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Study on effectiveness of transfusion program in thalassemia major patients receiving multiple blood transfusions at a transfusion centre in Western India
Shah, Neeraj
Mishra, Anupa
Chauhan, Dhaval
Vora, C.
Shah, N. R.
Asian Journal of Transfusion Science
Children suffering from beta-thalassemia major require repeated blood transfusions which may be associated with dangers like iron overload and contraction of infections such as HIV, HCV, and HBsAg which ultimately curtail their life span. On the other hand, inadequate transfusions lead to severe anemia and general fatigue and debility.
Materials and Methods:
Data were obtained from 142 beta-thalassemia major patients aged 3 years or more receiving regular blood transfusions at a transfusion centre in Western India from 1 April 2009 to 30 June 2009. The clinical data and laboratory results were subsequently analyzed.
Of the 142 patients, 76 (53.5%) were undertransfused (mean Hb <10 gm%). 96 (67%) of the patients were taking some form of chelation therapy but out of them only 2 (2%) were adequately chelated (S. ferritin <1000 ng/ml). 5 (3.5%) of the patients were known diabetics on insulin therapy. 103 (72%) of the patients were retarded in terms of growth. The prevalence of transfusion-transmitted infections (TTIs) such as HCV, HIV, and HBsAg was respectively 45%, 2%, and 2%, with the prevalence of HCV being significantly more than the general population. The HCV prevalence showed positive correlation with the age of the patients and with the total no of blood transfusions received. As many as 15% (6 out of 40) children who were born on or after 2002 were HCV positive despite the blood they received being subjected to screening for HCV.
The study suggests the need to step up the transfusions to achieve hemoglobin goal of 10 gm% (as per the moderate transfusion regimen) and also to institute urgent and effective chelation measures with the aim of keeping serum ferritin levels below 1000 ng/ml to avoid the systemic effects of iron overload. In addition, strict monitoring of the children for endocrinopathy and other systemic effects of iron overload should be done. Rigid implementation of quality control measures for the ELISA kits used to detect HCV in donor blood needs to be done urgently. Alternately, more sensitive and specific measures (like NAT testing) should be employed for detection of HCV. In the absence of a definitive cure accessible and available to all patients, strict implementation of the above suggested measures will go a long way in improving the quality (and quantity) of life in patients of beta-thalassemia major.
Beta-thalassemia major; chelation; HCV positivity; iron overload
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Prevalence of Hepatitis B and C Infections and HCV Genotypes Among Haemophilia Patients in Ahvaz, Southwest Iran
Assarehzadegan, Mohammad Ali
Ghafourian Boroujerdnia, Mehri
Zandian, Khodamorad
Iranian Red Crescent Medical Journal
Transfusion-transmitted hepatitis is the most important cause of transmitted infections by the parenteral route in patients with haemophilia.
This study was performed to determine the prevalence of HBV, HCV, and different genotypes of HCV among haemophilia patients in Ahvaz city, southwest Iran.
Patients and Methods
A cross-sectional study was conducted on 87 haemophilia patients referred to the Hemoglobinopathy and Thalassemia research centre during February 2008 to March 2009. Patients, sera were tested for HBsAg and anti-HCV using ELISA and confirmed by PCR (HBV) and RT-PCR (HCV). HCV genotypes were determined with HCV genotype specific primers using HCV genotyping kit.
The overall prevalence rate of HBsAg and anti-HCV were 1.1% (95% CI: 0-3.39) and 54% (95% CI: 43.5-64.4), respectively. Forty two of the anti-HCV patients (89.3%) were also HCV RNA positive. The prevalence of anti-HCV seropositivity was significantly higher (P = 0.0008) among patients who had started to receive transfusions before implementation of blood donor screening. Moreover, the number of transfusion were significantly associated with anti-HCV and HCV RNA positivity (P = 0.0041 and P = 0.023, respectively). The predominant HCV genotype among haemophilia patients in our region was 1a (26/42, 61.9%), although genotypes 1b and 3a were found in 26.1% (11/42) and 11.9% (5/42) of the patients, respectively.
It appears stringent donor selection procedures reduced HCV infection in multi-transfused patients, but it is still serious risk for these subjects.
Hepatitis B; Hepatitis C; Prevalence; Genotype; Haemophilia A
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Prevalence of Hepatitis C among Multi-transfused Thalassaemic Patients in Oman
Al-Naamani, Khalid
Al-Zakwani, Ibrahim
Al-Sinani, Siham
Wasim, Fauzia
Daar, Shahina
Sultan Qaboos University Medical Journal
Regular blood transfusions are essential for patients with thalassaemia major. However, infections with hepatotropic viruses remain a major concern. The objective of this study was to evaluate the prevalence and characteristics of hepatitis C viral (HCV) infection among patients with homozygous beta thalassaemia in a single centre in Oman.
A retrospective chart review of 200 patients treated at the Thalassemia Unit of Sultan Qaboos University Hospital (SQUH) in Muscat, Oman, between August 1991 and December 2011 was performed. Relevant demographic and clinical characteristics were collected, including age, gender, HCV status and the presence of endocrinopathies.
A total of 81 patients (41%) were found to be anti-HCV-antibody (anti-HCV)-positive. HCV ribonucleic acid tests were performed on 65 anti-HCV-positive patients and were positive among 33 (51%); the remaining 16 patients died before these tests were available. Anti-HCV-positive patients were significantly older than anti-HCV-negative patients (P <0.001) and were more likely to be diabetic than anti-HCV-negative patients (27% versus 8%; P <0.001). A total of 100 patients had been transfused before they were transferred to SQUH in 1991; of these, 70 (70%) were anti-HCV-positive. Only 11 (11.5%) of the 96 patients who were seronegative in 1991, or who were transfused later, became seropositive.
It is likely that the high prevalence of HCV among multi-transfused thalassaemic patients in Oman is due to blood transfusions dating from before the implementation of HCV screening in 1991 as the risk of HCV-associated transfusions has significantly reduced since then. Additionally, results showed that anti-HCV-positive patients were more likely to be diabetic than anti-HCV-negative patients.
Hepatitis C; Anti-HCV Antibodies; Beta Thalassemia; Seroprevalence; Blood Transfusions; Blood Safety; Oman
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Torque Teno Virus and Hepatitis C Virus Co-Infection in Iranian Pediatric Thalassemia Patients
Alavi, Samin
Valeshabad, Ali Kord
Sharifi, Zohreh
Nourbakhsh, Kazem
Arzanian, Mohammad Taghi
Navidinia, Masoumeh
Seraj, Siamak Mehdizadeh
Turkish Journal of Hematology
Objective: Torque teno virus (TTV) infects patients at risk for parenteral exposure and chronic blood transfusion, such as those with β-thalassemic. This study aimed to assess the prevalence of TTV infection and co-infection of TTV and hepatitis C virus (HCV) in pediatric thalassemia patients receiving chronic blood transfusion.
Material and Methods: The study included 90 pediatric thalassemia patients receiving chronic blood transfusion that presented to the Mofid Children's Hospital, Tehran, Iran. The control group included 90 healthy volunteer children. Serum TTV DNA detection via semi-nested PCR and HCV Ab were performed in all the participants. Demographic characteristics and clinical data were collected from each participant for statistical analysis.
Results: In all, 64.4% of the patients had TTV infection, versus 24.4% of the controls (P < 0.01). The thalassemia patients had a greater probability of having TTV and HCV infections than the controls, with a common OR of 5.60 (95% CI: 2.94-10.69) and 2.15 (95% CI: 1.83-2.50), respectively. In total, 17.2% (10/58) of the patients that were TTV positive were also HCV positive, whereas 6.3% (2/32) of the TTV-negative patients were anti-HCV antibody (Ab) positive (P = 0.14).
Conclusion: The prevalence of TTV and HCV infection was higher in the Iranian thalassemia patients on chronic transfusion therapy than in the controls. The high prevalence of TTV in pediatric thalassemia patients on chromic transfusion therapy may indicate the superiority of the parenteral route compared to other routs of TTV transmission.
Thalassemia; Torque teno virus; Hepatitis C virus
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Transfusion Transmitted Hepatitis: Where Do We Stand Now? A One Center Study in Upper Egypt
El-Faramawy, Amel Abdel Magied
El-Rashidy, Omnia Fathy
Tawfik, Perihan Hamdy
Hussein, Galal Helmy
Hepatitis Monthly
Despite progress made in the prevention of transfusion-transmitted infections (TTI) over the last few years, they continue to be a problem in many parts of the world, particularly in multitransfused patients.
The aim of this study was to estimate the prevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and to evaluate the screening and vaccination program among our cohort of multitransfused children from Qena, Upper Egypt.
Patients and Methods
One-hundred children suffering from diseases requiring repeated blood transfusions were included in the study. They were classified into group 1, which included 67 children with thalassemia, and group 2, which included 33 children with hemophilia. Screening for hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody and antibody to HCV was done using a second-generation enzyme-linked immunosorbent assay technique.
Only 12% of all patients were either acutely or chronically infected with HBV. 46% were immune due to previous vaccination, whereas 39% of patients were not protected from HBV infection. HCV antibodies were positive in 45% of cases. Seventy-eight patients had a complete hepatitis B vaccination in the form of three doses as documented by birth certificate. Thirty-six patients mentioned history suggestive of hepatitis. The prevalence of the studied hepatitis markers was similar in both the thalassemia and hemophilia groups of children.
Transfusion-transmitted hepatitis is still a major problem for multitransfused children in Egypt. More effort is required to reduce the infection rate through proper screening of blood and blood products, strict emphasis on receiving the vaccine, regular follow-up for those children with a hepatitis B antibody titer, and providing booster doses for those in need.
Child; Hepatitis; Transfusion; Egypt
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Prevalence and trends of markers of hepatitis B virus, hepatitis C virus and human Immunodeficiency virus in Argentine blood donors
Flichman, Diego M
Blejer, Jorgelina L
Livellara, Beatriz I
Re, Viviana E
Bartoli, Sonia
Bustos, Juan A
Ansola, Claudia P
Hidalgo, Susana
Cerda, Martin E
Levin, Alicia E
Huenul, Adriana
Riboldi, Victoria
Treviño, Elena MC
Salamone, Horacio J
Nuñez, Felix A
Fernández, Robert J
Reybaud, Juan F
Campos, Rodolfo H
BMC Infectious Diseases
Transfusion-transmitted infections are a major problem associated with blood transfusion. The aim of this study was to determine prevalence and trends of HBV, HCV and HIV in blood donors in Argentina.
