Adjusted estimate of the prevalence of hepatitis delta virus in 25 countries and territories

BACKGROUND & AIMS

Hepatitis delta virus (HDV) is a satellite RNA virus that requires the hepatitis B virus (HBV) for assembly and propagation. Individuals infected with HDV progress to advanced liver disease faster than HBV-monoinfected individuals. Recent studies have estimated the global prevalence of anti-HDV antibodies among the HBV-infected population to be 5-15%. This study aimed to better understand HDV prevalence at the population level in 25 countries/territories.

METHODS

We conducted a literature review to determine the prevalence of anti-HDV and HDV RNA in hepatitis B surface antigen (HBsAg)-positive individuals in 25 countries/territories. Virtual meetings were held with experts from each setting to discuss the findings and collect unpublished data. Data were weighted for patient segments and regional heterogeneity to estimate the prevalence in the HBV-infected population. The findings were then combined with The Polaris Observatory HBV data to estimate the anti-HDV and HDV RNA prevalence in each country/territory at the population level.

RESULTS

After adjusting for geographical distribution, disease stage and special populations, the anti-HDV prevalence among the HBsAg+ population changed from the literature estimate in 19 countries. The highest anti-HDV prevalence was 60.1% in Mongolia. Once adjusted for the size of the HBsAg+ population and HDV RNA positivity rate, China had the highest absolute number of HDV RNA+ cases.

CONCLUSIONS

We found substantially lower HDV prevalence than previously reported, as prior meta-analyses primarily focused on studies conducted in groups/regions that have a higher probability of HBV infection: tertiary care centers, specific risk groups or geographical regions. There is large uncertainty in HDV prevalence estimates. The implementation of reflex testing would improve estimates, while also allowing earlier linkage to care for HDV RNA+ individuals. The logistical and economic burden of reflex testing on the health system would be limited, as only HBsAg+ cases would be screened.

IMPACT AND IMPLICATIONS

There is a great deal of uncertainty surrounding the prevalence of hepatitis delta virus among people living with hepatitis B virus at the population level. In this study, we aimed to better understand the burden in 25 countries and territories, to refine techniques that can be used in future analyses. We found a lower prevalence in the majority of places studied than had been previously reported. These data can help inform policy makers on the need to screen people living with hepatitis B virus to find those coinfected with hepatitis delta virus and at high risk of progression, while also highlighting the pitfalls that other researchers have often fallen into.

Low Tesla MR Imaging for Spine with Hardware

PURPOSE/OBJECTIVE(S)

Acquiring MR images with minimized susceptibility artifacts is essential for spines with medical hardware to delineate clinical target volumes (CTVs) in radiation therapy for chordomas, chondrosarcomas, and other sarcomas. Since it can be more challenging to visualize the primary structures in high-tesla MR images due to metal-induced artifacts, we optimized imaging parameters to acquire high-quality, low-tesla MR images for clinical use.

MATERIALS/METHODS

OptimalMR imaging parameters were investigated under general guidelines for artifact reduction techniques by testing several 3D spin echo and gradient echo sequences in a 0.23-T MR scanner. A customized spine phantom was developed to acquire MR images for bony materials which included, 4-6 industrial titanium screws, an aluminum plate, and a superflab bolus. While the 3D b-FFE sequence was used to acquire MR images with a high signal-to-noise ratio, the other 3D T1-FFE, THRIVE, and DTSE sequences were applied to reduce susceptible artifacts to the medical hardware. The optimized parameters determined in the phantom test were applied to the 15 clinical cases, including patients with residual spinal tumors and fusion hardware. The low-tesla MR imaging technique was also used to scan sarcomas of the extremities and re-irradiation cases of spinal metastases.

RESULTS

The optimized low-tesla MR images in the spine were noticeably useful to guide CTV delineations for patients with medical hardware, especially for residual or recurrent tumors. The imaging technique to minimize susceptibility artifacts enabled a more defined separation of each hardware component from the spinal cord and CTVs. In spine metastasis cases, pre-irradiated target volumes were determined, reflecting property changes in the bone marrow.

CONCLUSION

The MR images acquired using the optimized parameters showed minimal artifacts to scan spine patients with hardware. By using the low-tesla MR images, spinal chordoma and chondrosarcoma patients could be treated to improve tumor control probabilities with minimized complications.

