presentó 5-7 puntos; el 37%, 8-10 puntos, y el 15%, 11-13 puntos. La tasa de mortalidad a 30 días fue del 30%, y el 31%
mostró discapacidad grave. La sobrevida a 30 días fue del 92% en pacientes con 5-7 puntos en la escala ICH-GS, mientras
que se redujo al 27% en aquellos con 11-13 puntos.
Conclusiones. En México, la HIC representa casi un tercio de las formas de enfermedad vascular cerebral aguda, y la mayoría de los pacientes que la padecen presentan discapacidad funcional grave o muerte a 30 días. La hipertensión es la principal causa, por lo que el control de este importante factor de riesgo debería reducir la carga sanitaria de la HIC.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Muscles of Mastication by Dr. Rabia Inam Gandapore.pptx
2. viral hepatitis in blood bank hospital civil
1. Annals of Hepatology 2005; 4(4): October-December: 275-278
Original Article
Annals
of
Hepatology Performance of the serologic and molecular
screening of blood donations for the hepatitis B
and C viruses in a Mexican Transfusion Center
Erwin Chiquete;1,2 Laura V. Sánchez;1,2 Guadalupe Becerra;3 Ángeles Quintero;3 Montserrat Maldonado;1,2 Arturo Panduro1,2
Abstract another (1%; 95% CI, 0–6%). All these 100 donors
tested negative to HBsAg and anti-HCV. Thus, the
Nucleic acid-amplification testing (NAT) is not routine- prevalence of positive results for HBV and HCV did not
ly practiced in blood banks from most low-income differ if considering immunoassays or NAT; neverthe-
countries. We did an exploratory comparison of the less, these methods did not coincide in detecting HBV
performance of the standard immunoassay-based or HCV in the molecular screening cohort. In conclu-
screening tests for the hepatitis B (HBV) and C (HCV) sion, NAT can detect cases of HBV and HCV infections
viruses with that of NAT, in blood donors. From Janu- that standard immunoassay techniques can not, even in
ary 1999 to March 2005, 94,806 blood donors were a highly selected population at low risk, like blood do-
screened for anti-HCV antibodies and for hepatitis B nors. Large-scale studies are warranted for NAT to be
surface antigen (HBsAg). Also, an exploratory period considered as a systematic method for screening of
of molecular screening was carried out on 100 consec- HBV and HCV in Mexican blood banks.
utive blood donors to detect HBV DNA and HCV RNA
by home-made PCR techniques without sera pooling. Key words: Blood bank, epidemiology, hepatitis B,
In the 75-month period of serologic screening, HBsAg hepatitis C, liver, serology, test.
was detected in 219 donors (0.23%; 95% CI, 0.20–
0.26%) and anti-HCV antibodies in 922 (0.97%; 95% Introduction
CI, 0.90–1.03%). The annual trend for HBsAg preva-
lence had a decreasing pattern over the years (p < Hepatitis B (HBV) and C (HCV) viruses are the most
0.001), whereas that for anti-HCV did not (p = 0.19). In important infectious agents causing non-alcoholic cir-
the molecular screening cohort, HBV DNA was detect- rhosis in Mexico.1 Parenteral exposure to blood is the
ed in one donor (1%; 95% CI, 0–6%) and HCV RNA in most frequent mode of transmission, especially related to
blood transfusion before the systematic practice of test-
ing for HBV and HCV in blood donations, in 1986 and
1992, respectively.2 Since then, laboratory screening of
potential blood donors has relied on the use of evolving
immunoassays to detect viral antibodies or antigens.
1
Department of Molecular Biology in Medicine, Hospital Civil de Non-remunerated blood donation and screening of po-
Guadalajara “Fray Antonio Alcalde”.
