A STAT4 variant increases liver fibrosis risk in Caucasian patients with chronic hepatitis B

BACKGROUND

Host genetic modifiers of the natural history of chronic hepatitis B (CHB) remain poorly understood. Recently, a genome-wide association study (GWAS)-identified polymorphism in the STAT4 gene that contributes to the risk for hepatocellular carcinoma (HCC) was shown to be associated with the full spectrum of hepatitis B virus (HBV) outcomes in Asian patients. However, the functional mechanisms for this effect are unknown and the role of the variant in modulating HBV disease in Caucasians has not been investigated.

AIMS

To determine whether STAT4 genetic variation is associated with liver injury in Caucasian patients with CHB and to investigate potential mechanisms mediating this effect.

METHODS

STAT4 rs7574865 was genotyped in 1085 subjects (830 with CHB and 255 healthy controls). STAT4 expression in liver, PBMCs and NK cells, STAT4 phosphorylation and secretion of interferon-gamma (IFN-γ) according to STAT4 genetic variation was examined.

RESULTS

STAT4 rs7574865 genotype was independently associated with hepatic inflammation (OR: 1.42, 95% CI: 1.07-2.06, P = 0.02) and advanced fibrosis (OR: 1.83, 95% CI: 1.19-2.83, P = 0.006). The minor allele frequency of rs7574865 was significantly lower than that in healthy controls. rs7574865 GG risk carriers expressed lower levels of STAT4 in liver, PBMCs and in NK cells, while NK cells from patients with the risk genotype had impaired STAT4 phosphorylation following stimulation with IL-12/IL-18 and a reduction in secretion of IFN-γ.

CONCLUSION

Genetic susceptibility to HBV persistence, hepatic inflammation and fibrosis in Caucasians associates with STAT4 rs7574865 variant. Downstream effects on NK cell function through STAT4 phosphorylation-dependent IFN-γ production likely contribute to these effects.

LOOP-MEDIATED ISOTHERMAL AMPLIFICATION (LAMP): SENSITIVE AND RAPID DETECTION OF SCHISTOSOMA HAEMATOBIUM DNA IN URINE SAMPLES OF EGYPTIAN SUSPECTED CASES

Schistosomiasis haemalobium is a major endemic parasitic disease in many tropical regions including Egypt. Typical infection results in haematuria, dysuria, anaemia, genital as well as urinary tract lesions, with prospect of kidney damage in complicated cases. In addition, deposited eggs in the tissue, eventually leads to squamous cell carcinoma of urinary bladder in chronically infected individuals. Microscopic detection of excreted ova in urine samples remains the gold standard diagnostic method, in spite of its inherited low sensitivity, inconsistent egg excretion and unreliable results in chronic phase of the disease. Moreover due to pre-requisite for skilled personals and pricey equipment, PCR-based technologies are of limited use especially in low-income endemic countries. So emergence of loop-mediated isothermal DNA amplification (LAMP) seemed a promising technique. Our study evaluated application of LAMP technique in detection of S. haematobium DNA in 69 urine samples of suspected patients for urogenital schistosomiasis, versus conventional urine filtration followed by microscopy ova detection method. Specificity of LAMP was tested using other parasites DNA samples that showed no cross reactivity. Furthermore our results of the calculated diagnostic parameters for sensitivity and specificity for LAMP assay were 100%, with 95% CI (88.78%-100%), and 63.16%, with 95% CI (45.99%-78.19%) respectively, moreover Positive likelihood ratio (LR+) 2.7, and Negative likelihood ratio (LR-) 0.0, which display that LAMP technique is an up-to-date simple, sensitive, diagnostic important tool that could be employed in clinical diagnosis in poorly equipped facilities, as well as in surveillance of infectious diseases. As authors knowledge, this is the first national report evaluation of LAMP technique as a promising diagnostic tool for urogenital schistosomiasis.

Dexmedetomidine as an additive to local anesthetics compared with intravenous dexmedetomidine in peribulbar block for cataract surgery

Background:

No studies compared parenteral dexmedetomidine with its use as an adjuvant to ophthalmic block. We compared between adding dexmedetomidine to bupivacaine in peribulbar block and intravenous (IV) dexmedetomidine during peribulbar block for cataract surgery.

