HCV Diseases Research Articles

A retrospective study of prevalance of hepatitis B and hepatitis C virus infections in hemodialysis patients in teritary care hospital Jamnagar

Patients getting upkeep hemodialysis (HD) are at higher gamble for gaining Hepatitis B infection (HBV) and Hepatitis C infection (HCV) diseases than everybody. Thus, we meant to examine the occurrence and predominance of HBV and HCV contamination in the HD populace in a tertiary consideration clinic Jamnagar.All grown-up patients getting support HD (n=1667)were read up for quite some time (2019 and 2020). Testing for Hepatitis B surface antigen (HBsAg) and hostile to HCV antibodies was performed at commencement of dialysis and each 3-6 months from that point. A review was done in view of information of serological testing of all CKD Patients.The middle period of patients was 60 years and 65% were male.1667 patients were concentrated on in which sero positive for HBV (0.83%) and HCV (hostile to HCV 2.57%). The predominance of HBV+HCV contamination differed broadly between HD focuses from 0% to 65.7% sero-positive patients were more youthful, made some more extended memories on dialysis and more past blood bondings. Imminent subsequent uncovered a rate of sero transformation of 0.35% during 1 year. Span of dialysis, more youthful age, and history of getting HD in one more place were altogether connected with sero-change.Patients on upkeep HD in tertiary consideration medical clinic, Jamnagar have a high frequency and predominance of HCV disease and lower paces of HBV contamination. The elements related with HBV and HCV diseases are exceptionally reminiscent of nosocomial transmission inside HD units. As end, we thus require sufficient improvement in contamination control estimates in Hemodialysis units in order to lessen reliance on blood bondings for the treatment of paleness.

COVID-19 AND THE THYROID FUNCTION IN PATIENTS WITH HCV- ASSOCIATED HEPATOCELLULAR CARCINOMA.

COVID-19 is more than a respiratory infection, with deep implications regarding multiple systems and organs. Thyroid damage is frequent in COVID-19 and may overlap previous HCV or HCC associated diseases. The objective of this study is to determine the effects of COVID-19 in patients with HCV associated HCC and thyroid comorbidities. We performed a retrospective study of the thyroid function tests and autoantibodies in patients with HCV-associated HCC prior and during COVID-19. We included 52 consecutive patients with HCV-associated HCC and documented thyroid disease, diagnosed with COVID -19 between April and October 2020. Serum values of thyroid-stimulating hormone, free T3, free T4, anti-thyroglobulin antibodies and anti-thyroid peroxydase antibodies were determined and compared to baseline levels. At baseline, 44 patients had positive antithyroid antibodies, 6 had hypothyroidism in substitution and 2 had hyperthyroidism under treatment. During COVID-19 we found an increase in serum values of antithyroid antibodies, and decreased levels of TSH, freeT3 and freeT4 levels. Specific therapies were discontinued in one patient with hyperthyroidism and 3 patients with hypothyroidism. There is a significant impact of COVID-19 on the thyroid homeostasis; a long-term prognostic value for patients with HCC infected with COVID-19 required further extensive research.

Rapid improvement of psychiatric stigmata after IFN-free treatment in HCV patients with and without cryoglobulinemic vasculitis

