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¥µ¥ëÅ÷¡¡¹ñΩ´¶À÷¾É¸¦µæ½ê¡¡https://www.niid.go.jp/niid/ja/kansennohanashi/408-monkeypox-intro.html

¥µ¥ëÅ÷¡¡WHO. 2018. https://apps.who.int/iris/bitstream/handle/10665/272620/WHO-WHE-IHM-2018.3-eng.pdf

¹¾ÀîϹ§¡¥³ÆÏÀ£±¡¥¥Ò¥È¥µ¥ëÅ÷¡¥²½³ØÎÅË¡¤ÎÎΰ补2017: 33(9). pp.67-74

 

1.           McCollum, A.M. and I.K. Damon, Human monkeypox. Clin Infect Dis, 2014. 58(2): p. 260-7.

2.           Nolen, L.D., et al., Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerg Infect Dis, 2016. 22(6): p. 1014-21.

3.           Moss, B., Poxvirus DNA replication. Cold Spring Harb Perspect Biol, 2013. 5(9).

 

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https://www.hindawi.com/journals/criem/2015/670979/
Case Rep Emerg Med. 2015;2015:670979. doi: 10.1155/2015/670979. Epub 2015 Mar 19.
PMID: 25874137 

Acquired methemoglobinemia is an uncommon hemoglobinopathy that results from exposure to oxidizing agents, such as chemicals or medications. Although, as reported in the adult population, it happens most often due to prescribed medication or procedural anesthesia and not due to easily accessed over-the-counter medications, the authors will describe an otherwise healthy male adult with no known medical history and no prescribed medications, who presented to the emergency department reporting generalized weakness, shortness of breath, headache, dizziness, and pale gray skin. In addition, the patient reported that he also had a severe toothache for several days, which he had been self-treating with an over-the-counter oral benzocaine gel. Ultimately, the diagnosis of methemoglobinemia was made by clinical history, physical examination, and the appearance of chocolate-colored blood and arterial blood gas (ABG) with cooximetry. After 2 mg/kg of intravenous methylene blue was administered, the patient had complete resolution of all signs and symptoms. This case illustrates that emergency physicians should be keenly aware of the potential of toxic hemoglobinopathy secondary to over-the-counter, nonprescribed medications. Discussion with patients regarding the dangers of inappropriate use of these medicines is imperative, as such warnings are typically not evident on product labels.



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Hepatocellular carcinoma in non-cirrhotic liver: A comprehensive review

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, which in turns accounts for the sixth most common cancer worldwide. Despite being the 6th most common cancer it is the second leading cause of cancer related deaths. HCC typically arises in the background of cirrhosis, however, about 20% of cases can develop in a non-cirrhotic liver. This particular subgroup of HCC generally presents at an advanced stage as surveillance is not performed in a non-cirrhotic liver. HCC in non-cirrhotic patients is clinically silent in its early stages because of lack of symptoms and surveillance imaging; and higher hepatic reserve in this population. Interestingly, F3 fibrosis in non-alcoholic fatty liver disease, hepatitis B virus and hepatitis C virus infections are associated with high risk of developing HCC. Even though considerable progress has been made in the management of this entity, there is a dire need for implementation of surveillance strategies in the patient population at risk, to decrease the disease burden at presentation and improve the prognosis of these patients. This comprehensive review details the epidemiology, risk factors, clinical features, diagnosis and management of HCC in non-cirrhotic patients and provides future directions for research.

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Aflatoxin B1: Aflatoxin B1 (AFB1) is an extremely potent hepatocarcinogen that is a secondary metabolite produced by fungi, Aspergillus flavus and Aspergillus parasiticus. They are typically found in tropical and sub-tropical regions of the world in which grains such as rice stored in hot humid conditions promote growth of these toxin-producing fungi. Most cases occur in sub-Saharan Africa, Southeast Asia and China where HBV is highly prevalent. However, its incidence in the United States is extremely low; 0.003 in HbsAg negative and 0.08 in HbsAg-positive patients. In addition, its burden in non-cirrhotic individuals is unknown. AFB1 is metabolized by the P450 enzymes in the liver to generate an epoxide, which binds to DNA and induces mutation of the p53 tumor suppressor gene. Like cirrhotic patients, non-cirrhotic patients with chronic HBV are also at a higher risk for aflatoxin-mediated HCC.

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CDC
Aflatoxin
Aflatoxin is a fungal toxin that commonly contaminates maize and other types of crops during production, harvest, storage or processing. Exposure to aflatoxin is known to cause both chronic and acute hepatocellular injury. In Kenya, acute aflatoxin poisoning results in liver failure and death in up to 40% of cases.