Materials and Methods:

A prospective, randomized, double-blind study on 90 patients for cataract surgery under peribulbar anesthesia. Study included three groups; all patients received 10 ml of peribulbar anesthesia and IV infusion of drugs as follows: Group I: Received a mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) + 150 IU hyaluronidase + IV infusion of normal saline, Group II: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + dexmedetomidine 50 μg (1 ml) +150 IU hyaluronidase + IV infusion of normal saline and Group III: Received mixture of bupivacaine 0.5% (4.5 ml) + lidocaine 2% (4.5 ml) + normal saline (1 ml) +150 IU hyaluronidase + IV dexmedetomidine 1 μg/kg over 10 min; followed by 0.4 μg/kg/h IV infusion. We recorded onset, duration of block, Ramsay Sedation Score, intra-ocular pressure (IOP), hemodynamics, and adverse effects.

Results:

There was a significant decrease in the onset of action and increase in the duration of block in Group II as compared with the Group I and Group III. Mean Ramsay Sedation Score was higher in Group III. The IOP showed a significant decrease in Group II and Group III 10 min after injection (P < 0.01). Heart rate showed a significant decrease in Group III in comparison with the two other groups (P < 0.05). Only two patients in Group III developed bradycardia.

Conclusion:

Dexmedetomidine as an additive shortens onset time, prolong block durations and significantly decreases the IOP with minimal side effects. IV dexmedetomidine, in addition, produces intra-operative sedation with hemodynamic stability.

Patient support and education for promoting adherence to highly active antiretroviral therapy for HIV/AIDS

BACKGROUND

Highly active antiretroviral therapy is associated with improved health outcomes for people living with HIV/AIDS. Unfortunately, full therapeutic benefit from HAART may require near-perfect adherence to prescribed regimens.

OBJECTIVES

To determine the effectiveness of patient support and education interventions for improving adherence to highly active antiretroviral therapy (HAART) in people living with HIV and AIDS.

SEARCH STRATEGY

Studies were identified using AIDSLINE, MEDLINE, CINAHL, HEALTHSTAR, PSYCHLIT, SOCIOLOGICAL ABSTRACTS, INTERNATIONAL PHARMACEUTICAL ABSTRACTS, SCIENCE CITATION INDEX, EMBASE, and abstracts from global AIDS meetings, ICAAC, and other major meetings from January 1996 to April 1999. Further information was sought through contact with authors, reference lists, and Collaborative Review Group databases.

SELECTION CRITERIA

To be included, studies had to describe a supportive or educational intervention to improve adherence to a HAART regimen in HIV positive patients, and include a comparison group. Eligible HAART regimens were defined as consisting of at least three anti-HIV drugs one of which must be a protease inhibitor or non-nucleoside reverse transcriptase inhibitor. At least one measure of adherence was also required.

DATA COLLECTION AND ANALYSIS

Data on study design, participants, interventions, and outcomes were extracted from the reports onto specifically designed data collection forms by at least two reviewers.

MAIN RESULTS

One study satisfied the eligibility criteria. It compared a pharmacist-led intervention consisting of educational counseling and availability of follow-up telephone support with conventional dispensing of HAART pills. This intervention significantly improved adherence to HAART, and adherence to HAART significantly predicted undetectable viral load at 24 weeks. However, participating in the intervention did not significantly predict a subsequently undetectable viral load at 24 weeks.

REVIEWER'S CONCLUSIONS

Implications for practice Currently a pharmacist-led program of educational and supportive counseling is the only available intervention which has been shown in a controlled study to improve adherence to HAART, with less evidence that viral load is subsequently reduced. Implications for research Controlled trials are urgently needed to determine which interventions can significantly improve adherence to HAART. Whether interventions that improve adherence also suppress viral load and improve clinical outcomes should also be considered.

The effect of different types of intragastric balloons with and without a behavior modification program in morbid obesity

Two consecutive and matched groups of morbidly obese patients, i.e. group (1) and (2) were selected to be treated with Garren-Edward Bubble (18 patients) and the Danish-Ballobe (10 patients), respectively, and according to the American FDA criteria. All patients were put on 1000-1200 K. cal diet and given the choice to enroll in the behavior modification program (BMP) or not; (15) patients enrolled in it (group A) and (13) patients refused (group B). At the end of the treatment period (i.e. 3 months group 1; 4 months group 2) the mean loss in the body mass index (BMI) for group (1) and (2) were 5.46 +/- 4.6 kg/m(2), and 3.98 +/- 5.5 kg/m(2) respectively. With insignificant statistical difference (P>1.0). While the mean loss in the BMI was 7.17 +/- 4.54 kg/m(2) and 1.85 +/- 0.92 kg/m(2) for group A & B respectively. With a very significant statistical difference (P< 0.01). No major complication was noticed except that in two patients (group 1) and four patients (group 2), the ballon had to be removed within the first week of insertion due to intolerance. In conclusion, although both balloons are safe, they are weakly effective and the main effect could be attributed to the BMP.