ObjectiveHepatitis C virus (HCV) causes neuropsychiatric disorders and quality of life impairment, especially in patients with cryoglobulinemic vasculitis (CV). Direct acting antivirals (DAAs) are effective in most extrahepatic HCV diseases, but limited information exists regarding the outcome of psychiatric disorders in patients with and without CV, after therapy. We aimed to evaluate psychiatric outcomes, in HCV-patients with and without CV, before and after successful DAA therapy.MethodsWe prospectively studied DAA-treated HCV-patients, stratified into presence (CV) or absence of CV (NON-CV). Four psychometric scales were administered to assess depression (HAM-D and MADRS), anxiety (HAM-A), and mania (MRS). Short-Form-36 questionnaires evaluated quality of life.ResultsSeventy-six patients were recruited, and 47 CV and 29 NON-CV were treated with antivirals. At baseline, depression and anxiety, from mild to severe, were frequently shown, with the most advanced cases in thee CV group; no patients achieved the scores for mania. A significant improvement emerged for all the psychometric scales in the entire population and in the subgroups, after viral eradication even in the short-term outcome. The Short-Form-36 summary components showed benefits.ConclusionsAfter HCV eradication, the depression and anxiety scores significantly improved and severity grade generally lowered. DAA-positive effects on mental disorders should be considered part of the therapy outcome, being beneficial especially in CV patients who usually have worse baseline mental scores.Key Points• HCV frequently causes psychiatric disorders and an often-invalidating autoimmune/lymphoproliferative disease called cryoglobulinemic vasculitis.• The new direct acting antivirals (DAAs) are very effective and well tolerated by HCV-patients.• This study shows DAA-induced benefits on depression and anxiety in HCV-patients that are especially evident in CV patients who usually have worse baseline mental scores.• DAA-induced benefits are observed in the short-term post-therapy follow-up, in contrast with data previously obtained in HCV patients treated with IFN-based anti-HCV therapy.

COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies.

COVID-19 vulnerability among people who use drugs: recommendations for global public health programmes and policies.

The U. S. Department of Veterans Affairs (VA) as a model for stronger public health infrastructure to combat HCV and other infectious diseases and reduce disparities

The U. S. Department of Veterans Affairs (VA) as a model for stronger public health infrastructure to combat HCV and other infectious diseases and reduce disparities

1057 National Demographic and Economic Trends of Primary Malignant Liver Neoplasms in the United States From 2000-2015

INTRODUCTION: Primary malignant liver neoplasms involve tumors arising from hepatocytes and biliary epithelium. Risk factors include host factors, co-morbid diseases, and environmental exposures. The purpose of this study is to analyze trends in demographics, mortality, inpatient costs, and risk factors. METHODS: The Nationwide Inpatient Sample (NIS) database generated from the Healthcare Cost and Utilization Project was used to obtain a subset of discharge level data obtained from every 3 years from 2000 to Q3 2015. All cases with primary ICD-9 diagnosis code of primary malignant liver neoplasm were identified. Analysis included patient and hospital demographics, total inpatient cost, inpatient mortality, and the presence of secondary diagnoses for known risk factors of hepatocellular carcinoma (chronic viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver diseases (NAFLD). RESULTS: A total of 79,200 discharges were recorded between 2000 and 2015. There was an initial 24.1% increase in prevalence between 2000 and 2009 (9949 to 16266 cases), with a subsequent plateau across 2012 and 2015. There was a consistent male predominance (approximate ratio of 2.4 to 1). While the majority of patients across all years were between the ages of 45-84, there were fewer cases of 18-44 year olds from 2000 to 2015. Rates have increased in Caucasian, African-American, and Hispanic populations, with regional predominance in the South. There was a concurrent increase in secondary diagnoses of chronic HCV and non-alcoholic liver diseases (59.1% and 49.4% relative increase from 2000 to 2015 respectively). Despite a reduction of in-hospital mortality, total charges per annum increased from $25,306 in 2000 to an extrapolated $100,581 in 2015. CONCLUSION: This study highlights the increasing burden of primary liver neoplasms in the United States. Despite reduction of in-hospital mortality, the annual cost has increased significantly. Further studies are required to elucidate factors contributing to increasing charges, and regional and racial variation. Future strategies should focus on the effect of risk factor reduction such as early detection and treatment of viral hepatitis and NAFLD.

Bile ductular reactions in the liver: similarities are only skin deep.

Extensive bile ductular reactions (DRs) accompany many cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis (PSC) as well as parenchymal liver cell diseases such as alcoholic liver disease, non-alcoholic steatohepatitis and HCV and HBV infections. DRs originate from bile ducts or hepatocytes after damage and can be identified by expression of markers associated with cholangiocytes, often being associated with disease progression and fibrosis. In a recent issue of The Journal of Pathology, Govaere et al employed high-throughput RNA sequencing to compare the transcriptomic profiles of DR cells from liver diseases of different aetiology; HCV infection affecting hepatocytes and PSC initially affecting biliary epithelial cells. Both DR transcriptomes were markedly different from that of their neighbouring hepatocytes and 330 genes were significantly differently expressed between the DRs of the HCV and PSC liver diseases. Exploring such gene expression profiles could enable therapeutic targeting of DRs, on the one hand to inhibit liver fibrosis and inflammation and conversely to promote hepatocyte and cholangiocyte regeneration. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