In developed countries, commercial crops are routinely screened for aflatoxin using detection techniques that are performed in a laboratory setting. Food supplies that test over the regulatory limit are considered unsafe for human consumption and destroyed.

In developing nations, many people are exposed to aflatoxin through food grown at home. Inadequate harvesting and storage techniques allow for the growth of aflatoxin-producing fungus and homegrown crops are not routinely tested for the presence of aflatoxin. As a result, an estimated 4.5 billion people living in developing countries may be chronically exposed to aflatoxin through their diet.

In May, 2006, an outbreak of acute aflatoxicosis was reported in a region of Kenya where aflatoxin contamination of homegrown maize has been a recurrent problem. CDC teams worked with the Kenyan Ministry of Health to trial a rapid, portable aflatoxin screening tool that could be used in the field to identify contaminated maize and guide urgent maize replacement efforts during an outbreak. To do this, we used a portable lateral flow immunoassay; a test validated for use at commercial silo laboratories, and modified the methods for use in rural Kenya without electricity or refrigeration.

We randomly surveyed 165 households in Southeastern Kenya and tested a small portion of their maize supplies for the presence of aflatoxin using our modified rapid screening test. At each village, a mobile laboratory station was set up to grind and test the maize samples. CDC teams worked closely with local residents, and government officials to perform the testing and relay results to local health officers in order to facilitate immediate maize replacement and other interventions.

Field methods used during the outbreak were compared to Vicam immunoaffinity methods currently used at the Kenya National Public Health Lab. Field screening methods showed a sensitivity and specificity of 98 and 91% respectively. This investigation demonstrates that rapid lateral flow immunoasssays may be modified to provide a simple, on-site screening tool that gives immediate results and facilitates timely interventions.

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Aflatoxins as a cause of hepatocellular carcinoma

J Gastrointestin Liver Dis. 2013 Sep;22(3):305-10.

Aflatoxins, metabolites of the fungi Aspergillus flavus and Aspergillus parasiticus, are frequent contaminants of a number of staple foods, particularly maize and ground nuts, in subsistence farming communities in tropical and sub-tropical climates in sub-Saharan Africa, Eastern Asia and parts of South America. Contamination of foods occurs during growth and as a result of storage in deficient or inappropriate facilities. These toxins pose serious public health hazards, including the causation of hepatocellular carcinoma by aflatoxin B1. Exposure begins in utero and is life-long. The innocuous parent molecule of the fungus is converted by members of the cytochrome p450 family into mutagenic and carcinogenic intermediates. Aflatoxin-B1 is converted into aflatoxin B1-8,9 exo-epoxide, which is in turn converted into 8,9-dihydroxy-8-(N7) guanyl-9-hydroxy aflatoxin B1 adduct. This adduct is metabolized into aflatoxin B1 formaminopyrimidine adduct. These adducts are mutagenic and carcinogenic. In addition, an arginine to serine mutation at codon 249 of the p53 tumor suppressor gene is produced, abrogating the function of the tumor suppressor gene, and contributing to hepatocarcinogenesis. Aflatoxin B1 acts synergistically with hepatitis B virus in causing hepatocellular carcinoma. A number of interactions between the two carcinogens may be responsible for this action, including integration of hepatitis B virus x gene and its consequences, as well as interference with nucleotide excision repair, activation of p21waf1/cip1, generation of DNA mutations, and altered methylation of genes. But much remains to be learnt about the precise pathogenetic mechanisms responsible for aflatoxin B1-induced hepatocellular carcinoma as well as the interaction between the toxin and hepatitis B virus in causing the tumor.



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http://www.jspid.jp/journal/full/02201/022010035.pdf

HCV ¤Ï¥Õ¥é¥Ó¥¦¥¤¥ë¥¹²Ê Flaviviridae ¥Ø¥×¥·¥¦¥¤¥ë¥¹Â° Hepacivirus ¤ËʬÎव¤ì¡¤°äÅÁ»Ò¤ÏÁ´Ä¹Ìó 9,600 ±ö´ð¤è¤ê¤Ê¤ë¥×¥é¥¹º¿1Ëܺ¿RNA¤Ç¡¤IRES¡Êinternal ribosome entry site¡Ë¤ò´Þ¤à 5¡ÇÈóËÝÌõÎΰ衤3¡ÇÈóËÝÌõÎΰè¤Î´Ö¤Ë°ì¤Ä¤Î open reading frame¡ÊORF¡Ë¤ò¤â¤Ä¡¥
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Press release: The Nobel Prize in Physiology or Medicine 2020