AWARENESS AND KNOWLEDGE OF OBSTRUCTIVE SLEEP APNEA AMONG THE POPULATION OF THE AL-BAHA REGION OF SAUDI ARABIA: A CROSS-SECTIONAL STUDY

Obstructive sleep apnea (OSA) is a known sleep-disordered breathing, with known morbidity and mortality, that affects a lot of people worldwide. In Saudi Arabia, the prevalence of OSA is estimated to be around 8.8% among adult males and 5.1% among adult females. The research is a cross-sectional study design conducted in the Al-Baha region; Saudi Arabia in 385 participants. To evaluate the knowledge and awareness of OSA, the study utilized a validated and reliable adapted Arabic version of the OSA questionnaire. The degree of consciousness and understanding regarding OSA demonstrated a noteworthy connection with varying levels of education and a favorable family history of OSAS (p<0.05). The regression analyses unveiled that people with a familial OSA background had a 2.565-fold increased likelihood of identifying daytime fatigue as a symptom of OSA (p<0.05). The study reported an insufficient level of awareness and knowledge of OSA among the Saudi Arabian population. Various factors, including gender, education, and family history of OSA, may affect the awareness and knowledge of this condition.

Dairy products intake and the risk of postpartum depression among mothers: A pilot study

Introduction

Postpartum depression is a prevalent consequence of childbirth experienced by many women. There has been evidence linking dairy intake during pregnancy with a reduction in postpartum depression symptoms. However, there is still a lack of understanding regarding the effects of postpartum dairy consumption on postpartum depression.

Objectives

To examine whether dairy products intake and calcium in dairy is associated with postpartum depression.

Methods

A pilot study was conducted (n = 49 postpartum women). A food frequency questionnaire was used to evaluate the participants' consumption of calcium and dairy products during pregnancy, and the Edinburgh Postnatal Depression Scale was used to screen for postpartum depression symptoms.

Results

Of 49 participants, 26 (53%) were at risk for postpartum depression (Edinburgh Postnatal Depression Scale ⩾ 12). Consuming >1 serving of Laban per day is significantly associated with reduced risk of postpartum depression (odds ratio = 0.01, 95% confidence interval [0, 0.3]). Total dairy intake >1 serving per day is significantly associated with reduced risk of postpartum depression (odds ratio = 0.17, 95% confidence interval [0.03, 0.83]). No significant association was found between the postpartum intake of milk, cheese, yogurt, or calcium and postpartum depression.

Conclusion

Our findings indicate that higher total dairy intake was associated with a lower likelihood of postpartum depression. Further assessment with a larger sample size of participants could provide additional insight into the potential of dietary dairy to mitigate postpartum depression.

Morphology and molecular phylogeny of trypanorhynchid metacestodes infecting commercial fish of the Mediterranean Sea

ABSTRACT Members of the order Trypanorhyncha are cestode parasites that are frequently found infecting the muscles of several marine fish species, affecting fish health, and resulting in consumers’ rejection of fish. Fifty-two specimens of marine fish were freshly caught throughout the year 2020 from boat landing sites at the Alexandria coast along the Mediterranean Sea in Egypt, including the grey trigger fish Balistes carolinensis (F: Balistidae); the mottled grouper Mycteroperca rubra (F: Serranidae) and the common sole Solea vulgaris (F: Soleidae). Blastocysts were isolated and ruptured; the generated pleurocerci were described morphologically and morphometrically by light and scanning electron microscopy. Also, multiple-sequence alignment was performed, and a phylogenetic tree was constructed following maximum likelihood analysis of the 18s and 28s ribosomal RNA sequences of the recovered worms. Thirty fish were infected; the infection was recorded as blastocysts embedded in fish flesh. Three different parasitic species were recovered and classified morphologically as Gymnorhynchus isuri, Pseudotobothrium dipsacum and Heteronybelinia estigmena. The taxonomic position of these parasites was justified by molecular analysis of their 18s and 28s rRNAs, which revealed high percentages of homology with species recovered from the GenBank. The accession numbers ON157059, ON139663 and ON139662 were respectively assigned to the recovered parasites after their deposition in GenBank. The results obtained from the molecular analyses confirmed the morphological records of the recovered parasites. Since metacestodes are found in the musculature of infected fish specimens, it is necessary to remove these areas in the commercialization of fish.

Assessment of genetic variation in Apis mellifera jemenitica (Hymenoptera: Apidae) using Cytochrome Oxidase I gene sequences

The Arabian Honeybee Apis mellifera jemenitica is endemic to the Arabian Peninsula. It is highly adapted to temperature extremes and drought dominating the region. In this study, the mitochondrial Cytochrome Oxidase I (COI) was analyzed in 133 specimens of A. m. jemenitica from eight localities along the Red Sea cost of Saudi Arabia. Results revealed 33 synonymous, and 6 non-synonymous mutations within the COI sequences, resulting in change of 4 amino acids. Phylogenetic analysis based on either type of mutations revealed two main haplogroups accounting for 94% of the samples. In total Eighteen new haplotypes were identified and uploaded in the genebank, Fourteen of them are restricted to one/both haplogroups. All haplotypes identified in this study clustered with reference COI sequences of the sub-lineag Z (African Lineage). However one Haplotype (MW428270) represents high COI variability compared to other haplotypes and may resemble different evolutionary sub-lineage. Tajima's Neutrality Test (Ps = 0.025; D = -1.5) indicated population size expansion that took place after selective sweep and/or purifying selection.