Prevalence of inpatients with liver disease in infectious diseases department of three comprehensive hospitals in Yunnan: a multi-center retrospective analysis

Objective: To study the constitutional features of diseases spectrum of inpatients with liver disease in infectious diseases department of three comprehensive hospitals to provide resource allocation proposition for the construction of Department of Infectious Diseases. Methods: Inpatients data were extracted from the department of infectious diseases of three comprehensive hospitals (Kunming General Hospital of the People's Liberation Army, Yuxi People's Hospital and Dali People's Hospital) between January 2010 to December 2015, and were retrospectively analyzed. The distribution of patients with viral hepatitis (A, B, C, E) and severe liver disease (Severe hepatitis, cirrhosis, liver cancer) was further analyzed in hospitalized patients. Data were analyzed by one-way analysis of variance. A chi-squared test was used for comparison between groups. The change trends of disease constituent ratio in different years were checked by 2 test. Results: Liver disease, tuberculosis and AIDS were the three common diseases of three comprehensive hospitals in Yunnan, accounting for 58.61% of all admissions. However, an inpatients with liver diseases (17.25%, 3555/20606, 95% CI 16.73%-17.77%) were significantly lower than tuberculosis inpatients (33.98%, 7002/20606, 95% CI 33.34%-34.62%). An observations from different hospitals and at different time points showed that the proportion of patients with liver disease was lower than that of tuberculosis patients. The proportion of inpatients with HBV infection showed a downward trend (P < 0.001), whereas the proportions of inpatients with HCV and severe liver diseases showed an increased trend over time (P < 0.001). Conclusion: The proportion of inpatients with liver diseases was lower than tuberculosis inpatients in the Department of Infectious Diseases of three comprehensive hospitals. Hence, the paucity of the disease spectrum should be considered for resource allocation in the construction of infectious disease department.

New phenylaniline derivatives as modulators of amyloid protein precursor metabolism

The chloroquinoline scaffold is characteristic of anti-malarial drugs such as chloroquine (CQ) or amodiaquine (AQ). These drugs are also described for their potential effectiveness against prion disease, HCV, EBV, Ebola virus, cancer, Parkinson or Alzheimer diseases. Amyloid precursor protein (APP) metabolism is deregulated in Alzheimer’s disease. Indeed, CQ modifies amyloid precursor protein (APP) metabolism by precluding the release of amyloid-beta peptides (Aβ), which accumulate in the brain of Alzheimer patients to form the so-called amyloid plaques. We showed that AQ and analogs have similar effects although having a higher cytotoxicity. Herein, two new series of compounds were synthesized by replacing 7-chloroquinolin-4-amine moiety of AQ by 2-aminomethylaniline and 2-aminomethylphenyle moieties. Their structure activity relationship was based on their ability to modulate APP metabolism, Aβ release, and their cytotoxicity similarly to CQ. Two compounds 15a, 16a showed interesting and potent effect on the redirection of APP metabolism toward a decrease of Aβ peptide release (in the same range compared to AQ), and a 3–10-fold increased stability of APP carboxy terminal fragments (CTFα and AICD) without obvious cellular toxicity at 100 µM.

Global control of HIV, HCV and infectious diseases: India is not a problem, but a solution

Global control of HIV, HCV and infectious diseases: India is not a problem, but a solution

Analysis of the Misconceptions about Aid and Hepatitis among the Student of Nishtar Medical College Multan: A Study of Knowledge, Aptitude, and Perspective