https://www.nobelprize.org/uploads/2020/10/press-medicine2020.pdf


Hepatitis – a global threat to human health Liver inflammation, or hepatitis, a combination of the Greek words for liver and inflammation, is mainly caused by viral infections, although alcohol abuse, environmental toxins and autoimmune disease are also important causes. In the 1940¡Çs, it became clear that there are two main types of infectious hepatitis.
The first, named hepatitis A, is transmitted by polluted water or food and generally has little long-term impact on the patient.
The second type is transmitted through blood and bodily fluids and represents a much more serious threat since it can lead to a chronic condition, with the development of cirrhosis and liver cancer (Figure 1). This form of hepatitis is insidious, as otherwise healthy individuals can be silently infected for many years before serious complications arise. Blood-borne hepatitis is associated with significant morbidity and mortality, and causes more than a million deaths per year world-wide, thus making it a global health concern on a scale comparable to HIV-infection and tuberculosis.


An unknown infectious agent
The key to successful intervention against infectious diseases is to identify the causative agent. In the 1960¡Çs, Baruch Blumberg determined that one form of blood-borne hepatitis was caused by a virus that became known as Hepatitis B virus, and the discovery led to the development of diagnostic tests and an effective vaccine. Blumberg was awarded the Nobel Prize in Physiology or Medicine in 1976 for this discovery.


At that time, Harvey J. Alter at the US National Institutes of Health was studying the occurrence of hepatitis in patients who had received blood transfusions. Although blood tests for the newly-discovered Hepatitis B virus reduced the number of cases of transfusion-related hepatitis, Alter and colleagues worryingly demonstrated that a large number of cases remained. Tests for Hepatitis A virus infection were also developed around this time, and it became clear that Hepatitis A was not the cause of these unexplained cases.

It was a great source of concern that a significant number of those receiving blood transfusions developed chronic hepatitis due to an unknown infectious agent. Alter and his colleagues showed that blood from these hepatitis patients could transmit the disease to chimpanzees, the only susceptible host besides humans. Subsequent studies also demonstrated that the unknown infectious agent had the characteristics of a virus. Alter¡Çs methodical investigations had in this way defined a new, distinct form of chronic viral hepatitis. The mysterious illness became known as ¡Ènon-A, non-B¡É hepatitis.



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Kuo G., Choo QL, Alter HJ, Gitnick GL, Redeker AG, Purcell RH, Miyamura T, Dienstag JL, Alter CE, Stevens CE, Tegtmeier GE, Bonino F, Colombo M, Lee WS, Kuo C., Berger K, Shuster JR, Overby LR, Bradley DW, Houghton M. An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis. Science. 1989; 244:362-364.




Kolykhalov AA, Agapov EV, Blight KJ, Mihalik K, Feinstone SM, Rice CM. Transmission of hepatitis C by intrahepatic inoculation with transcribed RNA. Science. 1997; 277:570-574.


pdf https://science.sciencemag.org/content/sci/277/5325/570.full.pdf?casa_token=Nitja_K6NyIAAAAA:FhoRVv49oyZq7cxSwpaRDivALbDn6aRE8Ga7L8YRvIek_tKp8Vfk-iwGXK4y0Hav5G1oibi3Q728JMqY


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https://www.anatomy.tokyo/systematic/%E7%B3%BB%E7%B5%B12-%E5%BE%AA%E7%92%B0%E5%99%A8%E7%B3%BB/%E7%B3%BB%E7%B5%B12-2-%E5%BF%83%E8%87%93/%E5%88%BA%E6%BF%80%E4%BC%9D%E5%B0%8E%E7%B3%BB-%E2%88%92-%E8%87%AA%E5%8B%95%E8%83%BD%E3%81%AE%E4%BB%95%E7%B5%84%E3%81%BF/

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https://www.med.nagoya-u.ac.jp/kansenseigyo/kousei/kousei1/CRE%20Fact%20Sheet%2020140530.pdf


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https://www.niid.go.jp/niid/ja/cre-m/cre-idwrs/9781-cre-191227.html

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2018ǯ¤ÎÊó¹ð¤Ï1600ÎãÁ°¸å¤Ç¿ä°Ü¤·¤Æ¤¤¤¿2015ǯ¡Ý2017ǯ¤ÈÈæ¤ÙÁý²Ã¤·¤Æ¤¤¤¿¡£2018ǯ¤ÎÊó¹ð¤Ï¡¢¿ÇÃÇ̾¤ª¤è¤ÓʬΥ¸¡ÂΤÎÆâÌõ¤Ï2017ǯ¤Þ¤Ç¤ÎÆϽФÈƱÍͤη¹¸þ¤Ç¤¢¤Ã¤¿¡£Ê¬Î¥¶Ý¼ï¤Ï2017ǯ¤«¤éE. cloacae¤ËÂå¤ï¤êK. aerogenes¤¬ºÇ¤â¿¤¯Êó¹ð¤µ¤ì¤ë¤è¤¦¤Ë¤Ê¤ê¡¢2018ǯ¤â°ú¤­Â³¤­¡¢K. aerogenes¤ÎÊó¹ð¿ô¤ÈCRE¤ËÀê¤á¤ëÊó¹ð³ä¹ç¤¬Áý²Ã¤·¤Æ¤¤¤¿¡£ 

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CDC
https://www.cdc.gov/hai/organisms/cre/

How does CDC define CRE?
Enterobacteriaceae that test resistant to at least one of the carbapenem antibiotics (ertapenem, meropenem, doripenem, or imipenem) or produce a carbapenemase (an enzyme that can make them resistant to carbapenem antibiotics) are called CRE.


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https://www.niid.go.jp/niid/ja/drug-resistance-bacteria-m/3306-carbapenem-qa.html


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¿Þ¤ÏCarbapenem-resistant Enterobacteriaceae (CRE) Infection, Japan
Åìµþ¡¢¿ÀÆàÀî¡¢Âçºå¡¢°¦ÃΡ¢Ê¡²¬¤Ç¿¤¤¡£

https://www.niid.go.jp/niid/en/iasr-vol40-e/865-iasr/8625-468te.html

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·ì´ÉÆ⥫¥Æ¡¼¥Æ¥ë´ØÏ¢´¶À÷¾É(catheter-related blood stream infection: CRBSI)¤Ë¤Ä¤¤¤Æ


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https://primary-care.sysmex.co.jp/speed-search/disease/index.cgi?c=disease-2&pk=11
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http://www.yoshida-pharm.com/2012/text03_01/


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https://yoshida-pharm.jp/files/pamphlet/66.pdf


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The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Christopher J Crnich, Dennis G Maki. Clin Infect Dis. 2002 May 1;34(9):1232-42. doi: 10.1086/339863. Epub 2002 Apr 2.
https://academic.oup.com/cid/article/34/9/1232/1993160

https://watermark.silverchair.com/34-9-1232.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAApowggKWBgkqhkiG9w0BBwagggKHMIICgwIBADCCAnwGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMOEaFf7r0vfX7BwJ8AgEQgIICTeU8aCYjBEwioHvR6_gWrPEP2lsjhZe3etsE1qgUeYDdxn5wRjCVrgRNm0djsQQ_bZaeGWYZNJsdcaJR_KWE7kkdpWvEzPPWae9SrC69UuL09X3rLEvO0jBx0sUaAeVfhUYKrj5sSQxED_XHcXlGqKfFdo5NtpnexHpSQOwOK6Y1gdLbpwm1zuHuftP3JFViHRpUYyk8-HkPT7tBtkOSv7PrUUfaRLm4Nqxm8aYjua1YxCZJ7nlfwasMKHaRrY9nMqiSFCrNruoiRdk-tXSs_67_AKwX6k86Wk1Opm75bj2V6-GsIPuTThG7D8yBKxGfYK9UzHyGyYfV8urXjmCEooGPYBsE9zxDA-Fd8Tqc5yeh0Zogn91JiL2lgSet75HGsVGipvSJThob4MgFv3pPPKvKeTjwjYuGACkSJF6ri6g1Wr8FWApfLGP662sSK8YREonWwNMi2qoOzLJJPTRIs1Uyz155mTRNX8PLtVnye-_kLTt0ICGFTwBhnQv8GggRsNvRpLJwuV3cenun-zBB2u95G1T09rzOTSJquMNPXIM_1vjgK6WOxGWpVOIJkvHESK4aF2BhkUM3tGBKc6IAHDbP7D_Pgqq1BYrg8GmsH163xj3Y8M06BpoqDXT1sJrS5t1q1dHRERLwLm_EmobiKwFY0wFUwxQLNYPhaMbXr56Vlr-WAmP5KQES8s4mkf7sDVCAjHzuaj_nM9qGAFwRZLso17xmp5AAupjwyF_Z0BQwU-yhrFNuxP1pK9U4NYFLuCoSwypHKFR-afExjOw




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