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BMJ No 7104 Volume 315 Papers - Abstracts Saturday 9 August 1997
Systematic review of role of polymerase chain reaction in
defining infectiousness among people infected with hepatitis C virus
Systematic review of role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virusGregory J Dore, John M Kaldor, Geoffrey W McCaughan
AbstractObjective: To assess the role of polymerase chain reaction in defining infectiousness among people infected with hepatitis C virus.Design: Published studies of hepatitis C transmission were examined. Twenty nine studies with identified sources of hepatitis C infection who were tested for presence of hepatitis C RNA by polymerase chain reaction were reviewed, including studies of vertical transmission (n=21), transmission after transplantation (n=3), transfusion of blood components (n=3), and needlestick exposure (n=2). Subjects: All patients identified in studies. Results: A total of 2,022 people who had been exposed to sources positive for antibody to hepatitis C were identified. Among 1,148 people exposed to sources positive by polymerase chain reaction 148 cases of transmission occurred compared with no definite case among 874 people exposed to negative sources. Rates of transmission from positive sources were 6.2% for perinatal exposure, 6.1% after needlestick exposure, 78% after solid organ or bone marrow transplantation, and 83% after transfusion of blood components. Other factors influencing risk of vertical transmission were coinfection with HIV and level of hepatitis C viraemia. Conclusions: Negative results by polymerase chain reaction indicate an extremely low probability of transmission of hepatitis C from a person with antibody to hepatitis C. National
Centre in HIV Epidemiology and Clinical Research, The AW Morrow Gastroenterology and
Liver Centre, Correspondence to: Dr Dore.
Evaluation of validity of British anthropometric reference data for assessing nutritional state of elderly people in Edinburgh: cross sectional studyElaine Bannerman, J J Reilly, W J MacLennan, T Kirk, F Pender AbstractObjectives: To evaluate the appropriateness of two sets of commonly used anthropometric reference data for nutritional assessment of elderly people.Design: Cross sectional study. Setting: Two general practices in Edinburgh. Subjects: 200 independently living men and women aged 75 or over randomly recruited from the age and sex register of the practices. Main outcome measures: Weight (kg), knee height (cm), demispan (cm), mid-upper arm circumference (cm), triceps skinfold thickness (mm), arm muscle circumference (cm) body mass index (kg/m2), and demiquet (kg/m2) in men and mindex (kg/m) in women. Results: Men and women in Edinburgh were significantly shorter than those in measured for the Nottingham reference data (demispan 0.79 v 0.80 (P<0.05) for men and 0.72 v 0.73 (P<0.01) for women). Comparison with data from South Wales showed that men and women from Edinburgh had significantly greater mid-upper arm circumference, triceps skinfold thickness, and arm muscle circumference. No one fell below the 10th centile of the South Wales data (the commonly used cut off point for determining malnutrition) for these measures. Conclusions: Both sets of reference data commonly used in Britain may be inappropriate for nutritional screening of elderly people in Edinburgh. Contemporary reference data appropriate for the whole of Britain need to be developed, and in the longer term biologically or clinically defined criteria for undernutrition should be established. Department of Dietetics and Nutrition, Department of Human Nutrition, Geriatric Medicine Unit, Correspondence to: Miss E Bannerman
Gastrointestinal Unit,
Reduced final height and indications for insulin resistance in 20 year olds born small for gestational age: regional cohort studyJuliane Leger, Claire Levy-Marchal, Juliette Bloch, Agnes Pinet, Didier Chevenne, Dominique Porquet, Dominique Collin, Paul Czernichow AbstractObjective: To investigate whether the association between low birth weight and increased risk of developing impaired glucose tolerance, insulin resistance, hypertriglyceridaemia, and hypertension in middle age is apparent by the age of 20 in people born small for gestational age.Design: Regional cohort study. Setting: Maternity registry, Haguenau, France. Subjects: 236 full term singleton babies born small for gestational age (birth weight or length, or both, below third centile) during 1971-8 and 281 with normal birth weight (between 25th and 75th centile). All subjects were contacted and evaluated at a mean (SD) age of 20.6 (2.1) years. Main outcome measures: Adult height; concentrations of glucose, insulin, and proinsulin during an oral glucose tolerance test; lipid and fibrinogen concentrations; and blood pressure. Results: After sex and target height were adjusted for, subjects who had been born small for gestational age were significantly shorter at age 20 than those with a normal birth weight (men 4.5 cm shorter (95% confidence interval 6.0 to 3.0 cm); women 3.94 cm shorter (5.2 to 2.7 cm )). After sex and body mass index were adjusted for, mean plasma glucose concentration 30 minutes after a glucose load, fasting insulin concentration (in women), and insulin and proinsulin concentrations 30 and 120 minutes after a glucose load were significantly higher in subjects who had been born small for gestational age than in those with a normal birth weight. Mean lipid and fibrinogen concentrations and blood pressure were not different between the two groups. Conclusions: Intrauterine growth retardation has long term consequences such as reduced final height. Raised insulin and proinsulin concentrations are present in young adults born small for gestational age and could be markers of early changes in insulin sensitivity. Paediatric Endocrinology and Diabetes
Unit and INSERM CJF 93-13, Department of
Biochemistry, Maternity Unit, Correspondence to: Dr Leger.
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