2
Department of Physiology, CUCS, Universidad de Guadalajara.
tential donors by using a structured questionnaire about
3
Department of Transfusion Medicine, Hospital Civil de risk factors, as well as by anti-HCV and hepatitis B sur-
Guadalajara “Fray Antonio Alcalde”. face antigen (HBsAg) testing have been practiced alto-
gether by law (among other laboratory tests) in Mexican
Abbreviations: CI: confidence interval; HBV: hepatitis B virus;
HBsAg, hepatitis B surface antigen; HCV: hepatitis C virus; NAT:
blood banks since 1993.2,3 This is the last revision to the
nucleic acid-amplification testing; PCR: polymerase chain reaction; regulations of these practices in blood banks from Mexi-
S/CO: immunoassay signal strength of the sample to cut-off. co. The advent of nucleic acid-amplification testing
(NAT) has not changed this practice, possibly because is
Address for correspondence:
Dr. Arturo Panduro
not considered cost-effective, in the context of a low-in-
Servicio de Biología Molecular en Medicina, Hospital Civil de come population with other health priorities. However,
Guadalajara “Fray Antonio Alcalde”, HCV infection is now one of the two leading causes of
Hospital 278, Guadalajara Jalisco México, Postal Code 44280. cirrhosis in Mexico1 and it is predicted that chronic liver
Phone: 52-3614-7743, Fax: 52-3614-7743.
E-mail:apanduro@prodigy.net.mx.
disease will be a major, still-growing cause of both mor-
bidity and mortality in the following years.4 Moreover, if
Manuscript received: 8 November and accepted: 18 November, 2005. other risk practices related to HBV and HCV infections as
2. 276 Annals of Hepatology 4(4) 2005: 275-278
the abuse of illicit intravenous drugs become more fre- directly proportional to the quantity of HBsAg.8 For HB-
quent, Mexico would be facing an increasing problem, sAg, S/CO ratio >2 is considered a positive result, ac-
and blood banks would need to change their conduct to cording to the manufacturer.
minimize the possibility of transfusion-associated viral
infections. Detection of HBV DNA in serum
We aimed to describe the seroprevalence of HBV and
HCV infections in a Mexican transfusion center and to do For HBV DNA assessment, a home-made qualitative
an exploratory comparison of the performance of the nested PCR was performed. An aliquot of 200 µL of sera
standard immunoassay-based screening tests for both vi- samples were obtained to isolate viral DNA using the QI-
ruses with that of NAT, in blood donors. Amp Blood Kit (QIAGEN, Chatsworth, CA). HBV DNA
was amplified by standardized first-round and nested
Methods PCR of S-gene fragment using the primers and condi-
tions described previously.10 These primers have a molec-
Design, data source and sample ular specificity of 100% for all strains of HBV, as as-
sessed by DNA sequencing and alignment.10 PCR assay
This study was done at the Department of Transfusion was practiced per duplicate systematically in all sera
Medicine and the Department of Molecular Biology in samples. Cases with detectable HBV DNA in serum were
Medicine of the Hospital Civil de Guadalajara “Fray confirmed in a third PCR assay, in order to adjudicate a
Antonio Alcalde”, which serves to urban and rural low- confirmed diagnosis. Appropriate measures were taken to
income populations from the West of Mexico, usually minimize the risk of sample cross-contamination. These
lacking of health-care insurance. From January 1999 to measures comprised the inclusion of serum samples from
March 2005, a total of 94,806 blood donors (aged 18 to normal subjects and aliquots of water as negative con-
65 years) were screened for anti-HCV antibodies and for trols. A positive control of a HBV genotype A strain was
HBsAg, among other serologic markers for blood-borne always included from the extraction of nucleic acids.
infectious agents. Also, a period of molecular screening This home-made PCR has a detection limit of 10 copies
in March 2001 was conducted on 100 consecutive blood per mL, as determined by in-house dilution experiments,
donors to detect HCV RNA and HBV DNA by home- from nucleic acids extraction to amplification (data not
made PCR techniques. Molecular screening (i.e., NAT) published).