A retrospective study was carried out in blood donors of 27 transfusion centers covering the whole country over a period of eight years (2004-2011). Serologic screening assays for HBsAg, anti-HBc, anti-HCV, and anti-HIV were performed in all centers and nucleic acid amplification testing (NAT) was performed in 2 out of the 27 centers.
The 2,595,852 samples tested nationwide from 2004 to 2011 showed that the prevalence of HBsAg decreased from 0.336% to 0.198% (p < 0.0001), that of anti-HBc from 2.391% to 2.007% (p < 0.0001), that of anti-HCV from 0.721% to 0.460%, (p < 0.0001) and that of anti-HIV from 0.208% to 0.200 (p = 0.075). The prevalence of HBV, HCV and HIV was unevenly distributed among the different regions of the country. Two out of 74,838 screening- negative samples were positive in NAT assays (1 HIV-RNA and 1 HCV-RNA); moreover, HBV-DNA, HCV-RNA and HIV-RNA were detected in 60.29, 24.54 and 66.67% of screening-positive samples of the corresponding assays. As regards donors age, positive HBV-DNA and HCV-RNA donors were significantly older than healthy donors (46.6, 50.5 and 39.5 y respectively, p < 0.001).
Argentina has a low prevalence of HBsAg, anti-HCV and anti-HIV in blood donors, with a decreasing trend for HBsAg, anti-HBc and anti-HCV but not for anti-HIV over the last 8 years. The uneven distribution of transfusion-transmitted infections prevalence among the different regions of the country highlights the need to implement regional awareness campaigns and prevention. The discrepancy between samples testing positive for screening assays and negative for NAT assays highlights the problem of blood donors who test repeatedly reactive in screening assays but are not confirmed as positive upon further testing. The uneven distribution of age between healthy donors and NAT-positive donors could be related to changes in risks of these pathogens in the general population and might be attributed to a longer exposure to transmission risk factors in elderly people.
Prevalence; Trend; Blood donors; HIV; HBV; HCV
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Serological study on parvovirus B19 infection in multitransfused thalassemia major patients and its transmission through donor units
Kishore, Janak
Srivastava, Manisha
Choudhury, Nabajyoti
Asian Journal of Transfusion Science
Human parvovirus B19 (B19) virus is a newly recognized agent for transfusion transmitted diseases. Beta-thalassemia major patients receive a hypertransfusion regimen, hence, are prone to acquire B19 infection; moreover, B19 escapes viral inactivation methods and donor units are not tested for B19, but there are just a couple of studies globally and none from the Asian continent. Hence, a study was designed to find the frequency of B19 infection and its transmission in multitransfused thalassemia patients.
Materials and Methods:
Ninety multitransfused beta-thalassemia major (thalassemia) patients, 32 controls (age, sex matched) without any history of transfusion were enrolled. Besides the donor units were tested in B19 un-infected patients. B19 specific IgG and IgM antibodies in the sera were analyzed by ELISA (in-house), using B19 VPI and VP2 recombinant and purified antigens; additionally HBsAg and anti-HIV and anti-HCV antibodies were tested for coexisting infections.
Seventy-three (81%) thalassemia patients tested positive for anti-B19 IgG antibodies as compared to seven (21%) in the controls group (P < 0.01), while anti-B19 IgM antibodies were detected in 37 (41.1%) compared to two (6.2%) in the controls (P < 0.01). Mean age of the thalassemia patient was eight years (range 2 – 18 years) and B19 infection was highest in the six-to-ten year range. Seropositivity increased with the number of transfusions. Two of the four HBsAg positive and five of the seven anti-HCV IgM antibody-positive patients also had anti-B19 IgM. After a six-month follow-up, four (25%) of the 16 seronegative patients seroconverted and anti-B19 IgM antibodies were detected in their donor units.
Most of multitransfused thalassemics were B19 seropositive or had anti-B19 IgM; in the remaining uninfected group, B19 got transmitted through infected / IgM-positive donor units.
B19; blood transfusion; parvovirus; seroconversion; thalassemia
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Blood Transfusion Transmitted Infections in Multiple Blood Transfused Patients of Beta Thalassaemia
Vidja, Prakash J.
Vachhani, J. H.
Sheikh, S. S.
Santwani, P. M.
Indian Journal of Hematology & Blood Transfusion
Transfusion Transmitted Infection (TTI) continue to be a problem in many parts of world and multi-transfused patients of beta thalassaemia major are at a particularly increased risk of TTI. This study is aimed to estimate the prevalence of blood TTI in multiple blood transfused patients of beta thalassaemia major. Cross-sectional study of 200 multi-transfused patients of beta thalassaemia major, who were interviewed using a structured questionnaire and history was taken regarding sero-status of HIV (Human Immunodeficiency Virus), HBV (Hepatitis B Virus), HCV (Hepatitis C Virus) infection from their case papers. This study was conducted at the department of Pathology, M.P. Shah medical college, Jamnagar and Thalassemia ward, G.G. Hospital, Jamnagar (Gujarat, India) from March to May 2010. Out of 200 multiple blood transfused patients 7% patients were infected with TTI. Total 9 male patients and 5 female patients were infected with TTI. The seroreactivity for HIV was 3% (06/200); 1% (02/200) were males and 2% (04/200) were females. The seroreactivity for HBV was 2% (04/200) all were males. The seroreactivity for HCV was 2% (04/200); 1.5% (03/200) were males and 0.5% (01/200) was female. HIV, HBV, HCV infections are most prevalent TTI among multiple blood transfused patients of beta thalassemia major, and remains a major health problem for these patients.
Transfusion transmitted infection; Multiple blood transfused patients of beta thalassemia major; Human immunodeficiency virus; Hepatitis B virus; Hepatitis C virus
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Hepatitis C virus in sickle cell disease.
Hassan, Mohamed
Hasan, Syed
Giday, Samuel
Alamgir, Laila
Banks, Alpha
Frederick, Winston
Smoot, Duane
Castro, Oswaldo
Journal of the National Medical Association
PURPOSE: To determine the prevalence of hepatitis C virus antibodies (anti-HCV) in patients with sickle cell disease. PATIENTS AND METHODS: Between 1983 and 2001, 150 patients from the Howard University Hospital Center for Sickle Cell Disease were screened for HCV antibody (52% women, 48% men, mean age 34 years). Frozen serum samples from 56 adult sickle cell patients who had participated in previous surveys (1983-92) of HIV and HTLV-1 serology and who were tested in 1992 for anti-HCV antibody--when commercial ELISA test (Ortho) became available--were included in this paper. Of the 150 patients in the study, 132 had sickle cell anemia genotype (SS), 15 had sickle cell hemoglobin-C disease (SC) and three had sickle beta thalassemia. Clinical charts were reviewed for history of blood transfusion, IV drug abuse, homosexuality, tattooing, iron overload, and alcohol abuse. RESULTS: Antibodies to HCV were detected in 53 patients (35.3%). Of the 55 patients who had frozen serum samples tested in 1992, 32 (58%) were reactive for anti-HCV, while only 21 of the 95 patients (22%) tested after 1992 were positive for HCV antibodies (P<0.001). Thirty-nine of 77 patients (51%) who received more than 10 units of packed red blood cells were positive for HCV antibody, and only 14 of 61 patients (23%) who received less than 10 units of packed red blood cells transfusion were positive for HCV antibodies (P<0.001). None of the 12 patients who never received transfusion were positive for HCV antibody. In the 53 anti-HCV positive patients, the mean alanine amino-transferase (ALT) value was 98- and 81 U/L, respectively, for males and females. These values were normal for the HCV-antibody negative patients. The aspartate amino-transferase (AST) and the total bilirubin were also higher in the anti-HCV positive patients compared to patients in the anti-HCV negative group. Forty-four patients (57.1%) who were transfused more than 10 units developed iron overload defined by a serum ferritin level higher than 1,000 ng/ml. A total of 20 of the patients with iron overload underwent liver biopsies. Seven of these 20 patients (35%) were HCV positive. These patients often had more severe liver disease and higher degree of iron deposition. CONCLUSION: The prevalence of HCV antibody and iron overload is directly related to the number of blood transfusions in patients with sickle cell disease. The prevalence of HCV infection has decreased significantly, since blood donor screening for HCV became available. Chronic HCV infection and iron overload place sickle cell patients at risk for significant liver disease.
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Possible Correlation of Transfusion Transmitted Diseases with Rh type and ABO Blood Group System
Tyagi, Surabhi
Tyagi, Alok
Journal of Clinical and Diagnostic Research : JCDR
Background: Screening of blood is mandatory for transfusion transmitted diseases and is routinely done in the blood banks. As blood is the major source transmission of hepatitis B, hepatitis C, human immunodeficiency virus & many other diseases the hazards can be minimised by effective donor selection and screening.
Aim: To find out the correlation between the transfusion transmitted diseases and blood groups and the seroprevalence of HIV, HBV, HCV & syphilis among the apparently healthy human blood donors.
Study, Setting & Design: This retrospective study was conducted at the blood bank of a tertiary health care teaching centre for a period of four years.
Material and Methods: All voluntary and replacement donors reporting to the blood bank were screened for HIV-1 & 2, HBsAg, HCV and Syphilis. Anti–HIV -1 & 2, HBsAg & anti - HCV was tested using the appropriate Enzyme–linked immunosorbent assay (ELISA) technique using micro–elisa kit supplied by J.Mitra & Co.Ltd. The seropositive samples were again tested on ELISA kits of RFCL &/or BIORAD for further confirmation & ruling out any false positive or false negative results. The rapid plasma reagain (RPR) test was used for estimation of syphilis infection.
Statistical Analysis: The data entry was carried out using Microsoft office excel worksheet and was analysed by percentage and comparison.
Results: Total of 6000 donors were screened which included voluntary and replacement donors. Seroprevalence of HIV (0.1833 %), HCV (1.28%), HBsAg (1.5833 %) and syphilis (0.4333 %) was detected. In the study done it was also noted - that the NEGATIVE blood groups were more prone to TTIs. Blood group A negative was more prone to TTIs with HIV, HBsAg and VDRL while blood group B negative was more affected by HCV.
Conclusion: Seroprevalence of these infections shows that routine screening is a must for blood and blood product safe transfusion.
Do negative blood groups predispose to TTIs? A finding which makes us think….
