Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review

Toy M, Önder FO, Wörmann T, et al. Age- and region-specific hepatitis B prevalence in Turkey estimated using generalized linear mixed models: a systematic review. BMC infectious diseases. 2011;11(1): 337.BACKGROUND: To provide a clear picture of the current hepatitis B situation, the authors performed a systematic review to estimate the age- and region-specific prevalence of chronic hepatitis B (CHB) in Turkey. METHODS: A total of 339 studies with original data on the prevalence of hepatitis B surface antigen (HBsAg) in Turkey and published between 1999 and 2009 were identified through a search of electronic databases, by reviewing citations, and by writing to authors. After a critical assessment, the authors included 129 studies, divided into categories: 'age-specific'; 'region-specific'; and 'specific population group'. To account for the differences among the studies, a generalized linear mixed model was used to estimate the overall prevalence across all age groups and regions. For specific population groups, the authors calculated the weighted mean prevalence. RESULTS: The estimated overall population prevalence was 4.57, 95% confidence interval (CI): 3.58, 5.76, and the estimated total number of CHB cases was about 3.3 million. The outcomes of the age-specific groups varied from 2.84, (95% CI: 2.60, 3.10) for the 0-14-year olds to 6.36 (95% CI: 5.83, 6.90) in the 25-34-year-old group. CONCLUSION: There are large age-group and regional differences in CHB prevalence in Turkey, where CHB remains a serious health problem

Common predictors of excessive adiposity in children from a region with high prevalence of overweight

Aim: To identify risk factors other than energy intake or expenditure that can predict adiposity and overweight in children from a region with high prevalence of obesity. Methods: We studied 551 children aged 6-12 years (50.5% girls) from a city in the North of Mexico. Tetrapolar bioimpedance was used to assess body fat content. Overweight was estimated by analysis of age- and gender-standardized body mass index (BMI) relative to reference data of the International Obesity Task Force (BMIs that predict obesity in adulthood). Multivariate analyses were modeled to find independent predictors of adiposity. Results: The frequency of overweight/obesity was 37.6%. There were no differences between genders with respect to weight, height and BMI; however, age-standardized percentage of body fat and a sedentary lifestyle were higher in girls than in boys (p < 0.001). Independent predictors of overweight/obesity were having first-degree relatives with obesity [adjusted odds ratio (OR) 2.26, 95% confidence interval (CI) 1.40-3.64], sedentary lifestyle (OR 1.58, 95% CI 1.05-2.37) and being the third child or younger in offspring (OR 1.59, 95% CI 1.02-2.47). Predictors of body fat in the highest quartile of the sample were having first-degree relatives with obesity (OR 2.59, 95% CI 1.41-4.74), female gender (OR 5.60, 95% CI 3.22-9.77) and being the third child or younger in offspring (OR 2.07, 95% CI 1.22-3.51). These effects could not be explained by social class, ethnicity, maternal age and duration of breastfeeding. Conclusions: Risk factors easily identified by history-taking can predict childhood adiposity and the high risk of obesity in adulthood. Having a first-degree relative with obesity underscores the impact of genes and the family lifestyle on excessive adiposity. Being the third child or younger may denote different nurture practices in offspring; however, this factor deserves more exploration. Copyright � 2008 S. Karger AG

Response to letter by Di Napoli and Godoy [7]

[No abstract available

Patients&#39; empowerment , physicians&#39; perceptions, and achievement of therapeutic goals in patients with type 1 and type 2 diabetes mellitus in Mexico

