Vertical transmission of hepatitis C virus infection

BACKGROUND: Cavernous carotid aneurysms are generally benign entities. Certain indications exist for their treatment, however, including transient ischemic events, subarachnoid hemorrhage or risk of subarachnoid hemorrhage, epistaxis or its risk, ophthalmoplegia, pain, and progressive visual loss. We feel certain angiographic features may indicate a greater likelihood that cavernous carotid aneurysms extend into the subarachnoid space, thus making their rupture a life-threatening event. METHODS: A case report of an intracavernous carotid aneurysm, which at surgery extended into the subarachnoid space, is described. RESULTS: In this particular case, deformation of the aneurysm (waisting) as seen at angiography was in retrospect an indication that the cavernous carotid aneurysm extended into the subarachnoid space, either through the dural ring or through the eroded dural roof of the cavernous sinus. This finding was verified at surgery when the lesion was explored and trapped. CONCLUSION: Angiographic waisting of a cavernous carotid aneurysm may indicate that the aneurysm extends into the subarachnoid space. Such extension means that rupture would be a life-threatening event. While deformation of the aneurysm may be secondary to compression against the optic nerve or anterior clinoid process with an intact layer of dura overlying the aneurysm, the neurosurgeon confronted with such findings should analyze such lesions carefully and consider surgical exploration.     

Clinical hepatitis after transplantation of hepatitis C virus-positive kidneys: HLA-DR3 as a risk factor for the development of posttransplant hepatitis

BACKGROUND: Exposure to hepatitis C virus (HCV) and subsequent infection after renal transplantation lead to significant clinical hepatitis in approximately 50% of graft recipients. METHODS: One hundred thirty-two consecutive renal allotransplant patients, who underwent transplantation of kidneys from HCV-positive cadaveric donors, were studied to investigate the relationship between donor and recipient HLA type and the risk of developing clinical hepatitis. Specific attention was directed toward the DR3 and DR4 alleles, as these had previously been associated with worse prognoses in autoimmune and viral hepatitis. RESULTS: Overall, 42% of patients receiving kidneys from donors seropositive for HCV developed clinical hepatitis. This was unrelated to preoperative recipient HCV serum reactivity (P=0.65). Patients receiving kidneys from seropositive donors with HCV RNA as detected by PCR were more likely to develop hepatitis than those receiving kidneys from PCR-negative donors (56% vs. 11%; P=0.005). The presence of the DR3 allele was associated with a significant risk of clinical hepatitis (P=0.025); 80% of DR3-positive recipients (n=34) progressed to hepatitis compared with 42% of DR3-negative patients. No other recipient HLA type was significantly related to prognosis. All patients receiving a donated kidney that expressed the B41 allele developed hepatitis, compared with 55% of recipients of non-B41 grafts (P=0.039). No association between the development of clinical hepatitis and HLA compatibility was found. CONCLUSIONS: These results suggest that both HLA type and viral presence as assayed by polymerase chain reaction, influence the risk of disease progression after transplantation of HCV-positive kidneys. Application of these associations may decrease the relative risk of a recipient contracting HCV hepatitis after cadaveric renal transplantation.     

Vertical transmission of hepatitis C virus in New Zealand

AIMS: To investigate the transmission of hepatitis C virus from viraemic mothers to infants. METHODS: The study group comprised 54 hepatitis C ribonucleic acid (RNA) positive, human immunodeficiency virus (HIV) negative women attending antenatal clinic, their infants when born, 12 previous children and 44 children of 29 additional nonpregnant, viraemic women. During the study period there were 60 live births (1 set of twins, 5 sequential pregnancies). All infants were tested at birth for hepatitis C virus (HCV) RNA. Thirty infants were retested at 6 months or later. Breast milk from 30 mothers was tested for HCV RNA. The 56 other children were tested for antibody to HCV and HCV RNA. RESULTS: Of the 60 infants tested at birth, 30 failed to attend a 6 month or later followup, 2 infants were HCV viraemic by six months of age, 2 infants had one episode of possible HCV RNA positivity followed by loss of detectable HCV RNA and 26 have shown no evidence of HCV infection. Five of the 30 breast milk samples tested were positive for HCV RNA. Four older children of viraemic mothers were HCV RNA positive. CONCLUSIONS: In this study, 2 of 30 (6.6%) of infants born to HIV negative, HCV viraemic mothers acquired HCV infection. Breast milk remains a possible contributory source of infant HCV infection. Management of babies born to HCV viraemic mothers should include retesting of baby for HCV RNA at 3 to 6 months of age.     

