Hepatitis C virus (HCV) infection and cryoglobulinemia: analysis of whole blood and plasma HCV-RNA concentrations and correlation with liver histology.

The influence of cryoprecipitate (CP) on liver histology and peripheral titers of hepatitis C virus (HCV) RNA was evaluated for 115 patients with chronic hepatitis. Fifty-four patients had measurable CP levels whereas 61 did not. Assessment of liver biopsies for grade of fibrosis revealed that patients with CP had increased fibrosis (P <.001) and incidence of cirrhosis (P =.001) compared with those without CP. In contrast, there was not a significant difference in the inflammatory activity score between the 2 groups. HCV RNA in whole blood (WB) and plasma (Pl) was evaluated in patients with or without CP by end-point-limiting dilution titer. Among patients with CP, WB titers were significantly higher than Pl titers (P <.001); however, there was no difference in WB or Pl titers in patients without CP (P =.068). Histological activity and fibrosis scores of patients from either group were compared with peripheral viral titers of WB and Pl, percentage of CP, rheumatoid factor (RF) titer, and serum alanine transaminase (ALT). There were significant correlations between the amount of fibrosis and the percentage of CP and rheumatoid factor titer, yet neither of the latter parameters was correlated with inflammatory activity. These data suggest that patients with CP and chronic hepatitis owing to HCV are more likely to have progressive disease than patients without CP. Furthermore, the presence of CP in patients infected with HCV appears to influence the amount of virus detected in patient Pl, suggesting that WB assays may be more reliable for HCV-RNA quantitation in patients with CP.

Effect of interferon therapy on hepatitis C virus RNA in whole blood, plasma, and peripheral blood mononuclear cells.

Fifty-two patients with chronic hepatitis C virus (HCV) infection were treated with standard doses of interferon alfa-2b. During treatment, HCV RNA detection was studied in samples of whole blood (WB), plasma (Pl), and peripheral blood mononuclear cells (PBMCs). Individuals were classified as sustained responders (SRs), complete responders with relapse (CRs), partial responders (PRs), or nonresponders (NRs) according to normalization of serum alanine transaminase (ALT) during treatment and follow-up. Before treatment, 100% of WB samples and more than 95% of Pl and PBMC samples were positive for HCV RNA. During treatment, there was progressive clearance of HCV RNA from Pl and PBMCs in SRs and CRs, but CRs had significantly more positive WB samples during and following treatment (P <.0001). At 6 months, only 10% of CR patients were positive by Pl assay, but 50% were positive by WB assay (P <.01). In the PR group, all WB samples remained positive throughout treatment, although 25% to 40% of PBMC and Pl samples became negative for HCV RNA during the first 2 months of therapy (WB > Pl or PBMC; P < .001). However, at later times during treatment most Pl and PBMC samples in the PR group were positive. Samples from the NR group showed no clearance of HCV RNA from WB, Pl, or PBMC fractions. These data document the increased sensitivity of WB assays for detecting HCV RNA in the peripheral blood of patients during interferon therapy. Furthermore, our findings suggest that WB analysis of HCV RNA may be a useful parameter to monitor in determining the end point of interferon therapy.

Role of serum prolactin determination in evaluation of impotent patient.

Hyperprolactinemia is a recognized cause of impotence. The discovery of elevated prolactin levels in impotent men is very important since pharmacotherapy in this instance is highly successful. We review our experience with prolactin determinations in impotent men, and a population is defined that may benefit from routine prolactin determination. In our experience, the predominant symptom associated with hyperprolactinemia in men is loss of libido.

The role of the physician in identifying and treating abused women.

The physician can identify abuse when probable or suspicious symptoms are presented. Interviewing and assessment techniques that help the patient disclose her abuse and make positive use of referral sources are discussed and illustrated. Identification of the abuse is the first step for most victims as they struggle toward social and psychological rehabilitation.

Support groups and other supportive efforts in residency programs.

Support groups and various other supportive efforts have been reported to be a positive factor in the management of stress. In the present paper, the author reviews medical residency programs that offer support groups and have taken other steps in support of the residents' adjustment. The author suggests that residency programs might offer residents support groups that are flexible and convenient and might provide other psychological and social support. Support can be institutionalized through the provision of advisers, individual and marital counseling, and recognition of the importance of residents' emotional health and development.

Round robin investigation of methods for recovering human enteric viruses from sludge.