Blood donors; Seroprevalence; Transfusion transmitted diseases; Human immunodeficiency virus; Hepatitis C; Hepatitis B surface antigen
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Treponema pallidum hemagglutination assay seroreactivity among healthy Indian donors and its association with other transfusion transmitted diseases
Pahuja, Sangeeta
Gupta, Santosh Kumar
Pujani, Mukta
Jain, Manjula
Asian Journal of Transfusion Science
The aim of the present study was to determine the prevalence of syphilis infection by Treponema pallidum hemagglutination assay (TPHA) among blood donors in Delhi and to study their correlation with other markers of transfusion transmitted infections such as hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B surface antigen (HBsAg) so as to establish the utility of TPHA over and above venereal diseases research laboratory test (VDRL), not only as a marker for testing T. pallidum infection, but also as a marker of high risk behavior.
Materials and Methods:
This prospective study was carried out in the Regional Blood Transfusion Centre, Lady Hardinge Medical College and associated Sucheta Kriplani Hospital, New Delhi for a period of 2 years. Donated blood was screened for TPHA seroreactivity along with screening for anti HIV I and II, anti-HCV, HBsAg by third generation enzyme-linked immunosorbent assay test. A total of 8082 serum samples of blood donors were collected from healthy blood donors in our blood bank. They were classified into two groups- test group and control group based on TPHA positivity. The co-occurrence of HBsAg, HIV and HCV infection were determined in TPHA positive blood donors (test group) in comparison with TPHA negative blood donors (control group).
We found the TPHA seroreactivity to be 4.4% in Delhi's blood donors. Nearly 8.2% (663/8082) of the donated blood had serological evidence of infection by at least one pathogen (syphilis/HIV/hepatitis B virus/HCV) and 6.63% (44/663) donors with positive serology had multiple infections (two or more). Quadruple infection was seen in one donor, triple infection was seen in three donors and double infection was seen in 40 donors. Prevalence of HIV seroreactivity was found to be statistically significant and HCV seroreactivity statistically insignificant in TPHA positive group in comparison to TPHA negative group.
In our study, the TPHA seropositivity correlated with higher HIV and HCV seropositivity and the same correlation has been observed by several other studies also. In view of these observations, we propose that testing for syphilis by more sensitive and specific treponemal markers like TPHA rather than VDRL, rapid plasma reagin tests; as TPHA also has the added advantage of picking up all the high risk donors, whereas, VDRL picks up only currently infected donors. Moreover, TPHA should be continued as a marker of high risk behavior especially in high prevalence areas like India where we don't have universal access to markers like nucleic acid amplification technique.
Syphilis; Treponema pallidum hemagglutination assay; transfusion transmitted infections; Co-infection
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Prevalence of Anti HCV Infection in Patients with Beta-Thalassemia in Isfahan-Iran
Ataei, Behrooz
Hashemipour, Marjan
Kassaian, Nazila
Hassannejad, Razieh
Nokhodian, Zary
Adibi, Peyman
International Journal of Preventive Medicine
Hepatitis C virus (HCV) is the major cause of post-transfusion hepatitis infection (PTH). Patients with thalassemia major are at high risk of hepatitis C due to the blood transfusion from donors infected by HCV. The aim of this study was to detect the prevalence of anti-HCV antibodies and risk factors in multitransfused thalassemic patients in Isfahan-Iran to establish more preventive strategies.
This study was conducted to assess the patients with beta-thalassemia in Isfahan hospitals during 1996-2011 for HCV infection. A structured interview questionnaire was developed by the trained researcher to collect the demographic and risk factors. Statistical analysis was done by Chi-square test, Mann-Withney and multiple logistic regressions using SPSS software, version 15.
466 patients with major thalassemia participated in this study. The mean age of patients was 17.46 ± 8.3. Two hundred and seventy (58.3%) and 193 (41.7%) of participants were male and female, respectively. The prevalence of HCV was estimated 8% among thalassemia patients. History of surgery, history of dental procedure, number of units transfused per month, number of transfusion per month and duration of transfusion had significant association with HCV seropositivity in univariate analysis. There were no statistical significant risk factors for HCV seropositivity in multiple logistic regression models.
Our findings revealed that blood transfusion was the main risk factors for HCV infection among beta-thalassemic patients. Therefore, more blood donor screening programs and effective screening techniques are needed to prevent transmission of HCV infection among beta-thalassemic patients.
Beta-thalassemia; HCV infection; Iran
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Determination of Hepatitis C Genotypes and the Viral Titer Distribution in Children and Adolescents with Major Thalassemia
Shahraki, Touran
Shahraki, Mansour
Moghaddam, Esmaiel Sanei
Najafi, Mehri
Bahari, Ali
Iranian Journal of Pediatrics
Hepatitis C virus (HCV) is an etiological agent responsible for occurrence of post-transfusion hepatitis in thalassemic patients. This study identified hepatitis C genotypes in pediatric and adolescent thalassemic patients and their correlation with age, blood transfusion, HCV RNA viral titer and liver function.
This study considers cross-sectional data from the Center for Thalassemia in Zahedan (Iran) carried out between August 2005 and September 2007. Twenty multitransfused patients suffering from β-thalassemia major and chronic HCV infection (13 males, 7 females) were included in the study. Patients were considered eligible for the study if they were seropositive for HCV RNA polymerase chain reaction (PCR) before initiation of evaluation. Blood sample was taken for HCV genotype and viral titer as well as biochemical markers. Type specific primer and real-time RT-PCR HCV were used for determination of viral genotype and HCV-RNA titer.
There was a significant positive correlation between serum HCV RNA titer and genotypes (P<0001). Serum HCV RNA levels were found higher in genotype 3a than in others. The most prevalent genotype in thalassemic patients was genotype 3a (40%) followed by 1b (25%), unclassified (20%) and la (15%). There was no meaningful relationship between genotype, Alanine aminotranferease, ferritin and alkaline phosphatase. Age, serum HCV RNA titer and number of transfusions were the only significant factors associated with genotypes (P<015, P<0.0001 and P<0.001 respectively).
This study showed that HCV genotype and viral titer are related to the number of blood transfusions received by thalassemic patients. Screening donated blood in blood banks would prevent the occurrence of hepatitis C in this high-risk group.
Hepatitis C; Virus Titer; Viral Load; Liver Function Tests; Thalassemia; Iran
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Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis among blood donors in Koudougou (Burkina Faso) in 2009
Nagalo, Marius Bolni
Sanou, Mahamoudou
Bisseye, Cyrille
Kaboré, Marilène Inès
Nebie, Yacouba K.
Kienou, Kisito
Kiba, Alice
Dahourou, Honorine
Ouattara, Siaka
Zongo, Jean Didier
Simporé, Jacques
Blood Transfusion
The high prevalence of numerous transfusion-transmitted infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and syphilis in sub-Saharan Africa affects the safety of blood for recipients. This study was undertaken with the aim of determining the seroprevalence of HIV, HCV, HBV, syphilis and socio-demographic risk factors associated with blood donation in a new regional blood transfusion centre in Burkina Faso.
Material and methods
Sera samples were screened for hepatitis B surface antigen (HBsAg), antibodies to HCV, HIV types 1 and 2 and to Treponema pallidum using enzyme-linked immunosorbent assays and Rapid Plasma Reagin test (RPR) respectively. All the reactive samples for HIV, HBsAg, and HCV were confirmed using a second enzyme-linked immunosorbent assays. Antibodies to Treponema pallidum were confirmed with a Treponema pallidum haemagglutination test (TPHA).
From the total of 4,520 blood donors in 2009, 1,348 (29.82%) were infected with at least one pathogen and 149 (3.30%) had serological evidence of multiple infections. The overall seroprevalence rate of HIV, HBV, HCV and syphilis was 2.21%, 14.96%, 8.69% and 3.96%, respectively. Among blood donors with multiples infections, the most common dual or triple combinations were HBsAg-HCV (1.39%), HBsAg-syphilis (0.66%) and HBsAg-HCV-syphilis (0.11%). The highest prevalences of HBsAg and HIV were found among blood donors from rural areas and in the age groups of 20–29 years and >40 years old, respectively.
HBV and HCV remain the greatest threats to blood safety in Burkina Faso. Strict selection and retention of voluntary, non-remunerated low-risk blood donors are recommended to improve blood safety in the regional blood transfusion centre of Koudougou.
transfusion; blood donors; HBV; HCV; Burkina Faso
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Prevalence of Serological Markers for Hepatitis B and C Viruses in Brazilian Blood Donors, and Incidence and Residual Risk of Transfusion-Transmission of Hepatitis C Virus
de Almeida-Neto, Cesar
Sabino, Ester Cerdeira
Liu, Jing
Blatyta, Paula Fraiman
Mendrone-Junior, Alfredo
Salles, Nanci Alves
Leão, Silvana Carneiro
Wright, David J.
Basques, Fernando Valadares
Ferreira, João Eduardo
Busch, Michael P.
Murphy, Edward L.
We evaluate the current prevalence of serological markers for HBV and HCV in blood donors and estimated HCV incidence and residual transfusion-transmitted risk at three large Brazilian blood centers.
Material and Methods
Data on whole blood and platelet donations were collected from January through December 2007 and analyzed by center, donor type (replacement vs. community), age, sex, donation status (first-time vs. repeat), and serological results for HBsAg, anti-HBc and anti-HCV. HBV (HBsAg+/anti-HBc+) and HCV (anti-HCV) prevalence rates were calculated for all first time donations. HCV incidence was derived including inter-donation intervals that preceded first repeat donations given during the study and HCV residual risk was estimated for transfusions derived from repeat donors.
There were 307,354 donations from January through December 2007. Overall prevalence of concordant HBsAg and anti-HBc reactivity was 289 per 100,000 donations and of anti-HCV confirmed reactivity 191 per 100,000 donations. There were significant associations between older age and hepatitis markers, especially for HCV. HCV incidence was 3.11 (95% CI 0.77-7.03) per 100,000 person-years, and residual risk of HCV window-phase infections was estimated at 5.0 per million units transfused.
Improvement in blood donor selection, socioeconomic conditions and preventive measures, implemented over time, may have helped to decrease prevalence of hepatitis B and C viruses, relative to previous reports. Incidence and residual risk of HCV are also diminishing. Ongoing monitoring of hepatitis B and C viral markers among Brazilian blood donors should help guide improved recruitment procedures, donor selection, laboratory screening methods and counseling strategies.
