Chronic hepatitis B infection (HBV) is the major cause of primary liver cancer worldwide and Asians are disproportionately affected. The prevalence of HBV among most Asian American groups has been well documented, except in Hmong immigrants in the United States. The aim of this study was to determine the prevalence of HBV among Hmong immigrants in the San Joaquin Valley of California. A convenient sample of 534 Hmong age ≥18 years was recruited at various locations throughout Fresno County. Blood samples from study participants were collected and tested for hepatitis B surface antigen (HBsAg) by enzyme-immunoassay. Two hundred and eighty-nine females and 245 males of Hmong descent (mean age, 43.93) were screened. Eighty-nine (41 males and 48 females) were positive for HBsAg, which accounts for a prevalence of 16.7% (95% C.I. 13.5–19.9). The majorities of HBsAg positive patients were ≥40 years (64.2%), married (66.7%), born in Laos (87.3%), and had lived in the United States ≥20 years (62.5%). Only 37.5% of the participants reported having a primary care physician. Our study revealed that approximately one out of every six Hmong immigrants screened was infected with HBV. Based on our findings, more than one-third of these infected patients have no primary care physician to provide further treatment, surveillance for liver cancer, or vaccination of their families. This supports the Institute of Medicine’s recent recommendations to the Center for Disease Control to engage in a national Hepatitis B surveillance system.
Costello syndrome (CS; MIM 214080) is a rare multiple congenital anomaly disorder in which individuals have characteristic dysmorphic craniofacial features, cardiac abnormalities, ectodermal and musculoskeletal anomalies, endocrinopathy, developmental delay, and a predisposition to neoplasia both benign and malignant. In this study, we examined a large, well-characterized cohort of patients with the clinical diagnosis of CS. We sequenced HRAS in 36 unrelated individuals with the clinical diagnosis of CS and three sets of parents and 10 normal controls. We screened for HRAS coding region mutations in an effort to define HRAS mutations in CS and attempt to establish a possible genotype-phenotype correlation. In addition, we sequenced HRAS to establish loss of heterozygosity in a rhabdomyosarcoma and fibrosarcoma from a CS patient. HRAS mutations were identified in 33 out of 36 (92%) patients with the clinical diagnosis of CS. Mutations were found in codon 12 or 13. Two different missense point mutations were identified in codon 12: 34G→A and 35G→C, predicting an amino acid substitution of gly12ser and gly12ala, respectively. The 34G→A transition mutation, the most common mutation observed in this cohort of patients, was found in 30 of 33 patients. Two patients were found to have a codon 12 35G→C transversion. One patient in the cohort had a codon 13 mutation: 37G→T transversion, predicting an amino acid substitution of gly13cys. Parental DNA samples from three CS patients with the 34G→A mutation did not harbor a mutation. HRAS was sequenced from DNA isolated from a rhabdomyosarcoma and fibrosarcoma from a patient who had the germline activating mutation 34GA. Sequence analysis demonstrated LOH of the wild-type allele of HRAS as demonstrated by detection of only 34A in exon 1. Our data show that the majority of Costello syndrome patients have de novo heterogeneous HRAS mutations. Furthermore, tumorigenesis in Costello syndrome patients is accompanied by additional somatic changes affecting the HRAS gene.
PurposeAbnormal serum magnesium values are commonly encountered in a wide spectrum of patients. However, except in unique circumstances, it is unclear whether or not minor magnesium abnormalities even require treatment or whether correction of the magnesium level to normal has any bearing on patient morbidity and mortality. During the past few years, there seems to have been a substantial increase in routine serum magnesium testing on patients admitted to hospitals. The primary objective of this study is to document the changes in the quantity of routine magnesium testing done on patients within a large community hospital setting. A second objective of the study is to measure the excess costs of unnecessary magnesium testing.MethodsTo test the hypothesis that there has been an increase in magnesium testing, two time periods were chosen for comparison: July 1, 1999 to June 30, 2000 and July 1, 2003 to June 30, 2004. Total magnesium lab tests were obtained from laboratory services and hospital administration at three hospitals in Fresno, California-Clovis Community Hospital (CCH), Fresno Community Hospital (FCH), and University Medical Center (UMC). For each time frame, 100 random patient charts were reviewed by the authors to determine whether or not magnesium testing was necessary.ResultsThe current patient charge for magnesium testing is $98.00 for inpatient and $54.00 for outpatient. Medicare reimbursement is $9.36. For the July 1, 1999 to June 30, 2000 time period there were a total of 28,457 magnesium lab tests performed (904 at CCH; 8,637 at FCH; 18,916 at UMC). This compares with the July 1, 2003 to June 30, 2004 time period when 38,830 magnesium lab tests were performed (2,917 at CCH; 15,265 at FCH; 20,648 at UMC). The percent change in magnesium testing for each hospital is as follows: +222.7% at CCH; +76.7% at FCH; and +9.2% at UMC. Based on the authors' own scoring system, during the 1999-2000 year, 55% of all magnesium testing was unnecessary while for the 2003-2004 year 54% of all testing was unnecessary.ConclusionsEven when corrected for changes in hospital volumes, there has been a substantial increase in the ordering of routine magnesium levels. With more than half of all magnesium tests unnecessary, patients could be spared the added costs of such testing.
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