Introduction: A number of evaluations regarding awareness among people about modes of transmission, sources of transmission and vaccination against HBV, HCV, and HIV have been carried out but very few of them have specifically focused medical students. This study reflects the degree of awareness of 3rd year MBBS students on these issues and their vaccination status. It also depicts whether medical students are afraid of examining patients afflicted with these diseases or not.&#x0D; Objectives of study: To determine the knowledge and aptitude of medical students about various aspects of HBV, HCV, and HIV diseases.&#x0D; Data &amp; Methodology: We used primary data in this study which is cross-sectional in study. The data was collected through a structured questionnaire. As many 130 third years students of MBBS students of Nishtar Medical College were selected as the sample of the study. The field survey method was used to collect the data. Statistical description methods such as frequency distribution, graphs, and tables were used to explain and analyze the data.&#x0D; Findings and Results: Our study evidence shows that 28.4 percent students possessed complete knowledge about the modes of transmission of HBV, HCV, and HIV while 70.7 percent have incomplete knowledge whereas 0.07 percent of the students have no knowledge about these diseases. Similarly, 60 percent of the students have no fear about the examinations of the patients suffering these diseases while 40 percent were afraid about them. Regarding the availability of vaccination against HBV, HCV and HIV 80.7 percent have knowledge about HBV, 42.3 percent about HCV and 16.9 percent about HIV. Our results show that 81.5 percent sampling students were vaccinated against HBV while 19.5 percent were not. Due to lack of awareness, negligence, etc.&#x0D; Conclusions: Our study concludes that majority of sampling students having full knowledge about these fatal diseases were lower than expected and it is, therefore, recommended that an awareness campaign should be launched so that students should be well-acquainted about the fatal impact of HBV, HCV, and HIV. Special seminars or workshops should be arranged to educate and train these students so that they may be able to cope with these diseases effectively after completion of their education.&#x0D;

Survey of health status, nutrition and geography of food selection of chronic liver disease patients

Background. Obesity, a complex disease determined both by genetic and environmental factors, is strongly associated with NAFLD, and has been demonstrated to have a negative impact on HCV and other chronic liver diseases (CLD).Rationale. This study assessed the association between type and location of food sources and chronic liver disease (CLD) using Geographic Information Systems (GIS).Results. CLD patients completed surveys [267 subjects, 56.5% female, age 55.8 ± 12.0, type of CLD: 36.5% hepatitis C (HCV), 19.9% hepatitis B (HBV), 19.9% non-alcoholic fatty liver disease (NAFLD); primary food source (PFS): 80.8% grocery store, secondary: 26.2% bulk food store, tertiary: 20.5% restaurants; fresh food (FF): 83%, pre-packaged (PP) 8.7%, already prepared (AP) 8.3%]. FF consumers had significantly fewer UEH servings/month (p = 0.030) and lived further away from convenience stores (1.69 vs. 0.95 km, p = 0.0001). Stepwise regression reveals the lowest FF consumers were NAFLD patients, subjects with UEH or restaurants and ethnic food stores as their PFS (R = 0.557, p = 0.0001). Eating already-packaged foods and utilizing restaurants or ethnic food stores as the PFS positively correlated with NAFLD (R = 0.546, p = 0.0001). Conclusions. Environmental food source measures, including type and density, should be included when examining areas hyper-saturated with a variety of food options. In hyper-saturated food environments, NAFLD patients consume more prepared food and less FF. CLD patients with UEH also eat significantly more prepared food and frequent restaurants and ethnic food stores as their PFS.

Risky behavior and correlates of HIV and Hepatitis C Virus infection among people who inject drugs in three cities in Afghanistan

BackgroundInjecting drug use is the primary mode of HIV transmission and acquisition in Afghanistan. People who inject drugs (PWID) in the country have been characterized by high risk injecting behavior and a high burden of HCV infection. We aimed to estimate the burden of HIV, HCV, and other infectious diseases and to identify the correlates of HIV and HCV infection among PWID living in three major Afghan cities in 2009. MethodsEpidemiologic data was collected among PWID for the integrated biological and behavioral surveillance (IBBS) survey between May and August, 2009 in three Afghan cities. Data were collected using a structured questionnaire and biologic specimens to screen for HIV, HBV, HCV, syphilis, and HSV-2 using rapid testing kits. Multiple logistic regression models were constructed to identify correlates of infection. ResultsAmong 548 participants, pooled HIV prevalence was 7.1% (Mazar-i-Sharif: 1.0%, Kabul: 3.1%, Herat: 18.4%) and HCV prevalence was 40.3%. Almost all participants with HIV infection were co-infected with HCV (94.9%). Pooled prevalence estimates for other diseases included 7.1% for HBV, 5.5% for syphilis; and 9.3% for HSV-2. Living in Herat, ever in prison and time injecting were independently associated with HIV infection. Living in Kabul, Herat and time injecting were independently associated with HCV infection. ConclusionsThere is a high and heterogeneous burden of HIV and HCV among PWID in Afghan cities. Provision of comprehensive harm reduction services to PWID in Afghanistan is warranted to reduce exposures associated with HIV and HCV infection, especially in the city of Herat.