Feasibility of using ultrasound in ambulances in Saudi Arabia

BACKGROUND

In developed countries, the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies, and this of course does not apply to Arab countries, as there are no current studies to support this. Therefore, this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.

AIM

To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.

METHODS

A cross-sectional study of five different groups of participants including radiation technologists, emergency physicians, paramedics, Red Crescent managers and the public. Email and social media were used to deliver a questionnaire to these groups. The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.

RESULTS

Each group had some knowledge on ultrasound and its benefits. More than 50% in each study group supported the availability of ultrasound in ambulances. Additionally, 60% of emergency physicians reported that they had difficulties in venous access, checking the presence of internal bleeding, recognizing pregnancy in trauma cases, and inserting endotracheal tubes, and the majority of them confirmed the effective role of ultrasound in achieving such tasks. Almost all paramedics (93.33%), physicians (98.89%), and Saudi Red Crescent managers (96.3%) emphasized the importance of communication between ambulance staff and emergency departments. Moreover, most physicians (77.78%), and technologists (82.73%) supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.

CONCLUSION

Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.

A268 PREOPERATIVE EUS-GUIDED FNA IS ASSOCIATED WITH BETTER OVERALL SURVIVAL IN RESECTABLE PANCREATIC CANCER WHEN COMPARED TO UPFRONT SURGERY WITHOUT PREOPERATIVE TISSUE ACQUISITION: A SYSTEMIC REVIEW AND META-ANALYSIS

Background

Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is the standard of care in advanced pancreatic cancer. In resectable disease, preoperative EUS-FNA can help to identify benign etiology and other cancers while preventing unnecessary surgery. However, concerns regarding tumor seeding and pancreatitis have led some experts to advocate for upfront surgery without tissue sampling.

Aims

To conduct a systematic review and meta-analysis of the risks and benefits of performing pre-operative EUS-FNA in patients with suspected, resectable pancreatic cancer.

Methods

A literature search was performed up to April 2019 using MEDLINE, EMBASE, and ISI Web of Knowledge databases with terms specified for pancreatic neoplasm and FNA. All fully published adult studies that compared preoperative EUS-FNA to EUS without FNA in resectable pancreatic cancer for short- and long-term outcomes were included. Results were reported as Odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CI) using a random effects model. Heterogeneity, publication bias and quality of studies were evaluated. Sensitivity analyses were performed. The primary outcome is overall survival. Secondary outcomes include cancer free survival, tumor recurrence and seeding, and post FNA adverse events.

Results

An initial search yielded 2814 citations. Six retrospective studies were included with 1155 patients in the EUS-FNA group vs 2067 patients in the comparator group. Overall survival was reported in three studies (n=2701: 796 EUS-FNA, 1905 non-FNA). Patients with preoperative EUS-FNA had better overall survival compared to the non-FNA group (WMD, 4.40 months [0.02 to 8.78]). In adenocarcinoma patients (2 studies, n=2050), there was no significant difference in overall survival (WMD, 2.94 months [-3.87 to 9.74]). Cancer-free survival did not differ significantly between the two groups (WMD, 2.08 months [-2.22 to 6.38]). Moreover, EUS with FNA was not associated with increased rates of tumor recurrence (OR, 0.55 [0.30–1.02]) or peritoneal carcinomatosis (OR, 0.81 [0.56–1.18]). Post-FNA pancreatitis was rare (1.7%), with all patients treated conservatively. Sensitivity analyses yielded similar findings across the different outcomes tested.

Conclusions

In this meta-analysis, preoperative EUS-FNA in resectable pancreatic cancer was associated with significantly greater overall survival when compared to the non-FNA group with no significant difference in rate of tumour recurrence and/or peritoneal seeding. These findings are limited by the retrospective nature of the included studies; randomized controlled trials are needed to confirm these results.

Funding Agencies

None

Enhanced electrochemical performance of α-MoO3/graphene nanocomposites prepared by an in situ microwave irradiation technique for energy storage applications

Nanoparticles of α-molybdenum oxide (α-MoO₃) are directly grown on graphene sheets using a surfactant-free facile one step ultrafast in situ microwave irradiation method.

