Feasibility and Acceptability of Antenatal Hepatitis C Screening: A Pilot Study.

Introduction: Hepatitis C virus (HCV) is not currently included in the United Kingdom routine antenatal screening program, but the latest guidelines from the Centers for Disease Control and Prevention, American Association for the Study of Liver Diseases, and Infectious Diseases Society of America recommend HCV screening for all pregnant women during each pregnancy. The aim of this study was to collect qualitative data on the feasibility and acceptability of antenatal HCV screening in pregnant women at the time of routine antenatal screening at 12 weeks, to estimate patient knowledge about HCV and identify the prevalence of HCV infection in antenatal women.

Methods: This was a pilot study targeting a single hospital-based antenatal clinic in Birmingham, initially conducted for eight weeks with a further extension of the study period to enhance recruitment to meet the feasibility target of 500 patients.

Assessment of depth of sedation using Bispectral Index™ monitoring in patients with severe traumatic brain injury in UK intensive care units.

Introduction: Severe traumatic brain injury affects ∼4500 per year across the UK. Most patients undergo a period of sedation to prevent secondary brain injury, however the optimal sedation target is unclear. This study aimed to assess the relationship between the electroencephalogram (EEG)-based Bispectral Index™ (BIS™) value and the clinical sedation score, along with other clinical outcomes.

Effects of Inorganic Arsenic on Type 2 Diabetes Mellitus In Vivo: the Roles and Mechanisms of miRNAs.

Accumulating studies have shown that chronic exposure to iAs correlates with an increased incidence of diabetes. In recent years, miRNA dysfunction has emerged both as a response to iAs exposure and independently as candidate drivers of metabolic phenotypes such as T2DM. However, few miRNAs have been profiled during the progression of diabetes after iAs exposure in vivo.

Association of fourteen years diet quality trajectories and type 2 diabetes mellitus with related biomarkers.

Diet quality fluctuates throughout one's adulthood, yet it remains unclear how long-term diet quality changes are related to type 2 diabetes mellitus (T2DM) and its biomarkers. We aimed to examine the association of long-term diet quality with T2DM and its biomarkers. Diet quality was assessed by the revised DBI-07, in which diet quality distance levels (DQD) represented the overall diet quality.

Takotsubo cardiomyopathy following resection of a fourth ventricle tumour.

Takotsubo cardiomyopathy is a rare disorder associated with catecholamine discharge in response to episodes of stress. We present the case of a 39-year-old patient with no other significant medical history who suffered acute ECG changes, left ventricular dysfunction with regional wall motion abnormalities and raised cardiac enzymes following a period of severe and sustained hypertension and tachycardia associated with resection of tumour from the floor of the fourth ventricle. We believe this to be only the second case of a takotsubo cardiomyopathy related to intracranial surgery.

The necessity of education and hepatitis B vaccination for young people: A study of high risk behaviour for blood borne viruses in the United Kingdom.

Blood borne virus (BBV) infection in adults involved in high risk behaviour is well recognized. There are limited reported data on young people involved in high risk behaviour. A descriptive questionnaire was used to ascertain risk behaviour at the Young People's Substance Misuse Service (Birmingham).

N-acetylcysteine infusion in preventing hepatotoxicity secondary to intravenous injection of household bleach.

We present a case of non-accidental injection of 40 ml of domestic bleach through a long-term central venous catheter (CVC) with subsequent AKI, and for the first time in the literature severe coagulopathy and acute liver injury. We detail the clinical course of events and our management plan which adds to the body of evidence for prognosis and treatment in these unusual cases.

Epidemiology and clinical features of childhood chronic hepatitis B infection diagnosed in England.

Background: This study aimed to estimate the prevalence of childhood chronic hepatitis B (CHB) infection diagnosed in England using capture-recapture analysis of 2 independent data sources and to describe the clinical and epidemiological characteristics, management, complications and outcome of children with CHB.

Methods: Pediatric specialists were contacted to report all CHB cases in children aged <16 years and complete a standardized questionnaire. Capture-recapture analysis of cases diagnosed during 2001-2009 using 2 independent data sources was performed to estimate the prevalence of childhood CHB.

Does genotype predict response to treatment in children infected with hepatitis B perinatally?

HBV genotype may correlate with outcome and treatment response. Genotype has been compared with treatment response in children infected perinatally with hepatitis B following treatment with oral antiviral drugs (lamivudine or adefovir) or interferon (IFN) alone and with prednisolone priming (Pred/IFN). All children who took part in clinical trials in this unit since 1990 were included.

