scholarly journals Risk factors for losing hepatitis B virus surface antibody in patients with HBV surface antigen negative/surface antibody positive serostatus receiving biologic disease-modifying anti-rheumatic drugs: a nested case-control study

2021 ◽  
Vol 61 (1) ◽  
Author(s):  
Ming-Hui Hung ◽  
Ya-Chih Tien ◽  
Ying-Ming Chiu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Surface Antigen ◽  
Risk Ratio ◽  
Hbv Reactivation ◽  
Biologic Dmards ◽  
Adjusted Risk ◽  
Lower Baseline ◽  
Adjusted Risk Ratio

Abstract Background Hepatitis B virus (HBV) reactivation consequent to immunosuppressive therapy is an increasingly prevalent problem with serious clinical implications. Treatment with biologic agents conduces to the loss of protective antibody to HBV surface antigen (anti-HBs), which significantly increases the risk of HBV reactivation. Hence, we investigated the risk factors for losing anti-HBs in patients with rheumatic diseases and HBV surface antigen negative/anti-HBs positive (HBsAg−/anti-HBs+) serostatus during treatment with biologic disease-modifying anti-rheumatic drugs (DMARDs). Methods Using a nested case-control design, we prospectively enrolled patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis/psoriasis, or juvenile idiopathic arthritis, who were treated with biologic DMARDs at Changhua Christian Hospital, Taiwan, from January 2013 to June 2019 and had HBsAg−/anti-HBs+ serostatus; the analytic sample excluded all patients with HBsAg+ or anti-HBs− serostatus. Anti-HBs titers were monitored 6-monthly and cases were defined as anti-HBs < 10 mIU/ml during follow-up. Cases were matched one-to-all with controls with anti-HBs ≥ 10 mIU/ml on the same ascertainment date and equivalent durations of biologic DMARDs treatment (control patients could be resampled and could also become cases during follow-up). Between-group characteristics were compared and risk factors for anti-HBs loss were investigated by conditional logistic regression analyses. Results Among 294 eligible patients, 23 cases were matched with 311 controls. The incidence of anti-HBs loss was ~ 2.7%/person-year during biologic DMARDs treatment. Besides lower baseline anti-HBs titer (risk ratio 0.93, 95% CI 0.89–0.97), cases were significantly more likely than controls to have diabetes mellitus (risk ratio 4.76, 95% CI 1.48–15.30) and chronic kidney disease (risk ratio 14.00, 95% CI 2.22–88.23) in univariate analysis. Risk factors remaining significantly associated with anti-HBs loss in multivariate analysis were lower baseline anti-HBs titer (adjusted risk ratio 0.93, 95% CI 0.88–0.97) and chronic kidney disease (adjusted risk ratio 45.68, 95% CI 2.39–871.5). Conclusions Besides lower baseline anti-HBs titer, chronic kidney disease also strongly predicts future anti-HBs negativity in patients with HBsAg−/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases. Patients with low anti-HBs titer (≤ 100 mIU/ml) and/or chronic kidney disease should be monitored during biologic DMARDs therapy, to enable timely prophylaxis to preempt potential HBV reactivation.

scholarly journals Risk factors associated with loss of hepatitis B virus surface antibody in patients with HBV surface-antigen negative/surface antibody positive serostatus receiving biologic DMARDs to treat rheumatic diseases – a nested case-control study

2019 ◽  
Author(s):  
Ming-Hui Hung ◽  
Ya-Chih Tien ◽  
Ying-Ming Chiu
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Rheumatic Diseases ◽  
Hbv Reactivation ◽  
Biologic Dmards ◽  
Adjusted Risk ◽  
Factors Associated ◽  
Adjusted Risk Ratio ◽  
Surface Antibody

