Objective The aim of this study was to systematically review the literature to summarize recent demographic characteristics of hepatitis C virus (HCV) infection during pregnancy and the efficacy of risk-based versus universal screening. Study Design PubMed, EMBASE, and Cochrane Library were searched to identify relevant studies. Studies that recognized hepatitis C as a primary or secondary outcome, with pregnant women as the population and written in English, were included. Studies were excluded if they were abstracts only, written in foreign language, or published prior to 1992. Two researchers independently screened all the studies by titles, abstracts, and full text. Conflicts were settled by a third researcher. Results A total of 698 studies were identified with 78 fitting inclusion criteria. In total, 69 epidemiologic and 9 comparison studies were found. Identified risk factors for HCV infection include intravenous or illicit drug use, sexually transmitted coinfection, high-risk behaviors in the partners, high parity, and history of miscarriages or abortions. Demographic characteristics associated with HCV include non-Hispanic white race, American Indian or Alaskan Native ethnicity, and increasing age. Providers may fail to adequately screen for each risk factor, and up to two-thirds of women with a known risk factor are not screened under current guidelines. Finally, up to 27% of HCV+ women have no identifiable risk factors for infection. Conclusion There is evidence that risk-based screening fails to identify a large proportion of HCV positive women in pregnancy and that pregnant women with HCV risk factors and consistent with current screening guidelines fail to be tested. We urge for the adoption of universal screening to identify these women and offer treatment.

Drug-induced hepatitis is the leading reason that an approved drug is removed from the commercial market. Halogenated anesthetics can induce hepatitis in susceptible persons, and cytochrome p4502E1 (CYP2E1) enzymes responsible for their metabolism induce antibodies in addition to hepatitis. CYP2E1 antibodies detected in anesthetic hepatitis patients have been detected in patients with viral hepatitis, suggesting that these different forms of hepatitis could develop immune reactions to a common segment or epitope of CYP2E1. We have found a common MHC-restricted CYP2E1 epitope in anesthetic and viral hepatitis that is a dominant epitope in anesthetic hepatitis and is significantly associated with fibrosis in patients with viral hepatitis. Along with conformational epitopes, our identification of MHC-restricted CYP2E1 epitopes can be used to develop specific diagnostic tests for drug-induced or viral hepatitis or associated fibrosis or to predict individuals at risk for developing these diseases or their sequelae.

Cancers of unknown primary (CUP) constitute a significant diagnostic and therapeutic challenge for clinicians and a frequent cause of cancer-related mortality in Western countries. Immunohistochemistry assays are commonly used to identify the primary cancer, but fail in approximately one-third of cases. The identification of the possible origin of CUP is crucial, as it may help select the appropriate treatment options. We herein present the case of a 54-year-old male patient, who presented with lower back pain in June, 2013. Following a thorough investigation, the clinical and pathological findings could not identify the primary cancer, leading towards a misdiagnosis. Ultimately, microRNA testing of the resected spine lesion was able to identify the primary tumor as male breast cancer and allow for optimal treatment of the patient.

Background Externally displaced pediatric Syrian refugees are at risk of adverse developmental health outcomes in the setting of food insecurity. To evaluate the impact of displacement on nutritional status of Syrian children, this study describes the prevalence of malnutrition of Syrian children residing in Jordan. Methods A retrospective cross-sectional analysis of data from patient records < 18 years of age from the Syrian American Medical Society's (SAMS) January 2019 mission trip to Jordan was performed. Prevalence of stunting, severe wasting, wasting, overweight, and underweight were calculated using the World Health Organization (WHO) definitions. Results Overall, 392 Syrian children were included. In the 0 to 59 months group (n = 191), prevalence of stunting was 13.9% (n = 165), severe wasting 4.2% (n = 165), wasting 6% (n = 165), overweight 16.4% (n = 165), and underweight 5.3% (n = 190). In the > 59 months group (n = 201), prevalence of stunting was 7.2% (n = 194), severe wasting 3.6% (n = 194), wasting 5.2% (n = 194), overweight 6.7% (n = 194), and underweight 4.6% (n = 153). Age group was significantly associated with stunting (odds ratio [OR]  = 2.08,9 5% CI 1.03 to 4.19) and overweight (OR = 2.72; 95% CI 1.36 to 5.47) with increased odds of each in the 0–59 months group. Conclusion The findings suggest evidence of higher prevalence of malnutrition in Syrian children compared with prior assessments and greater impact on the younger cohort. In 0 to 59 months' old Syrian children, stunting and wasting were of medium severity and overweight was of high severity. This may reflect food insecurity in the setting of ongoing conflict, strain on resources, and evolving refugee policies, acknowledging study limitations. Syrian refugee children living in Jordan experience wasting and stunting. Comprehensive assessment of current nutritional status of Syrian children is needed. Access to adequate and nutritious food is paramount.