ACP/CDC new recommendations on hepatitis B screening and vaccination

ACP/CDC new recommendations on hepatitis B screening and vaccination

The American College of Physicians (ACP) and the Centers for Disease Control and Prevention (CDC) have jointly issued new recommendations for care of patients with hepatitis B including screening and vaccination with an aim to reduce chronic hepatitis B infections by screening at-risk adults, increasing hepatitis B vaccination rates, and linking infected persons to care.

Published November 21, 2017 in the Annals of Internal Medicine, the best practice statements are as follows:

·         Hepatitis B vaccination is the most effective measure to prevent Hepatitis B infection and its complications. All unvaccinated adults, including pregnant women, at risk for infection due to sexual, percutaneous, or mucosal exposure should be vaccinated against HBV. Other high risk groups including health care and public safety workers at risk for blood exposure; adults with chronic liver disease, end-stage renal disease (including hemodialysis patients), or HIV infection; travelers to HBV-endemic regions; and adults seeking protection from HBV infection should also be advised vaccination.

·         Clinicians should screen (hepatitis B surface antigen, antibody to hepatitis B core antigen, and antibody to hepatitis B surface antigen) for HBV in high-risk persons, including persons born in countries with 2% or higher HBV prevalence, men who have sex with men, persons who inject drugs, HIV-positive persons, household and sexual contacts of HBV-infected persons, persons requiring immunosuppressive therapy, persons with end-stage renal disease (including hemodialysis patients), blood and tissue donors, persons infected with hepatitis C virus, persons with elevated alanine aminotransferase levels (≥19 IU/L for women and
≥30 IU/L for men), incarcerated persons, pregnant women, and infants born to HBV-infected mothers.

·         All HBsAg-positive patients should be referred for or provided posttest counseling and hepatitis B–directed care

(Source: Annals of Internal Medicine, November 20, 2017)

Universal screening for alcohol misuse at hospitalization is a feasible strategy

Universal screening for alcohol misuse at hospitalization is a feasible strategy A study published online July 27, 2017 in the Journal of Hepatology has demonstrated that universal screening for alcohol misuse at the time of hospitalization to identify patients at risk of developing alcohol-related liver disease, is a feasible strategy. Researchers from the UK screened all admissions to the Acute Medical Unit of a large acute hospital using an electronic data capture system. At the time of admission, information about the amount of alcohol consumed, previous visits and or admissions and whether they were alcohol-related was recorded. Around 91% patients completed the screening; of these, around 3% of the patients were grouped as “increasing”, and 4% as “high” risk of alcohol harm. The high risk group had more frequent emergency room (ER) visits and higher re-admission rates; gastrointestinal bleeding, mental health disorders, poisoning and liver disease were the most common diagnoses for hospitalization. What this study showed was that it is possible to screen patients for alcohol misuse at hospitalization, identify patients with a very high unit consumption and then to refer them for appropriate intervention, potentially reducing the burden of alcohol-related harm. While, lower risk patients can be given brief advice by any trained healthcare professional This study assumes all the more importance because alcohol misuse is a major cause of preventable death. It also offers a solution to the unmet need to identify patients with alcohol-related liver disease at an earlier stage. According to the WHO, 3.3 million deaths (~6% of all deaths) globally every year are due to alcohol-related harm. It is all the more worrisome because alcohol consumption causes death and disability relatively early in life, particularly in the younger age group. Alcohol has been linked to many noncommunicable diseases, including alcohol-related liver disease and injuries. Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs). Source 1. Westwood G, et al. Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease. Journal of Hepatology, published 27 July 2017. Dr KK Aggarwal National President IMA & HCFI

A novel screening tool to diagnose silent MI in type 2 diabetes

A novel screening tool to diagnose silent MI in type 2 diabetes Researchers from the UK have devised a novel and practical 4-component screening tool to diagnose silent myocardial infarction (MI) in patients with type 2 diabetes, which had significantly superior diagnostic accuracy than current ECG criteria to detect silent MI in asymptomatic patients. The test had an 82% sensitivity and 72% specificity for silent MI. The study included 100 patients with type 2 diabetes who had no history of known heart disease and were asymptomatic. These patients underwent electrocardiogram (ECG), echocardiography, biomarker assessment and cardiac MRI including assessment of left ventricular ejection fraction (LVEF) and late gadolinium enhancement. The four parameters included in the screening tool were age, E/A ratio, GLS and NT-proBNP. The optimum cutoff measures for these components were: Age ≥62 years, E/A ratio ≤0.7, global longitudinal strain (GLS) of at least 18.4% and NT-proBNP > 29 ng/L. Seventeen patients with no history of heart disease had silent MI defined by late gadolinium enhancement in an infarct pattern on cardiac MRI. Only four patients with silent MI had Q waves on ECG. All patients who scored 0 or 1 were free of MI. Of the 16 patients who scored 4, seven had experienced a silent MI and nine had not. Patients with silent MI were older, had lower E/A ratio, lower GLS and higher amino-terminal pro brain natriuretic peptide levels. The findings of the study were presented at the European Association for the Study of Diabetes (EASD) 2016 Annual Meeting in Munich, Germany.