Clinical development of monoclonal antibody-based drugs in HIV and HCV diseases

Today there are many licensed antiviral drugs, but the emergence of drug resistant strains sometimes invalidates the effects of the current therapies used in the treatment of infectious diseases. Compared to conventional antiviral drugs, monoclonal antibodies (mAbs) used as pharmacological molecules have particular physical characteristics and modes of action, and, therefore, they should be considered as a distinct therapeutic class. Despite being historically validated, antibodies may represent a novel tool for combatting infectious diseases. The current high cost of mAbs' production, storage and administration (by injection only) and the consequent obstacles to development are outweighed by mAbs' clinical advantages. These are related to a low toxicity combined with high specificity and versatility, which allows a specific antibody to mediate various biological effects, ranging from the virus neutralization mechanisms to the modulation of immune responses.This review briefly summarizes the recent technological advances in the field of immunoglobulin research, and the current status of mAb-based drugs in clinical trials for HIV and HCV diseases. For each clinical trial the available data are reported and the emerging conceptual problems of the employed mAbs are highlighted.This overview helps to give a clear picture of the efficacy and challenges of the mAbs in the field of these two infectious diseases which have such a global impact.

Treatment of Recurrent Hepatocellular Carcinoma with Sorafenib in a HIV/HCV Co-Infected patient in HAART: A Case Report

BackgroundLiver disease is the second cause of death among HIV patients receiving highly active antiretroviral therapy (HAART) in Europe. HIV patients have a high prevalence of chronic HBV (6–10%) and HCV (33%) co-infection, and accelerated progression of viral hepatitis. Furthermore, the long duration of both HIV and HCV diseases in the HAART era increases the risk of hepatocellular carcinoma.FindingsWe report the case of a 49 year -old HIV/HCV co-infected male patient who developed hepatocellular carcinoma. The patient underwent a partial hepatectomy, and a few months later was treated with transcatheter arterial chemoembolisation due to hepatocarcinoma recurrence. Two months later, advanced hepatocellular carcinoma was diagnosed and sorafenib therapy was initiated. The patient achieved partial response of the main lesions, complete regression of the smallest lesions and did not experience clinical progression during the 20-month follow-up period. During therapy with sorafenib, the patient was treated with HAART with good viral and immunological responses. We used the therapeutic drug monitoring to assess antiretroviral concentrations during co-administration of sorafenib. Fosamprenavir Ctrough was found under the minimum level recommended by international guidelines. No grade 3 or 4 toxicities were observed. At month 20 of treatment, new liver lesions with portal vein thrombosis were diagnosed. After 28 months of sorafenib therapy, the patient deceased for severe liver insufficiency.ConclusionsSorafenib monotherapy demonstrated a marked delay in HCC disease progression in an HIV/HCV co-infected patient. Fosamprenavir Ctrough was found under the minimum level recommended by international guidelines, suggesting a possible interaction.

HCV Infection and Cryptogenic Cirrhosis are Risk Factors for Hepatocellular Carcinoma Among Latinos in New York City

