Editorial

Expert Commentary

Vertebral Hemangiomas (VH) are common benign vascular tumors, present in as many as 10% to 12% of autopsy specimens(1), the presentation of which varies from asymptomatic lesions often diagnosed incidentally (1,5) to the rare lesions that cause vertebral compression fractures with spinal cord compression. VH typically occurs in the lower thoracic and upper lumbar regions and are more frequent in the female population (7,8). Although malignant degeneration is extremely uncommon, fewer than 5% of them could be labeled "aggressive hemangiomas", presenting with localized spinal pain (60%), fracture (10%), compression of the spinal cord with myelopathy, or radiculopathy (30%). Posterior spinal structures (pedicle, laminae, and spinous processes) involvement is seen in 10-15% of patients, and this is indicative of an atypical, aggressive lesion. Lesions generally become symptomatic when there is neural arch expansion, vertebral body enlargement, or direct compression of the thecal sac or nerve roots (2,3). Cord compression leading to neurological deficits and paraplegia is usually a late event. Management of symptomatic vertebral hemangiomas includes observation, radiotherapy, enbloc excision/spondylectomy, laminectomy with preoperative embolizaton and percutaneous vertebroplasty/Kyphoplasty. We have reviewed the currently available literature regarding the evaluation and management of these lesions with illustrative case examples and propose a treatment approach to be followed

Introduction: Influenza (H1N1) is very sensitive and newly emerged pandemic. Influenza (H1N1) pandemics are caused by new influenza viruses that have recently adapted to humans and resemble major natural disasters both in terms of recurrence and magnitude. Aims and Objectives: To study the outcome and epidemiological factors of suspected H1N1 influenza cases. Study Design: Hospitalbased descriptive study, Study Period: Study was conducted over a period of seven months from April 2009 to October 2009. Study Variable: Outcome, age, sex, time, place of residence. Results and Discussion: The total 110 cases of suspected H1N1 influenza were admitted in Infectious diseases ward of Government Hospital Solapur. Out of 110 total suspected cases, 91 (82.72%) were cured and discharged. Among these 91 (82.72%) suspected cases, 17 (15.45%) were laboratory confirmed for Influenza (H1N1). Conclusion: In present study, maximum case fatality rate (32%) was observed in females in age group of 15-44 years as compared to male.

Background: The risk of acquiring hepatitis B virus (HBV) and hepatitis C virus (HCV) infections through exposure to blood or its products and contact with other body fluids is high amongst health care workers (HCWs). Despite potential risks, a proportion of HCWs never get vaccinated. This study aimed to investigate the vaccination practices and the prevalence of HBV infection in HCWs. Aims: To determine the prevalence of HBV and HCV, their possible association with occupational and non-occupational risk factors. We also studied the prevalence of vaccination for hepatitis B in different subgroups of study population. Materials and Methods: In this cross-sectional study, total 1347 hospital staffs were screened for hepatitis B and hepatitis C. HBV is detected by HBsAg testing, and HCV is detected by anti-HCV testing by ELISA method. Positive results were confirmed by HBV DNA testing (Qualitative) and HCV RNA testing (Qualitative). A questionnaire used to collect data from study participants was pre-designed by the authors. Results: Out of total 1347 hospital staffs screened, 6 (0.4%) were HBsAg-positive and 2 (0.1%) were anti-HCV-positive. Only 54% had a history of complete vaccination, and 0.3% had incomplete vaccination. Vaccination coverage was highest in residents (76.7%), medical students (68.9%), nursing (66.1%), and teachers (61.4%) and lowest in servants (5.4%), office staff (6.6%), and lab technicians (24.3%). Awareness about the risk factor for transmission of HBV and HCV and complication related to them was 77.7%. It was highest in teachers (93.9%) and residents (97.8%), lowest in servants (16.3%). No statistically significant difference in the exposure to various risk factors among those who are HBsAg or anti-HCV-positive and HBsAg or anti-HCV-negative. Conclusions: The prevalence of HBV and HCV infection is not high in hospital staff than general population. Hepatitis B vaccination coverage was below expectation in all the subgroups even in resident doctors and teachers.

Background and Objective: HBeAg-positive chronic hepatitis B patients have high serum HBV DNA level showing high viral replication. Goal of treatment of hepatitis B is to prevent cirrhosis, hepatic failure and hepatocellular carcinoma by serum alanine transaminase (ALT) normalization, decrease in serum hepatitis B virus (HBV) deoxyribonucleic acid (DNA) and loss in hepatitis B e antigen (HBeAg). Interferons (IFNs) have antiviral, anti-proliferative, and immunomodulatory effects. IFN-a is effective in suppressing HBV replication and in inducing remission of liver disease. Materials and Methods: In this prospective, single treatment arm study, HBeAg-positive chronic hepatitis patients without decompensated liver disease were enrolled to receive indigenous recombinant IFN-a 2b in the dose of 5 MU daily for 6 days a week subcutaneously for 16 weeks. Quantitative HBV-DNA, HBeAg, and hepatitis B surface antigen (HBsAg) were assessed at baseline and at the end of treatment. ALT level assessment was done at baseline and during therapy at week 1, week 2, week 8, week 12, and week 16. Results: Out of 37 patients enrolled in the study, 8 patients (21.62%) did not complete study due to lost to follow-up (3 patients), discontinuation due to adverse event (3 patients), and consent withdrawal (2 patients). Among 29 patients who completed the study, 10 patients (34.48%) had clearance of HBeAg and 1 patient (3.44%) had lost HBsAg after 16 weeks of therapy. Mean ALT level started decreasing after 4 weeks of therapy but did not come to normal range till 16 weeks of therapy. At least 2 log decreases in HBV DNA was observed in 9 (31.03%) patients and at least 1 log decrease in 18 (62.06%) patients. Overall decline in HBV DNA level was observed in 62% patients after 16 weeks of therapy. Conclusion: IFN-a treatment does result in HBeAg and HBsAg loss and decreases HBV-DNA levels in chronic hepatitis B patients. Most of adverse events were mild to moderate in intensity. So, interferon-a therapy was well tolerated, safe, and efficacious to treat HBeAg-positive chronic hepatitis B patients without decompensated liver disease.