Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Thesis (Ph.D.)--Edith Cowan University, 2006. / Submitted to the Faculty of Education and Arts. Includes bibliographical references.

Thesis (Ph. D.)--University of Virginia, 2008. / Title from title page. Includes bibliographical references. Also available online as viewed 10/12/2009 through Digital Dissertations.

Thesis (M.D.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 102-116).

Thesis (M.D.S.)--University of Hong Kong, 1996. / Includes bibliographical references (leaves 144-167).

Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2000. / Typescript. Bibliography: leaves 219-243.

Thesis (M.D.S.)--University of Hong Kong, 1996. / Includes bibliographical references (leaves 144-167). Also available in print.

Thesis (M.D.)--University of Hong Kong, 1996. / Includes bibliographical references (leaf 102-116). Also available in print.

BACKGROUND: Hepatitis C (HCV) is the most common chronic blood-borne infection in the US5,6 and has life-threatening complications.10,11,18,27,44 HCV rates in Cambodian Americans are as high as national rates,5,11,22,37,41 but the transmission risks for Cambodians in the US are unclear. Rates of drug use, the most common national transmission risk,3,6,21 are not as high in this population.14,21 With the second largest population of Cambodians nationally, Lowell, Massachusetts12,19 provides a unique opportunity to study the risk factors associated with HCV transmission. OBJECTIVE: The objective of this study is to examine the risk factors associated with HCV in Cambodian Americans. The hypothesis is that HCV infected Cambodian Americans will have different rates of the United States Preventive Services Task Force (USPSTF) recognized risk factors compared to HCV infected non-Cambodian Americans.28 METHODS: This is a cross sectional study of HCV infected Cambodian and non-Cambodian Americans. Medical record data were abstracted for adults with reactive HCV antibody or RNA virus testing at Lowell Community Health Center (LCHC) between 2009 and 2012. Information regarding USPSTF-designated HCV risk factors was collected, and a comparison was made of HCV risk factors between infected Cambodian and non-Cambodian Americans. RESULTS: Cambodian Americans with HCV (n=128) were older (mean age 53 vs. 43 years old) and less likely to be male (41%) than the non-Cambodian group (67% male, n=541). Cambodians had far lower rates of overall recreational drug use (2.3% vs. 82.1%) and intravenous drug use (1.6% vs. 33.6%). The predominant HCV risk factor in Cambodians was birth between 1945 and 1965, while that for non-Cambodians was drug use. CONCLUSION: Most HCV infected Cambodian Americans treated at LCHC between 2009 and 2012 lacked any history of drug use. In contrast, the major risk factor for HCV infected non-Cambodian Americans treated at LCHC was drug use, consistent with the major risk factor for HCV transmission nationwide.3,6,21 This suggests that the current major HCV risk factors fail to describe how this virus was transmitted to Cambodian Americans who seek care at LCHC.

Introdução. Hepatite B oculta é caracterizada pela presença do HBV-DNA em pacientes que não expressam o antígeno B de superfície (HBsAg) e é relatada com maior freqüência em pacientes infectados pelo vírus da hepatite C (HCV). Nesse estudo avaliamos a prevalência de hepatite B oculta em transplantados renais infectados ou não pelo HCV e avaliamos a função hepática nos diferentes grupos. Material e métodos. Amostras de soro de 101 pacientes transplantados renais foram avaliadas para testes de função hepática, marcadores sorológicos e reação de polimerização em cadeia (PCR) para o HBV-DNA. Todos os pacientes eram HBsAg negativos e havia 51 pacientes anti- HCV reagentes e 50 pacientes não reagentes. A pesquisa do HBV-DNA foi feita por técnica de PCR aninhado para os genes S e “core”. Resultados. A pesquisa do gene S do HBV-DNA resultou positiva em 2 pacientes, sendo um do grupo anti-HCV reagente e o outro do grupo não reagente. A pesquisa do gene da região do “core” foi positiva em um paciente do grupo anti-HCV não reagente. A análise demonstrou que os pacientes do grupo anti-HCV reagente apresentam maior tempo de tratamento dialítico (50,8 + 34,6 e 32,02 + 20,87; p<0,001). Da mesma forma o grupo anti-HCV reagente apresentou valores mais elevados de aminotransferases: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); gama glutamiltranspeptidase : 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) e fosfatase alcalina : 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Os níveis de ciclosporina sérica também mais elevados também foram encontrados no grupo anti-HCV reagente 170.9 ± 69.8 and 135.0 ± 48.1 respectivamente (P < 0.02). No modelo de análise multivariada evidenciou-se que apenas a presença de infecção pelo HCV é determinante das alterações nas provas de função hepática. Conclusão. Hepatite B oculta foi um achado infreqüente na nossa população de pacientes transplantados renais, não tendo sido encontrada diferença na sua prevalência em pacientes infectados ou não pelo HCV. Pacientes anti-HCV reagentes apresentam alterações significativas das provas de função hepática e dos níveis sangüíneos de ciclosporina. / Background: Occult hepatitis B (HB) is characterized by the presence of HBV-DNA in patients who do not present HB surface antigen (HBsAg) detectable in sera. This condition is frequently described in patients with hepatitis C virus (HCV) infection and its clinical implications are uncertain. Since transplant patients were at risk for hepatitis B and/or C infection by blood transfusions, dialysis treatment and the transplant procedure itself we aimed to evaluate the prevalence of occult HB either with or without HCV infection. Patients and Methods: One hundred and one HBsAg negative renal transplant patients were evaluated. Fifty-one were anti-HCV reagents (Elisa III). Sera was analyzed for the presence of the S and core genes of the HBV-DNA by a nested PCR technique. Serological markers of HBV infection, liver function testes and ciclosporine through levels were also analysed. Results: The core gene of the HBV-DNA was identified in one HCV infected patient and in one anti-HCV negative who also presented the S gene (prevalence: 2% and 1% for each gene respectivelly). HCV infected patients presented longer pre-transplant dialysis time (50.8 ± 34.6 versus 32.0 ± 20.9; p<0,001). Results of liver function tests were also increased in the HCV infected group: ALT: 34.5 ± 26.7 x 20.9 ± 10.0; (P < 0.001); AST: 31.7 ± 17.7 x 24.9 ± 14.9; (P < 0.05); GGT: 66.1 ± 82.4 x 33.4 ± 44.6; (P < 0.02) and alkaline phosphatase: 307.9 ± 397.7 x 186.9 ± 63.4; (P< 0.04). Ciclosporine through levels were also significantly higher in HCV infected patients 170.9 ± 69.8 and 135.0 ± 48.1 respectivelly (P < 0.02). Multivariate analysis revealed that only HCV infection was determinant of the increased results of the LFTs. Conclusion: We found that occult hepatitis B is infrequent condition in our population of renal transplant patients and that HCV infection seems not to be a risk factor. In accordance with our previous work HCV we showed that infected renal transplant patients present evidence of liver damage and altered metabolism evidenced by the elevated liver function testes a higher ciclosporine through levels.