ABSTRACTObjectivesTo elucidate risk factors for loss of hepatitis B virus (HBV) surface antibody (anti-HBs) in patients with rheumatic diseases and HBV surface-antigen negative/anti-HBs positive (HBsAg−/anti-HBs+) serostatus during biologic disease-modifying anti-rheumatic drug (DMARD) treatment.MethodsThis nested case-control study prospectively enrolled patients with rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis/psoriasis, and juvenile idiopathic arthritis, who were treated with biologic DMARDs from January 2013 to September 2017. The analytic sample included patients with HBsAg−/anti-HBs+ serostatus. Anti-HBs titers were monitored, and cases defined as anti-HBs <10 mIU/mL during follow-up. Cases were matched one-to-all with controls with anti-HBs ≥10 mIU/mL on the same event date and equivalent durations of biologic DMARDs treatment. Between-group characteristics were compared and risk factors for anti-HBs loss elucidated by conditional logistic regression analyses.ResultsAmong 189 enrolled patients, 15 cases were matched with 211 controls. Risk factors associated with anti-HBs loss in multivariate analysis were low baseline anti-HBs titer (adjusted risk ratio = 0.96, 95% CI 0.93–0.99) and chronic kidney disease (adjusted risk ratio = 26.25, 95% CI 1.85–372.35). All cases had baseline anti-HBs titer <100 mIU/mL, and none developed HBV reactivation upon losing anti-HBs.ConclusionsIn addition to low baseline anti-HBs titer, chronic kidney disease is also an independent risk factors associated with loss of anti-HBs in patients with HBsAg−/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases.SignificanceGiven that loss of anti-HBs precedes HBV reactivation and that the use of biologic DMARDs is increasingly widespread nowadays, understanding those who are at risk of loss of anti-HBs is an important and practical clinical issue.InnovationIn addition to low baseline anti-HBs titer, chronic kidney disease is also an independent risk factors associated with loss of anti-HBs in patients with HBsAg−/anti-HBs+ serostatus who receive biologic DMARDs to treat rheumatic diseases.

scholarly journals Enteric Pathogen Diversity in Infant Foods in Low-Income Neighborhoods of Kisumu, Kenya

2019 ◽  
Vol 16 (3) ◽  
pp. 506 ◽  
Author(s):  
Kevin Tsai ◽  
Sheillah Simiyu ◽  
Jane Mumma ◽  
Rose Aseyo ◽  
Oliver Cumming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Ratio ◽  
Low Income ◽  
Pathogen Transmission ◽  
Enteric Pathogen ◽  
Infant Food ◽  
Food Hygiene ◽  
Adjusted Risk ◽  
Household Food ◽  
Adjusted Risk Ratio

Pediatric diarrheal disease remains the second most common cause of preventable illness and death among children under the age of five, especially in low and middle-income countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 infant weaning foods in Kisumu, Kenya, using a multi-pathogen PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoan enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow’s milk was significantly more likely to contain a pathogen (adjusted risk ratio = 14.4; 95% confidence interval (CI) 1.78–116.1) and more likely to have higher number of enteric pathogen species (adjusted risk ratio = 2.35; 95% CI 1.67–3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.

scholarly journals Risk factors and knowledge assessment of general public for chronic kidney disease in Taif Region, Saudi Arabia

2020 ◽  
Vol 8 (1) ◽  
pp. 123-143
Author(s):  
Shaheen Sultana ◽  
Rawan Alqurashi ◽  
Thekra Alqarni ◽  
Maram Alnefaie ◽  
Afnan kalakattawi ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Saudi Arabia ◽  
Kidney Disease ◽  
Risk Ratio ◽  
General Public ◽  
Knowledge Assessment ◽  
Poor Knowledge ◽  
History Of

