The “New & Interesting” series is a biweekly compilation of select research findings, news articles, and random tidbits in bullet-point format. The entries are highly abbreviated, but provide links to the original articles or abstracts if you desire to read further.

General Articles

• The Sun Herald reports on how cardiologists in Mississippi have been using the iPhone to diagnose patients more quickly through more rapid access to EKGs and other medical information (Sun Herald)

• The presence of an infection at the time of gluten introduction in childhood is not a major risk factor for celiac disease (Pediatrics)

Technical Articles

• Updated 2009 guidelines on the diagnosis, prevention, and treatment of catheter-associated urinary tract infections. This was published by the Infectious Diseases Society of America (IDSA). (Clin Infect Dis)

• A meta-analysis of randomized statin trials revealed a 9% increased risk of diabetes with statin use. The study authors nevertheless add that “the risk is low both in absolute terms and when compared with the reduction in coronary events. Clinical practice in patients with moderate or high cardiovascular risk or existing cardiovascular disease should not change.” (Lancet)

• Successful development of human liver chimeric mouse model for the study of HBV and HCV infections (J Clin Invest)

• Eradication of H pylori may help treat gastric low-grade, B-cell, mucosa-associated lymphoid tissue (MALT) lymphoma (Clin Gastroenterol Hepatol)

Statins (HMG CoA reductase inhibitors) have traditionally been prescribed for the treatment of hypercholesterolemia, but the landmark JUPITER trial revealed other cardiovascular benefits of their use even in patients with low LDL. I also recently wrote an blog article about a published sub-analysis of the JUPITER data demonstrating that rosuvastatin decreases the risk of symptomatic venous thromboembolism.

Read more … »

The “New and Interesting” series features short compilations of select research findings, news articles, and random tidbits in bullet-point format.

• Housing homeless adults with chronic medical conditions shortens hospital stays and reduces ED visits (JAMA)

• Hypothyroidism linked to HCC (hepatocellular carcinoma) (Hepatology)

• High serum folate levels associated with lower risk of atopy and wheeze (Journal of Allergy and Clinical Immunology)

• Chronic kidney disease is a risk factor for hypoglycemia, with or without diabetes (Clinical Journal of the American Society of Nephrology)

A Turkish study, published in the British Journal of Sports Medicine, recently reported the presence of occult hepatitis B virus (HBV) infection in 13% of Turkish Olympic wrestlers. Occult HBV infection is the detectable presence of virus through PCR (polymerase chain reaction), despite the lack of a viral protein called HBsAg (hepatitis B surface antigen) in the blood. The current standard for evaluating hepatitis B infection or immunity relies on measuring hepatitis antibody and antigen markers. By definition, the standard tests used in hospitals did not reveal hepatitis B in these wrestlers even though they were infected. Interestingly, 11% of the wrestlers also secreted HBV in their sweat.

Several studies estimate the HBsAg positivity (indicator for acute or chronic hepatitis B) to be roughly 7% in Turkey. This figure is less than the prevalence of occult HBV found in the wrestlers. For comparison, low-risk regions, such as the United States and Western Europe, have an HBV prevalence of <2%.

Although more studies are needed, it is interesting to speculate the significance of the recent findings. For one, there may be a higher prevalence of hepatitis B infection than earlier believed. It is not standard of care to test individuals for HBV DNA. The occult HBV category may comprise a large yet underdiagnosed group. On the other hand, by nature of their profession, wrestlers sweat copiously and engage in prolonged bodily contact. Their increased risk for exposure could have contributed to the increased prevalence in this population.

Hepatitis B possesses several modes of transmission: maternal-fetal, mucous membranes, exposure to blood via needlestick injuries or contaminated transfusions, and transplantation. Excessive bodily contact has been suggested before as a form of transmission, particularly in children, but the data are unclear. With the finding of HBV DNA in the sweat, we wonder whether this supports transmission through bodily contact and fomites. Should we be concerned about it? Our knowledge in this area of study is still superficial. I am only aware of a few groups engaged in epidemiologic and laboratory-based research of occult HBV. It is nevertheless possible that wrestlers in endemic areas may someday need to get vaccinated prior to participation in sports.

• Sources
• Bereket-Yücel S. Risk of hepatitis B infections in Olympic wrestling. Br J Sports Med 2007.
• Maynard JE. Hepatitis B: global importance and need for control. Vaccine 1990;8 Suppl:S18-20.
• Mehmet D, Meliksah E, Serif Y, Gunay S, Tuncer O, Zeynep S. Prevalence of hepatitis B infection in the southeastern region of Turkey: comparison of risk factors for HBV infection in rural and urban areas. Jpn J Infect Dis 2005;58:15-9.

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