Latinos in the US experience a 60% higher death rate from primary hepatocellular carcinoma (HCC) when compared to Non-Latinos. The goal of this study was to examine risk factors that are associated with ethnic disparities among HCC patients seen at the transplant center of a metropolitan medical center in New York City. We compared HCC risk factors in 140 Non-Latino and 55 Latino patients that presented with HCC from 1995 to 2003. Surnames were used to define Latino and Non-Latino HCC patients in a retrospective analysis. Latino and Non-Latino HCC patients did not vary by gender or age at presentation (mean Latino age 60.8). Latino HCC patients had a higher frequency of presentation with advanced disease, defined as patients with unresectable HCC, than non Latino HCC patients (Latino 52.7%; 95% CI 39.1-66.3 vs. Non-Latino vs. 36.4%; 95% CI 28.3-44.4). Latinos were more likely than Non Latinos to have underlying HCV (34.5 vs. 22.1%, P < .0001; adjusted odds ratio [Siegel, 2008 #564], 3.69; 95% CI, 1.16-11.7) and cryptogenic liver diseases (7.2 vs. 3.5%, P < .0001; OR 8.86; 95% CI, 1.21-65.0) after adjusting for age, gender and alfa-fetoprotein levels. Although more advanced disease may signal delay in access to care or more aggressive disease, HCV infection and cryptogenic cirrhosis at presentation are likely key factors for the greater burden of HCC among Latinos in New York City.

Prevalence of opioid analgesic injection among rural nonmedical opioid analgesic users

Objective The purpose of this study was to examine the prevalence and correlates of opioid analgesic injection (OAI) in a cohort of rural opioid analgesic users. Methods Cross-sectional study of 184 participants from rural Appalachian Kentucky. Results The majority of participants were male (54.9%), white (98.4%) and the median age was 30 years (interquartile range: 24–37). The self-reported lifetime prevalence of injection drug use (IDU) was 44.3%, with 35.3% of respondents reporting injection of oral opioid analgesic formulations. The prevalence of self-reported hepatitis C (HCV) was 14.8%, significantly greater than those not injecting opioid analgesics (1.7%) ( p < 0.001). Receptive needle sharing, distributive needle sharing and sharing of other injection paraphernalia was reported by 10.5%, 26.3%, and 42.1% of those currently injecting, respectively. Conclusions Opioid analgesic injection was more prevalent in this rural population than has been found in previous reports. This study suggests a rising problem with injecting among rural opioid users, a problem more typically associated with urban drug users. Educating injectors of opioid analgesics on safe needle practices is necessary in order to curb the transmission of HIV, HCV, and other infectious diseases. Further study on the longitudinal course of opioid analgesic injection in this population appears warranted.

Risk of cirrhosis in chronic viral hepatitis patients

The risk of cirrhosis in HCV and HBV-related liver diseases is higher in males than in females ; it increases exponentially after the age of 40 for the two genders. Alcohol consumption exceeding 50 gr per day multiplies cirrhosis risk by 6.0 in HBV patients and by 2.4 in HCV patients. B and C virus liver-related diseases are worsened by HIV co-infection particularly in patients with CD4 count lower than 200 per ml. Steatosis due to high body mass index (BMI) and/or metabolic syndrome is a newly described risk factor for cirrhosis in HBV and HCV patients and for hepatocellular carcinoma in HCV patients. Steatosis may become in a near future one of the major predicting factors of severity for chronic liver disease. The knowledge of worsening factors in patients suffering from chronic B and C viral hepatitis must lead clinicians to consider specific therapeutics against these factors and antiviral treatment even in case of borderline indication.

Anemia and Associated Comorbidities among the Elderly.