Fernando J Lavalle-Gonz&aacute;lez,1 Erwin Chiquete2 On behalf of the IDMPS-3W Collaborative Group (Mexico) 1Department of Endocrinology, Hospital Universitario Dr Jos&eacute; Eleuterio Gonz&aacute;lez, Monterrey, NL, 2Department of Neurology and Psychiatry, Instituto Nacional de Ciencias M&eacute;dicas y Nutrici&oacute;n Salvador Zubir&aacute;n, Mexico City, Mexico Background: Physicians&rsquo; perception may not parallel objective measures of therapeutic targets in patients with diabetes. This is an issue rarely addressed in the medical literature. We aimed to analyze physicians&rsquo; perception and characteristics of adequate control of patients with diabetes.Patients and methods: We studied information on physicians and their patients who participated in the third wave of the International Diabetes Management Practices Study registry in Mexico. This analysis was performed on 2,642 patients, 203 with type 1 diabetes mellitus (T1DM) and 2,439 with type 2 diabetes mellitus (T2DM), treated by 200 physicians.Results: The patients perceived at target had lower hemoglobin A1c (HbA1c) and fasting blood glucose than those considered not at target. However, overestimation of the frequency of patients with HbA1c &lt;7% was 41.5% in patients with T1DM and 31.7% in patients with T2DM (underestimation: 2.8% and 8.0%, respectively). The agreement between the physicians&rsquo; perception and the class of HbA1c was suboptimal (&kappa;: 0.612). Diabetologists and endocrinologists tested HbA1c more frequently than primary care practitioners, internists, or cardiologists; however, no differences were observed in mean HbA1c, for both T1DM (8.4% vs 7.2%, P=0.42) and T2DM (8.03% vs 8.01%, P=0.87) patients. Nevertheless, insulin users perceived at target, who practiced self-monitoring and self-adjustment of insulin, had a lower mean HbA1c than patients without these characteristics (mean HbA1c in T1DM: 6.8% vs 9.6%, respectively; mean HbA1c in T2DM: 7.0% vs 10.1%, respectively).Conclusion: Although there is a significant physicians&rsquo; overestimation about the optimal glycemic control, this global impression and characteristics of patients&rsquo; empowerment, such as self-monitoring and self-adjustment of insulin, are associated with the achievement of targets. Keywords: A1c, care, diabetes, HbA1c, goal, IDMPS, insulin, management, Mexico, opinion, self-monitoring, treat to targe

Routes of infection and clinical outcome of Mexican women reactive to anti-hepatitis C virus antibodies

Background: Risk factors for the hepatitis C virus (HCV) infection influence both the frequency and the progression of the liver disease. Routes of transmission and severity of the liver damage may differ by gender. We aimed to describe the risk factors for HCV infection and for the severity of the liver disease among women seroreactive to anti-HCV antibodies. Also, we tested the hypothesis that length of infection influences the levels of anti-HCV, in transfusion-associated hepatitis C. Methods: Eighty-six interferon-naive women, repeatedly seroreactive to anti-HCV antibodies, aged > 20 years, were studied. Results: Surgeries (80%) and transfusion before 1993 (58%) were the main risk factors (52% cases had both). The main reason for practicing surgery was obstetric/gynecologic (74%). The main indication for transfusion was also obstetric/gynecologic (68%). Fifty-five (64%) women were positive to HCV RNA in serum, of them, coinfection with the hepatitis B virus (HBV) occurred in three (5%) cases, being occult hepatitis B (i.e., positive to HBV DNA, but negative to hepatitis B surface antigen) in two (4%). In multivariate analysis, determining factors of cirrhosis at histologic examination were age and the antecedent of transfusion before 1993. Anti-HCV levels correlated with the elapsed time from transfusion to diagnosis, but not with age. Conclusion: An obstetric/gynecologic indication was the most frequent reason for both surgery and transfusion. Hepatitis B coinfection had a low prevalence and did not influence the severity of the liver disease, as age and the antecedent of transfusion certainly did. Infection length influenced the levels of anti-HCV antibodies in transfusion-associated hepatitis C. © 2006 Elsevier Ireland Ltd. All rights reserved

JR vertebral body prosthesis: A modular, anatomical and expandable device, with cage function and plate dual designed ad hoc for spine stabilization after corpectomy [Prótesis de cuerpo vertebral JR: Dispositivo modular, anatómico y expandible, con funcion de jaula y placa diseñada ad hoc para estabilizar la columna después de corpectomía]

Introduction: due to the unsatisfactory results obtained with posterior instrumentations in cases of vertebral tumors and to the economical limitations of our patients for acquiring the systems available in the market, a vertebral body prosthesis to stabilize the spine after corpectomy was designed. Objective: to describe the structural and functional characteristics of the JR prosthesis, the biomechanical assays in cadaver and the surgical technique on the patient. Methods: firstly, it was performed a detailed anatomical study of the vertebral bodies. A design of a modular, anatomical and expandable device was obtained. Its components once assembled make an implant with expandable cage and plate dual function. Afterwards, a biomechanical assay was performed in a cadaver and the device was implanted in a patient with vertebral body metastasis. Results: the radiographs extracted from the cadaver after implant location did not show loss of fixation. When the cadaver was raised, flexion moments were generated laterally with levers 80 cm long; therefore, the prosthesis was demanded in its most vulnerable point with a force of approximately 588 N. With rotation, flexion and extensions forced, stability was preserved and no movement was observed. The device was implanted in a 50-year-old woman with metastatic thyroid cancer affecting L3. Pain improved in the postoperative immediate, as well as its motor function, which allowed her to walk with a stable and painless spine for seven years. No implant failure was observed. Conclusion: the dual cage function and plate integrated in a single device offers a mechanical advantage, compared with the cages and plates used separately, since the prosthesis design permits to apply a distraction axial force with lateral fixation at the same time, through one implant. The results of the implant placement in the patient were satisfactory