Blood donors; Brazil; Residual Risk; Hepatitis B; Hepatitis C; Prevalence; Incidence
Related Articles
Hepatitis B and/or C co-infection in HIV infected patients: A study in a tertiary care centre from south India
Chandra, Naval
Joshi, Nayana
Raju, Y.S.N.
Kumar, Ajit
Teja, Vijay D.
The Indian Journal of Medical Research
Background & objectives:
Co-infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus (HIV) infected individuals results in increased hepatic complications. We undertook this study to evaluate the presence of HBV and HCV in HIV infected individuals attending a tertiary care centre in southern India.
A total of 120 cases with HIV infection and 120 healthy adult control subjects were included in the study. Samples were tested for hepatitis B surface antigen (HBsAg) and anti-HCV antibodies by enzyme linked immunosorbent assay (ELISA) method. HBsAg and anti-HCV positive serum samples were further tested for the presence of hepatitis B e antigen (HBeAg), anti-HBe antibodies, HBV-DNA and HCV-RNA.
The most common mode of transmission was sexual promiscuity (79%), followed by spouse positivity (15%) and history of blood transfusion (6%). HBsAg and anti-HCV were positive in 18 (15%) and 10 (8.3%) HIV infected patients; the corresponding figures in healthy controls being 2 (1.6%) 0 (0%) (P<0.0001). Among HIV infected patients, presence of HBeAg and anti-HBe antibodies was seen in 33.3 and 55.5 per cent, respectively; both HBeAg and anti-HBe antibodies were negative in 11.1 per cent. HBV DNA and HCV RNA were positive in 10 of 18 and in all anti-HCV positive samples. Triple infection with HBV, HCV and HIV was seen in three patients. CD4+ T-lymphocyte count less than 200/μl was seen in 22 of 28 co-infected cases.
Interpretation & conclusions:
The findings of our study showed presence of HBV (15%) and HCV (8.3%) co-infections in HIV positive patients which was higher than that seen in HIV negative controls. Co-infection with HBV and HCV is a common problem in HIV infected patients in India. Hence, all HIV patients need to be routinely tested for markers of HBV and HCV infection.
Co-infection; hepatitis B virus; hepatitis C virus; human immunodeficiency virus
Related Articles
Prevalence of Antibodies to Hepatitis C Virus in Voluntary Blood Donors: Are Women Better Donors?
Pandit, Dakshayani Padmakar
Pagaro M., Pradhan
Nabamita, Chaudhury
Journal of Clinical and Diagnostic Research : JCDR
Background: Hepatitis C virus (HCV) is transmitted by blood and blood products and it causes a major proportion of transfusion transmitted hepatitis. It can lead to chronic liver disease which has great morbidity and mortality. HCV is responsible for more deaths than Human immunodeficiency virus (HIV). As no vaccine is available and as the treatment is costly and lengthy, with a poor success rate, donor screening remains a very important means of primary prevention of HCV transmission.
Aims and Objectives: This study was conducted to know the prevalence of anti-HCV in healthy voluntary blood donors (VBD) in a semi-urban region of western Maharashtra, India with a special focus on female donors.
Settings and Design: This was an unlinked, anonymous, retrospective study.
Materials and Methods: During January 2006 to December 2012, sera of 17976 VBD, which comprised of 16972 (94.41%) males and 1004 (5.59%) females, were tested for presence of anti-HCV antibody (anti-HCV) by using a 3rd generation ELISA test. Data was statistically analyzed by using Chi-Square for linear trends (Extended Mantel-Haenszel test). - 0.72732.
Results and Conclusion: Thirty six donors (0.2%) were positive for anti-HCV. Seroprevalence in males was 0.21%, while that in females was 0%. The positivity of anti-HCV remained stable over the tenure of this study (Chi-Square for linear trends - 0.72732). This region has a lower prevalence of anti-HCV as compared those seen in other states of India. Zero prevalence in women indicated that encouraging women to undergo blood donations would still reduce the transmission of HCV. Detection can be improved by doing better tests like HCV RNA detection and further prevention of HCV transmission can be enhanced.
Voluntary blood donors; Blood transfusion; Hepatitis C; HCV; Anti-HCV
Related Articles
The Prevalence of Transfusion Transmitted Infections in ABO Blood Groups and Rh Type System
Nigam, Jitendra Singh
Singh, Savitri
Kaur, Viplesh
Giri, Sumit
Kaushal, Ravi Prakash
Hematology Reports
Screening of blood and blood products is important to reduce the risk of transfusion transmitted infections (TTIs). The transfusion of unscreened or inadequately screened blood and blood products are the major source of TTIs. The aim of this paper is to find out the prevalence of TTIs in ABO blood groups and Rh type system. A total of 4128 blood donors were screened from January 2010 to April 2014. Serological tests were performed for hepatitis B surface antigen (HBsAg), anti hepatitis C virus (Anti-HCV), anti HIV-1 and 2, venereal disease research Laboratory test (VDRL) and malaria parasite (MP) antigen. In seroreactive donors, HBsAg, Anti-HCV, VDRL, MP antigen and anti HIV were positive in 40 cases, 26 cases, 19 cases, 6 cases and 2 cases, respectively. Highest percentage of HBsAg, Anti HCV, VDRL, MP antigen and anti HIV was observed in blood group A negative (2/50), O negative (1/66), B negative (1/91), AB positive (2/377) blood group respectively. In the present study, the total number of Rhnegative donors is lower when compared to Rh-positive blood donors, but Rh-negative blood donors show higher percentages of seroreactivity for TTIs. Larger scale studies at molecular level are required to improve the knowledge of this aspect.
transfusion transmitted infections; blood products; ABO blood groups; Rh type system; India
Related Articles
Seroprevalence of HBV, HCV & HIV Co-Infection and Risk Factors Analysis in Tripoli-Libya
Daw, Mohamed A.
Shabash, Amira
El-Bouzedi, Abdallah
Dau, Aghnya A.
PLoS ONE
In 1998 Libya experienced a major outbreak of multiple blood borne viral hepatitis and HIV infections. Since then, no studies have been done on the epidemic features and risk factors of HBV, HCV, HIV and co-infection among the general population.
A prospective study was carried out using a multi-centre clustering method to collect samples from the general population. The participants were interviewed, and relevant information was collected, including socio-demographic, ethnic, and geographic variables. This information was correlated with the risk factors involved in the transmission of HBV, HCV and HIV. Blood samples were collected and the sera were tested for HBsAg, anti-HCV and anti-HIV using enzyme immunoassay.
A total of 9,170 participants from the nine districts of Tripoli were enrolled. The average prevalence of HBsAg was 3.7%, anti-HCV 0.9%, anti-HIV 0.15% and co-infection 0.02%. The prevalence varied from one district to another. HBV was more prevalent among those aged over 50 years and was associated with family history. Anti-HCV and anti-HIV were more prevalent among those aged 20–40 years. Intravenous drug use and blood transfusion were the main risk factors for HCV and HIV infection.
HBV, HCV, HIV and co-infection are relatively common in Libya. High prevalence was associated with geographic, ethnic and socioeconomic variability within the community. HCV and HIV infections among the younger age groups are becoming an alarming issue. Regulations and health care education need to be implemented and longer term follow-up should be planned.
Related Articles
Hepatitis G virus infection in Egyptian children with chronic renal failure (single centre study)
Hammad, Ayman Mohammad
Zaghloul, Mohammad Hosam El Deen
Annals of Clinical Microbiology and Antimicrobials
Hepatitis G virus (HGV) is an RNA virus. It is mainly transmitted through exposure to contaminated blood although other routes may also exist. Patients with chronic renal failure (CRF) are at high risk of acquiring HGV because they require frequent blood transfusions. Ongoing HGV infection can be only diagnosed by demonstrating viremia in patient sample by reverse transcriptase (RT) PCR. Antibodies to the envelop protein E2 (anti E2) of HGV is an indicator of virus clearance and testify past HGV contact. This cross sectional study was done to assess the frequency of HGV exposure (ongoing and past infection) in Egyptian children with CRF and to study the possible risk factors of infection.
This study included 100 children with CRF [34 on regular haemodialysis (HD) and 66 before the start of dialysis (predialysis)]. All patients sera were tested for HGV RNA by RT-PCR, anti E2, hepatitis C virus (HCV) antibody, hepatitis B surface antigen (HBsAg), and hepatitis B core antibody (HBcAB). Twenty five healthy children of matched age & sex were used as controls.
HGV RNA was positive in 9 (26.5%) of HD and 9 (13.6%) of predialysis children. Anti E2 was positive in 14 (41.2%) of HD and 19 (28.8%) of predialysis children.
In comparison to controls; CRF (n = 100); HD and predialysis children had significantly higher prevalence of anti E2 [4% VS 33% for all CRF cases; (p = 0.002)& 41.2% (p = 0.002) and 28.8% (p = 0.01); for HD and predialysis groups; respectively]. HGV RNA was significantly more prevalent only in HD children in comparison to controls (p = 0.03). HD and predialysis children did not have significant difference in the prevalence of HGV RNA (p = 0.16) or anti E2 (p = 0.26).
HGV exposure was not correlated with positivity of anti HCV (p = 0.32), HCV RNA (0.09), HBsAg/HBcAB (p = 1), age (p = 0.06), or gender (p = 0.83). It was significantly correlated with duration of the disease (p < 0.001). Ongoing HGV infection was significantly more prevalent with frequent blood transfusion (p < 0.001). There were no significant differences in serum levels of ALT (p = 0.09), total bilirubin (p = 0.1) and albumin (p = 0.06) in children with ongoing infection in comparison to healthy controls.
The frequency of HGV exposure in Egyptian children with CRF appears to be high and is mainly related to frequent blood transfusions and longer disease duration. HGV infection in these children is not associated with significant changes in hepatic biochemical parameters.
Related Articles
Hepatitis B and C infection in haemodialysis patients in Libya: prevalence, incidence and risk factors
Alashek, Wiam A
McIntyre, Christopher W
Taal, Maarten W
BMC Infectious Diseases
Patients receiving maintenance haemodialysis (HD) are at higher risk for acquiring Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infections than the general population. Strict infection control measures are essential to prevent nosocomial transmission. We aimed to investigate the incidence and prevalence of HBV and HCV infection in the HD population of Libya as well as risk factors for infection.
All adult patients receiving maintenance HD (n=2382) in Libyan dialysis centres (n=39) were studied between May 2009 and October 2010. Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies was performed at initiation of dialysis and every 3–6 months thereafter. Patients who were sero-negative for HBV and HCV (n=1160) were followed up for 1 year to detect sero-conversions.