Abstract Introduction: Anemia among the elderly population is often under-diagnosed or goes undetected. The incidence of anemia among this population is believed to be 4–6 times greater than reported, with an underlying condition found in over half of anemics, especially men and older individuals (J Am Geriatr Soc1997;45(7):825–31). Given the number of comorbidities in elderly patients a better understanding of the relationship between these underlying conditions and anemia is warranted. Methods: A retrospective analysis of a large health claims database (1997–2002) examined the prevalence of anemia and associated comorbidities in patients &amp;gt;/=65 years with &amp;gt;/=3 years of follow-up. Chronic anemia was defined using the WHO criteria (hemoglobin [Hb] &amp;lt;/= 12 for women; &amp;lt;/= 13 for men) among patients with &amp;gt;/=2 Hb measurements &amp;gt;30 days and &amp;lt;/= 1 year apart; patients with nutrient deficiencies, chemotherapy, HIV, HCV, and hematological diseases were excluded. Comorbidities were defined by the presence of &amp;gt;/=2 ICD-9 diagnosis codes or &amp;gt;/=1 CPT code for each condition, and categorized a priori as ‘linked’ [potential association with anemia (rheumatoid arthritis and/or lupus, CKD, CHF, untreated cancer and TB)] or ‘non-linked’ [not associated with anemia (diabetes, asthma and/or COPD, osteoarthritis, osteoporosis, hypertension and CVD]. Patients were categorized by number of comorbidities (0–1, 2–3, 4–5, &amp;gt;5) and age (65–74, 75–84, &amp;gt;/= 85). Results: The mean age among the study sample (chronic anemics: n=2729; non-anemics: n=7648) was 72.9 years (SD=5.9); 56.8% were women and 31.2% were African American. Mean Hb was similar for all groups (65–74 [n=1446]: 11.7±0.89; 75–84 [1080]: 11.7±0.94; &amp;gt;/=85[203]: 11.6±0.96, and &amp;gt;/=65[2729]: 11.7±0.91). Only 19.6% of anemics had an anemia diagnosis code. Patients with chronic anemia had significantly more comorbid conditions than those without anemia (p&amp;lt;.0001) (chronic anemics: 9.6%, 43.9%, 35.8% and 10.7%; non-anemics: 20.1%, 54.3%, 22.9% and 2.8% with 0–1, 2–3, 4–5 and &amp;gt;5 comorbidities, respectively). The same trend was observed across all age groups. Regardless of anemia status, the number of comorbid conditions increased with age among patients with and without anemia, however, patients with anemia were 2.5 times as likely to have &amp;gt;3 comorbidities compared to patients without anemia across all ages (OR=2.51, 95%CI=2.30–2.75). The number of linked comorbidities was observed to increase with age. Approximately 7% of non-anemic patients had &amp;gt;/=2 linked diseases, while almost 23% of chronic anemics had &amp;gt;/=2 linked comorbidities (p&amp;lt;.0001). Non-linked conditions were twice as common among anemics than non-anemics (&amp;gt;3 conditions: 19.5% vs. 11.0%, p&amp;lt;.0001). Conclusions: Comorbid disease is common among older adults and is frequently unrecognized. Elderly patients with chronic anemia are more likely to have comorbid disease than non-anemic patients, including conditions not considered to be associated with anemia. These data identify a potential relationship between anemia and comorbid conditions in the elderly.

The Occupational Hazards of Interns &amp; Residents During Training

O b j e c t s: Residents are exposed to various hazards and harassed by sleep deficiency due to overwork. This study was performed to outline the health condition of residents and develop the ways of improving it. M e t h o d s: A questionnaire was distributed to 881 army doctors who enrolled at the Korea Third Military Academy and The Armed Force Health Service School in 2000 with the exception of medical doctors who joined the armed service without going through intern and resident periods , dental and oriental medical doctors. 784 (89.0%) of the 881 questionnaires were returned of which 704 cases (79.9%). This should actually be 89.0% were regarded for analyses as being reliable data. R e s u l t s: More than 20% of residents were exposed to radiation, laser, disinfectants, anesthetic gas, and anticancer drugs during their training periods with preventive measures for each of these hazards taken in about 10% of the cases of the lesser hazards but in about 35% for the hazards from radiation and laser. 91.1% of residents had experience of needlestick injuries during their training periods with over 36.3% being exposed to patients with infection during that time. The cases contracting HBV and HCV diseases due to pricking are 2.3% and 0.6% respectively. The average number of night duties per month during a one-year resident’s period was about 19. The average sleeping time on duty during a one-year residents was less than 4 hours. 28.4% of respondents were not satisfied with their occupation, 96.5% felt tired from overwork and 69.5% wanted to change their occupation to another that would pay the same salary. C o n c l u s i o n: Residents are exposed to harmful physical , chemical and biological factors, but the preventive care seldom undertaken. In addition, their overwork brings about lack of sleep which causes them problems when giving medical treatment to patients during their training periods. Despite the r e s i d e n t’s interest in an occupation as a doctor, many intend to select other occupations if they can receive the same salary. According to the above results, preventative systems and measures should be prepared with environmental improvements for residents, and proper rewards for their overwork should be accomplished