To select a tentative standard method for detection of viruses in sludge the American Society for Testing and Materials D19:24:04:04 Subcommittee Task Group initiated round robin comparative testing of two procedures that, after initial screening of several methodologies, were found to meet the basic criteria considered essential by the task group. Eight task group member laboratories agreed to perform round robin testing of the two candidate methods, namely, The Environmental Protection Agency or low pH-AlCl3 method and the Glass or sonication-extraction method. Five different types of sludge were tested. For each particular type of sludge, a single laboratory was designated to collect the sludge in a single sampling, make samples, and ship it to the participating laboratories. In most cases, participating laboratories completed all the tests within 48 h of sample arrival. To establish the reproducibility of the methods, each laboratory tested each sludge sample in triplicate for the two candidate virus methods. Each processed sludge sample was quantitatively assayed for viruses by the procedures of each individual round robin laboratory. To attain a more uniform standard of comparison, a sample of each processed sample from all laboratories was reassayed with one cell line and passage number by a single laboratory (Environmental Protection Agency Environmental Monitoring and Support Laboratory, Cincinnati, Ohio). When the data were statistically analyzed, the Environmental Protection Agency method was found to yield slightly higher virus recoveries for all sludge types, except the dewatered sludge. The precisions of both methods were not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

Inactivation of indigenous viruses in raw sludge by air drying.

Air drying of raw sludge caused inactivation of indigenous viruses. A gradual loss of infectivity occurred with the loss of water until the solids content reached about 80%. A more rapid decline of viral infectivity occurred with further dewatering.

Comparison of methods for recovering indigenous viruses from raw wastewater sludge.

Five general methods for recovering indigenous viruses from raw wastewater sludge were compared. Each method included elution, concentration, and disinfection steps. The elution method, found to consistently yield the greatest viral recovery, was a two-phase technique that involved blending sludge with Freon. Other methods, including two being tested as American Society for Testing Materials tentative standard methods, were less effective. Viral recoveries were generally greater (sometimes much greater) if samples were concentrated by high-speed centrifugation rather than by organic flocculation with 3% beef extract. Three cell lines were used to measure viral recoveries by the plaque assay. The efficiency of recovery was greatest on BGM cells, followed by RD and MA-104 cells.

Virus in water. I. A preliminary study on a flow-through gauze sampler for recovering virus from waters.

A preliminary study was carried out on evaluating a flow-through gauze sampler for its efficiency in recovering virus from both fresh and seawater. An attenuated type 1 poliovirus was used as the working model. When tap water was sampled, the amounts of virus adsorbed by the gauze pads were very small, about 2% of the total number of virus particles flowing through the device. The virus adsorption and recovery increased to 15 to 19% when seawater was sampled. Addition of NaCl to tap water produced a much better effect on virus adsorption and recovery by this device, i.e., 47% of the total virus particles in each sample. The best viral elution from the pads was obtained by using buffer solution of pH 8.0 to 9.0 containing a small amount of animal serum. Repeated elutions from the pads were necessary to recover the most virus although the first eluate contained approximately 50% of the adsorbed virus. Further development of this device appears warranted, because of (i) the simplicity of the procedure, (ii) its capability of sampling large volume of water, (iii) the low cost of collecting samples, and (iv) the feasibility of obtaining a rough quantitative assessment of viral pollutants in water examined.

Viral depuration by assaying individual shellfish.

A study was carried out to further evaluate the practicability of viral depuration by assaying individual shellfish. The Northern quahaug and a strain of the type 1 attenuated poliovirus were used as the working model. Two types of depuration systems were employed: the small experimental tanks and a pilot-size tank with a capacity of approximately 24 bushels (836 liters) of shellfish. Volumes of the individual shellfish samples were found uniform throughout the experiments when a prior selection for the weight of the shellfish was made. There was also no significant difference in volumes of the individual samples during the course of depuration (24 to 96 hr). Under controlled hydrographic conditions, however, the uptake of virus in individual shellfish varied considerably. In general, the individual variability reached 10- to 100-fold. This wide variation would explain the variability of viral contents obtained in pooled samples during depuration as reported previously. During a later phase of depuration, although a great majority of shellfish were free of the virus, a few still harbored minimal amounts of contaminants. The presence of virus in some of the shellfish after various periods of depuration would, theoretically, be obscured by the pooling of the sampled shellfish. Further examination of the negative samples by assaying larger quantities than those routinely used revealed that a few still contained virus. To simulate naturally polluted shellfish as closely as technically possible, shellfish were polluted with minimal amounts of virus. The shellfish were cleansed more rapidly by the depuration process than were those polluted with more virus. Since the naturally polluted shellfish were shown to contain less virus than those studied in the laboratory, it is anticipated that the former type of shellfish may be cleansed more readily by this process within a reasonable period of time. Justification for a field trial of depuration in this country is presented.