Participant median age was 49 years and 58% were male. 831 patients (34.9%) were sero-positive for HBV and/or HCV (anti-HCV positive 31.1%; HBsAg positive 2.6%; both positive 1.2%). Of the sero-positive patients 4.7% were known to be infected before the initiation of HD. The prevalence of HBV±HCV infection varied widely between HD centres from 0% to 75.9%. Sero-positive patients were younger, had longer time on dialysis and more previous blood transfusions. Prospective follow-up revealed an incidence of sero-conversion of 7.7% during 1 year (7.1% HCV; 0.6% HBV). Wide variation in rates of newly acquired infections was observed between dialysis centres. All new HBV cases were referred from centres already treating HBV infected patients. New HCV infections were reported in most centres but the rate of HCV sero-conversion varied widely from 1.5% to 31%. Duration of dialysis, history of previous renal transplant and history of receiving HD in another centre in Libya were significantly associated with sero-conversion.
Patients on maintenance HD in Libya have a high incidence and prevalence of HCV infection and lower rates of HBV infection. The factors associated with HBV and HCV infection are highly suggestive of nosocomial transmission within HD units. Urgent action is required to improve infection control measures in HD centres and to reduce dependence on blood transfusions for the treatment of anaemia.
Haemodialysis; Hepatitis B; Hepatitis C; Incidence; Libya; Nosocomial infection; Prevalence
Related Articles
Patient-to-Patient Transmission of Hepatitis C at Iranian Thalassemia Centers Shown by Genetic Characterization of Viral Strains
Samimi-Rad, Katayoun
Asgari, Freshteh
Nasiritoosi, Mohsen
Esteghamati, Abdoulreza
Azarkeyvan, Azar
Eslami, Seyedeh Masoomeh
Zamani, Farhad
Magnius, Lars
Alavian, Seyed Moayed
Norder, Heléne
Hepatitis Monthly
Hepatitis C is prevalent among thalassemia patients in Iran. It is mainly transfusion mediated, in particular among patients treated before 1996 when blood screening was introduced.
The current study aimed to investigate why patients still seroconvert to anti-HCV in Iranian thalassemia centers.
Patients and Methods
During 2006-2007 sera were sampled from 217 anti-HCV positive thalassemia patients at nine thalassemia centers in Tehran and Amol city, where 34 (16%) patients had been infected after 1996. The HCV subtype could be determined by sequencing and phylogenetic analysis of partial NS5B and/or 5׳NCR-core region in 130 strains.
1a (53%) was predominant followed by 3a (30%), 1b (15%), and one strain each of 2k, 3k and 4a. Phylogenetic analysis revealed 19 clades with up to five strains diverging with less than six nucleotides from each other within subtypes 1a and 3a. Strains in seven clades were from nine patients infected between 1999 and 2005 and similar to strains from eight patients infected before 1996, indicating ongoing transmission at the centers. Further epidemiological investigation revealed that 28 patients infected with strains within the same clade had frequently been transfused at the same shift sitting on the same bed. An additional eight patients with related strains had frequently been transfused simultaneously in the same room.
The results suggest nosocomial transmission at these thalassemia centers both before and after the introduction of blood screening. Further training of staff and strict adherence to preventive measures are thus essential to reduce the incidence of new HCV infections.
Hepatitis C; Thalassemia; Iran
Related Articles
Prevalence and Predictors of Hepatitis B Virus Co-infection in a United States Cohort of Hepatitis C Virus-infected Patients
Tyson, Gia L.
Kramer, Jennifer R.
Duan, Zhigang
Davila, Jessica A.
Richardson, Peter A.
El-Serag, Hashem B.
Hepatology (Baltimore, Md.)
Background and Aim
There is sparse epidemiologic data on co-infection of hepatitis B (HBV) and hepatitis C (HCV) in the United States. Therefore, the aim of this study was to determine the prevalence and predictors of HBV co-infection in a large United States population of HCV patients.
We used the National Veterans Affairs HCV Clinical Case Registry to identify patients tested for HCV during 1997–2005. Patients were categorized based on HCV exposure (any two +HCV tests or one test with a diagnostic code), HCV infection (+RNA or genotype), HBV exposure (any +HBV test, excluding +HBsAb only) and HBV infection (+HBsAg, HBV DNA, or HBeAg). The prevalence of HBV exposure among patients with HCV exposure and that of HBV infection among patients with HCV infection were determined. Multivariable logistic regression evaluated potential demographic and clinical predictors of HBV co-infection.
Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% CI 34.5–35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV co-infection for a prevalence of 1.4% (95% CI 1.3–1.5). Independent associations with HBV co-infection compared with HCV mono-infection were age ≤ 50 years, male sex, positive HIV status, history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use; there was decreased risk in patients of Hispanic ethnicity.
This is the largest cohort study in the United States on the prevalence of HBV co-infection in HCV patients. Among veterans with HCV, exposure to HBV is common (~35%), but HBV co-infection is relatively low (1.4%). Several possible risk factors were identified.
Epidemiology; Risk factors; HBV; HCV; Viral hepatitis
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Evaluation of the Prevalence of Hepatitis B, Hepatitis C, and HIV in Inmates with Drug-Related Convictions in Birjand, Iran in 2008
Azarkar, Zohreh
Sharifzadeh, Gholamreza
Hepatitis Monthly
Background and Aims
Hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) are common infections among prisoners. Addicted prisoners are at a higher risk than the normal population for contracting these diseases. Many studies have reported higher prevalence rates of HBV, HCV, and HIV in prisoners. Because of this problem, this study was conducted to evaluate the serologic prevalence of these three diseases in prisoners convicted of drug-related crimes.
A descriptive cross-sectional study was conducted on a random sample of prisoners with drug charges who were inmates in a prison in Birjand, Iran. Information was collected via questionnaire after obtaining prisoners' informed consent and blood samples were tested for hepatitis B surface antigen (HBsAg), antibodies to HCV (anti-HCV), and antibodies to HIV (anti-HIV). The results were analyzed by chi-square tests.
In this study, 358 prisoners were selected. 80.2% of prisoners were male, and 19.8% were female. The average age was 34.7±12 years. 39.1% were addicted to drugs, 54.2% were smokers, and 19.3% had tattoos. 8.4% had had extramarital intercourse, and 16.8% had had a sexually transmitted disease (STD) in past. HBsAg, anti-HCV, and anti- HIV prevalence in these samples were 6.1%, 8.1%, and 0%, respectively.The prevalence rate of HBV in the addicted prisoners was 4.3%, and the rate in non-addicted prisoners was 7.3% (P = 0.24).The prevalence of HCV in addicted prisoners was 15.7%, and the prevalence in non-addicted prisoners was 3.2%; this difference was significant (P < 0.001).Furthermore, a significant difference between the prevalence of HBV and extramarital intercourse was noted (P < 0.005).A significant difference between HCV and transfusion, history of STDs, addiction, and tattooing was noted.
The survey showed that HCV, HBV, and HIV prevalence rates in prisoners were 8.1%, 6.1%, 0%, respectively. The prevalence rates of HCV and HBV in addicted prisoners were 15.7% and 4.3 %, respectively. Studies performed in Iran and other countries have shown that the prevalence rates of HBV, HCV, and HIV in addicted prisoners were higher than the rates in non-addicted prisoners. These results indicate that HBV, HCV, and HIV are significant problems in prisons, and efforts to reduce the risk of these infections, such as education and vaccination, should be considered.
HBV; HCV; HIV; Prisoner; Drug-Related Crimes
Related Articles
The Global Spread of Hepatitis C Virus 1a and 1b: A Phylodynamic and Phylogeographic Analysis
Magiorkinis, Gkikas
Magiorkinis, Emmanouil
Paraskevis, Dimitrios
Ho, Simon Y. W.
Shapiro, Beth
Pybus, Oliver G.
Allain, Jean-Pierre
Hatzakis, Angelos
PLoS Medicine
Using phylodynamic and phylogeographic methods, Angelos Hatzakis and colleagues find that the global spread of Hepatitis C virus coincided with widespread use of transfused blood and with the expansion of intravenous drug use.
Hepatitis C virus (HCV) is estimated to affect 130–180 million people worldwide. Although its origin is unknown, patterns of viral diversity suggest that HCV genotype 1 probably originated from West Africa. Previous attempts to estimate the spatiotemporal parameters of the virus, both globally and regionally, have suggested that epidemic HCV transmission began in 1900 and grew steadily until the late 1980s. However, epidemiological data suggest that the expansion of HCV may have occurred after the Second World War. The aim of our study was to elucidate the timescale and route of the global spread of HCV.
Methods and Findings
We show that the rarely sequenced HCV region (E2P7NS2) is more informative for molecular epidemiology studies than the more commonly used NS5B region. We applied phylodynamic methods to a substantial set of new E2P7NS2 and NS5B sequences, together with all available global HCV sequences with information in both of these genomic regions, in order to estimate the timescale and nature of the global expansion of the most prevalent HCV subtypes, 1a and 1b. We showed that transmission of subtypes 1a and 1b "exploded" between 1940 and 1980, with the spread of 1b preceding that of 1a by at least 16 y (95% confidence interval 15–17). Phylogeographic analysis of all available NS5B sequences suggests that HCV subtypes 1a and 1b disseminated from the developed world to the developing countries.
The evolutionary rate of HCV appears faster than previously suggested. The global spread of HCV coincided with the widespread use of transfused blood and blood products and with the expansion of intravenous drug use but slowed prior to the wide implementation of anti-HCV screening. Differences in the transmission routes associated with subtypes 1a and 1b provide an explanation of the relatively earlier expansion of 1b. Our data show that the most plausible route of the HCV dispersal was from developed countries to the developing world.
Please see later in the article for the Editors' Summary
Editors' Summary
About 150 million people (3% of the world's population) harbor long-term (chronic) infections with the hepatitis C virus (HCV) and about 3–4 million people become infected with this virus every year. HCV—a leading cause of chronic hepatitis (inflammation of the liver)—is spread through contact with infected blood. Transmission routes include medical procedures (for example, transfusions with unscreened blood) and needle-sharing among intravenous drug users. This second transmission route is the most common one in developed countries where blood is now routinely screened before being used in transfusions. HCV infection can cause a short-lived illness characterized by tiredness and jaundice (yellow skin and eyes), but most newly infected people progress to a symptom-free, chronic infection that can eventually cause liver cirrhosis (scarring) and liver cancer. HCV infections can be treated with a combination of two expensive drugs called interferon and ribavirin, but these drugs are ineffective in many patients.