Freestanding flexible, pure and composite form of reduced graphene oxide paper for ammonia vapor sensing

Metal oxides based graphene nanocomposites were used for ammonia vapour sensing. The self-assembly process was adopted to prepare freestanding flexible pure rGO, CeO₂-rGO and SnO₂-rGO composite papers. The structural studies confirmed the formation of rGO composite papers. The ammonia vapor sensing was demonstrated using an impedance analyzer at different humidity levels as well as concentration. The CeO₂-rGO composite paper achieved a sensitivity of 51.70 ± 1.2%, which was higher than that of pure rGO and SnO₂-rGO composite paper. Both the surfaces (top and bottom) of the papers are active in efficiently sensing ammonia, which makes the present work unique. The results reveal that metal oxide/rGO papers can be effectively utilized in real time sensor application.

TBX18 overexpression enhances pacemaker function in a rat subsidiary atrial pacemaker model of sick sinus syndrome

KEY POINTS

The sinoatrial node (SAN) is the primary pacemaker of the heart. SAN dysfunction, or 'sick sinus syndrome', can cause excessively slow heart rates and pauses, leading to exercise limitation and syncope, currently treated by implantation of an electronic pacemaker. 'Biopacemaking' utilises gene therapy to restore pacemaker activity by manipulating gene expression. Overexpressing the HCN pacemaker ion channel has been widely used with limited success. We utilised bradycardic rat subsidiary atrial pacemaker tissue to evaluate alternative gene targets: the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18 known to be involved in SAN embryonic development. TBX18 overexpression restored normal SAN function, as assessed by increased rate, improved heart rate stability and restoration of isoprenaline response. TBX3 and NCX1 were not effective in accelerating the rate of subsidiary atrial pacemaker tissue. Gene therapy targeting TBX18 could therefore have the potential to restore pacemaker function in human sick sinus syndrome obviating electronic pacemakers.

ABSTRACT

The sinoatrial node (SAN) is the primary pacemaker of the heart. Disease of the SAN, sick sinus syndrome, causes heart rate instability in the form of bradycardia and pauses, leading to exercise limitation and syncope. Biopacemaking aims to restore pacemaker activity by manipulating gene expression, and approaches utilising HCN channel overexpression have been widely used. We evaluated alternative gene targets for biopacemaking to restore normal SAN pacemaker physiology within bradycardic subsidiary atrial pacemaker (SAP) tissue, using the Na+ /Ca2+ exchanger NCX1, and the transcription factors TBX3 and TBX18. TBX18 expression in SAP tissue restored normal SAN function, as assessed by increased rate (SAN 267.5 ± 13.6 bpm, SAP 144.1 ± 8.6 bpm, SAP-TBX18 214.4 ± 14.4 bpm; P < 0.001), improved heart rate stability (standard deviation of RR intervals fell from 39.3 ± 7.2 ms to 6.9 ± 0.8 ms, P < 0.01; root mean square of successive differences of RR intervals fell from 41.7 ± 8.2 ms to 6.1 ± 1.2 ms, P < 0.01; standard deviation of points perpendicular to the line of identity of Poincaré plots (SD1) fell from 29.5 ± 5.8 ms to 7.9 ± 2.0 ms, P < 0.05) and restoration of isoprenaline response (increases in rates of SAN 65.5 ± 1.3%, SAP 28.4 ± 3.4% and SAP-TBX18 103.3 ± 10.2%; P < 0.001). These changes were driven by a TBX18-induced switch in the dominant HCN isoform in SAP tissue, with a significant upregulation of HCN2 (from 1.01 × 10-5  ± 2.2 × 10-6 to 2.8 × 10-5  ± 4.3 × 10-6 arbitrary units, P < 0.001). Biophysically detailed computer modelling incorporating isoform-specific HCN channel electrophysiology confirmed that the measured changes in HCN abundance could account for the observed changes in beating rates. TBX3 and NCX1 were not effective in accelerating the rate of SAP tissue.

The variation in quality and content of patient-focused health information on the Internet for otitis media

BACKGROUND

When symptoms of otitis media appear, parents and patients often access the Internet for health information. We study the content and quality of health information in parent-patient-focused websites for otitis media.

METHODS

We searched the 3 search engines (Google, Yahoo, and Bing) using "otitis media" and "middle ear infection" then reviewed the top 30 hits for each search. We included sites that were focused on providing patient-patient information about otitis media. A variety of instruments were used to assess website content and quality.