Absence of nonpercutaneous transmission of hepatitis C virus in a colony of chimpanzees

Transmission of hepatitis C virus (HCV) was studied in a colony of 85 chimpanzees using assays for anti-HCV and HCV-RNA. Thirteen of the 85 sera were positive for anti-HCV, and 12 of the 13 were also positive for HCV-RNA. All of the anti-HCV positive sera except one were obtained from chimpanzees which had been inoculated with non-A, non-B hepatitis virus. On the other hand, only one of 63 sera of chimpanzees without history of experimental infection of the virus was positive for anti-HCV. Transmission to this chimpanzee was thought to be a needle contaminated with HCV. All 39 samples of chimpanzees born in the center were negative for both anti-HCV and HCV-RNA. Sixteen of their mothers had undergone experimental infection, and 6 of them were positive for both anti-HCV and HCV-RNA. These results suggest that nonpercutaneous transmission, including sexual and mother-to-infant transmissions, is not an important mode of transmission. If these findings apply to humans, definition of inapparent sources of the infection is needed.     

Pruritus as a presenting symptom of chronic hepatitis C

Pruritus is a common symptom in cholestatic liver disease but is rare in chronic hepatitis C. Eight patients with chronic hepatitis C and severe pruritus were compared with regard to biochemical, serological, and histological features to eight disease controls with primary biliary cirrhosis and seven with cirrhosis due to hepatitis C. Among those with severe pruritus associated with chronic hepatitis C, serum aminotransferases were raised in all, alkaline phosphatase in four, and gamma-glutamyl-transpeptidase levels in all except one. Serum cholylglycine levels were elevated in seven of eight patients. Liver biopsies showed moderate to severe fibrosis in all patients and cirrhosis in five. Compared to control subjects with cirrhosis due to hepatitis C but no pruritus, ductopenia, and cholestatic changes were prominent, although less so than in controls with primary biliary cirrhosis. Chronic hepatitis C with moderate to severe fibrosis may result in low-grade cholestasis with pruritus, possibly in association with bile duct disappearance.     

Sexual transmission of GB virus C/hepatitis G virus

Tooth transposition is a positional interchange of two adjacent teeth. The most commonly transposed tooth is the permanent canine with either the first premolar or lateral incisor. The records of 54 subjects with transposed canines, both maxillary and mandibular, were collected. Pretreatment study models of these subjects were matched with a similar number of models from unaffected individuals. Bucco-lingual and mesio-distal tooth widths, arch depth and arch width were measured on each model. Thirty-four subjects (63 per cent) were female. Thirty-seven (68.5 per cent) of the cases involved the maxillary arch and thirty-three (89.2 per cent) of these upper arch transpositions were of the canine and first premolar. In cases involving the lower arch the canine was invariably transposed with the lateral incisor. Peg-shaped lateral incisors, supernumerary and/or congenitally absent teeth occurred in 19 subjects. There were some small, but significant differences in the dimensions of some teeth, however there were no statistically significant differences in arch depths, arch widths and most tooth dimensions in subjects with and without transposed canines. These factors do not appear to be related to the development of canine transposition.     

Face recognition accuracy as a function of mode of representation.

The relative effectiveness of line drawings and photographs as ways of representing information in face reconstruction systems was compared in 2 experiments. In Exp I, 3 independent groups of college students (27 in each group) were required to identify well-known faces shown either as photographs, detailed line drawings, or outline drawings. Photographs were significantly more effective as stimuli than line drawings, which in turn were superior to outlines. In Exp II, 80 Ss aged 16–60 yrs recruited from the public participated in a recognition task. Photographs and detailed line drawings of previously unknown faces served as stimuli. Ss recognized photographs significantly more accurately than line drawings, even when the pose of the target was changed between the exposure and test series. Results are discussed in terms of the development of computer-based face reconstruction systems and theories of face recognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mother-to-infant transmission of GB virus C/hepatitis G virus: the role of high-titered maternal viremia and mode of delivery

To study mother-to-infant transmission of GB virus C/hepatitis G virus (GBV-C/HGV), blood samples of infants born to carrier mothers were collected beginning 3 months after birth and were tested for GBV-C/HGV RNA until 1 year of age. Of 2046 mothers, 2.1% were positive for GBV-C/HGV RNA, and 25 of their infants were followed for a median of 12 months. Thirteen infants (52%) were viremic, and infection became persistent in all. Maternal GBV-C/HGV RNA levels of this group were >10(7) copies/mL. Nucleotide sequence comparison in 5 viremic mother-infant pairs revealed a homology of 93%-98.2%, and none delivered by elective cesarean section. In comparison, of the 12 uninfected infants' mothers, 10 had lower GBV-C/HGV RNA levels (mean, 5 x 10(4) copies/mL), and the remaining 2 high-titered mothers had elective cesarean section. Thus, high-titered maternal viremia and mode of delivery are closely associated with the mother-to-infant transmission of GBV-C/HGV to infants, and the infection usually becomes persistent.     

