439 research outputs found
Immigration and viral hepatitis
WHO estimates reveal that the global prevalence of viral hepatitis may be as high as 500 million, with an annual mortality rate of up to 1.3 million individuals. The majority of this global burden of disease is borne by nations of the developing world with high rates of vertical and iatrogenic transmission of HBV and HCV, as well as poor access to healthcare. In 2013, 3.2% of the global population (231 million individuals) migrated into a new host nation. Migrants predominantly originate from the developing countries of the south, into the developed economies of North America and Western Europe. This mass migration of individuals from areas of high-prevalence of viral hepatitis poses a unique challenge to the healthcare systems of the host nations. Due to a lack of universal standards for screening, vaccination and treatment of viral hepatitis, the burden of chronic liver disease and hepatocellular carcinoma continues to increase among migrant populations globally. Efforts to increase case identification and treatment among migrants have largely been limited to small outreach programs in urban centers, such that the majority of migrants with viral hepatitis continue to remain unaware of their infection. This review summarizes the data on prevalence of viral hepatitis and burden of chronic liver disease among migrants, current standards for screening and treatment of immigrants and refugees, and efforts to improve the identification and treatment of viral hepatitis among migrants
Prevalence and predictors of complementary and alternative medicine modalities in patients with chronic hepatitis B
Background & Aims
The use of complementary and alternative medicine (CAM) in patients with chronic hepatitis B (CHB) can interact with antiviral treatment or influence healthâseeking behaviour. We aimed to study the use of individual CAM modalities in CHB and explore determinants of use, particularly migrationârelated, socioâeconomic and clinical factors.
Methods
A total of 436 CHB outpatients who attended the Toronto Centre for Liver Disease in 2015â2016 were included in this crossâsectional study. Using the comprehensive IâCAM questionnaire and health records, data were collected on socioâdemographic and clinical variables and on usage of 16 CAM modalities in the last year.
Results
Sixty percent of patients were male, 74% were Asian and 46% were using antiviral treatment. Threeâhundred and nine (71%) patients used CAM. Vitamin/mineral preparations (45% of patients) were most commonly used. Overall CAM use and the specific use of potentially injurious CAM, such as green tea extract (9.2%) and St. John's wort (0.2%), were not associated with liver disease severity. Female sex, family history of CHB, lower serum HBV DNA, and higher socioâeconomic status were independently associated with bioâholistic CAM use, the clinically mostârelevant CAM group (P < 0.05); ethnicity, antiviral therapy use and liver disease severity were not.
Conclusions
CAM use among CHB patients was extensive, especially use of vitamin and mineral preparations, but without direct influence on liver disease severity. Bioâholistic CAM use appeared to be associated with socioâeconomic status rather than with ethnicity or liver disease severity. Despite the rare use of hepatotoxins, physicians should actively inquire about it
Hepatic abnormalities in patients with chronic granulomatous disease
Chronic granulomatous disease (CGD) is a rare congenital disorder characterized
by repeated bacterial and fungal infections. Aside from a high incidence of liver
abscess, little is known about hepatic involvement in CGD. The aim of this study
was to describe the spectrum of liver abnormalities seen in CGD. The charts of
194 patients with CGD followed at the NIH were reviewed, with a focus on liver
abnormalities. Liver enzyme elevations occurred on at least one occasion in 73%
of patients during a mean of 8.9 years of follow-up. ALT elevations were
generally transient. Although transient alkaline phosphatase (ALP) elevations
were also common, persistent ALP elevations lasting up to 17.6 years were seen in
25% of patients. Liver abscess occurred in 35% of patients. Drug-induced
hepatotoxicity was documented in 15% of patients but likely occurred more
frequently. Hepatomegaly was found in 34% and splenomegaly in 56% of patients.
Liver histology showed granulomata in 75% and lobular hepatitis in 90% of
specimens. Venopathy of the portal vein was common (80%) and associated with
splenomegaly. Venopathy of the central vein was also common (63%) and was
associated with the number of abscess episodes. Nodular regenerative hyperplasia
(NRH) was seen in 9 patients, including 6 of 12 autopsy specimens. CONCLUSION:
Liver enzyme abnormalities occur frequently in patients with CGD. In addition to
liver abscesses and granulomata, drug hepatotoxicity is likely underappreciated.
Vascular lesions such as venopathy and--to a lesser extent--NRH are common. The
cause and clinical consequences of venopathy await prospective evaluation
D* Production in Deep Inelastic Scattering at HERA
This paper presents measurements of D^{*\pm} production in deep inelastic
scattering from collisions between 27.5 GeV positrons and 820 GeV protons. The
data have been taken with the ZEUS detector at HERA. The decay channel
(+ c.c.) has been used in the study. The
cross section for inclusive D^{*\pm} production with
and is 5.3 \pms 1.0 \pms 0.8 nb in the kinematic region
{ GeV and }. Differential cross
sections as functions of p_T(D^{*\pm}), and are
compared with next-to-leading order QCD calculations based on the photon-gluon
fusion production mechanism. After an extrapolation of the cross section to the
full kinematic region in p_T(D^{*\pm}) and (D^{*\pm}), the charm
contribution to the proton structure function is
determined for Bjorken between 2 10 and 5 10.Comment: 17 pages including 4 figure
Observation of hard scattering in photoproduction events with a large rapidity gap at HERA
Events with a large rapidity gap and total transverse energy greater than 5
GeV have been observed in quasi-real photoproduction at HERA with the ZEUS
detector. The distribution of these events as a function of the
centre of mass energy is consistent with diffractive scattering. For total
transverse energies above 12 GeV, the hadronic final states show predominantly
a two-jet structure with each jet having a transverse energy greater than 4
GeV. For the two-jet events, little energy flow is found outside the jets. This
observation is consistent with the hard scattering of a quasi-real photon with
a colourless object in the proton.Comment: 19 pages, latex, 4 figures appended as uuencoded fil
Search for a W' boson decaying to a bottom quark and a top quark in pp collisions at sqrt(s) = 7 TeV
Results are presented from a search for a W' boson using a dataset
corresponding to 5.0 inverse femtobarns of integrated luminosity collected
during 2011 by the CMS experiment at the LHC in pp collisions at sqrt(s)=7 TeV.
