H.R. Dalton

We explored the association between serological status for hepatitis E and neurocysticercosis (NCC) in neurologic patients attending a national neurological referral center in Lima, Perú, between the years 2008 and 2012. Anti-hepatitis E antibodies were evaluated in patients with and without NCC, and a control group of rural general population. Ant...

Background and study aims Mallory Weiss tears (MWTs) are relatively uncommon causes of upper gastrointestinal bleeding (UGIB), and patients are generally considered at low risk of poor outcome, although data are limited. There is uncertainty about use of endoscopic therapy. We aimed to describe and compare an international cohort of patients presen...

The purpose of the present study was to investigate pigs in Northern Bulgaria for serological evidence of hepatitis E virus (HEV). Sera from 225 individuals from three industrial farms were tested for anti‑HEV IgG antibodies. The overall HEV seroprevalence was 36% (81/225); weaners 6.8% (5/74); fattening pigs 38.7% (29/75) and in sows 61.8% (47/76)...

After an acute hepatitis E (HEV) outbreak in Southern Switzerland, in January 2017 the local public health authorities started an active program of food chain control and public education. In this retrospective study, we analysed all laboratory-confirmed acute cases of HEV infection diagnosed between 2014 and 2020. In the period before the public h...

The first clinical case of persistent HEV infection in England was reported in 2009. We describe the demography, virology and outcomes of patients identified with persistent HEV infection in England and Wales between 2009 and 2017. A series of 94 patients with persistent HEV infection, defined by HEV viraemia of more than 12 weeks, was identified t...

Hepatitis A and E are both ancient diseases but have only been properly recognized as being caused by distinct pathogens in modern times. Despite significantly different genomic structures, both viruses employ remarkably similar strategies to avoid host detection and increase environmental transmission. There are millions of cases of acute viral he...

Objectives Existing scores are not accurate at predicting mortality in upper (UGIB) and lower (LGIB) gastrointestinal bleeding. We aimed to develop and validate a new pre-endoscopy score for predicting mortality in both UGIB and LGIB. Design and setting International cohort study. Patients presenting to hospital with UGIB at six international cent...

Background Hepatitis E virus (HEV) is the most common acute viral hepatitis in Scotland. Little is known about the burden of morbidity and mortality, which can be high in chronic liver disease or immunocompromised states. Aims To record the morbidity and mortality of HEV in Scotland. Methods Demographic, clinical and laboratory data were collecte...

While neural networks are good at learning unspecified functions from training samples, they cannot be directly implemented in hardware and are often not interpretable or formally verifiable. On the other hand, logic circuits are implementable, verifiable, and interpretable but are not able to learn from training data in a generalizable way. We pro...

Objective: To assess the prevalence and clinical features of neurologic involvement in patients with acute hepatitis E virus (HEV) infection in Southern Switzerland. Methods: Among 1,940 consecutive patients investigated for acute hepatitis E, we identified 141 cases of acute of HEV infection (anti-HEV immunoglobulin M and immunoglobulin G both...

Background and aims: Hepatitis E Virus is endemic in Europe with increasing numbers of cases in recent years, also in Italy where this phenomenon has hitherto been modest. The aim of this study was to document the clinical features/natural history of locally acquired hepatitis E in our territory and explore factors which determine adverse outcome....

Background: Acute upper gastrointestinal bleeding (UGIB) remains a major cause of hospital admission worldwide. The recent UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report on UGIB suggested use of the Shock Index to identify patients at risk of a poor outcome after UGIB. However, this has never been prospectively val...

Hepatotropic viruses are extremely common worldwide and among frequent causes of acute hepatitis and acute liver failure. Most commonly, these infections present with a viral prodrome and an acute increase in liver enzymes but atypical presentations can occur. Whereas most infections are benign and self-limiting, chronic states do occur; in the cas...

Background & aims: Scoring systems are suboptimal for determining risk in patients with gastrointestinal bleeding (UGIB); these might be improved by a machine learning model. We used machine learning to develop a model to calculate risk of hospital-based intervention or death in patients with UGIB and compared its performance with other scoring sy...

Adomain decomposition method is one of the most interesting and important method for solving non-linear equations. Also improving Newton-Rapson method by Adomain decomposition method.

Hepatitis E virus has two distinct clinical and epidemiological patterns based on the varying genotypes. Genotypes 3 and 4 cause widespread, sporadic infection in high-income countries and are emerging as the most common type of viral hepatitis in much of Europe. These infections carry significant morbidity and mortality in the growing numbers of i...

Background: Risk stratification for upper gastrointestinal bleeding (UGIB) is recommended. However, scoring systems accuracy is suboptimal and score calculation can be complex. Our aim was to develop a new score, the MAP (ASH) score, with information available in the emergency room (ER), and to validate it. Methods: The score was built from a pr...

Background and Aims: In the past decade Hepatitis E virus (HEV) infection has become the most common acute viral hepatitis in Scotland. Little is known about the burden of morbidity and mortality, which can be high in chronic liver disease and Immunosuppressed patients. Infection is also associated with nerve and kidney injury. The study aims to re...