Clinical and serological courses of a newborn with post-transfusion hepatitis C

The clinical and serological course of a haemophilic baby who was transfused with 160 ml of blood containing the hepatitis C virus (HCV) (0.70 Meq. ml-1) on the sixth-post-natal day is described. He is the infant of an HCV-negative mother. One month after the transfusion, there was a marked increase in HCV RNA and a small amount of HCV antibody was detected. This case provides evidence that a newborn is capable of producing HCV antibodies.     

Rationale for a trial of prevention of perinatal transmission of hepatitis C via specific immunoglobulins

Insects perceive a large number of airborne chemicals as olfactory components mainly through the antenna. It is thought that detection of the odorants by specific receptors is followed by a degradative pathway that clears the olfactory organ from accumulating chemicals. In Drosophila, a number of P450 monooxygenases are involved in the metabolism of foreign chemicals [Dunkov et al. (1996) Cytochrome P450 gene cluster in Drosophila melanogaster, Mol. Gen. Genet. 251, 290-297]. NADPH-cytochrome P450 oxidoreductases serve to transfer reducing equivalents to P450 monooxygenases. We isolated cDNA and genomic clones coding for a Drosophila NADPH cytochrome P450 oxidoreductase (CPR). The largest cDNA of 2471 nucleotides in length contained an open reading frame of 693 amino acids that includes the putative CPR sequence. CPR is a single copy gene as shown by genomic Southern hybridisation and maps to the cytogenetic map position 26C on the second chromosome. Comparison of genomic and cDNA CPR sequences revealed a gene structure that is split into at least six exons. The CPR protein sequence is almost identical with that of house fly and remarkably conserved when compared to vertebrates and yeast. RNA expression is high in embryos and antennae as compared to adult heads, adult bodies and larvae. High expression in antennae may reflect the putative function in olfactory clearance.     

Clinical application of hepatitis C virus core protein in early diagnosis of acute hepatitis C

OBJECTIVE: To investigate the prevalence of currently recognised inherited prothrombotic states in a population of children with arterial stroke. METHODS: Children with arterial stroke presenting to a tertiary level paediatric neurology centre between 1990 and 1996 were investigated for inherited prothrombotic states. RESULTS: Sixty seven children with arterial stroke were investigated. Abnormalities were initially identified in 16 patients; however, only eight children (12%) had an inherited prothrombotic state. This was type 1 protein S deficiency in one patient, the factor V Leiden mutation in six, and activated protein C resistance (without the factor V Leiden mutation) in one. The prevalence of the factor V Leiden mutation was not significantly higher in children with arterial stroke (12%) than in a control population of children without thrombosis attending the same institution (5.2%; Fisher's exact test, p=0.19; difference in prevalence between patients and controls (95% confidence interval)=6.8% (-2.78% to 16.8%)). CONCLUSIONS: Currently recognised inherited prothrombotic tendencies were rarely associated with stroke in this group of children, although larger numbers of patients would be needed to confirm this. Age appropriate normal values should be used when interpreting the results of a prothrombotic screen. Prothrombotic abnormalities seen acutely are as often transient as inherited. Longitudinal assessment and family studies are required before low concentrations of an anticoagulant protein found acutely can be attributed to an inherited abnormality.     

Clinical outcome of patients infected with hepatitis C virus infection on survival after primary liver transplantation under tacrolimus

In 1994, as a result of both programme evaluations which identified students' fears and apprehensions about their practical ability, and a review of the literature on skill acquisition, experiential skills teaching was resumed within the faculty. Having invested considerable finance into the reconstruction of a skills centre to teach skills, it is now imperative that its use be formally evaluated. Part of the evaluative process includes a review of the empirical literature on the acquisition of psychomotor skills in nursing. This paper summarizes this review.     