Introduction: Chronic kidney disease (CKD) is a worldwide public health problem since the rapid increasing prevalence of relevant risk factors, like diabetes, hypertension, unhealthy diet, low to no physical activity and metabolic syndrome. The current study aimed at assessing the risk factors and the general public awareness of CKD in Taif region, Saudi Arabia. Method: We conducted a cross-sectional study during the period of September 2019 to March 2020. For risk factors assessment data regarding CKD cases were collected from the department of nephrology at AL-Hada Military hospital in Taif. An online-based questionnaire was distributed to the general public for knowledge assessment of CKD. 6th year pharmacy student at Taif University and nephrologists from the hospital were also invited to answer the questionnaire. Results: The data of 456 CKD patients with 600 non-CKD individuals were compared for assessment of the most common risk factors. 99% of participants were CKD stage III-V patients. The majority, n=371(81.57%), of the participants were >50 years old. N=328(71.93%) had type 2 diabetes mellitus (Risk ratio= 2.32, CI= 2.03-2.65; Odd ratio=5.7, CI= 4.36-7.45), n=396(86.84%) had hypertension (Risk ratio =9.65,CI-7.46-12.48; Odd ratio: 66.73, CI=45.19-98.54) and n=264(57.89%) had a history of heart diseases (Risk ratio= 3.62, CI=2.96-4.42; Odd ratio= 7.22, CI= 5.42-9.62). In CKD groups, 28.07% of them had low physical activity. In contrast with the control group, only 4% had low physical activity level in their daily routine (p<0.00001). In the general public (n=1419), 919 (64.7%) had poor knowledge, 273 (19.22%) had fair knowledge, and 227 respondents (16.01%) had good knowledge of CKD. Conclusion: The finding suggests that age >50 years, low educational attainment, family history of CKD, diabetes, hypertension, history of kidney stone, CVD and high BMI were significantly associated with CKD progression. We also found that the majority of the general public had poor knowledge of CKD compared to pharmacy graduates and nephrologists. These findings warrant the need for the development of awareness initiatives and programs designed to increase the level of knowledge of the general public of CKD.

scholarly journals Enteric Pathogen Diversity in Infant Foods in Low-income Neighborhoods Of Kisumu, Kenya

2018 ◽  
Author(s):  
Kevin Tsai ◽  
Sheillah Simiyu ◽  
Jane Mumma ◽  
Rose Evalyne Aseyo ◽  
Oliver Cumming ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Ratio ◽  
Low Income ◽  
Enteric Pathogen ◽  
Infant Food ◽  
Food Hygiene ◽  
Adjusted Risk ◽  
Infant Foods ◽  
Household Food ◽  
Adjusted Risk Ratio

Pediatric diarrheal disease remains the 2nd most common cause of preventable illness and death among children under the age of five, especially in Low and Middle-Income Countries (LMICs). However, there is limited information regarding the role of food in pathogen transmission due to measuring infant food contaminations in LMICs. For this study, we examined the frequency of enteric pathogen occurrence and co-occurrence in 127 weaning infant foods in Kisumu, Kenya using a multi-pathogen rt-PCR diagnostic tool, and assessed household food hygiene risk factors for contamination. Bacterial, viral, and protozoa enteric pathogen DNA and RNA were detected in 62% of the infant weaning food samples collected, with 37% of foods containing more than one pathogen type. Multivariable generalized linear mixed model analysis indicated type of infant food best explained the presence and diversity of enteric pathogens in infant food, while most household food hygiene risk factors considered in this study were not significantly associated with pathogen contamination. Specifically, cow's milk was significantly more likely to contain a pathogen (adjusted Risk Ratio=14.4; 95% Confidence Interval (CI) 1.78-116.1) and contained 2.35 more types of pathogens (adjusted Risk Ratio=2.35; 95% CI 1.67-3.29) than porridge. Our study demonstrates that infants in this low-income urban setting are frequently exposed to diarrhoeagenic pathogens in food and suggests that interventions are needed to prevent foodborne transmission of pathogens to infants.

Stroke in chronic renal failure

2008 ◽  
Vol 149 (15) ◽  
pp. 691-696
Author(s):  
Dániel Bereczki
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Chronic Renal Disease ◽  
Kidney Diseases ◽  
Cerebrovascular Diseases ◽  
Lipid Lowering ◽  
Increased Risk ◽  
Intracerebral Hemorrhages

Chronic kidney diseases and cardiovascular diseases have several common risk factors like hypertension and diabetes. In chronic renal disease stroke risk is several times higher than in the average population. The combination of classical risk factors and those characteristic of chronic kidney disease might explain this increased risk. Among acute cerebrovascular diseases intracerebral hemorrhages are more frequent than in those with normal kidney function. The outcome of stroke is worse in chronic kidney disease. The treatment of stroke (thrombolysis, antiplatelet and anticoagulant treatment, statins, etc.) is an area of clinical research in this patient group. There are no reliable data on the application of thrombolysis in acute stroke in patients with chronic renal disease. Aspirin might be administered. Carefulness, individual considerations and lower doses might be appropriate when using other treatments. The condition of the kidney as well as other associated diseases should be considered during administration of antihypertensive and lipid lowering medications.

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