Why Was This Study Done?
Noone knows for sure where HCV originated although there is some evidence that it appeared first in West Africa or Southeast Asia. It is also unclear when the current HCV epidemic began. In this study, the researchers try to elucidate both the timescale and route of the global spread of the HCV epidemic by analyzing the genome sequence of HCV samples collected at different times and places. HCV is a ribonucleic acid (RNA) virus. That is, it stores the information it needs to replicate itself—its genome—as a series of "ribonucleotides." Like other RNA viruses, the HCV genome continually accumulates small changes (mutations) and, over time, HCV has evolved into several different "genotypes," each of which has several distinct subtypes. Furthermore, the viruses within a single subtype have subtly different genomes. By analyzing this viral diversity using complex "phylodynamic" and "phylogeographic" methods, scientists can build up a picture of how HCV has evolved in populations and how it has spread to reach its current geographical distribution.
What Did the Researchers Do and Find?
By examining the genomes of HCV samples collected between 1994 and 2006 at the Athens University Medical School (Greece), the researchers first defined a variable region of HCV called E2P7NS2 that is more informative for phylodynamic studies than the NS5B region that has been used in previous studies. They then retrieved the sequences of both regions for subtype 1a and 1b samples collected over the past 20–30 years in the Los Alamos HCV sequence database; HCV subtypes 1a and 1b cause 60% of global HCV infections. The researchers' phylodynamic analyses of these globally representative sequences (collected in the USA, Germany, Switzerland, and Greece) indicate that the transmission of HCV subtype 1a occurred at a low rate from 1906 until the 1960s, at which time there was an explosive increase in its transmission rate. Similarly, subtype 1b transmission occurred at a low rate from 1922 until the late 1940s but then increased exponentially. From 1980 onwards, the prevalence of both subtypes stabilized at a high level. The researchers' phylogeographic analyses (which considered 1a and1b NS5B sequences collected in 21 and 29 countries, respectively) suggest that HCV subtypes 1a and 1b may have spread from the developed to the developing world.
What Do These Findings Mean?
These findings indicate that the epidemic of HCV subtype 1b began in the 1940s when the use of transfused blood and blood products became widespread whereas the start of the subtype 1a epidemic coincided with the expansion of injected drug use that occurred in the 1960s. The findings also suggest that the transmission rates of both subtypes may have slowed before the widespread implementation of HCV screening in the early 1990s, possibly because the medical community was aware by then of the general risks associated with blood contamination. Finally, these findings provide new insights into how the HCV epidemic spread around the world and suggest that HCV may be evolving faster than previously thought. However, because this study relied on a small number of samples collected over a short time period, its findings need to be confirmed in larger studies.
Additional Information
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000198.
The World Health Organization provides detailed information about hepatitis C and HCV
The US Centers for Disease Control and Prevention provides information on hepatitis C for the public and for health professionals (information is also available in Spanish)
The US National Institute of Diabetes and Digestive and Kidney Diseases provides basic information on hepatitis C (in English and Spanish)
MedlinePlus provides links to further resources on hepatitis C
The Los Alamos HCV database is available
The US National Center for Biotechnology Information provides a science primer on how scientists reconstruct evolutionary pathways from sequence information
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text:
There will be an audit on shares short and it will surely show a high amount of illegal naked shorting and will force a cover. I expect about 15 million shares will need to be bought and could cause a panic. I have seen this before. Sometimes it is extreme. Very extreme. A panic could send this to 20-30 a share. Don't laugh. it has happened before!!
How do you know there is a big amount. And how did you come up with the calculation of 15 million?
ROFLMAO. I'm sorry, but that maybe the silliest thing ever post to this board. 15M shares????? $20-30/share?????? ROFLMAO.
Sentiment: Sell
can you give us an example?
Lets see. TASR went from 0.3 to 30
and there was a biotech a few years back that went from about a dollar to 130, let me look that up
Shorts are idiots
Sentiment: Strong Buy
The dividend date of Aug 30 will trigger the automatic audit
ROFLMAO. This will be the 5th or 6th STOCK dividend. not a thing happened previously (except for teh dilution). Why will this time be any different?

subset: commoncrawl


text:
The one year target price for ATRS has been getting bumped lately and other analyst will be doing the same I am sure. On the NASDAQ site I see the target is now $6,
Sentiment: Strong Buy
One year from when?
If it is one year from today I think their prediction is much too low.
In one year ATRS well be well into the teens or it will be bought out.
Nothing new. I like this company, and accept the risk.
Sentiment: Hold


text:
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HN-CRS295 Carruth Studio
Peace Snowflake Wall PlaqueItem # HN-CRS295
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- Made of durable stone/concrete material
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About Carruth StudioWe've chosen to carry Carruth Studio designs based on their integrity and authentic dedication to aesthetics. Since 1983, sculptor George Carruth has been creating whimsical images out of limestone, concrete and clay, all with one thing in common: the ability to make people smile. With a nod toward the world of nature, Carruth's signature works include a menagerie of bunnies, cats, frogs and other delightful creatures, flowers, angels, celestial bodies


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Baseball: Roger Clemens Profile
The New York Yankees lose Game 4 of the World Series to the Florida Marlins last night in the 12th inning. After pitching seven innings, Yankee pitcher Roger Clemens left the game. The 41-year-old is the oldest pitcher to start a World Series game since 1929. NPR's Tom Goldman reports.
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Hey guys, sorry I havn't been around in awhile, I have been so busy (but, one does not forget thier heart and thier beliefs). But, I am back and ready to storm. Mena
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URL: http://medtropolis.com/virtual-body/
Levels: Grades 4-12
Topics: biology, the human body
Description: Go straight to the "heart" of the matter with The Virtual Body's diagrams, animations, and narrated tour of the complex and vital organ. The online tour allows visitors to "see" the path of blood as it flows through the heart. Explore more mysteries of the body through guided tours of the brain, skeleton, and digestive tract.
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Phillips Edison-ARC Shopping Center REIT Inc. Increases Distribution Rate
CINCINNATI, Jan. 28, 2013 /PRNewswire/ -- Phillips Edison–ARC Shopping Center REIT Inc. (the "Company") announced today that its board of directors authorized and the Company has declared an increase to the annualized rate of distributions. The distribution rate will increase from 6.5% to 6.7% based on a share price of $10.00 for distributions payable to shareholders of record during the months of February and March 2013. The increased distributions begin to accrue February 1, 2013 for the distributions payable in March 2013. The board of directors unanimously approved such an increase to the distribution rate as a result of the Company's growth through numerous strategic acquisitions. The total size of the Company's portfolio contains 32 grocery-anchored properties consisting of approximately 3 million square feet, with 13 market-leading grocers in 15 states with an aggregate purchase price of approximately $367.5 million."We are pleased to announce this increase in our monthly distribution to our shareholders," said Jeff Edison, Co-Chairman of the Board and CEO of the Company. Mr. Edison continued, "We feel this increase comes at the right time, as the combination of favorable debt markets and attractive cap rates at which we can acquire properties, has allowed us to continue to increase the size of our portfolio." About Phillips Edison – ARC Shopping Center REIT Inc. Phillips Edison-ARC Shopping Center REIT Inc. is a public non-traded REIT that seeks to acquire and manage well-occupied grocery-anchored neighborhood shopping centers having a mix of national and regional retailers selling necessity-based goods and services, in strong demographic markets throughout the United States. The REIT is co-sponsored by two industry leaders: Phillips Edison & Company, who has acquired over $1.8 billion in shopping centers throughout the United States, and AR Capital, LLC, a real estate investment program sponsor dedicated to governance best practices. As of January 28, 2013, Phillips Edison-ARC owned, directly or indirectly through a joint venture in which it has a controlling interest, and managed an institutional quality retail portfolio consisting of 32 grocery-anchored shopping centers totaling 2,997,845 square feet. For more information on the company, please visit the website at www.phillipsedison-arc.com. The statements in this press release that are not historical facts may be forward-looking statements. These forward-looking statements involve risks and uncertainties that could cause the outcome to be materially different. In addition, words such as "anticipate," "believe," "expect," and "intend" indicate a forward-looking statement, although not all forward-looking statements include these words.
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Action/Vehicle/Building Sets
Shop for Toy Farm Animals, Schleich Animals, Native American Toys and more.
Funrise Tonka Toughs Steel Road Grader 92510$21.98
Since 1987, Funrise has been producing and distributing some of your family's favorite toys, including industry-leading Tonka brand. For generations, Tonka has been manufacturing well-recognized toy trucks and construction equipment. Known for their durability and attention to detail, Tonka toys are built to last.
Clear the way for new construction! Scrape dirt, small rocks, or even sand out of your way! Built from steel, this Tonka Toughs Road Grader is the toy for the job! Use the handy lever to steer the blade from side to side. Free-wheeling design allows the front wheels to move easily for added maneuverability. And be confident knowing this is a toy your family can enjoy for years to come. Tonka toys come with a manufacturer's lifetime warranty.
Vivid yellow color and chunky wheels round out this toy's appealing design. Adds great fun to any indoor or outdoor play construction site. Makes a great addition to any vehicle collection or toy truck fleet.
Key Features:
- Made of steel
- Movable grader blade and front wheels
- Manufacturer's lifetime warranty
- Measures 7.5" x 7.5" x 17.88"
Funrise Classic Mighty Front Loader Tonka 93920/90697$28.98
Looking for a toy that has stood the test of time? Look to the Tonka brand toy, the one that has been around since the mid 1940s and continues to stay strong. Your little construction worker will enthusiastically take his hard hat and lunch box to the sand pile or to the driveway with the Funrise Classic Mighty Front Loader Tonka.
He or she can move this product easily and realistically with the to-scale giant free wheels. The moveable front loader goes up and down to make this working toy seem like the real thing. It can handle the loads of dirt, rocks and sand, making kids' hard day on the job a breeze.
And how many brands can tout this? The construction is steel!! How's that for the rough and tumble of the sandbox? This toy is easily guaranteed for life. It might just make you nostalgic for the days when you hung out in the sandbox. Join in the fun!