was done on approved candidates for blood donation, on
the basis of a structured questionnaire regarding risk fac- Detection of HCV RNA in serum
tors, as well as self-exclusion strategies. Researchers who
performed NAT were not aware of the serologic status or A home-made qualitative nested reverse-transcription
any personal or clinical information of the blood donors, polymerase chain reaction (RT-PCR) was used to detect
until completion of the molecular analysis of all sam- HCV RNA in sera samples of the 100 donors of the mo-
ples. Also, no sera pooling was done for NAT. lecular screening cohort. Total RNA was extracted from
The internal Committee of Ethics of our hospital ap- each serum without pooling, using QIAamp Viral RNA
proved the present work. Informed consent was obtained Mini Kit (QIAGEN, Chatsworth, CA) as indicated the
from the donors in all cases. manufacturer. Afterwards, RT was carried out to obtain
complementary DNA (cDNA) using M-MLV RT kit
Detection of anti-HCV antibodies and of HBsAg (MMLV, GIBCO/BRL). PCR amplification of cDNA and
later a nested-PCR were performed with two pairs of
An automated third-generation microparticle enzyme primers that hybridize in a segment of the 5’ non-coding
immunoassay (MEIA, AxSYM HCV Version 3.0 Abbott region of HCV genome, as is described elsewhere.9 Posi-
Diagnostics, Chicago, IL, USA) was used to detect anti- tive sera controls obtained with this technique and con-
HCV antibodies in all sera samples. The signal strength firmed to be specific for HCV by nucleic acids sequenc-
of immunoassay (i.e., fluorescence) of the sample is di- ing and alignment of amplified products were always in-
vided by that of the internal cut-off rate (S/CO) of each troduced from RNA extraction to cDNA amplification.
sample. This is a semi-quantitative assay in which S/CO This qualitative nested RT-PCR was performed per du-
value is directly proportional to the quantity of antibod- plicate systematically in all samples and the products of
ies directed to HCV.5-7 S/CO ratio >1 is considered a posi- the reaction were analyzed in gel electrophoresis. This
tive result, according to the manufacturer’s instructions. home-made RT-PCR has a detection limit of <100 copies
Similarly, detection of HBsAg was done by using an au- per mL, as assessed by in-house experiments (data not
tomated third-generation microparticle enzyme immu- published). The criterion for adjudication of a confirmed
noassay (MEIA, AxSYM HBsAg Version 3.0 Abbott Di- diagnosis and the measures taken to minimize the risk of
agnostics, Chicago, IL, USA). This is also a semi-quanti- cross-contamination were the same as in the assessment
tative assay in which S/CO value is calculated. S/CO is of the presence of HBV DNA.
3. Chiquete E et al. Performance of the serologic and molecular screening of blood donations for the hepatitis B and C viruses 277
Data analysis differ when comparing the frequency of HBsAg and
anti-HCV antibodies with that of HBV DNA and HCV
The frequency of positive results in serologic and mo- RNA, respectively. However, and very important from
lecular assessments is provided with the respective 95% the clinical and epidemiological perspective, NAT and
confidence interval (CI, calculated with the modified immunoassay methods did not coincide in detecting
Wald method). Pearson chi-square test was used to com- neither HBV nor HCV infections in the persons who
pare the frequency of seroreactive results obtained by im- tested positive to viral nucleic acids. Hence, seronega-
munoassay and molecular methods and to assess the an- tive persons (i.e., with false-negative markers for infec-
nual trend of the serologic frequency for HBsAg and anti- tion) were detected by NAT, in the cohort of molecular
HCV antibodies, from January 1999 through December screening. Since the two blood donors who tested posi-
2004. A p < 0.05 was considered statistically significant. tive to NAT came from rural areas, they could not be lo-
cated to reassess their serologic and molecular status.
Results Fortunately, the contaminated blood units were not
transfused.
