Renal grafts from anti-hepatitis B core-positive donors: a quantitative review of the literature.

BACKGROUNDS AND AIMS: Organ shortage is a major problem in transplantation. The use of organs from hepatitis B surface antigen (HBsAg)-negative and hepatitis B core antibody (HBcAb)-positive donors could significantly increase the donor pool. However, little information is available about the impact of HBcAb status of renal donors on viral transmission to recipients. To address this issue, the present quantitative review of relevant studies has been performed. MATERIALS AND METHODS: Electronic databases including Medline, EMBASE, ISI, and Scopus were systematically searched for studies that evaluated risk of hepatitis B virus (HBV) transmission through renal transplantation from HBsAg-/HBcAb+ donors. Eligible studies were identified according to predefined criteria. The final outcome was one of HBV markers seroconversion defined as HBsAg, hepatitis B surface antibody (HBsAb), or HBcAb detection in previously seronegative end-stage renal disease (ESRD) patients after transplantation, and without other identified major sources of infection. RESULTS: Nine studies with 1385 eligible kidney recipients were included. In total, 45 subjects showed seroconversion of HBV markers as follows: HBsAg (n = 4) (0.28%; 95% confidence interval [CI] 0.006; 0.57), HBcAb (n = 32), HBsAb (n = 5), and either HBcAb or HBsAb (n = 4). The total rate of seroconversion after renal transplantation was calculated to be 3.24% (95% CI: 2.31-4.18). CONCLUSION: Our review indicates that the risk of HBV transmission from HBcAb-positive kidney donors is extremely low. Therefore, kidneys from these donors can be transplanted safely into ESRD patients.

Halothane: how should it be used in a developing country?

The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics.

Halothane: How should it be used in a developing country?

The anaesthetic agent halothane is still widely used in developing countries including the Islamic Republic of Iran because of its low price. Because of halothane-induced hepatitis, a rare complication, it has been replaced by other inhalation anaesthetics in Western countries; it has been suggested by some Iranian professionals that the Islamic Republic of Iran should do the same. We evaluated various dimensions of this replacement through a literature review to assess the incidence of halothane-induced hepatitis and costs of anaesthetics in the country. We also conducted a questionnaire survey of 30 anaesthesiology/gastroenterology experts about their views on the subject. The results indicate that the incidence of halothane hepatitis in the Islamic Republic of Iran is very low and could mostly be avoided by strict adherence to guidelines. Complete withdrawal of halothane in the Islamic Republic of Iran might not be appropriate at present. Comprehensive cost-effectiveness studies are needed before a decision is made on complete replacement of halothane with other anaesthetics

Knowledge, attitudes, and influenza vaccination of medical students in Warsaw, Strasbourg, and Teheran.

OBJECTIVE: Influenza vaccinations are recommended for health professionals by the WHO and the CDC. Medical students are important health professionals not only as future physicians, but also due to their frequent contact with patients during their education. The aim of this study was to compare the knowledge, attitudes, motivations and influenza vaccinations of medicine students in three different countries: Poland, France, and Iran. MATERIAL AND METHODS: 1045 self-reported questionnaires were given to medical students of Warsaw Medical University (n = 502), the Faculty of Medicine of Strasbourg University (n = 371) and Teheran University of Medical Sciences (n = 172). In France, students working in a hospital can be vaccinated free of charge. In Poland and Iran students are required to pay for the vaccine and have to arrange the administration of the vaccine on their own. RESULTS: Vaccination of students during the year of the study time was generally infrequent: the highest was in Strasbourg 29.7%; it was lower in Warsaw 15.2%, and lowest in Teheran at 4.7%. Similarly, 60% of medical students in Strasbourg, 65% of students in Warsaw and 86% of students in Teheran have never been vaccinated. The percentage of students knowing that they belong to the group of people that have strong indications for being vaccinated was 78% in Strasbourg, 48% in Warsaw and 40% in Teheran. The main reasons for obtaining a shot, cited by students, were to protect from influenza and the fear of disease sequelae. The most important reasons for not being vaccinated were laziness, lack of time, and also lack of knowledge of the indications in favor of being vaccinated. Being vaccinated at least once in the past is the most important predictor of the vaccination in the current season. CONCLUSIONS: Few medical students in all of the examined countries are immunized against influenza. Data indicate that providing access to free vaccinations, although very important, cannot alone solve the problem. Strengthening educational efforts seems crucial, although no immediate effects should be expected due to remarkable inertia. Influencing attitudes at an earlier stage can be more advantageous.

Hepatitis B virus infection in dentistry: a forgotten topic.

More than two billion people have been infected with hepatitis B virus (HBV). Globally, 350-400 million suffer from chronic HBV infection. It is postulated that dentists and dental staff are infected and transmit the virus to their patients more than any other occupation. The aim of this article is to review the HBV incidence in dental society, the points of view of dentists and their patients regarding transmission of the virus during dental procedures, the occurrence of HBV outbreaks in dental clinics and the importance of methods of preventing HBV infection in dentistry.

Increasing resistance to nalidixic acid in Shigella subgroups in a comparative study between 2001-2003 and 2004-2006.

INTRODUCTION: The Shigella spp. is an organism with an ongoing changing resistance pattern to different antibiotics, thus making its appropriate treatment difficult. Nalidixic acid has been one of the most common agents used for the treatment of shigellosis. Recently, some studies have reported an emerging resistance to this agent. METHODS: In this study, we compared the resistance of Shigella isolates during the period 2001-2003 with the period 2004-2006. RESULTS: Shigella spp. resistance was increased totally and in each subgroup, except for Shigella sonnei. CONCLUSION: Our results showed an increasing resistance of the Shigella spp., thus identifying an emergent need for an alternative agent for the treatment of shigellosis in future.