Hepatitis E virus (HEV) is the most common cause of viral hepatitis in the world. It is estimated that millions of people are infected every year, resulting in tens of thousands of deaths. However, these estimates do not include industrialized regions and are based on studies which employ assays now known to have inferior sensitivity. As such, this...

Objectives: Several risk scores have been developed for prediction of mortality in patients with upper gastrointestinal bleeding (UGIB). It would be clinically useful if a score was accurate at predicting mortality in both UGIB and lower GI bleeding (LGIB). The recently described pre-endoscopic International Bleeding Risk Score (IBRS) includes the...

Introduction: Mallory Weiss tears (MWT) are relatively uncommon causes of upper GI bleeding (UGIB) and patients with these lesions are generally considered at low risk of poor outcome. However there are relatively limited data on this condition. In addition, there is uncertainty about which patients with MWT require endoscopic therapy and which mod...

Introduction: Upper GI bleeding (UGIB) is a common cause of hospitalisation. The admission Rockall (ARS), Glasgow-Blatchford (GBS) and AIMS65 scores are validated pre-endoscopy risk assessment tools. The UK NCEPOD report into UGIB used Shock Index (SI = pulse/systolic blood pressure) to assess risk of poor outcome. However existing data on SI are m...

Introduction Upper GI bleeding (UGIB) is a common cause of hospitalisation. The admission Rockall (ARS), Glasgow-Blatchford (GBS) and AIMS65 scores are validated pre-endoscopy risk assessment tools. The UK NCEPOD report into UGIB used Shock Index (SI=pulse/systolic blood pressure) to assess risk of poor outcome. However existing data on SI are most...

Introduction Mallory Weiss tears (MWT) are relatively uncommon causes of upper GI bleeding (UGIB) and patients with these lesions are generally considered at low risk of poor outcome. However there are relatively limited data on this condition. In addition, there is uncertainty about which patients with MWT require endoscopic therapy and which moda...

Objectives Dysphagia is a presenting symptom of both pharyngeal and oesophageal cancer. The referral pathway choice is determined by whether it is thought to be oropharyngeal or oesophageal, and this is in turn influenced by whether dysphagia is perceived to be above or below the suprasternal notch. We studied the concordance between the presence o...

Background & Aims While hepatitis E virus (HEV) infections are a relevant topic in Europe, knowledge about epidemiology of HEV infections in the USA and Latin America is still limited. Aim of this study was to estimate anti‐HEV IgG seroprevalence in the Americas and to assess whether low socioeconomic status is associated with HEV exposure. Method...

Background and aims: Anti-thrombotic agents are risk factors for upper gastrointestinal bleeding (UGIB). However, few studies have evaluated their effects on patient outcomes. We assessed the effects of anti-thrombotic agents on outcomes of patients with high-risk UGIB. Methods: We performed a prospective study of 619 patients with acute UGIB (d...

In the Bolivian Chaco, south-east of Bolivia, studies conducted over the past three decades reported hepatitis A virus (HAV) andHelicobacter pyloriseroprevalences above 90% and 60%, respectively. Hepatitis E virus (HEV) prevalence was previously found to be 6-7% but is probably an underestimate because of the poor sensitivity of the assays used. In...

Following the introduction of robust serological and molecular tools, our understanding of the epidemiology of zoonotic hepatitis E virus (HEV) has improved considerably in recent years. Current thinking suggests that consumption of pork meat products is the key route of infection in humans, but it is certainly not the only one. Other routes of inf...

Background Previous studies showed low levels of circulating hepatitis E virus (HEV) in Scotland. We aimed to reassess current Scottish HEV epidemiology.Methods:Blood donor samples from five Scottish blood centres, the minipools for routine HEV screening and liver transplant recipients were tested for HEV antibodies and RNA to determine seroprevale...

Infection with hepatitis E virus (HEV) is a significant cause of morbidity and mortality, representing an important global health problem. Our understanding of HEV has changed completely over the past decade. Previously, HEV was thought to be limited to certain developing countries. We now know that HEV is endemic in most high-income countries and...

Objectives: Numerous reviews indicate bloody hematemesis signifies more severe bleeding than coffee-grounds hematemesis. We assessed severity and outcomes related to bleeding symptoms in a prospective study. Methods: Consecutive patients presenting with hematemesis or melena were categorized as bloody emesis (N=1209), coffee-grounds emesis without...

Hepatitis E virus (HEV), family Hepeviridae, is a main cause of epidemic hepatitis in developing countries and sporadic and cluster cases of hepatitis in industrialized countries. There are an increasing number of reported cases in humans especially in industrialized countries, and there is a high potential for transboundary spread of zoonotic geno...