In the 75-month period of serologic screening, a total
of 94,806 blood donors were assessed for the presence of Discussion
HBsAg and anti-HCV antibodies by the standard immu-
noassay techniques. A total of 219 persons tested posi- We found that seroprevalence of HBV infection (as as-
tive to HBsAg (0.23%; 95% CI, 0.20 – 0.26%) and 922 to sessed by the presence of HBsAg) among blood donors
anti-HCV antibodies (0.97%; 95% CI, 0.90 – 1.03%). The from our center is having a decreasing pattern. This may
annual frequency of the presence of HBsAg in blood do- be due to the success in strategies aimed to minimize
nors clearly demonstrated a decreasing tendency (p for HBV acquisition in Mexican blood banks and in practice
trend < 0.001) (Figure 1), whereas that for anti-HCV anti- of sanitary personnel (i.e., dentists and surgeons) since
bodies behaved relatively constant (p for trend = 0.19) the 1980’s. On the other hand, seroprevalence of HCV in-
(Figure 2). fection (as assessed by anti-HCV antibodies) have not
In the period of molecular screening, a total of 100 changed in the last years, possibly reflecting the fact that
consecutive blood donors were assessed for the pres- most persons currently infected with HCV in Mexico ac-
ence of HBV DNA and HCV RNA by NAT in serum. quired the infection by transfusion before the systematic
None of these blood donors tested positive to HBsAg or screening in blood banks,7,9 strategy that was introduced
anti-HCV antibodies. HBV DNA was detected in one in relatively recent years.3
person (1%; 95% CI, 0 – 6%) and HCV RNA in another Taking into account the limitation of a small cohort
case (1%; 95% CI, 0 – 6%). Therefore, the frequency of that received NAT assessment, we also found that sero-
positive results for HBV and HCV infections did not logic and molecular screenings do not always coincide in
0.60 1.40 p = 0.19
p < 0.001
Prevalence of anti-HCV antibodies (%)
0.50 1.30
Prevalence of HBsAg (%)
1.20
0.40
1.10
0.30
1.00
0.20
0.90
0.10 0.80
0.00 0.70
1999 2000 2001 2002 2003 2004 1999 2000 2001 2002 2003 2004
Year Year
Number of Number of
blood donors 13 618 14 927 15 240 14 700 15 553 16 449 blood donors 13 618 14 927 15 240 14 700 15 553 16 449
Number of Number of
positive cases 61 49 36 29 17 23 positive cases 118 142 174 135 147 148
Figure 1. Annual trend of the prevalence of positive results to Figure 2. Annual trend of the prevalence of positive results to anti-
HBsAg among blood donors, from 1999 to 2004. The total num- HCV antibodies among blood donors, from 1999 to 2004. The to-
ber of donors tested and the respective HBsAg-positive cases for tal number of donors tested and the respective anti-HCV-positive
each year are depicted. Error bars represent 95% CI. cases for each year are depicted. Error bars represent 95% CI.
4. 278 Annals of Hepatology 4(4) 2005: 275-278
detecting HBV and HCV infections, and that NAT can de- Acknowledgments
tect cases that serologic approach can not, a very impor-
tant issue that should change the way low-income coun- We are indebted to the personnel of Blood Bank and
tries are facing the problems of blood-borne infections. Transfusion Medicine for their friendship and commit-
Furthermore, even when the risk for acquisition of HBV ment with an excellent work in caring for the suffering.
and HCV infections from a blood donation is markedly This work was supported by a grant from The National
lower than previous years, today the possibility is not re- Council of Science and Technology, Mexico, to Dr. Ar-
duced to zero.11-13 Since the evolution of infectious dis- turo Panduro (Salud 2004-C01-025, CONACyT).
eases is a very dynamic process, the recent experience on
HIV and HCV pandemics gave us the knowledge that References
transfusions need to be applied when undoubtedly indi-
cated and that highly-effective preventive strategies 1. Méndez-Sánchez N, Aguilar-Ramírez JR, Reyes A, Dehesa M,
Juárez A, Castañeda B, et al. Etiology of liver cirrhosis in Mexico.
should be applied, even when we apparently have safer Ann Hepatol 2004; 3: 30-33.
blood units in the context of current blood-borne infec- 2. Rivera-López MR, Zavala-Méndez C, Arenas-Esqueda A. Preva-
tious diseases (but possibly not in that of future emerging lence for seropositivity for HIV, hepatitis B and hepatitis C in
infectious diseases). blood donors [in Spanish]. Gac Med Mex 2004; 140: 657-660.
