Detection of hepatitis E virus RNA in saliva for diagnosis of acute infection.

Diagnosis of acute hepatitis E virus (HEV) infection is established by detection of anti-HEV IgM antibodies by ELISA or by amplification of serum viral RNA. Here, we evaluate the diagnostic value of testing HEV RNA in saliva to identify patients with acute HEV infection. Prospective proof-of-concept study including patients with acute hepatitis. Whole blood and neat saliva samples were obtained from all patients. Saliva samples were processed and analysed for HEV RNA by RT-PCR within 2 hr after collection. A total of 34 patients with acute hepatitis and 12 healthy donors were included in the study. HEV RNA in serum was confirmed by RT-PCR in eight of these patients (23.5%; 95% CI: 12.2%-40.2%). HEV was isolated in the saliva of eight of 34 patients (23.5%; 95% CI: 12.2%-40.2%). All patients with HEV RNA amplified in saliva had detectable HEV RNA in serum. HEV was isolated neither in the saliva of any of the 26 patients without detectable HEV RNA in serum nor in healthy donors. Our study suggests that acute HEV infection could be diagnosed by assessing viral load in saliva.

Rural habitat as risk factor for hepatitis E virus seroconversion in HIV-infected patients: A prospective longitudinal study.

Our objective was to determine the incidence and clinical manifestations of acute hepatitis E virus (HEV) in HIV-infected patients. A prospective longitudinal study including HIV-infected HEV-seronegative patients was conducted; HEV seroconversion (to IgG and/or IgM) was the main outcome variable. All patients were tested for HEV antibodies every 3-6 months. For patients who developed HEV seroconversion, a data collection protocol was followed to identify associated clinical manifestations and analytical alterations. A total of 627 patients (89.9%) were followed during a median of 11.96 months (IQR: 8.52-14.52 months) and formed the study population. Forty-one patients developed detectable anti-HEV antibodies (7.2 cases per 100 patients/year). Our study found a high incidence of HEV in HIV-infected patients in southern Spain strongly associated with a rural habitat.

Familial Hepatitis E Outbreak Linked to Wild Boar Meat Consumption.

An HIV-infected patient was diagnosed with acute hepatitis E infection in our hospital. An epidemiological inquiry was performed to collect demographic, food and animal exposure variables in order to identify the potential route of transmission. The patient reported that his family traditionally hunted wild boar for food. All family members were analysed for hepatitis E virus infection. Additionally, route of transmission by wild boar meat consumption and prevalence of HEV infection among wild boar from the same hunting area were investigated. In all-family members (n = 8), HEV-RNA was amplified. Two wild boar meat slices consumed was analysed, showing the presence of HEV. The virus isolated was consistent with genotype 3, revealing 100% homology between family members and meat. Additionally, we tested nine wild boar hunted in the same hunting area. All of them were RNA-HEV positive, isolating the same HEV genotype 3 viral strain. We demonstrated by phylogenetic analysis zoonotic transmission of HEV by wild boar meat consumption. The prevalence of HEV infection among wild boar found in our study suggests that this species is an important route of transmission to human.

Correlation between the complex PSA/total PSA ratio and the free PSA/total PSA ratio, sensitivity and specificity of both markers for the diagnosis of prostate cancer.

