Viral Resistance in Hepatitis B: Prevalence and Management

Hepatitis B is a DNA virus affecting hundreds of millions of individuals worldwide. As the clinical sequelae of cirrhosis and hepatocellular cancer are increasingly recognized to be related to viral levels, the impetus increases to offer treatment to those previously not treated. With the development of more robust antivirals with reasonable safety profiles, long-term treatment is becoming more common. The oral nucleos(t)ide analogs have become the preferred first-line therapies for most genotypes of hepatitis B. Five are now available, all with different potencies and resistance profiles. Long-term data spanning several years are now available for most compounds in this arena. This article focuses on the common natural variants and those secondary to nucleos(t)ide therapy, as well as diagnostic methods to detect resistance

Large Fragment Pre-S Deletion and High Viral Load Independently Predict Hepatitis B Relapse after Liver Transplantation

Hepatitis B virus (HBV) associated end-stage liver diseases are the leading causes of liver transplantation (LT) in Taiwan. Relapse of hepatitis B occurs after LT, raising the risk of graft failure and reducing patient survival. Although several oral antiviral agents have been approved for anti-HBV treatment, lamivudine (LAM) remained to be the most widely used preventive regimen in Taiwan. While several clinical predictors have been identified for hepatitis B relapse, the predictive roles of the histopathological characteristics in liver explants as well as the genotypic features of the viruses in pre-LT serum samples have not been assessed. Between September 2002 and August 2009, 150 consecutive hepatitis B surface antigen (HBsAg) positive patients undergoing LT were included for outcome analysis following assessment of the clinicopathological and virological factors prior to LT. Kaplan-Meier analyses discovered that pre-operative LAM treatment ≤3 months; membranous distribution and higher expression of tissue HBsAg in liver explants; preoperative viral load ≧106 copies/ml; and presence of large fragment (>100 base pairs) pre-S deletion (LFpreSDel) correlated significantly with hepatitis B relapse. Multivariate Cox regression analysis showed that the presence of LFpreSDel (P = 0.001) and viral load ≧106 copies/mL (P = 0.023) were independent predictors for hepatitis B relapse. In conclusion, besides high viral load, LFpreSDel mutation is an important independent predictor for hepatitis B relapse after LT. More aggressive preventive strategies should be applied for patients carrying these risk factors

Evaluating the risk for Usutu virus circulation in Europe : comparison of environmental niche models and epidemiological models

Abstract Background Usutu virus (USUV) is a mosquito-borne flavivirus, reported in many countries of Africa and Europe, with an increasing spatial distribution and host range. Recent outbreaks leading to regional declines of European common blackbird (Turdus merula) populations and a rising number of human cases emphasize the need for increased awareness and spatial risk assessment. Methods Modelling approaches in ecology and epidemiology differ substantially in their algorithms, potentially resulting in diverging model outputs. Therefore, we implemented a parallel approach incorporating two commonly applied modelling techniques: (1) Maxent, a correlation-based environmental niche model and (2) a mechanistic epidemiological susceptible-exposed-infected-removed (SEIR) model. Across Europe, surveillance data of USUV-positive birds from 2003 to 2016 was acquired to train the environmental niche model and to serve as test cases for the SEIR model. The SEIR model is mainly driven by daily mean temperature and calculates the basic reproduction number R0. The environmental niche model was run with long-term bio-climatic variables derived from the same source in order to estimate climatic suitability. Results Large areas across Europe are currently suitable for USUV transmission. Both models show patterns of high risk for USUV in parts of France, in the Pannonian Basin as well as northern Italy. The environmental niche model depicts the current situation better, but with USUV still being in an invasive stage there is a chance for under-estimation of risk. Areas where transmission occurred are mostly predicted correctly by the SEIR model, but it mostly fails to resolve the temporal dynamics of USUV events. High R0 values predicted by the SEIR model in areas without evidence for real-life transmission suggest that it may tend towards over-estimation of risk. Conclusions The results from our parallel-model approach highlight that relying on a single model for assessing vector-borne disease risk may lead to incomplete conclusions. Utilizing different modelling approaches is thus crucial for risk-assessment of under-studied emerging pathogens like USUV

I tumori neuroendocrini dello stomaco: il gastrinoma.

Tra i molteplici tumori neuroendocrini dello stomaco viene descritto un raro caso di gastrinoma

GEOMORPHOLOGICAL EVOLUTION AND ENVIRONMENTAL RECLAMATION OF FUSARO LAGOON (CAMPANIA PROVINCE, SOUTHERN ITALY).

Analysis of geomorphological and geological features of the Fusàro lagoon has shown the dynamic evolution of this transitional environment. The lagoon developed in the western part of the active volcanic area of the Phlegrean Fields during the mid-Holocene, within a wide marine bay bounded by the volcanic structures of Mt. Cuma, on the north, and by Torregaveta, on the south. Subsequently, the bay was gradually filled with pyroclastic products from phlegrean eruptive vents and sediments carried by the rivers Volturno and Clanis thus creating an open lagoon. During the late Holocene it evolved into a partially closed lagoon because of the formation of a continuous littoral spit, probably wider than the present-day one, characterised by dune ridges and surrounded by marshlands. In the Graeco-Roman period, the total closure of the lagoon took place, following the stabilization of the foreland dune ridge. At the end of the 18th century the Lagoon assumed a shape similar to present-day one. Between the Roman period and 1941 three lagoon channels were opened in order to avoid the frequent environmental crises which continue to affect, although for different reasons, this salt-water basin. Moreover, in the 1980s, in order to reduce the effects of these environmental crises, dredging of the lagoon bottom has been carried out, altering both the morphological and sedimentary characteristics of the basin. Finally, since the second half of the 1950s the littoral to the S of Volturno River mouth has registered a general retreat, locally of several hundreds meters, due to marine erosion as well as reduced river supply

Beauveria bassiana keratitis: Management of an atypical clinical presentation

We report an atypical presentation of Beauveria bassiana keratitis which unusually presented in a 85-year-old patient with a corneal ulcer with an anterior segment inflammation and hypopyon. Despite negative culture and unspecific results from panfungal PCR-based sequencing, the patient was treated for a presumed fungal infection. Following clinical deterioration an emergency surgical intervention with apposition of a corneal patch was performed. Infection resolution was achieved following the introduction of systemic voriconazole to the topical one

Linfagioma cistico del surrene

Si descrivono le metodiche diagnostiche e la tecnica chirurgica per il trattamento di un linfangioma cistico del surrene