Kaliuretic response to aldosterone: influence of the content of potassium in the diet

The excretion of potassium (K+) decreased by 50% (30 v 63 mEq/d, P < .01) when subjects consumed a diet that was low in K+ for 3 days. Although part of this conservation of K+ was achieved in part by suppressing the release of aldosterone, nevertheless providing exogenous mineralocorticoids did not lead to a large kaliuresis when there was a modest degree of K+ depletion. Accordingly, the purpose of this study was to evaluate possible mechanisms for this antikaliuretic response to mineralocorticoids. The renal handling of K+ was examined by independent analysis of the two factors that influence its excretion, the driving force to secrete K+ and the urine volume. This driving force is reflected in a noninvasive fashion by the transtubular [K+] gradient (TTKG). Stimuli to increase the rate of excretion of K+ in subjects on a normal and a low-K+ diet included the administration of 200 micrograms fludrocortisone (9 alpha F), the induction of a high urine flow rate (9 alpha F+furosemide), the induction of bicarbonaturia (9 alpha F+acetazolamide), and the excretion of Cl(-)-poor urine (< 15 mEq/L). On the low-K+ diet, the peak value for the TTKG 3 to 4 hours after 9 alpha F was less than half that while on the normal diet (6.4 v 14, P < 0.01). In contrast, the TTKG was not significantly different on either diet when there was bicarbonaturia or the excretion of a Cl(-)-poor urine (18 v 17 and 17 v 16, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Projections of group Ia afferents to motoneurons of thigh muscles in man

Changes in the firing probability of single motor units in response to electrical stimulation of muscle nerves and to tendon taps were used to derive the projections of large muscle afferents to the motoneurons of various thigh muscles in man. Homonymous facilitation was demonstrated to virtually all of the sampled motor units of biceps (BI), semitendinosus (ST), vastus lateralis (VL) and vastus medialis (VM). Heteronymous facilitation was readily demonstrated between VM and VL but was never obtained from ST to BI and never unequivocally obtained from BI to ST. Reciprocal inhibition was demonstrated from femoral nerve afferents to all of the sampled units of BI, and ST but reciprocal inhibition of VM or VL was never obtained from BI afferents and infrequently from ST afferents. These projections of group I afferents in man show certain specific differences from those of the cat and baboon that may reflect the normal function of the limb.

Kuwait nutritional survey: comparison of the nutritional status of Kuwaiti children aged 6-9 years with the NCHS/CDC reference population

A national cross-sectional survey of the heights and weights of Kuwaiti primary school children aged 6-9 years was conducted on a stratified multistage sample of 5132 subjects from two socio-economic districts. The collected data were used to compare the nutritional status of Kuwaiti children with their American counterparts using the NCHS/CDC reference population. The basic indices used for comparison were height for age and weight for height, each considered in terms of centiles and SD scores and cross-classified using SD scores. The results indicated that although Kuwaiti children in the studied age groups are shorter than American children severe short stature is relatively infrequent as 48.3% fell below the 30th centile of the reference population. Conversely, Kuwaiti children are relatively heavier than American children as 61.1% fell above the 50th centile of the reference population.

Adverse drug reaction monitoring in Kuwait (1981-1984)

The methodologic, operational, and medical aspects of general population spontaneous adverse drug reaction (ADR) monitoring system organized in the State of Kuwait between June 1981 to June 1984 are described. The objectives of the study were to outline the procedures required for the establishment of a national ADR center in addition to studying the pattern of ADRs. Ethnic and sociocultural variables were factors influencing the frequency of adverse effects. A computer data base was created to handle incoming reports. A total of 704 reports were received from 26 hospitals and health clinics; the majority (90.5%) were classified as having a possible positive causal relationship. Anti-infectives were the most commonly reported drugs (32.2%), and cutaneous reactions were encountered most often (48.6%). Serious drug-induced reactions have been identified. Intake of nifedipine adversely affected glucose tolerance among diabetic and nondiabetic subjects. Bromocriptine causal sexual dysfunction was reported among women. Cimetidine and ethambutol were associated with optic neuritis and blindness. Metoclopramide and prochlorperazine resulted in dystonic reactions in children. Based on this study, the health authorities in Kuwait indicated their intention to establish a national ADR center.