OBJECTIVE: To compare the behaviour of the PSAcomplex/PSAtotal percentage (PSAc%) against the PSA free/PSA total (PSAl%) and analyse both markers for their usefulness in diagnosing prostate cancer. MATERIAL AND METHODS: We measured total PSA (PSAt), free PSA (PSAl), complex PSA (PSAc), PSAl% and PSAc% levels in 158 patients. Of these, 98 (62%) were biopsied for presenting PSAt≥3 ng/dl and PSAl%<20, PSAt>10, suspicious rectal examination or suspicious ultrasound node. We performed linear regression and Passing-Bablok regression analyses. The ROC curves were calculated to study the sensitivity and specificity of PSAl% and PSAc% and were compared to each other. The prostate cancer diagnoses were analysed by PSAl% and PSAc% by applying the χ(2) test. RESULTS: The correlation coefficient (r) was good (0.7447, P<.0001), and the index of determination (r(2)) was 0,5. The result of the Passing-Bablok analysis was a slope of 1.658 (1.452 to 1.897) and an intersection of 2.044 (-0,936 to 5.393). The optimal cutoff for PSAl% (≤14.7854) showed a sensitivity of 89.29% [95% CI, 0,642-0,823] and a specificity of 54.29% (95% CI, 0,642-0,823). The optimal cutoff for PSAc% (>89.7796) had a sensitivity of 71.43% (95% CI, 0,616-0,802) and a specificity of 71.43% (95% CI, 0,616-0,802). There were no significant differences when comparing the areas under the curve of both markers (P=.59). The PPV of PSAl% was less than that of PSAc% (45.7% vs. 71%). CONCLUSION: There was a good correlation between PSAl% and PSAc%. PSAc% has demonstrated greater specificity and efficacy than PSAl% in the diagnosis of prostate cancer.

Correlación del cociente PSA complex/PSA total con el cociente PSA libre/PSA total, sensibilidad y especificidad de ambos marcadores para el diagnóstico del cáncer de prostata / Correlation between the Complex PSA/total PSA Ratio and the Free PSA/total PSA Ratio, Sensitivity and Specificity of Both Markers for the Diagnosis of Prostate Cancer

Objetivo: Comparamos el comportamiento del cociente PSA complex/PSA total porcentual (PSAc%) frente al cociente PSA libre/PSA total (PSAl%) y analizamos ambos marcadores en su utilidad para el diagnóstico del cáncer de próstata. Material y métodos: Se midieron los niveles de PSA total (PSAt), PSA libre (PSAl), PSA complex (PSAc), PSAl% y PSAc% en 158 pacientes. Noventa y ocho (62%) fueron biopsiados si presentaban PSAt ≥3 ng/dl y PSAl% < 20, PSAt > 10, tacto rectal sospechoso o nódulo ecográfico sospechoso. Se realizó un análisis de regresión lineal y de regresión Passing-Bablock. Se calcularon las curvas ROC para estudiar la sensibilidad y especificidad del PSAl% y PSAc% y se compararon entre ellas. Se analizaron los diagnósticos de cáncer de próstata por el PSAl% y el PSAc% aplicando el test χ2. Resultados: El coeficiente de correlación (r) fue bueno, 0,7447 (p < 0,0001) y el índice de determinación (r2) fue de 0,5. El resultado del análisis Passing-Bablock fue una pendiente de 1.658 (1.452 a 1.897) e intersección de 2.044 (−0,936 a 5.393). El punto de corte óptimo de PSAl%, ≤ 14.7854, mostró una sensibilidad del 89,29% (IC 95%; 0,642-0,823) y una especificidad del 54,29% (IC 95%; 0,642-0,823) y el punto de corte óptimo de PSAc%, > 89.7796, una sensibilidad del 71,43% (IC 95%; 0,616-0,802) y una especificidad del 71,43% (IC 95%; 0,616-0,802). No hubo diferencias significativas al comparar las áreas bajo la curva de ambos marcadores (p = 0,59). El VPP del PSAl% fue menor respecto al PSAc% (45,7% vs 71%). Conclusión: Existe una buena correlación entre el PSAl% y PSAc%. El PSAc% ha demostrado una mayor especificidad y eficacia que el PSAl% en el diagnóstico del cáncer de próstata (AU)