RESULTS

In 35 included websites, there was considerable variation in content, with the average site having 11 out of 15 informational items potentially useful to parents and patients on otitis media (range 4-15). Across included websites, the mean DISCERN score was 47 out of 80 (low to medium quality), 16 (46%) were HONcode certified, and 8 (23%) fulfilled all the JAMA benchmark criteria. The average website was written at a 9th/10th-grade reading level.

CONCLUSION

The content and quality of health information for otitis media in parent-and-patient-focused websites is highly variable. Although easy-to-read, high-quality websites with complete content are available, the average website sites is difficult to read without a high school education and is difficult to use. Consideration should be given to adopting a standard approach for presenting disease-specific information to parents and patients.

Successful treatment of gastrointestinal mucormycosis in an adult with acute leukemia: case report and literature review

Mucormycosis has emerged as an important cause of invasive fungal infection in patients with hematologic malignancies. Gastrointestinal mucormycosis is an unusual presentation of this invasive fungal infection, and it causes considerable morbidity and mortality. Such outcomes are due in part to a nonspecific presentation that results in delays in diagnosis and treatment. Successful treatment of gastrointestinal mucormycosis involves surgical debridement and appropriate antifungal therapy.

Megawatt-scale average-power ultrashort pulses in an enhancement cavity

We investigate power scaling of ultrashort-pulse enhancement cavities. We propose a model for the sensitivity of a cavity design to thermal deformations of the mirrors due to the high circulating powers. Using this model and optimized cavity mirrors, we demonstrate 400 kW of average power with 250 fs pulses and 670 kW with 10 ps pulses at a central wavelength of 1040 nm and a repetition rate of 250 MHz. These results represent an average power improvement of one order of magnitude compared to state-of-the-art systems with similar pulse durations and will thus benefit numerous applications such as the further scaling of tabletop sources of hard x rays (via Thomson scattering of relativistic electrons) and of soft x rays (via high harmonic generation).

No evidence for an evolutionary trade-off between learning and immunity in a social insect

The immune response affects learning and memory in insects. Given this and the known fitness costs of both the immune system and learning, does an evolutionary trade-off exist between these two systems? We tested this by measuring the learning ability of 12 bumble-bee (Bombus terrestris) colonies in a free-flying paradigm. We then tested their immune response using the zone of inhibition assay. We found a positive relationship between colony learning performance and immune response, that is, fast-learning colonies also show high levels of antimicrobial activity. We conclude that there is no a priori reason to demand an evolutionary relationship between two traits that are linked physiologically.

Immune response impairs learning in free-flying bumble-bees

Parasites can influence different host behaviours including foraging, mate choice and predator avoidance. Several recent papers have shown reduced learning abilities in infected insects. However, it is difficult to separate the effects of the immune response from the direct effects of the parasite. Using a free-flying learning paradigm, this paper shows that learning performance is impaired in bumble-bees (Bombus terrestris) that are not infected but whose immune system is stimulated non-pathogenically. This demonstrates that before it is assumed that a parasite has a direct effect on a host's behaviour, the effect of the immune response stimulated by the parasite must first be quantified.

Uterine secretion from mares with post-breeding endometritis alters sperm motion characteristics in vitro

Uterine secretion was collected from five normal mares during estrus by the use of a tampon. In subsequent estrus cycles, mares were inseminated with 1 x 10(9) spermatozoa from a stallion of known fertility, and uterine secretion was collected randomly at 6, 12, and 24 hours after insemination. All mares had negative endometrial cytology before insemination. At the time of uterine secretion sampling, semen was collected from two stallions and extended with Kenney's extender to a concentration of 50 x 10(6) spermatozoa/mL. Extended semen was diluted 2:1 with uterine secretion; semen extender; and centrifuged uterine secretion (noncellular). Samples were kept at room temperature and sperm motion characteristics (corrected motility (CMOT), progressively motile spermatozoa (PMS), and mean path velocity (MPV) were evaluated using a computer-assisted semen analyzer every 40 minutes for a total of 4 hours. Sperm motion characteristics of spermatozoa were significantly better when incubated in semen extender compared to uterine secretion (P < 0.05). The CMOT and PMS were significantly better in uterine secretion collected before, compared to after AI with the lowest values observed in samples collected at 12 hours after breeding (P < 0.05). Sperm motion characteristics of spermatozoa incubated in centrifuged uterine secretion was only slightly suppressed compared to spermatozoa incubated in semen extender, suggesting that the altered motion characteristics were mostly due to the presence of polymorphonuclear neutrophils (PMNs) in the samples. It was concluded from this study that spermatozoa can survive in inflamed uterine secretion, but that sperm motion characteristics in vitro are altered.