RESUMEN
The prevalence of occupational low-back pain was investigated in 407 female nurses in a large tertiary health care unit in Athens, Greece. Work-related back pain within the previous 2 weeks was reported by 63% of respondents and within the previous 6 months by 67%. Prevalence was higher (66% in the previous 2 weeks) in the wards with physically heavy duties than in the rest (52%, P = 0.003), but all grades of nursing staff were affected equally. The specific factors which claimed to be responsible for causing back pain included moving heavy items (36%), lifting patients onto trolleys (32%) or in bed (29%), helping patients out of bed (24%) and bending to lift objects from the floor (24%). Absence from work because of back pain in the previous 2 weeks was reported by 28% of the sample.
Asunto(s)
Dolor de la Región Lumbar/epidemiología , Personal de Enfermería en Hospital , Enfermedades Profesionales/epidemiología , Adulto , Fenómenos Biomecánicos , Femenino , Grecia/epidemiología , Humanos , Elevación , PrevalenciaRESUMEN
Nine HBeAg+ and 24 anti-HBe+ subjects with chronic hepatitis B virus (HBV) infection were studied for HBV DNA in the serum by molecular hybridization, for HBcAg in the liver by immunofluorescence, and for histologic evidence of liver disease. All HBeAg+ patients had underlying chronic liver disease (chronic persistent hepatitis, chronic active hepatitis, or cirrhosis with or without hepatocellular carcinoma), and all were found positive for both HBV DNA in the serum and HBcAg in the nucleus of hepatocytes. Of the 24 anti-HBe+ individuals, 18 had various forms of chronic liver disease. Six HBsAg+/anti-HBe+ patients had normal liver histology except for numerous "ground-glass" hepatocytes with abundant cytoplasmic HBsAg. All six were negative for nuclear HBcAg and serum HBV DNA, but three showed HBV DNA which appeared to be integrated into unique sites in host liver DNA by hybridization analysis. In contrast, 14/18 (78%) of HBsAg+/anti-HBe+ patients with chronic liver disease were positive for nuclear HBcAg, serum HBV DNA, or both of these markers of HBV replication. It is suggested that in long-term HBsAg carriers with serum anti-HBe and normal liver histology, viral replication is suppressed or inactive and HBV potential infectivity is presumably very low or absent. However, when viral replication is present in HBsAg+/anti-HBe+ carriers (as demonstrated by serum HBV DNA and/or nuclear HBcAg), active liver disease is often found. In these individuals, active chronic liver disease appears to be related to continued replication and secretion of HBV and may occur in a much higher proportion of HBsAg+/anti-HBe+ carriers than was previously suspected.
Asunto(s)
Portador Sano/inmunología , ADN Viral/sangre , Anticuerpos contra la Hepatitis B/análisis , Antígenos de la Hepatitis B/análisis , Antígenos del Núcleo de la Hepatitis B/análisis , Antígenos e de la Hepatitis B/análisis , Hepatitis B/inmunología , Hepatopatías/inmunología , Adulto , Anciano , Citoplasma/inmunología , Femenino , Virus de la Hepatitis B/inmunología , Virus de la Hepatitis B/patogenicidad , Virus de la Hepatitis B/fisiología , Humanos , Hígado/análisis , Hígado/inmunología , Hígado/patología , Masculino , Persona de Mediana Edad , Replicación ViralRESUMEN
Since testing for serologic markers of hepatitis B virus (HBV) became routine, we have observed in our hospital 28 patients with two distinct episodes of illnesses, each of which was compatible with acute viral hepatitis. We found no distinctions between the first and second bouts with respect to clinical characteristics, abnormalities of liver function or epidemiologic background. Testing of specimens obtained during each of the two acute episodes, the interval between the two episodes and the period subsequent to the second by sensitive procedures for hepatitis B surface antigens (HBsAg) and their corresponding antibodies (anti-HBs) permitted the following classification: 13 of 28 patients experienced first bouts serologically classifiable as due to HBV; 11 patients had second bouts serologically classifiable as due to HBV; 2 patients had two episodes both which were serologically indeterminate; and 2 patients had two bouts neither of which appeared compatible with HBV infection by present criteria. No patient had a second episode for which the HB2Ag and anti-HBs data suggested HBV recurrence or reinfection. This evidence does not favor the speculation that HBV can account for repeated episodes of acute icteric hepatitis.