Histological and clinical outcome after liver transplantation for hepatitis C

Hepatitis frequently recurs after liver transplantation for hepatitis C. However, the histological progression of disease, predictors of recurrence and disease severity, and patient survival remain uncertain. Fifty-five patients with cirrhosis caused by chronic hepatitis C underwent liver transplantation between January 1990 and December 1993. Hepatitis C genotype was determined, and liver biopsies were performed at frequent intervals posttransplantation. The median follow-up time was 40.4 months. The cumulative rate of survival was no different in liver transplant recipients for hepatitis C than in liver transplant recipients for other chronic liver diseases (P = .62). Histological recurrent hepatitis C developed in 33 of 50 patients assessable for disease recurrence; the median recurrence-free survival time was 13.4 months. Histological activity and stage were mild in most cases. Only 2 patients developed cirrhosis, and no patient required a second transplantation for recurrent disease. Patients with acute cellular rejection had a shorter recurrence-free survival (P = .0141). In patients with recurrent hepatitis, rejection also was correlated with increased histological grade 2 years after transplantation (P = .0061). Recurrence-free survival was decreased in patients infected with genotype 1 (1a and 1b combined) compared with genotypes 2 and 3 combined (P = .02), whereas there was no difference between genotypes 1a and 1b (P > .80). Only patients infected with genotype 1a or 1b developed bridging fibrosis or cirrhosis. In addition, patients who had an early recurrence had a greater risk of progressing to bridging fibrosis or cirrhosis (hazard ratio, 5.1; P = .0473). In our experience, recurrent hepatitiS C after liver transplantation in most cases is mild and survival is unaffected. Both acute cellular rejection and infection with genotype 1 are independent risk factors for reduced recurrence-free survival, and early recurrence is associated with a higher risk of disease progression.     

Gastrointestinal problems as a function of carbohydrate supplements and mode of exercise

The aim of the study was to examine prevalence and duration/seriousness of gastrointestinal (GI) problems as a function of carbohydrate-rich (CHO) supplements and mode of exercise. The relationship between GI problems and a variety of physiological and personal factors (age, exercise experience) was also examined. Thirty-two male tri-athletes performed three experimental trials at 1-wk intervals, each trial on a different supplement: a conventional, semisolid supplement (S; 1.2 g CHO, 0.1 g protein, and 0.02 g fat.kg BW-1 x h-1); an almost isocaloric fluid supplement (F; 1.3 g CHO.kg BW-1 x h-1, no fat, no protein); and a fluid placebo (P). The 3 h of exercise started at 75% VO2max and consisted of alternately cycling (bouts 1 and 3) and running (bouts 2 and 4). GI symptoms were monitored by a questionnaire. Analysis of variance revealed that nausea lasted longer with P as compared with S (P < 0.05). Bloating lasted longer during bout 3 with P as compared with F and S (P < 0.05). Accounting for confounding factors, most GI symptoms occurred more frequently and lasted longer during running than during cycling. Multiple regression analysis revealed significant relationships between nausea and urge to defecate, between an urge to defecate, GI cramps and flatulence, and between belching and side ache. From all other factors energy depletion, CHO malabsorption, exercise intensity, exercise experience, and age were significantly related to GI symptoms during the exercise.     

Treatment outcome as a function of follow-up difficulty in substance abusers.

Studied 150 consecutive male alcoholic and drug addict admissions to inpatient treatment at a VA medical center to determine if Ss who were more difficult to follow up also had poorer posttreatment outcomes. Of the original sample, 144 Ss were successfully followed up 6 mo from the date of admission, for an overall completion rate of 96%. Of that total, 2 were found to be deceased, leaving complete and valid information for 142 (95%). Ss were grouped according to the number of attempts necessary to complete follow-up. Comparisons on 18 measures indicated essentially no difference in the outcome status of Ss harder to follow up than those more easily contacted. Subsequent analyses of the alcoholic and drug addict samples individually yielded similar results. Further analyses indicated that the results obtained were not a function of the length of time spent in treatment or the length of time between treatment discharge and follow-up. Results are discussed in light of their importance in the interpretation of follow-up evaluations. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recognition of expressive patterns as a function of their mode of production.

The question of whether complex motor behavior, such as handwriting, is a function primarily of built-in neuromuscular patterns or of an imagined design was studied by testing whether judges (15 male and 15 female) were able to correctly match samples of normal writing with variant samples produced by the same persons; the latter consisted of "writing" by means of the foot, mouth, chest, and nondominant hand. Some variants (foot and nondominant hand) were matched at well above the chance level and others were not, suggesting that a motor pattern may be a function of one's imagined design but only if expressed through effective neuromuscular mechanisms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)