Objective: To compare the behaviour of the PSAcomplex/PSAtotal percentage (PSAc%) against the PSA free/PSA total (PSAl%) and analyse both markers for their usefulness in diagnosing prostate cancer. Material and methods: We measured total PSA (PSAt), free PSA (PSAl), complex PSA (PSAc), PSAl% and PSAc% levels in 158 patients. Of these, 98 (62%) were biopsied for presenting PSAt ≥3 ng/dl and PSAl% < 20, PSAt > 10, suspicious rectal examination or suspicious ultrasound node. We performed linear regression and Passing-Bablok regression analyses. The ROC curves were calculated to study the sensitivity and specificity of PSAl% and PSAc% and were compared to each other. The prostate cancer diagnoses were analysed by PSAl% and PSAc% by applying the χ2 test. Results: The correlation coefficient (r) was good (0.7447, P <0 .0001), and the index of determination (r2) was 0,5. The result of the Passing-Bablok analysis was a slope of 1.658 (1.452 to 1.897) and an intersection of 2.044 (−0,936 to 5.393). The optimal cutoff for PSAl% (≤ 14.7854) showed a sensitivity of 89.29% [95% CI, 0,642-0,823] and a specificity of 54.29% (95% CI, 0,642-0,823). The optimal cutoff for PSAc% (>89.7796) had a sensitivity of 71.43% (95% CI, 0,616-0,802) and a specificity of 71.43% (95% CI, 0,616-0,802). There were no significant differences when comparing the areas under the curve of both markers (P = 0.59). The PPV of PSAl% was less than that of PSAc% (45.7% vs. 71%). Conclusion: There was a good correlation between PSAl% and PSAc%. PSAc% has demonstrated greater specificity and efficacy than PSAl% in the diagnosis of prostate cancer (AU)

Impacto del síndrome de apneas-hipopneas del sueño en los marcadores séricos de isquemia miocárdica / No disponible

Objetivos: Estudiar si el syndrome de apneas-hipopneas del sueño (SAHS) induce estrés miocárdio valorado mediante marcadores séricos. Pacientes y métodos: Estudio (..) (AU)

Patients and methods: Prospective, observational study with consecutive sampling conducted in patients with (..)(AU)

Síndrome de apnea del sueño, catecolaminas y alteración lipídica / Sleep adnea syndrome, catecholamines and lipid desorder

Objetivos: determinar si el síndrome de apneas-hipopneas del sueño (SAHS) incrementa las cifras de catecolaminas y a través de este mecanismo puede alterar el perfil lipídico. Pacientes y métodos: estudio prospectivo, grupo control y muestreo consecutivo de sujetos con sospecha de SAHS. Fueron excluidos aquellos con enfermedad grave de órgano o ingesta de fármacos con efecto sobre la actividad simpática y/o perfil lipídico. Según el índice de apneas-hipopneas (IAH) obtenido en la polisomnografía, los sujetos se asignaron al grupo clínico (IAH >5) o al grupo control (IAH <5). En ambos se compararon las cifras de colesterol total, HDL-c, triglicéridos y noradrenalina urinaria. Resultados: Fueron incluidos 33 en el grupo clínico y 16 en el control sin existir diferencias en edad, género e índice de masa corporal (IMC). En el grupo clínico, la noradrenalina en orina y colesterol total se elevaron significativamente mientras que disminuyeron las del HDL-colesterol. Se observó una correlación significativa entre los valores de la saturación periférica de O2 (SapO2) y la noradrenalina urinaria, aunque la variabilidad de ésta sólo se asoció independientemente con el índice de desaturación y el IMC. También se detectó correlación significativa entre la noradrenalina urinaria y colesterol total, HDL-c y triglicéridos, sin embargo esta correlación desapareció al ajustar por edad, género e IMC. Conclusiones: el SAHS aumenta la actividad simpática nocturna y el índice de desaturación es el factor de mayor influencia. En los pacientes con SAHS se incrementan significativamente las cifras séricas de colesterol total mientras descienden las del HDL-c, aunque estos resultados no fueron explicados de forma independiente por el aumento en la actividad simpática (AU)

Objectives: To determine whether the syndrome sleep apnea-hypopnea syndrome (SAHS) increases catechilamine value and throught this mechanism may alter the lipid profile. (..) (AU)