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Background: In the United States, blood donor testing for hepatitis B surface antigen (HBsAg) was initiated in the early 1970s. More recently, testing for antibody to hepatitis B core antigen (anti-HBc) and hepatitis B virus (HBV) DNA have been added. The incidence of hepatitis B has been declining. This study reviews the current status of testing and questions the need for continuation of HBsAg testing.Study Design and Methods: From July 2011 to June 2015, a total of 22.4 million donations were serologically tested for HBsAg and anti-HBc and for HBV-DNA by nucleic acid testing (NAT). All reactive results were evaluated and a subset of donations that were either potential NAT yield (seronegative) or serologically positive but nonreactive by HBV NAT in minipools (MPs) of 16 were further evaluated by individual donation (ID)-NAT. Samples with detectable HBV DNA were defined as actively infected and considered potentially infectious.Results: Routine testing plus supplemental ID-NAT identified 2035 samples representing active infection including 1965 with anti-HBc, 1602 with HBsAg, and 1453 with HBV DNA by MP-NAT, for respective rates per hundred-thousand donations of 9.10, 8.78, 7.16, and 6.50, continuing the downward trend previously observed. There were 29 HBV DNA-yield samples (1:771,389), 35 HBsAg-yield samples (anti-HBc nonreactive), and 404 with occult hepatitis B infection. There were six samples with HBsAg and HBV DNA detectable only by ID-NAT in the absence of anti-HBc; additional testing was consistent with extremely low or negligible levels of DNA.Conclusions: Point estimates of HBV infection rates among blood donors continue to decline, as do those for incidence and residual risk. Elimination of HBsAg screening would have negligible impact, with a risk less than 1 per 4 million donations. [ABSTRACT FROM AUTHOR]

Objective: The hepatitis B virus (HBV) testing rates and patterns in rheumatoid arthritis (RA) patients starting disease-modifying antirheumatic drugs (DMARDs) have not been well studied. We describe and compare the practice patterns of HBV testing among RA patients in the US and Taiwan.Methods: We conducted a retrospective cohort study, including RA patients starting a first DMARD in the US or Taiwan. The first date patients newly received any DMARD was defined as the index date, and the 1-year period before the index date was the baseline period. HBV testing was defined as any of the following tests 1 year before or after the index date: hepatitis B surface antigen, hepatitis B surface antibody, hepatitis B core antibody, hepatitis B envelope antigen, hepatitis B envelope antibody, or HBV DNA. We calculated the HBV testing rate by year and used Poisson regression to calculate the testing rate ratio.Results: We identified 14,568 RA patients in the US and 46,265 in Taiwan. The overall testing rate was 20.3% in the US and 24.5% in Taiwan, and gradually increased over the study period from 13.1-23.0% in the US and 16.8-30.0% in Taiwan. More than one type of HBV test was used in 43.4% of patients in the US and 16.3% of patients in Taiwan receiving tests. Results of Poisson regression found Taiwan had a 17% higher testing rate over the US during the followup period (crude rate ratio 1.17 [95% confidence interval 1.12-1.22]).Conclusion: We found small differences in the HBV testing rates across the US and Taiwan. Although the rate gradually increased in the past decade, it remained low in both countries. [ABSTRACT FROM AUTHOR]

Assiduous measures are taken to prevent perinatal transmission of hepatitis B virus ( HBV) to infants; it is unclear whether the mothers receive appropriate care for their chronic HBV. We sought to assess the quality of HBV care in hepatitis B surface antigen ( HBsAg)-positive mothers following pregnancy. HBsAg-positive women ( n = 243) who had sought prenatal care at Massachusetts General Hospital were retrospectively identified and charts reviewed. The primary outcome was adherence to the American Association for the Study of Liver Diseases ( AASLD) and American College of Obstetricians and Gynecologists guidelines. Over one-third (37%) of women were first diagnosed with HBV infection at a prenatal visit. One-third (32%) did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients. One-third (34%) of the women were at high-risk for HCC based on AASLD criteria, yet only 33% of these women underwent timely imaging. Nearly half (49%) never saw a liver specialist for their HBV care. In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist ( P = 0.001, <0.001). We demonstrate remarkably inadequate and discontinuous HBV care for chronically infected mothers following pregnancy. As HBV infection is already being identified prenatally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care postpregnancy. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives: While controversial, the use of prostate specific antigen (PSA) testing is common and may reduce the morbidity and mortality associated with prostate cancer. The use of age-specific reference ranges (ASRRs) has been suggested to increase the sensitivity of the PSA test in younger men. The objective of this study was to determine the normal age-specific reference ranges for a large group of clinically cancer-free men and to compare these findings with similar studies. Materials and Methods: A retrospective chart review of PSA values was conducted on 1199 students from the National Defense University, Fort McNair, Washington, DC, who were matriculating between 1994 and July 1999. The AsXYM system using MEIA technology with monoclonal antibodies from Abbott laboratories was used to determine the PSA values. The mean, median, 95th percentile, 99th percentile, and range were calculated for each decade. Results: A total of 1123 students between the ages of 30 and 59 were included in the study (1105 with PSA levels ≤ 4.0 ng/ml). The largest number of students (67.4%) fell in the 40–49-year-old group. The median PSA level was 0.74 ng/ml. There was a significant correlation between age and PSA level for the 40–59-year-old age group (r = 0.06, p = 0.044). There was no significant correlation between age and PSA for the 40–49-year-old age group (r = 0.048, p = 0.192). The median PSA value and the 95th percentile increased from 0.7 and 2.3, respectively, in the 40–49-year-old age group to 0.8 and 2.7, respectively, in the 50–59-year-old age group. Conclusions: The results of this study indicate that PSA values in young men are quite low. The 95th percentile of PSA levels for men in their 40s and 50s was 2.3 and 2.7 ng/ml, respectively, which is significantly lower than the traditional normal value of 4.0 ng/ml. Although further prospective studies are needed, our data suggest that a lower PSA value threshold of... [ABSTRACT FROM AUTHOR]

A number of factors are considered in immunologic studies of American leishmaniasis. The intradermal test is reviewed in its various modalities: (1) the classical Montenegro reaction with a suspension of leptomonad forms of Leishmania braziliensis; (2) the "delayed' reaction of Rotberg; (3) the reaction with the polysaccharide antigen; and (4) the reaction with total extract of soluble antigen, including quantitative studies. Immunofluorescence techniques to detect circulating antibodies, using as antigens different species of Leishmania, and the problem of group reactivity are considered. In the light of the hypersensitivity the author discusses subclinical infection as revealed by positive intradermal test in endemic foci; the clinical manifestation known as leishmanids; and the immunological behavior of leishmaniasis tegumentaria diffusa due to L. braziliensis pifanoi. The value of immunology in the diagnosis of American leishmaniasis is also discussed. [ABSTRACT FROM AUTHOR]

The article offers information on the release of updated guidelines related to prostate cancer screening. The United States Preventive Services Task Force (USPSTF) has released a review of the benefits and consequences associated with screening for prostate cancer. The guidelines concluded that testing for early prostate cancer with prostate-specific antigen can detect some cases of prostate cancer.

The article discusses a study of almost 600,000 men aged 70 and older at hospitals in the U.S. that reveals high rates of prostate-specific antigen (PSA) testing. The study shows that 56% of elderly men in the cohort had PSA testing done. The PSA testing prevalence for men aged 85 or older was 36%, but less than 10% of men this age live 10 or more years.