Single doses of both haloperidol and risperidone produce negative symptoms in normal individuals. Drowsiness may be an important confounding factor in the assessment of negative symptoms in antipsychotic trials.
Objective: to analyze the epidemiological, clinical, and virological characteristics of patients newly diagnosed with active hepatitis B virus (HBV) infection based on the presence of positive hepatitis B surface antigen (HBsAg) in the digestive diseases department of a district hospital.Patients and methods: we performed a 3-year prospective study in patients newly diagnosed with HBV infection. We analyzed epidemiological, clinical, and virological characteristics, complete HBV markers, quantification of HBV DNA, and infection by hepatitis delta virus. We performed genotyping and resistance testing in patients with a high viral load. Results were obtained for patients who required liver biopsy.Results: we diagnosed 213 patients (18.8/10,000 inhabitants/year). Men accounted for 61%, and 59% were aged 20 to 40 years. Immigrants accounted for 53% of the population: 46% were from Rumania and 37% from Sub-Saharan African countries. At diagnosis, 2.3% had acute hepatitis (all with jaundice) and 3.3% had cirrhosis with portal hypertension. With the exception of cases of acute hepatitis, positive HBeAg was observed in 9%. Serum transaminase levels were normal in 62.2% of patients, HBV DNA was > 2,000 IU/mL in 33.8%, and delta virus was present in 3.3%. Genotyping and resistance testing were performed in 70 patients: the most common genotype was D, followed by A. Resistance was detected at baseline in only 2 cases: to adefovir in one case and to entecavir in another. Among the 36 biopsies performed, 32.4% showed inflammatory activity ≥ 2, and 23.5% had fibrosis ≥ 2 according to the METAVIR scoring system. According to clinical practice, specific treatment for HBV infection was necessary (any reason) in 17.4% of those diagnosed (3 patients per 100,000 inhabitants/year).Conclusions: despite prevention and vaccination, HBV infection is a health problem that most commonly affects the immigrant population and men. Serum transaminase levels are normal in 62.2% of patients. The most frequent genotype is D, followed by A, and baseline resistance is scarce.
A 40-year-old man underwent endoscopic ultrasound (EUS) because of suspected submucosal gastric tumor diagnosed after an episode of severe bleeding (• " Fig. 1). EUS revealed a well-delineated, 18-mm hypoechogenic lesion in the submucosa with a calcified area inside it (• " Fig. 2,
Background Translocation of bacteria from the gut to other organs is one cause of systemic complications in obstructive jaundice. Furthermore, hyperbilirubinaemia appears to cause anergy. This study investigated whether these responses (translocation of gut bacteria and anergy) increase the postoperative mortality rate in rats in which obstructive jaundice is induced surgically by ligature of the bile duct. Methods Some 88 male Wistar rats were divided into six groups. All rats except those in group 1 received gentamicin by the oral route (0·7 mg in 1 ml water, daily for 6 days) to ensure intestinal decontamination. On day 7, all rats except those in groups 1 and 2, which had vehicle only, received Enterococcus. Statistical analysis was by Student's test and Fishers's exact test. Group Gentamicin Enterococcus Operation 1−−−2+−−3++−4++Sham5++CBD ligation6++CBD ligation and section All animals underwent standard blood testing, delayed hypersensitivity tests, haematimetry and serum endotoxin determinations. Flow cytometry was used to count CD3‐, CD4‐ and CD8‐positive lymphocytes. On the day 5 after surgery, these assays were repeated and, in addition, the rats were killed for microbiological analysis of gut and viscera contents (liver, spleen, mesentery and lung). Results Five days after surgery, mean bilirubin levels in groups 5 and 6 were greater than 14 mg dl−1. In addition, all rats in groups 5 and 6 showed absence of the delayed hypersensitivity response, indicating anergy. Lymphocyte counts in each group are shown in the Table. Lymphocyte counts (%) 1 2 3 4 5 6 CD3767667655151CD4464947473034CD8242616171515 The mean proportion of CD8‐positive lymphocytes in rats that had received Enterococcus (groups 3–6) was 16 per cent compared with 25 per cent in groups 1 and 2 (P < 0·05). The mean percentage of CD3‐positive lymphocytes in groups 5 and 6 was 51 per cent, but 71 per cent in all other groups (P < 0·05). Likewise, the mean percentage of CD4‐positive lymphocytes in groups 5 and 6 was 32 per cent, but 47 per cent in all other groups (P < 0·05). The postoperative mortality rate in group 4 (17 per cent) was significantly lower than that in the obstructive jaundice groups 5 and 6 (62 per cent) (P < 0·01). Post‐mortem microbiological analyses revealed translocation of Enterococcus only in groups 5 (80 per cent) and 6 (70 per cent). Enterococci were most frequently present in the mesentery (80 and 70 per cent respectively), followed by the liver (40 and 40 per cent), spleen (20 and 20 per cent) and lungs (10 and 10 per cent). Conclusion (1) Obstructive jaundice in rats leads to immunological alterations including anergy. (2) Obstructive jaundice in rats favours translocation of enterococci from the gut to other organs. (3) The postoperative mortality rate in jaundiced rats was much higher than that in sham‐operated rats. © 2000 British Journal of Surgery Society Ltd
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