An expandable prosthesis with dual cage-and-plate function in a single device for vertebral body replacement: The clinical experience on 14 consecutive cases with vertebral tumors

Aim. The aim of this paper was to test the hypothesis that an expandable prosthesis with dual cage-and-plate function can provide immediate and durable spine stabilization after corpectomy. Methods. We designed an expandable vertebral body prosthesis with dual cage-and-plate function in a single device (JR-prosthesis). Anatomical studies were performed to design a titanium-made prosthesis. Cadaver assays were done with a stainless steal device to test fixation and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors (8 metastatic) underwent corpectomy and vertebral body replacement with the JR-prosthesis. Results. All patients had neurological deficit, severe pain and spine instability (mean follow-up: 25.4 months). Mean pain score before surgery in a visual analog scale improved from 7.6 to 3.0 points after operation (P=0.002). All patients achieved at least one grade of improvement in the Frankel score (P=0.003), excepting the 3 patients with Frankel grade A presurgery. Two patients with renal cell carcinoma died during the following 4 days after surgery (renal failure and massive bleeding), the rest attained a painless and stable spine immediately and maintained for long periods. No significant infections or implant failures were registered. A non-fatal case of inferior vena cava surgical injury was observed (repaired during surgery without further complications). 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. These observations await confirmation in different scenarios

An expandable prosthesis with dual cage-and-plate function in a single device for vertebral body replacement: The clinical experience on 14 consecutive cases with vertebral tumors

Aim. The aim of this paper was to test the hypothesis that an expandable prosthesis with dual cage-and-plate function can provide immediate and durable spine stabilization after corpectomy. Methods. We designed an expandable vertebral body prosthesis with dual cage-and-plate function in a single device (JR-prosthesis). Anatomical studies were performed to design a titanium-made prosthesis. Cadaver assays were done with a stainless steal device to test fixation and adequacy to the human spine anatomy. Then, 14 patients with vertebral tumors (8 metastatic) underwent corpectomy and vertebral body replacement with the JR-prosthesis. Results. All patients had neurological deficit, severe pain and spine instability (mean follow-up: 25.4 months). Mean pain score before surgery in a visual analog scale improved from 7.6 to 3.0 points after operation (P=0.002). All patients achieved at least one grade of improvement in the Frankel score (P=0.003), excepting the 3 patients with Frankel grade A presurgery. Two patients with renal cell carcinoma died during the following 4 days after surgery (renal failure and massive bleeding), the rest attained a painless and stable spine immediately and maintained for long periods. No significant infections or implant failures were registered. A non-fatal case of inferior vena cava surgical injury was observed (repaired during surgery without further complications). 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. These observations await confirmation in different scenarios

JR vertebral body prosthesis: A modular, anatomical and expandable device, with cage function and plate dual designed ad hoc for spine stabilization after corpectomy [Pr�tesis de cuerpo vertebral JR: Dispositivo modular, anat�mico y expandible, con funcion de jaula y placa dise�ada ad hoc para estabilizar la columna despu�s de corpectom�a]

Introduction: due to the unsatisfactory results obtained with posterior instrumentations in cases of vertebral tumors and to the economical limitations of our patients for acquiring the systems available in the market, a vertebral body prosthesis to stabilize the spine after corpectomy was designed. Objective: to describe the structural and functional characteristics of the JR prosthesis, the biomechanical assays in cadaver and the surgical technique on the patient. Methods: firstly, it was performed a detailed anatomical study of the vertebral bodies. A design of a modular, anatomical and expandable device was obtained. Its components once assembled make an implant with expandable cage and plate dual function. Afterwards, a biomechanical assay was performed in a cadaver and the device was implanted in a patient with vertebral body metastasis. Results: the radiographs extracted from the cadaver after implant location did not show loss of fixation. When the cadaver was raised, flexion moments were generated laterally with levers 80 cm long; therefore, the prosthesis was demanded in its most vulnerable point with a force of approximately 588 N. With rotation, flexion and extensions forced, stability was preserved and no movement was observed. The device was implanted in a 50-year-old woman with metastatic thyroid cancer affecting L3. Pain improved in the postoperative immediate, as well as its motor function, which allowed her to walk with a stable and painless spine for seven years. No implant failure was observed. Conclusion: the dual cage function and plate integrated in a single device offers a mechanical advantage, compared with the cages and plates used separately, since the prosthesis design permits to apply a distraction axial force with lateral fixation at the same time, through one implant. The results of the implant placement in the patient were satisfactory