- Steel Construction
- Free-wheeling vehicle
- Moveable Front Loader
Bruder JLG 2505 Telehandler 02140$19.98
The JLG telescopic loader is a true all-rounder. Do large amounts of earth have to be shovelled? Or delicate goods loaded onto palettes? The JLG telescopic loader is a reliable and effective partner in any situation. Its small size and the greatly extendable telescopic arm are exactly what make it the number one choice for many different locations of use. The JLG model is carefully controlled with four accentuated silver turning handles. Besides the adjustable arm height, the extendibility of the arm and alterability of the angle of the tool holder, the telescopic loader has fully functional four-wheel steering. This makes steering both the JLG telescopic loader and the Bruder model as easy as child's play.
Drivers Cab:
- Cabin windows made of transparent and high-quality polycarbonate
Automotive Body:
- The telescopic arm is extended and its height adjusted with the top rotary knob
- Changeable front loader scoop
- The angle of the bucket can be adjusted using the silver turning handle
- Four-wheel steering with silver handle
- Removable drawbar coupling
- Tread tires
Additional Information:
- Compatible with figure
- WARNING! Not suitable for children under 36 months. Choking hazard - small parts.
- Recommended age: suitable from 3 years upwards for playing indoors and outdoors
- Manufactured from high-quality plastics such as ABS
- Made in Germany
- Scale 1:16
*********TRAILER NOT INCLUDEDLearn More
Funrise Tonka Classic Mighty Dump Truck 93918$24.98
This Classic Mighty Dump Truck is built for hauling! This sturdy, steel construction vehicle is ready for the toughest loading jobs. Move the bed up and down to trigger its unloading action! Constructed with Steel and guaranteed for life!
- Steel Construction
- Free-wheeling Truck
- Moveable bed for dumping
- 16in L x 10in H x 8.5in W
Funrise Tonka Toughs Steel Bulldozer 92961$19.98
The Tonka Classic Bulldozer is ready to demolish and clear away anything in its path. Move dirt, sand and gravel with the workable blade and take control of any job site! This Bulldozer is built to last and guaranteed for life!
- Steel Construction
- Free-wheeling Bulldozer
- Movable Blade
Dragon-I Toys Dinosaur T-Rex R/C Infra-Red Control 80041$19.98
T-Rex with high quality detail, realistic growing sounds, walking function and light up eyes.
- Includes Infra-Red Remote Control
Funrise Tonka Steel Tow Truck 92202$19.98
The Funrise Tonka Steel Tow Truck is styled as realistic as the life size model. The Tonka Tow Truck is perfect for your child to play with in the sandbox. The sturdy build features a four-position life that really lifts and tows and deep cleated tires help young drivers maneuver like a pro!Learn More
Calico Critters Sea Otter Family CC1477$22.97
Adorable critters come with removable clothing. Family critters are poseable, with jointed arms and legs, and heads that turn! Twins have heads that turn.
Parents are approximately 3" tall, brothers and sisters are 2 1/4" tall, and the twins are 1 1/4" tall.
- Parents: 3"
- Brothers & Sisters: 2 1/4"
- Twins: 1 1/4"
Fisher Price imaginext Ion Alien Headquarters CCH64$24.98
With the Fisher-Price® Imaginext® Ion Alien Headquarters, kids become part of an outer space world of adventures where they control the action! Can the evil aliens protect their headquarters from the brave and daring humans? Move the eyeball scanner up and down to "scan" figures and detect if they are humans or aliens. Turn the bottom disk to open the front door and let figures inside. Turn the disk near the lookout tower to move the tentacles back and forth to scare away intruders. Press the lever in back to activate a snapping tentacle that can knock over figures trying to enter the front door. If humans are detected infiltrating headquarters, your little space explorer can move the launcher throughout the play set and fire projectiles at them – or trap them in the tentacled jail cell! The space adventures and the imaginative play never end!
Product Features:
- Move the eyeball scanner up and down to "scan" figures and detect if they are human or alien
- Turn the bottom disk to open the front door and let figures inside
- Turn the disk near the lookout tower to move the tentacles back and forth to scare away intruders
- Press the lever in back to activate a snapping tentacle that can knock over figures trying to enter Ion Alien Headquarters
- Move the launcher to many locations throughout the play set, including any of the tentacle arms, and fire a projectile!
- Trap humans in the tentacled jail cell!
- Includes Ion Alien Headquarters, an alien figure, a human figure with fake alien headpiece, and alien projectile launcher with projectile
Calico Critters Carry and Play House CC9900$24.97
Equipped with a convenient built-in handle, it's perfect for the Calico fan on the go! Great for taking the critters over to a friend's house, on a trip, or simply set it up at home.
- 2 cozy rooms for hours of decorating fun
- 3 drawers to hold all the critters and accessories
CRITTERS AND ACCESSORIES NOT INCLUDEDLearn More


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Find a Doctor
With over 450 board-certified physicians, Albany Med Faculty Physicians are some of the most expert in their field. All Albany Med Faculty Physicians, along with a variety of other medical providers, are affiliated with Albany Medical Center Hospital. Find the right physicians who meet your medical needs.
Physicians displayed with the Albany Med logo participate in all listed insurance plans.
Those listed without the Albany Med logo may or may not accept all plans listed.
Please contact those physician's offices directly for a listing of participating insurance plans. Charges are available upon request.
Marc Judson MDChief, Division of Pulmonary and Critical Care Medicine
Board Certification:
American Board of Internal Medicine, 1986
(Pulmonary Disease)
American Board of Internal Medicine, 1983
(Internal Medicine)
Contact Information:
AMC Pulmonary & Critical Care Medicine
47 New Scotland Avenue, MC 91
Physicians Pavilion, 4th Floor
Albany, NY 12208
Tel: (518) 262-5196
Fax: (518)262-6472
Pulmonary and Critical Care Medicine
Interstitial lung disease
Fungal diseases of the lung
Evaluation of shortness of breath
Pulmonary complications of solid organ transplantation and bone marrow transplantation
Pulmonary & Crit Care Med
07/01/1983 - 06/30/1985
NYU Medical Center
New York, NY
Internal Medicine
07/01/1980 - 06/30/1983
Montefiore Medical Center
Bronx, NY
Medical Education
8/1/1976 - 05/09/1980
Vanderbilt Medical School
Nashville, TN
Dr. Marc A. Judson is a Professor of Medicine and Chief of the Division of Pulmonary and Critical Care Medicine at Albany Medical College. He is an internationally known in the field of sarcoidosis, a disease of unknown cause that affects the lung and other organs of the body. He is currently the President of the Americas Association of Sarcoidosis and Other Granulomatous Disorders, the American sarcoidosis medical society.
He is currently ranked as the #2 expert in the world concerning sarcoidosis and pulmonary sarcoidosis by expertscape.com. He has published more than 100 articles concerning the disease, and runs one of the largest sarcoidosis clinics in the Northeast. Dr. Judson's other areas of expertise include interstitial lung diseases and fungal diseases of the lung.
Dr. Judson was also selected by the Times Union as one of the Top Doctors of 2015.


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June 19, 2013
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What I have gathered so far it is a really nice club. The people are very friendly and helpful. I like it.
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Reviews for
Sammy Keyes and the Art of Deception
Booklist Monthly Selections - #1 February 2003
Gr. 5-8. Sammy Keyes returns, as feisty as ever, this time lurking around the art world to learn the secret a painter is keeping. As with other books in the series, there's more going on than just sleuthing. Sammy and her nemesis, Heather, mix it up once more. And there's some romance here for Sammy, but mostly for her grandmother, with whom she lives, and for Hudson, Sammy's 72-year-old best friend, who appears to be more interested in artist Diane Rejiden than in Grams. Van Draanen only makes slight concessions to her audience. Her tone is sharp, her dialogue fast, and the mystery, on the face of it, is not particularly kid-friendly. Yet Van Draanen's fresh take on things, painted with a patina of realism, will attract a new audience and also keep fans turning pages. ((Reviewed February 1, 2003)) Copyright 2003 Booklist Reviews
Horn Book Guide Reviews 2003 Fall
In the latest Sammy Keyes mystery, the seventh-grade sleuth investigates a break-in at an art gallery (and uncovers an even larger crime) as she continues to grow closer to school foe Heather Acosta's brother Casey and achieves a new appreciation for her grandmother (who helps catch the criminal here). Another light, fast-moving mystery featuring the spunky, down-to-earth Sammy. Copyright 2003 Horn Book Guide Reviews
Kirkus Reviews 2003 March #1
Shenanigans take a back seat to affairs of the heart in this teenaged Sherlock's eighth outing. Assigned to find and analyze "art" at either a local gallery or an upcoming Renaissance Faire, Sammy tries both, and stumbles into a tangle of vicious intrigue, inflated egos, hidden motives, and general bad behavior-not unlike junior high school, where Sammy continues to be whipsawed by encounters with archenemy Heather Acosta and her friendly, disturbingly attractive brother Casey. Having foiled an attempted robbery at the gallery that looks more and more like a setup, Sammy smells something fishy-and finds an unlikely ally in her grandma, with whom she lives illegally in a seniors-only apartment, and whose budding romance with Sammy's septuagenarian confidante Hudson seems headed for the rocks after a charming artist turns his head. Despite robberies, shocking revelations, mysterious strangers, and pumped-up language ("Anyhow, I blasted over to art class, and the minute I blew through the door . . . "), Sammy's preoccupation with Gram's love life and getting her own feelings for Casey in order, along with ruminations about good art vs. bad, orient this episode more toward character and personal issues than its suspenseful, danger-laden precursors. Still, thoughtful readers will understand from Sammy's anguish, when she sees a work of art that had moved her profoundly destroyed by its larcenous owner, that there are moral felonies at least as wicked as the more conventional legal kind. (Fiction. 11-15) Copyright Kirkus 2003 Kirkus/BPI Communications.All rights reserved
Publishers Weekly Reviews 2003 February # 3
Wendelin Van Draanen's Sammy Keyes and the Art of Deception marks the eighth title about the spunky detective. To fulfill an assignment, the sleuth attends an art opening. When a bandit crashes the event and yanks paintings from the wall, Sammy attacks. But the real detective work begins when Sammy seeks the truth about a so-called painter. Copyright 2003 Reed Business Information.
