Summary Background The prevalence of hepatitis E virus (HEV) genotype 3 infections in the English population (including blood donors) is unknown, but is probably widespread, and the virus has been ...detected in pooled plasma products. HEV-infected donors have been retrospectively identified through investigation of reported cases of possible transfusion-transmitted hepatitis E. The frequency of HEV transmission by transfusion and its outcome remains unknown. We report the prevalence of HEV RNA in blood donations, the transmission of the virus through a range of blood components, and describe the resulting morbidity in the recipients. Methods From Oct 8, 2012, to Sept 30, 2013, 225 000 blood donations that were collected in southeast England were screened retrospectively for HEV RNA. Donations containing HEV were characterised by use of serology and genomic phylogeny. Recipients, who received any blood components from these donations, were identified and the outcome of exposure was ascertained. Findings 79 donors were viraemic with genotype 3 HEV, giving an RNA prevalence of one in 2848. Most viraemic donors were seronegative at the time of donation. The 79 donations had been used to prepare 129 blood components, 62 of which had been transfused before identification of the infected donation. Follow-up of 43 recipients showed 18 (42%) had evidence of infection. Absence of detectable antibody and high viral load in the donation rendered infection more likely. Recipient immunosuppression delayed or prevented seroconversion and extended the duration of viraemia. Three recipients cleared longstanding infection after intervention with ribavirin or alteration in immunosuppressive therapy. Ten recipients developed prolonged or persistent infection. Transaminitis was common, but short-term morbidity was rare; only one recipient developed apparent but clinically mild post-transfusion hepatitis. Interpretation Our findings suggest that HEV genotype 3 infections are widespread in the English population and in blood donors. Transfusion-transmitted infections rarely caused acute morbidity, but in some immunosuppressed patients became persistent. Although at present blood donations are not screened, an agreed policy is needed for the identification of patients with persistent HEV infection, irrespective of origin, so that they can be offered antiviral therapy. Funding Public Health England and National Health Service Blood and Transplant.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This article by Rachel Brett highlights the key issues to be aware of when carrying out international company searches and reviews the information available online from the national company ...registries for some of the key European and offshore jurisdictions including: Jersey, Guernsey, Isle of Man, France, Germany, Ireland, Luxembourg, the Netherlands, Switzerland, the Cayman Islands and the British Virgin Islands.
This book focuses, for the first time ever, on the protection roles of human rights NGOs since the establishment of the United Nations and the adoption of the Universal Declaration of Human Rights. ...It also looks at how NGOs are responding to future challenges such as artificial Intelligence, robots in armed conflicts, digital threats, and the protection of human rights in outer space. Written by leading NGO human rights practitioners from different parts of the world, it sheds light on the multiple roles of the leading pillar of the global human rights movement, the Non-Governmental Organizations.
Abstract only
Introduction:
Pulmonary hypertension (PH) is a common complication and cause of death in sickle cell disease (SCD). Prior study demonstrated poor correlation between the assessment of ...mean pulmonary artery pressures (mPAP) by echocardiogram (TTE) and right heart catheterization (RHC) in SCD. Yet, most PH studies in SCD have used TTE for the identification of PH. We sought to better characterize the clinical features of symptomatic SCD patients with/without PH confirmed on invasive testing.
Methods:
All symptomatic, defined as dyspnea or shortness of breath, SCD patients with RHC between 2008-2017 in a single large center in the Chicagoland area were recruited. PH was defined by mPAP
>
20 mmHg. Based on World Health Organization PH classification, Group 2 PH was differentiated from Group 1 PH by a pulmonary capillary wedge pressure (PCWP) ≥16 mmHg. Diagnosis and etiology of Group 1 PH was confirmed by chart review. We analyzed categorical and continuous variables using Pearson’s χ2 test and the Student’s t test, respectively, with Bonferroni correction as appropriate.
Results:
62 individuals with SCD and invasive hemodynamic testing were identified. All were African American, 37% were female, 90.3% were homozygous SS genotype, and 74.2% were on hydroxyurea (
Table 1
). Only mean LDH concentration was significantly different in those with PH compared to without (361 vs 448 U/L;
P
=0.02). Compared to Group 1 PH, those with Group 2 PH were younger (34.5 yr vs. 49 yr.;
P
=0.01), had higher mPAP (38 mmHg vs. 28 mmHg;
P
=0.002), had a higher prevalence of hypertension (
P
=0.03) and chronic kidney disease (
P
=0.004), and were frequently on a diuretic, angiotensin pathway blocking medication, calcium channel blocker, β-blockers, and/or nitrates (
Table 1)
.
Conclusions:
In symptomatic patients with SCD, PH diagnosed on invasive hemodynamics is associated with higher LDH. Those with Group 2 PH tend to be younger, have worse renovascular disease, and require more cardiovascular medications.
This article by Rachel Brett of Lovells reports on the results of a survey into classification practice in law libraries carried out through the BIALL and LIS-Law mailing lists in March 2007. Major ...findings were that only three respondents did not use any form of subject classification. The most frequently used classification scheme was Moys, and the single largest grouping was the 40 respondents (40.8%) who used their own in-house classification schemes.
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Background:
The duration of the QRS carries valuable information regarding structural disease, conduction defects, or even ischemia. Studies have shown that a widened QRS (>120) is ...associated with poor cardiovascular outcomes. In this study we investigated the impact of the presence of a widened QRS (wQRS )previous to Transcatheter Aortic Valve Replacement (TAVR) and clinical outcomes.
Methods::
Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois Chicago identified TAVR patients. Patients were placed into two groups: a wQRS and a nQRS group. Those with pacemakers prior to procedure were excluded. Primary outcomes included PPM placement prior to discharge, composite MACE (all-cause mortality, MI, or CVA), and (LOS) at 6 and 12 months.
Results:
We included 149 patients in this analysis. There were 76.1% male, 57.1% non-white, and 74 ± 13 years old on average. A wQRS was found in 46 (30.9%) and 103 (69.1%) were found to have a nQRS. Of this group, 40.2% had a history of congestive heart failure (CHF). The average ejection fraction (EF) was 50% with 80% of patients having a normal (EF). The CoreValve was placed in 65.7% of patient compared to 34.3% of patients having the Sapian valve placed. There were no differences in age, sex, or race between the two groups. Of all patient’s in the study, those with a wQRS were more likely to have a PPM placed prior to discharge compared to those with nQRS (17.4% (8) vs 5.8% (6) , p=0.025). Though not significant, 14% (13)of patients with the CoreValve placed required PPM prior to discharge compared to 2.5%(1) in the Sapian valve group (p=.175). There was no statistically significant difference in composite MACE, LOS, or significant bleeding events in either groups at 6 or 12 months.
Conclusion:
Our results suggest that patients with a wQRS are more likely to receive a PPM placement post TAVR during index hospitalization compared to those with a nQRS. This study suggests further investigation into the predictive nature of EKG parameters on clinical outcomes be done.
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