Day 3 :
Regional Health Agency of Tuscany, Italy
Time : 09:30-10:10
Cristina Stasi graduated in Medicine and Surgery at the Catholic University of “Sacro Cuore”, Rome (2001). In 2006 she specialized in Gastroenterology at the University of Pisa. From 2006 to 2009 she took part in Clinical Research Projects at the University Hospital “Careggi”, Florence. At the same time, she improved her knowledge in Study Design, Management of Clinical Research Project, Statistics and Epidemiology. In 2013, she received her PhD in Experimental and Clinical Medicine from the University of Florence. She has published about 50 papers in reputed international journals and has been serving as an Editorial Board Member of some international journals.
Statement of the Problem: Despite a vaccine against Hepatitis B Virus (HBV) has been available since 1982, the prevalence of adult with chronic HBV infection in sub-Saharan Africa and East Asia was estimated to be 5–10%. High rate of chronic infections is also found in the Amazon and the southern parts of eastern and central Europe. In the Middle East and the Indian subcontinent, the prevalence is of 2–5%. Less than 1% of the population of Western Europe and North America was chronically infected. Given the high prevalence of infections such as human immunodeficiency virus (HIV), HBV, and Hepatitis C Virus (HCV) among inmates, particularly those with a history of injection drug use, prison is considered reservoir facilitating these infections. The prevalence of HBsAg in prisoners in west and central Africa was very high (23.5%). High levels of chronic HBV infection were also reported in east and southern Africa (5.7%) and in Eastern Europe and central Asia (10.4%).
Purpose: The purpose of this review is to analyse the most recent data on HBV prevalence and vaccination in prison.
Methodology: Relevant studies were searched on PubMed database. The Centres for Disease Control and Prevention (CDC) has highlighted the importance of HBV blood screening and the subsequent anti-HBV vaccination in the prison population. The vaccination was recommended to all inmates and it represents an opportunity to prevent HBV infection in persons at high risk. In these subjects, an accelerated hepatitis B immunization schedule may result in a rapid seroconversion and practically in an early short-term protection.
Conclusion & Significance: Although hepatitis B vaccination of inmates has been recommended since the vaccine first became available in 1982, only some state vaccinate inmates routinely. Therefore, it is necessary to have a collaboration between public health, clinicians and correctional authorities to implement vaccination program.
Universite Pierre et Marie Curie, France
Guy H Fontaine MD PhD HDR has made 15 original contributions in the design and the use of the first cardiac pacemakers in the early 60s. He has serendipitously identified ARVD during antiarrhythmic surgery in the early 70s. He has developed the technique of Fulguration to replace surgery in the early 80s. He has been one of the 216 individuals who have made a significant contribution to the study of cardiovascular disease since the 14th century and one of the 500 greatest geniuses of the 21st Century (USA Books), one of the 100 lifetime of achievement (UK Book). He has > 900 publications including 201 book chapters. He is a reviewer of 17 scientific journals both in basic and clinical science. He has given 11 master lectures of 90 minutes each in inland China in 2014. He is now developing new techniques for brain protection in OHCA, stroke and spinal cord injury by hypothermia.
Introduction: Tonet et al. from Paris were the first to demonstrate a susceptibility of ARVD patients to supraventricular tachyarrhythmias. This concept was confirmed on larger series of ARVD patients from the USA and Switzerland. It was also observed by the senior author that atrial fibrillation/tachyarrhythmias (AF/AT) could be the first presentation of the disease. It was therefore logical to study the atrial pathology of three ARVD patients who died of a non-cardiac cause. This abstract is the first to present the atrial histology of ARVD patients with comparison to healthy controls considering the typical histologic changes known in the RV in ARVD.
Methods: Histology of the right atrium (RA) was available in only 3 cases from a series of 73 ARVD patients, in whom ARVD was confirmed by pathology. The observed anomalies were adipocytes in two cases, interstitial fibrosis in all, associated with replacement fibrosis in one case. This prompted us to study the RA structure in four subsequent control patients without cardiovascular disease. Light microscopic examination with Leica digital image processing was performed. Staining was performed with HPS in ARVD to improve identification of fibrosis, and HE in the control group.
Results: The atrial pathology of all of these so-called normal individuals presented anomalies, which can be interpreted as the background of an atrial arrhythmogenic substrate similar to the recently reported pathology of the RV in ARVD (GF Editorial AJC 2014). As such, we found adipose tissue, interstitial and replacement fibrosis including one case of lymphocytic infiltration in the atria of these healthy controls, like histologic changes of the RV observed in ARVD. Furthermore, we identified a perpendicular orientation of atrial myocardial fibres.
Discussion: The interface between the two perpendicular layers can be a zone of weakness leading to fat and fibrosis, particularly if increased loading conditions are present. Desmosomal variants may enhance this remodelling. However, since desmosomal mutations have not been observed in the normal heart, it is therefore possible to consider other genes or posttranslational modification to underlay these changes. The unexpected results of this preliminary study need further confirmation. However, we propose new mechanisms including the role of active as well as healed myocarditis which may precede the development of AF/AT and explain why these arrhythmias are the most frequent in the human species.
Conclusions: The same pathological substrate of ventricular myocardium in ARVD is also extending to the atrium explaining the high frequency of AF in ARVD patients.