School Library Journal Reviews 2003 March
Gr 5-8-In this eighth novel featuring the feisty seventh grader, Sammy's art teacher encourages her students to visit local galleries and while attending an opening reception, the young sleuth foils an attempted robbery. Intrigued by the work, she interviews Diane Reijden to learn more about being an artist, and to try and figure out why her paintings were the object of the thief. Unfortunately, Sammy is not the only one intrigued by Diane. Her good friend, 72-year-old Hudson, is entranced, much to the distress of Sammy's grandmother. There are dead ends and red herrings before the protagonist figures it all out, this time with the help of her grandmother, who turns out to be just as bold, fearless, and gutsy as her granddaughter. Lively, with nonstop action, this novel will be enjoyed by longtime fans of the detective and by those who are meeting her for the first time. Subplots involve Sammy's budding romance with eighth-grader Casey (brother of her arch-rival Heather), and her gradual realization that her grandmother is a separate person with her own emotions and complications.-Terrie Dorio, Santa Monica Public Library, CA Copyright 2003 Reed Business Information.
VOYA Reviews 2003 August
Irrepressible, spunky heroine Sammy is back solving the mystery of an art gallery theft in this eighth title of the Sammy Keyes series. Sammy's school assignment is to interview a professional artist and learn what art is about. She attends an art gallery premier with her grandmother and older friend, Hudson, but the event is interrupted when a bandit attempts to steal local artist Diane's paintings from the wall. Sammy foils the robbery and then pairs up with her grandmother to discover why the thief would want only this particular artist's work. They discover that the art world is full of petty, competitive people and that Diane might not be as blameless as first believed. Their investigation is further complicated by other characters who have hidden motives. Propelled by numerous plot twists, sneaky characters, and intrigue, this story does not have as much adventure and daring as other series titles. The danger does not seem convincing, and the potential villains do not appear wicked. More an insightful study in character, this installment features the gutsy Sammy relentlessly investigating, analyzing, and using the little information she has discovered to successfully solve the mystery. The middle school subplot of cat fighting between Sammy and her nemesis, Heather, and Sammy's crush on Casey provide a realistic backdrop and will involve readers. Sammy is still a funny, smart, and independent character who will keep readers cheering and waiting for her next adventure.-Eileen Kuhl. 3Q 3P M Copyright 2003 Voya Reviews


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Find out which states have the highest percentage of religious people in this slideshow based on information from the Pew Research Center.
This is my German Shepard/Huskey mix. His name is Odin. He went missing April 1 around the Santa Fe and 15th area in Edmond. Feel free to contact me or message Hannah Berry.
If National Tourism Week, which runs May 1-7, has you thinking of getting out of town, check out which U.S. destinations Lonely Planet ranks as the best places to visit this year.
2012: Former NFL linebacker Junior Seau commits suicide at age 43 by shooting himself in the chest in Oceanside, California. Seau, a 10-time All-Pro, 12-time Pro Bowl selection and member of the NFL 1990s All-Decade Team, started for the San Diego Chargers for 13 seasons before spending three years with the Miami Dolphins and then finished his career with four years for the New England Patriots. After his death, studies by the National Institutes of Health concluded that he suffered from chronic traumatic encephalopathy, a type of chronic brain damage that had also been found in other deceased former NFL players.
May 1-7 marks National Pet Week. With that in mind, be sure to keep both your furry friend and your wallet happy with these tips to save money on pets from U.S. News & World Report:
2011: American actor Jackie Cooper, the first child actor to receive an Academy Award nomination, dies of natural causes at the age of 88 in Santa Monica, California. Cooper was nominated for an Oscar for Best Actor at the age of 9 for the 1931 movie "Skippy," making him the youngest actor to be nominated for the award. For nearly 50 years, he would remain the youngest Oscar nominee in any category, until he was surpassed by Justin Henry's nomination, at age 8, in the Best Supporting Actor category for 1979's "Kramer vs. Kramer." As a child actor, Cooper also appeared in the "Our Gang" comedy series and also appeared in movies such as "The Champ," "The Bowery" and a 1934 version of "Treasure Island." As an adult he worked as a TV executive, producer and director, with his work directing episodes of "M*A*S*H" and "The White Shadow" earning him Emmy Awards. He also found renewed fame in the 1970s and 1980s as Daily Planet editor Perry White (pictured) in the "Superman" film series starring Christopher Reeve.


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Sign Up For The WYRK Eat + Greet With Sugarland's Kristian Bush!
You'll recognize Kristian Bush as half of the super-duo Sugarland!
You'll recognize Kristian Bush as half of the super-duo Sugarland!
Sugarland was hardly Jennifer Nettles' first successful musical enterprise. She fronted the Jennifer Nettles Band prior to becoming part of the now-famous group. But before that, she was one-half of a duo that MTV called "the next big band from Athens, Ga." There are some stunning similarities and differences between her current sound and the music she created as part of Soul Miner's Daughter.
Following a confetti-filled countdown to 2014, Kristian Bush of fan-favorite duo Sugarland will head out on the road to play a few solo tour dates.
Sugarland frontwoman Jennifer Nettles, announced via Twitter on Monday (Nov. 5) that her solo album finally has a release date. The album, 'That Girl,' will be Nettles' first without her Sugarland bandmate Kristian Bush and is set for release on Jan. 14.
For the first summer in nearly a decade, Kristian Bush didn't tour with Sugarland, as the duo is on hiatus. This meant more time to write, pursue solo projects and just be a dad again. The co-founder of country's most successful duo since Brooks and Dunn says he's rolling all three of those jobs into one enjoyable ball -- and loving it.
American fans of Sugarland star Kristian Bush's solo material have been begging him to release 'Love or Money' at iTunes, and he's been paying attention. Thursday's (Oct. 10) release will be his first official release as a solo artist since ... umm, maybe ever?
Fear not, Sugarland fans: Even though Kristian Bush and Jennifer Nettles both have solo projects going on, the duo isn't breaking up.
There's always some less-than-thrilling things that happen each week, whether it's across the country, down to Music City in Nashville, or right here in our WNY backyards.
Approximately 60 people affected by the stage collapse at the Indiana State Fair two years ago will get their day in court this winter. A trial date has been set for those looking to hold Sugarland and the companies responsible for building the stage accountable.
Sugarland's Kristian Bush can now add a new job title to his resume: video game character creator. Or ... something like that. The Grammy-winning singer joined forces with Big Blue Bubble, Inc. to create a new character for My Singing Monsters, the company's award-winning musical video game.
It's family first for Jennifer Nettles, who gave birth to her first child, son Magnus, last December. She took a career pause so she could enjoy life as a new mom, then decided to do a solo album all the while remaining a member of Sugarland.


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"Holy Place - Center of the World" Mecca by Khalid_eg
Mecca Travel Guide: 160 reviews and 341 photos
The Kaaba.. most holy mosque for muslims, muslims make the pilgrimage to it from all over they world.. and The Kaaba is our kiblah "direction Moslems turn to in prayer"
- Pros:Everythin'
- Cons:Nothin' but humidity in the summer time.. i think it comes from Jeddah :)
Reviews (2)
when u r in Mecca so u r there for Haj or Ommra.. i mad ommra, i won't explain more about it cuz u can find the steps in... more travel advice
It's nice hotel and i was in the 11st story.. check the photos. one of my room and the other the view from the window..... more travel advice
Travelogues (1)
- 1
Comments (11)
amazing to know that mecca is the centre of the world..
You have a very informative tip of Mecca. The picture of Mecca always amazed me. Nice view from your hotel eh. I miss the ME environment.
Gorgeous pictures of Mecca, Khalid. You are very fortunate to have made this journey. I hope 2007 is full of happiness & travel. :)
Great pictures, Khalid! If you come across my friend Bahaa and his parents say Hi from me! They are there now as well. I hope your prayers are answered, Khalid!
Very nice pictures of Mecca. .. it looks beautiful with the lighted mosques and all of the people. i didnt know you were going this year !
Omrah Maqboolah inshaa Allah ,Realy nice page ,i hope u feel how ramadan in mecca is grate and defferent from other places.
Very very very very nice pics taqabbal allah
what a great and fabulous page keep it up
Nice page, Khalid. It remembers me a documentary I saw on Discovery Channel about this year's haj. And I hope you can write more on the subject because is very interesting. Have a wonderful time there!
Nice place khalid I heard about it since ramadan muslim people must to visit this Holy Place, Its so beautiful hope someday I will see this place too.
Khalid_eg's Related Pages
Mecca Travel Guide
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Latest Activity in Mecca
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Top 10 Pages
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Alea, an 18 year old student from New Mexico, likes to fuck and what better way to do so then to do porn. With Tonys help, the fact that she has the perfect ass and body tightly packed into a five-foot-two frame, and what she calls her memory foam pussy, cause its always stays tight, she has no problem getting some shoots set-up. She says no guy can give her enough. During her first shoot she gave Jmac a run for his money, so Tony calls in the big guns this time and invites Juan Largo over. While waiting for Juan to come over Alea struts around, poppin her ass, and showin off her tight package. Juan shows up and without any hesitation she leads him to the couch and jumps on his lap. Then she stands up and dips her pussy down to give Juan a mouthful. Followed by a blowjob and multiple sex positions Alea finally gets her fill from Juans big cock. After cumming multiple times herself she cries out to taste and have her face covered in Juans cum.
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Car DVR L2 Full HD Camera Vehicle Blackbox DVR Dash Camera w/ 2.4" LCD / 8GB TF - Blue + Black
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(0 Review)
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x AV cable (108cm length) 1 x DC 12~24V car charger (382cm cable) 1 x Chinese/English manual
(2 Reviews)
3MP Dual Lens Wide Angle Car DVR Black Box w/ GPS Logger/TF Slot (2.7" LCD)
/ Spanish / Italian / Simplified Chinese / Traditional Chinese / Japanese etc. System: Windows 2000/XP/Vista/7/MAC OS X10.3.6 or above Accessories: 1 x Mount holder 1 x Car
(1 Review)
ALADDN A808 2.7" TFT LCD 1080P 5.0 MP Wide Angle Car Black Box DVR Camcorder w/ 2-IR LED - Black
,Chinese Traditional Packing List 1 x Car DVR 1 x Camera 1 x Holder 1 x USB cable (71cm) 1 x Car charger (395cm-cable) 1 x External camera extension cable (494cm) 1 x Chinese
2000A 3.0" LCD 5.0 MP CMOS 120 Degree Wide Angle Car Camcorder w/ HDMI / AV-Out - Black
Time 1.5 H Operating Voltage DC 12V Language English / Chinese / Russian / Japanese / French / Spanish / German / Italian Other Features This car blackbox DVR adopts the
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