Septicaemia in a teaching hospital in Kuwait--II: Factors influencing the outcome in III episodes

The case fatality rate (CFR) among III episodes of septicaemia in Kuwait was 22.5%. It increased with age but was not influenced by sex. Gram-negative, polymicrobial and hospital-acquired septicaemia carried a high mortality rate. Due to the influence of the more common, but less fatal salmonella infections, however, mortality from septicaemia caused by Gram-negative bacteria was lower than that reported from more developed countries. Patients with underlying conditions, such as malignancy, chronic liver disease, diabetes mellitus, renal transplant and conditions requiring surgery, as well as those with unknown sources of infection or infection originating from the respiratory tract or from surgical wounds had high mortality rates. The chances of survival increased with the use of appropriate antibiotic therapy and the absence of underlying disease. None of the patients with underlying conditions survived after receiving inappropriate therapy as compared with 50% who were previously healthy. The changing aetiology and the emergence of immuno compromised patients are possible causes for the failure to reduce significantly the mortality from septicaemia in Kuwait.

Kuwait nutritional survey: comparison of the nutritional status of Kuwaiti children aged 0-5 years with the NCHS/CDC reference population

A national cross-sectional survey of the heights and weights of Kuwaiti preschool-age children of 0-5 years was conducted on a stratified multistage sample of 2554 subjects from high and low socioeconomic levels. The collected data were used to compare the nutritional status of these children with their American counterparts using the NCHS/CDC reference population. The basic indices for comparison were height for age and weight for height, each considered in terms of centiles and standard deviation (SD) scores and cross-classified using the SD scores. The results indicated that Kuwaiti children in the studied age groups were shorter than American children, 47.7% falling below the 30th centile of the reference population. Conversely, the weights of Kuwaiti children aged 0-5 years were much closer to their American counterparts, 51.8% falling above the 50th centile of the reference population.

Standards for growth in prepubertal primary school Kuwaiti children, a cross-sectional study

In a cross-sectional study, anthropometric measurements were made in Kuwaiti primary school children aged six to nine years. The sample included 6765 children, of whom there were 3534 boys and 3231 girls. A minimum of 400 children were included in each of the 16 age-sex groups studied. Anthropometric data are presented as percentiles for weight-for-age, height-for-age, and weight-for-height. The results were smoothed and figures were constructed for the three growth standards. A comparison between locally constructed standards and a Western reference growth standard (Tanner et al.) revealed marked similarities in attainable growth. We think that the Western reference standards are suitable for use in Kuwait and probably in other similar developing countries, and the setting of lower targets for those countries is not recommended.

Fiberoptic colonoscopy. A report of findings in 481 patients from Kuwait

The authors report 481 colonoscopic examinations, performed in the Amiri Hospital, Kuwait. The objective of this paper is to demonstrate the pattern of colonic diseases in this region and to compare our findings with those reported from elsewhere. Although these are preliminary results, they suggest that colonic diseases, in general, are uncommon in this area. Ulcerative colitis was the most common pathology detected on colonoscopy. Polyps and diverticulosis were less common than those observed in the west. The frequency of Crohn's disease in Indians and Pakistanis in Kuwait was found to be high, although it is reported to be a very rare disease in their native countries.

Hepatitis B virus (HBV) markers among patients with chronic liver disease in Kuwait

The prevalence of hepatitis B surface antigen (HBsAg), antibody to the hepatitis B core (anti-HBc) and to surface antigen (anti-HBs), was investigated, using sensitive radioimmunoassay (RIA) systems, among patients with different clinical entities of chronic liver disease in Kuwait, and compared to a control blood donor population. 81% of patients and 44% of the controls had at lease one HBV marker. 24% of patients, but non of the controls had both HBsAg and a high titre of anti-HBc in the absence of anti-HBs, suggesting a chronic infection. 31% of our patients with hepatosplenic schistosomiasis, 20% with cryptogenic cirrhosis and chronic active liver disease and 60% with hepatocellular carcinoma had these two markers. HBV antigenaemia was significantly more prevalent among male than among female patients and was particularly high among those less than 35 years old. The high prevalence of the various HBV markers among our patients suggests that HBV is a major factor in the development of chronic liver disease in our area. Furthermore, in view of a high prevalence of antigenaemia in patients with hepato-splenic schistosomiasis, HBV infection must play a concomitant role in the development of more serious form of chronic liver disease among such patients.