BackgroundExtra-oesophageal reflux (EOR) may lead to microaspiration in patients with cystic fibrosis (CF), a probable cause of deteriorating lung function. Successful clinical trials of ivacaftor highlight opportunities to understand EOR in a real world study.MethodsData from 12 patients with CF and the G551D mutation prescribed ivacaftor (150 mg bd) was collected at baseline, 6, 26 and 52 weeks. The changes in symptoms of EOR were assessed by questionnaire (reflux symptom index (RSI) and Hull airway reflux questionnaire (HARQ)).ResultsSix patients presented EOR at baseline (RSI > 13; median 13; range 2–29) and 5 presented airway reflux (HARQ > 13; median 12; range 3 to 33). Treatment with ivacaftor was associated with a significant reduction of EOR symptoms (P < 0 ∙ 04 versus baseline) denoted by the reflux symptom index and Hull airway reflux questionnaire.ConclusionIvacaftor treatment was beneficial for patients with symptoms of EOR, thought to be a precursor to microaspiration.
Roughly a quarter of the world's population, or 2 billion people, has serological evidence of past or present hepatitis B virus (HBV) infection. A total of 250 million people are estimated to have chronic hepatitis B (CHB) infection. It is further estimated that almost 700,000 die of HBV per year, with 300,000 because of the development of HBV-induced hepatocellular carcinoma, the second most common cause of death from cancer. 1,2 This is true despite the presence of a safe and effective vaccine and the availability of efficient therapy. In industrialized Western countries, including the United States, immigrants from hepatitis B-endemic areas represent an important source of new HBV infections. 3 This group represents a much greater risk than, for example, the intravenous drug user population, which is estimated to account worldwide for slightly more than a million CHB infections, whereas the immigrant HBV population in the United States alone is estimated at 1.6 million. 3 HBVendemic countries are defined as countries hyperendemic for HBV where more than 8% of the population is HBV infected, as well as countries displaying intermediate endemicity with an HBV prevalence rate between 2% and 8%. Countries in the Middle Eastern region belong to the latter group and, because of their political instability, have recently become an important source of migration. The discussion of the current HBV epidemiology and in general the burden of HBV in this area is thus timely and is the aim of this review.
HBv ePiDeMiOlOGYMiddle Eastern countries are considered developing countries that possess a suboptimal health care infrastructure. Reliable data on epidemiology may be difficult to obtain. In such areas, assessing HBV prevalence in blood donors appears attractive because they are based on a large number of individuals. Data obtained from blood donor studies can be considered acceptable indicators of the HBV burden in developing countries provided it is understood that these prevalence data underestimate the real problem because high-risk groups for HBV are rejected from blood donation without pretransfusion blood screening for hepatitis B surface antigen (HBsAg). 4
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