Consistent high prevalence of undiagnosed blood-borne virus infection in patients attending large urban emergency departments in England.

Innovative care pathways including case finding and linkage to care are crucial to achieve the World Health Organization targets for the elimination of viral hepatitis.(1) In England there were over 23.4 million attendances at Emergency departments (EDs) in 2016-17 representing a significant opportunity to engage for case finding.(2) EDs may be the only healthcare access point for some marginalised groups including recent migrants, homeless, or people who inject drugs. Seroprevalence studies have been used in the USA to guide public health interventions where large scale, integrated ED testing and linkage programs are increasingly common.(3) Since 2008 routine opt-out testing for HIV in UK ED settings has been recommended for those in high prevalence areas (>0.2%). This article is protected by copyright. All rights reserved

Aiming at the global elimination of viral hepatitis:challenges along the care continuum

Abstract A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection, adopting point-of-care testing to improve coverage of diagnosis, and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programs.</jats:p

Assessing and improving the Hepatitis C virus cascade of care for marginalised populations

Much emphasis has been placed on addressing the gap in diagnosis and treatment of hepatitis C virus (HCV) among people who inject drugs (PWID) in order to achieve HCV elimination. In this thesis we describe, identify and address challenges to enhancing retention to the HCV cascade of care in two marginalised populations. These findings informed a decision tree and Markov state transition model to assess the cost-effectiveness of scaling-up screening and treatment, designed to reflect the process for each setting. First, we describe the HCV cascade of care for PWID attending a methadone clinic in Dar-es-Salaam, Tanzania, indicating almost one-third had HCV exposure and a significant burden of liver disease (17% moderate fibrosis or cirrhosis). As reliable access to HCV nucleic acid testing was identified as a major obstacle, novel methods of HCV viraemia confirmation were validated in this setting. Dry blood spot (DBS) HCV core antigen was limited by suboptimal sensitivity (76%), while Xpert® HCV fingerstick viral load had an excellent performance, with the need for repeat sampling being the main drawback. Incarcerated individuals in a London remand prison were the other focus of this thesis. We found that the existing DBS-based cascade of care was time-sensitive and introducing a rapid point-of-care-based screening an fast-track treatment intervention doubled screening uptake and resulted in a four-fold increase in treatment initiation. Improved HCV screening and treatment is likely to be cost-effective in both settings. The cost of harm reduction (HR) has the largest influence on the outcome among PWID in Dar-es-Salaam, while resource-determined universal or targeted strategies may both be useful in remand prison settings, adherence to all aspects of the cascade of care is fundamental. Overall, a simplified model of care employing innovative technology and integration of existing resources and services represents a strong formula to overcome the existing challenges to scaling-up HCV care among marginalised communities.Open Acces

Severe Refractory Coeliac Disease with Response Only to Parenteral Nutrition

Refractory coeliac disease (RCD) is characterised by recurrent or persistent malabsorptive symptoms and villous atrophy, despite strict adherence to a gluten-free diet for at least 6 months and where other causes of malabsorption including malignancy have been excluded. There is limited evidence and guidance on the effective management of these patients. We describe a case of severe RCD in our hospital, with symptoms controlled effectively only by total parenteral nutrition (TPN). This 68-year-old woman initially presented to the clinic with persistent non-bloody diarrhoea and vomiting. A diagnosis of coeliac disease was confirmed with a positive tissue transglutaminase assay and histology. A strict gluten-free diet was ineffective and she represented 6 months later with 13 kg weight loss (16.7%), ongoing abdominal pain and diarrhoea, with bowels opening 16 times a day. She was oedematous, had an albumin of 12 g/l and required hospital admission. She was treated for pancreatic insufficiency and presumptively for small bowel bacterial overgrowth with no resolution of symptoms. We ruled out infectious causes and investigated for small bowel malignancy; all results were negative. Small bowel enteroscopy showed ulcerative jejunitis. She was given 5 days of TPN, following which her symptoms improved and albumin normalised. This was sustained with symptom resolution and weight gain seen at follow-up. TPN successfully and rapidly induced remission in this case. Thus, a short period of TPN should be considered as a potential component of management in patients with severe RCD

Role of hepatitis C virus core antigen assay in hepatitis C care in Africa

International audienc

In vitro anti-inflammatory, anti-arthritic and antiproliferative activity of green synthesized silver nanoparticles - Phoenix dactylifera (Rothan dates)

Traditionally dates is consumed as a rich source of iron supplement and the current research discuss the synthesis of silver nanoparticles (AgNPs) using methanolic seed extract of Rothan date and its application over&nbsp;in vitro&nbsp;anti-arthritic, anti-inflammatory and antiproliferative activity against lung cancer cell line (A549). FTIR result of synthesised AgNPs reveals the presence of functional group OH as capping agent. XRD pattern confirms the crystalline nature of the AgNPs with peaks at 38º, 44º, 64º and 81º, indexed by (111), (200), (220) and (222) in the 2θ range of 10-90, indicating the face centered cubic (fcc) structure of metallic Ag. HR- TEM results confirm the morphology of AgNPs as almost spherical with high surface areas and average size of 42 ± 9nm. EDX spectra confirmed that Ag is only the major element present and the Dynamic light scattering (DLS) assisted that the&nbsp;Z-average size was 203nm and 1.0 of PdI value. Zeta potential showed − 26.5mv with a single peak. The results of the biological activities of AgNPs exhibited dose dependent activity with 68.44% for arthritic, antiinflammatory with 63.32% inhibition and anti-proliferative activity illustrated IC50&nbsp;value of 59.66 μg/mL expressing the potential of AgNPs to combat cancer

Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents:A systematic review and meta-analysis

Compared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n = 1608) of CI and INT, and 15 studies (n = 1115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n = 833; r = 0.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n = 295; r = 0.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties