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The seroprevalence of viral hepatitis in healthcare workers has important public health implications. To assess the risk factors for the acquisition of viral hepatitis in an unvaccinated cohort from an hyperendemic region, 567 healthcare workers from a large hospital in the capital of the Republic of Yemen were interviewed and tested for serological markers of infection with viral hepatitis. 54/543 (9.9%) tested positive for hepatitis B surface antigen (HBsAg), 174/543 (32.0%) had positive hepatitis B core antibodies (anti‐HBc), and 19/546 (3.5%) had hepatitis C antibodies (anti‐HCV). Age (OR = 1.04, 95% CI 1.02–1.06), male sex (OR = 2.0, 1.32–3.03), and occupation (healthcare workers not carrying out exposure prone procedures, OR = 1.61, 1.06–2.44) were found to be independent predictors for the likelihood of detecting either HBsAg or anti‐HBc by multivariate logistic regression analysis. No independent risk factors for anti‐HCV positive status were identified. Our findings support the adoption of universal HBV immunisation programmes and infection control precautions. The absence of known risk factors predicting anti‐HCV positive serostatus suggests the main mode of transmission of hepatitis C in this cohort in the Yemen remains undiscovered. J. Med. Virol. 73:562–565, 2004. © 2004 Wiley‐Liss, Inc.

1 Studies of paracetamol metabolism were performed in a 58-year-old female with rheumatoid arthritis who had consumed 15-20 g paracetamol daily for 5 years with out developing liver damage and data were compared with results in seven normal volunteers.2 After a test dose of 2 g paracetamol, the formation of paracetamol sulphate and glucuronide conjugates detected in plasma from the patient was delayed by around 2 h relative to values in normal volunteers and the proportion of sulphate conjugates excreted in urine was 1.5 to 2 times those in normal volunteers (52% vs 26-35% of dose, respectively). The fractional metabolite clearance of paracetamol to glutathione-derived conju gates (0.28 ml min-1kg-1) in our patient was > 30% lower than in normal females.3 A combination of slow paracetamol absorption, enhanced detoxication of paracetamol (by sulphation) and reduced metabolism to potentially cytotoxic metabolites may have reduced the risk of liver damage in this patient. The latter may have reflected pharmaco- genetic deficiencies in cytochrome P450 isoenzymes per sisting despite chronic alcohol consumption (40—60 g per day) or resulted from inhibition of paracetamol acti vation by concomitant ingestion of aminophylline.

HBeAg or anti HBe were detected using radioimmunoassay in 93 out of 100 British patients who were chronic HBsAg carriers. HBeAg was found more commonly than anti HBe in younger patients and those with higher titres of HBsAg and abnormal liver function tests. HBeAg was present particularly in patients with chronic active hepatitis (26 out of 29) and chronic persistent hepatitis (16 out of 21). Anti HBe was found particularly in healthy carriers (19 out of 27), and patients with cirrhosis (4 out of 8) and hepatocellular carcinoma (7 out of 8). However, the system was of little help in predicting the liver biopsy appearances in the individual patient. During a mean follow‐up period of 44 months, 6 of the 62 (9.7%) HBeAg positive carriers converted to anti HBe, a spontaneous seroconversion rate of 2.68% per year.

Of 9 patients who survived the immediate postoperative period after hepatic transplantation, 6 later died from infection. Pulmonary infection was the major problem. Biliary infection related to bile fistulas may be less in the future with the improved technique of a cholecystdochostomy which was carried out in the last 2 patients. Frequent bacteriaemias were noted and the organisms were often the same as those found in the bile. Most infections were thought to be autogenous. Cytomegalovirus infection occurred in 6 patients, but in none was there evidence that the virus did harm. Broad-spectrum antibiotic therapy was freely used in the earlier patients but was often followed by superinfection with resistant organisms and fungi. The present policy is not only to use antibiotics sparingly but to rely on narrow-spectrum drugs wherever possible.

Measurements of liver area on antero-posterior 99Tcmsulphur colloid scans in fulminant hepatic failure (FHF) showed reduction in liver size in six of the 33 patients and enlargement in three. By contrast, liver area was normal or increased in all 20 patients with severe acute hepatitis without encephalopathy. The serum bilirubin and aspartate aminotransferase were not significantly different between the two groups but there was greater prolongation of the prothrombin time in the FHF patients. All six patients with reduction of liver area on the initial scan died but neither the finding of a normal or enlarged liver area on admission nor serial liver scans were helpful in assessing the prognosis of an individual patient. Peak activity over the liver was sometimes higher than normal, possibly due to shrinkage of the liver with approximation of the Kupffer cells.

The causes of acute icteric viral hepatitis were determined in 78 adult Yemeni patients. Acute hepatitis B (IgM anti‐HBc positive) was the most common type (26.9%). Acute hepatitis E (IgM anti‐HEV positive) occurred in 14% and was not associated with travel outside Yemen. Sixty percent of all 78 patients were positive for IgG anti‐HEV as were 40% of a series of 48 healthy male blood donors and pregnant females, indicating that HEV is prevalent in Yemen. Acute hepatitis A (IgM anti‐HAV positive) and hepatitis C and D were responsible for 5.1%, 6.4%, and 2.6% cases, respectively. This totals to 106%, as an infection with two viruses occurred in 6.4% cases. In 51.3% of all cases, no virological markers of acute hepatitis were detected, suggesting an as yet undiscovered agent. J Med Virol 51:64–66, 1997.© 1997 Wiley‐Liss, Inc.

The leaves of the Qat plant (Catha edulisForsk., Celastraceae) which contain amphetamine like compounds are widely chewed in Yemen and East Africa for their pleasurable stimulant properties. There are also a number of unwanted side-effects and this paper studies the effect on heart rate and blood pressure in 80 healthy volunteers. During a 3-h period of chewing fresh Qat leaves there was a significant and progressive rise in systolic and diastolic blood pressure and heart rate, and levels had not returned to baseline 1h after chewing had ceased. Further studies are needed on possible cardiovascular morbidity associated with regular Qat chewing.

PROTEIN concentrations after liver transplantation are of interest because most plasma proteins, other than the immunoglobulins, are made wholly or partly in the liver. The concentrations of eighteen immunologically distinct proteins have been measured by a quantitative immunoelectrophoresis technique1in a single subject before and for 4.5 months after receiving an orthotopic liver graft.