Hepatitis B virus transmission in pre-adolescent schoolchildren in four multi-ethnic areas of England.

The aim of this study was to estimate the amount of childhood hepatitis B virus transmission in children born in the UK, a very low-prevalence country, that is preventable only by universal hepatitis B immunization of infants. Oral fluid specimens were collected from schoolchildren aged 7-11 years in four inner city multi-ethnic areas and tested for the presence of antibody to hepatitis B core antigen (anti-HBc). Those found positive or indeterminate were followed up with testing on serum to confirm their hepatitis B status.

Chronic hepatitis C in children--review of natural history at a National Centre.

The natural history of hepatitis C virus (HCV) infection in adults has been established, but less is known about outcome in children. We conducted a retrospective review of patients referred to Birmingham Children's Hospital Liver Unit, from 1991 till 2008, with the diagnosis of HCV was undertaken. Only children with documented positive HCV RNA and a minimum duration of follow-up of 6 months were included.

Differential diagnosis of cystic neck lesions.

Objectives: In patients less than 40 years of age who present with an upper anterior triangle cystic mass, branchial cyst is the presumed clinical diagnosis. Squamous cell malignancy is the important differential diagnosis in a patient more than 40 years of age. We sought to identify the range of lesions that can be clinically mistaken for, and removed as, branchial cysts.

Cyanoacrylate ("superglue") injury to the nasal cavity: case report and a proposed management algorithm.

We report the case of a deliberate application of cyanoacrylate adhesive (commonly called "superglue") to the nose of a 9-year-old boy during a fight. The glue was successfully removed under general anesthesia without causing trauma to the nasal mucosa. To the best of our knowledge, only 1 other case of cyanoacrylate injury to the nasal cavity has been published in the literature.

Discordant outcome of perinatal transmission of hepatitis C in twin pregnancies.

Background: Mother to infant transmission of hepatitis C virus (HCV) is dependent on significant HCV viraemia being present in the mother. As yet there are no appropriate interventions to prevent perinatal transmission. The investigation of twin pregnancies where only one twin is infected may reveal further information relating to transmission and specific risks.

Perinatal hepatitis C virus infection: diagnosis and management.

Hepatitis C virus (HCV) infection in children is becoming an increasing challenge to health professionals. As our understanding of the disease evolves, so must our diagnostic and management strategies. In the 1990s, when HCV testing became available, children identified with HCV infection in the UK were mostly those who had required blood products, particularly those with haematological disorders.

Long-term follow-up of hepatitis B carrier children treated with interferon and prednisolone.

The long-term outcome of treatment with Interferon Alpha 2B with and without Prednisolone priming in children infected perinatally with hepatitis B was reviewed. The group studied included 48 children (aged 2-16 years), who were HBe antigen and hepatitis B DNA positive between 1991 and 1993. Twenty children were randomized to a therapeutic trial at that time, and received Prednisolone in reducing doses for 6 weeks and Interferon for 16 weeks while 22 children were monitored without treatment for 12 months.

Natural history of hepatitis B in perinatally infected carriers.

Objectives: To establish natural seroconversion rates and incidence of hepatic pathology in perinatally infected hepatitis B carriers.

Methods: Seventy three perinatally infected hepatitis B carriers identified through maternal screening were evaluated. Fifty three were born to parents from the Indian subcontinent, nine were Oriental, six were Afro-Caribbean, and five were white.

Successful ribavirin therapy for life-threatening laryngeal papillomatosis post liver transplantation.

A 3-yr-old girl developed severe progressive juvenile laryngeal papillomatosis (JLP) 2 yr after liver transplantation (Tx) for biliary atresia. The papillomata were resistant to withdrawal of immunosuppression, to laser surgery, and to subcutaneous interferon (3 MU/m2, three times weekly), necessitating tracheostomy. Oral ribavirin therapy (25 mg/kg/day) in combination with no immunosuppression effectively prevented the rapid recurrence of JLP over 5 yr.

Hepatitis: exploding the myths.

This article outlines the foundations of hepatitis infectivity and discusses preventive measures for avoiding cross-infection. The purpose of this article is to enable nurses to be well informed so that patients, their families and social contacts are appropriately advised and any perceived myths associated with the disease are dispelled.