3. SSA. Mexican Official Norm on the use of human blood and its
There is no doubt regarding the superiority of NAT components with therapeutic objectives (NOM-003-SSA2-1993);
over the immunoassay techniques in detecting blood- Mexico, 1993. Available at http://www.salud.gob.mx/. Accessed
borne viral hepatitis, 5-7,12 but apparently the discussion July 25 2005.
is whether NAT is cost-effective in low-income coun- 4. Méndez-Sánchez N, Villa AR, Chávez-Tapia NC, Ponciano-
Rodríguez G, Almeda-Valdés P, González D, et al. Trends in
tries with low prevalence of such infections. However, liver disease prevalence in Mexico from 2005 to 2050 through
the best strategy among several approaches should be mortality data. Ann Hepatol 2005; 4: 52-55.
evaluated. For instance, minipooling of sera samples 5. Sookoian S, Castaño G. Evaluation of a third generation anti-
reduces the number of NAT assays to be performed, HCV assay in predicting viremia in patients with positive HCV
antibodies. Ann Hepatol 2002; 4: 179-182.
and it has resulted in a very efficient way to detect vi- 6. Dal Molin G, Tiribelli C, Campello C. A rational use of labora-
ral genomes in serum. Moreover, available semi-auto- tory tests in the diagnosis and management of hepatitis C virus
mated techniques reduce the need of highly-special- infection. Ann Hepatol 2003; 2: 76-83.
ized personnel and the time it takes to provide a defi- 7. Chiquete E, Sánchez LV, Maldonado M, Quezada D, Panduro A.
Prediction of the hepatitis C viremia using immunoassay data and
nite test result. With time, less expensive chemicals clinical expertise. Ann Hepatol 2005; 4: 107-114.
and devices will arise to market, facilitating even 8. Moerman B, Moons V, Sommer H, Schmitt Y, Stetter M. Evalu-
more these processes. ation of sensitivity for wild type and mutant forms of hepatitis B
Given the exploratory nature of this study, data re- surface antigen by four commercial HBsAg assays. Clin Lab
2004; 50: 159-162.
ported here should be interpreted with caution. More 9. Rivas-Estilla AM, Sánchez LV, Matsui O, Campollo O, Armendariz-
studies sufficiently powered to demonstrate that NAT Borunda J, Segura-Ortega JE, Panduro A. Identification of hepa-
should complement the screening of blood donations titis C virus (HCV) genotypes in infected patients from the west of
for HBV and HCV in Mexican blood banks are neces- Mexico. Hepatology Research 1998; 12: 121-130.
10. Sánchez LV, Maldonado M, Bastidas-Ramírez BE, Norder H,
sary. Moreover, although very cautious measures were Panduro A. Genotypes and S-gene variability of Mexican hepa-
taken to avoid errors, we used a home-made NAT titis B virus strains. J Med Virol 2002; 68: 22-34.
which are plenty of steps that can be susceptible of 11. Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepa-
technical mistakes in a large-scale work in blood titis C virus infection. Lancet Infect Dis 2005; 5: 558-567.
12. Stramer SL, Glynn SA, Kleinman SH, Strong DM, Caglioti S,
banks. Possibly an automated method of nucleic acids Wright DJ, Dodd RY, Busch MP. Detection of HIV-1 and HCV
extraction and amplification is the best option for this infections among antibody-negative blood donors by nucleic
objective. acid-amplification testing. N Engl J Med 2004; 351: 760-768.
In conclusion, NAT can detect cases of HBV and HCV 13. Koerner K, Cardoso M, Dengler T, Kerowgan M, Kubanek B.
Estimated risk of transmission of hepatitis C virus by blood trans-
infections that standard immunoassays can not, even in fusion. Vox Sang 1998; 74: 213-216.
blood donors, a highly selected population at low risk. 14. Flanagan P, Snape T. Nucleic acid technology (NAT) testing and
NAT should receive more study in order to be considered the transfusion service: a rationale for the implementation of
as a systematic method to detect prevalent viral blood- minipool testing. Transfusion Med 1998; 8: 9-13.
15. Romano L, Velati C, Baruffi L, Fomiatti L, Colucci G, Zanetti
borne infectious agents in Mexican blood banks. There- AR, et al. Multicenter evaluation of a semiautomated, standard-
fore, large-scale technical and cost-effective studies are ized assay for detection of hepatitis B virus DNA in blood dona-
warranted. tions. J Clin Microbiol 2005; 43: 2991-2993.