The W' boson is modeled as a heavy W boson, but different scenarios for the
couplings to fermions are considered, involving both left-handed and
right-handed chiral projections of the fermions, as well as an arbitrary
mixture of the two. The search is performed in the decay channel W' to t b,
leading to a final state signature with a single lepton (e, mu), missing
transverse energy, and jets, at least one of which is tagged as a b-jet. A W'
boson that couples to fermions with the same coupling constant as the W, but to
the right-handed rather than left-handed chiral projections, is excluded for
masses below 1.85 TeV at the 95% confidence level. For the first time using LHC
data, constraints on the W' gauge coupling for a set of left- and right-handed
coupling combinations have been placed. These results represent a significant
improvement over previously published limits.Comment: Submitted to Physics Letters B. Replaced with version publishe
Search for the standard model Higgs boson decaying into two photons in pp collisions at sqrt(s)=7 TeV
A search for a Higgs boson decaying into two photons is described. The
analysis is performed using a dataset recorded by the CMS experiment at the LHC
from pp collisions at a centre-of-mass energy of 7 TeV, which corresponds to an
integrated luminosity of 4.8 inverse femtobarns. Limits are set on the cross
section of the standard model Higgs boson decaying to two photons. The expected
exclusion limit at 95% confidence level is between 1.4 and 2.4 times the
standard model cross section in the mass range between 110 and 150 GeV. The
analysis of the data excludes, at 95% confidence level, the standard model
Higgs boson decaying into two photons in the mass range 128 to 132 GeV. The
largest excess of events above the expected standard model background is
observed for a Higgs boson mass hypothesis of 124 GeV with a local significance
of 3.1 sigma. The global significance of observing an excess with a local
significance greater than 3.1 sigma anywhere in the search range 110-150 GeV is
estimated to be 1.8 sigma. More data are required to ascertain the origin of
this excess.Comment: Submitted to Physics Letters
Hepatitis C Core-Antigen Testing from Dried Blood Spots
In order to expand hepatitis C virus (HCV) screening, a change in the diagnostic paradigm
is warranted to improve accessibility and decrease costs, such as utilizing dried blood spot (DBS)
collection. In our study, blood from 68 patients with chronic HCV infection was spotted onto DBS cards
and stored at the following temperatures for one week: â80 âŚC, 4 âŚC, 21 âŚC, 37 âŚC, and alternating
37 âŚC and 4 âŚC; to assess whether temperature change during transportation would affect sensitivity.
Sample was eluted from the DBS cards and tested for HCV antibodies (HCV-Ab) and HCV core
antigen (core-Ag). HCV-Abs were detected from 68/68 DBS samples at â80 âŚC, 4 âŚC, 21 âŚC, and 67/68 at
37 âŚC and alternating 37 âŚC and 4 âŚC. Sensitivity of core-Ag was as follows: 94% (â80 âŚC), 94% (4 âŚC),
91% (21 âŚC), 93% (37 âŚC), and 93% (37 âŚC/4
âŚC). Not only did temperature not greatly affect sensitivity,
but sensitivities are higher than previously reported, and support the use of this assay as an alternative
to HCV RNA. We then completed a head-to-head comparison (n = 49) of venous versus capillary
samples, and one versus two DBS. No difference in core-Ag sensitivity was observed by sample
type, but there was an improvement when using two spots. We conclude that HCV-Abs and core-Ag
testing from DBS cards has high diagnostic accuracy and could be considered as an alternative to
HCV RNA in certain settings
Measurement of the Lambda(b) cross section and the anti-Lambda(b) to Lambda(b) ratio with Lambda(b) to J/Psi Lambda decays in pp collisions at sqrt(s) = 7 TeV
The Lambda(b) differential production cross section and the cross section
ratio anti-Lambda(b)/Lambda(b) are measured as functions of transverse momentum
pt(Lambda(b)) and rapidity abs(y(Lambda(b))) in pp collisions at sqrt(s) = 7
TeV using data collected by the CMS experiment at the LHC. The measurements are
based on Lambda(b) decays reconstructed in the exclusive final state J/Psi
Lambda, with the subsequent decays J/Psi to an opposite-sign muon pair and
Lambda to proton pion, using a data sample corresponding to an integrated
luminosity of 1.9 inverse femtobarns. The product of the cross section times
the branching ratio for Lambda(b) to J/Psi Lambda versus pt(Lambda(b)) falls
faster than that of b mesons. The measured value of the cross section times the
branching ratio for pt(Lambda(b)) > 10 GeV and abs(y(Lambda(b))) < 2.0 is 1.06
+/- 0.06 +/- 0.12 nb, and the integrated cross section ratio for
anti-Lambda(b)/Lambda(b) is 1.02 +/- 0.07 +/- 0.09, where the uncertainties are
statistical and systematic, respectively.Comment: Submitted to Physics Letters
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