International Liver Congress / 52nd Annual Meeting of the European-Association-for-the-Study-of-the-Liver, Amsterdam, NETHERLANDS, APR 19-23, 2017

Background Hepatitis E virus (HEV) is a common zoonotic infection associated with pigs which is endemic in many developed countries. Most infections are asymptomatic, with only a minority causing clinically evident hepatitis. Numerous extra-hepatic manifestations are associated with HEV, most commonly neurological injury. The aim of the study was t...

Background HEV-NA may have a distinct clinical phenotype and outcome compared to cases of NA without HEV infection. Methods Cases of NA were identified in 11 centres from 7 countries, with retrospective analysis of demographics, clinical/laboratory findings, treatment and outcome. HEV-NA cases were compared to NA cases without evidence of HEV infe...

Hepatitis E virus (HEV) infection can lead to acute and chronic hepatitis as well as to extrahepatic manifestations such as neurological and renal disease; it is the most common cause of acute viral hepatitis worldwide. Four genotypes are responsible for most infection in humans, of which HEV genotypes 1 and 2 are obligate human pathogens and HEV g...

Objective: To determine the clinical phenotype and outcome in hepatitis E virus-associated neuralgic amyotrophy (HEV-NA). Methods: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases w...

Background and aims HEV has been associated with a number of neurological syndromes, but causality has not yet been established. Aim: to explore the relationship between HEV and neurological illness by prospective HEV-testing of patients presenting with acute non-traumatic neurological injury. Methods 464 consecutive patients presenting to hospita...

Introduction Drug induced liver injury (DILI) can be difficult to differentiate from ischaemic hepatitis (IH). We hypothesised that the temporal pattern in the change of bilirubin and alanine transaminase (ALT) may help distinguish those patients with IH compared to DILI. Method Retrospective single centre analysis of biochemical data from 68 sequ...

Introduction Both drug induced liver injury (DILI) and ischaemic hepatitis (IH) present acutely and neither have specific diagnostic tests. Therefore, diagnosis and hence the management relies upon signature pattern of manifestations. We hypothesised that the temporal pattern in the change of bilirubin and alanine transaminase (ALT) may help distin...

Hepatitis E is the most common cause of hepatitis worldwide. While originally considered a disease of developing countries, it is increasingly recognised in developed countries, probably related to contaminated pork meat, and where infection is often asymptomatic. However, several non-liver manifestations have become apparent, the most important of...

Aims: to determine the relative utility of in situ testing for hepatitis E virus (HEV) RNA and paraffin section PCR to diagnose HEV infection in paraffin-embedded clinical liver biopsies, and to correlate with clinico-pathological characteristics. Methods and results: We evaluated in situ and quantitative PCR (qPCR)-based approaches to identifyi...

International prospective observational study of upper gastrointestinal haemorrhage: does out-of-hours presentation affect outcome? Iain A Murray1, Adrian Stanley2, Harry R Dalton1, Jing H Ngu3, B Maybin2, Mahmoud Eid2, Kenneth G Madsen4, Rozeta Abazi4, Hafiz Hamad Ashraf1, Mohamed Abdelrahim1, Rebecca Lissmann1, Jenny Herrod1, Christopher JL Khor...

Background: Hepatitis E virus (HEV) is a leading cause of acute icteric hepatitis and acute liver failure in the developing world. During the last decade, there has been increasing recognition of autochthonous (locally acquired) HEV infection in developed countries. Chronic HEV infection is now recognised, and in transplant recipients this may lea...

Background & aims: We performed a prospective multi-national study of patients presenting to the emergency department with upper gastrointestinal bleeding (UGIB) and assessed the relationship of time to presentation after onset of UGIB symptoms with patient characteristics and outcomes. Methods: Consecutive patients presenting with overt UGIB (r...

Introduction: Out of hours admissions have higher mortality for many conditions but upper gastrointestinal haemorrhage studies have produced variable outcomes. Methods: Prospective study of 12 months consecutive admissions of upper gastrointestinal haemorrhage from four international high volume centres. Admission period (weekdays, weeknights or...

AIM To determine if patients can localise dysphagia level determined endoscopically or radiologically and association of gender, age, level and pathology. METHODS Retrospective review of consecutive patients presenting to dysphagia hotline between March 2004 and March 2015 was carried out. Demographics, clinical history and investigation findings...

Hepatitis E virus (HEV), as a hepatotropic virus, is supposed to exclusively infect the liver and only cause hepatitis. However, a broad range of extrahepatic manifestations, in particular idiopathic neurological disorders, have been recently reported in association with its infection. In this study, we have demonstrated that various human neural c...

We compared the epidemiology of hepatitis A and hepatitis E cases in China from 1990-2014 to better inform policy and prevention efforts. The incidence of hepatitis A cases declined dramatically, while hepatitis E incidence increased. During 2004-2014, hepatitis E mortality rates surpassed those of hepatitis A.

We compared the epidemiology of hepatitis A and hepatitis E cases in China from 1990–2014 to better inform policy and prevention efforts. The incidence of hepatitis A cases declined dramatically, while hepatitis E incidence increased. During 2004–2014, hepatitis E mortality rates surpassed those of hepatitis A.

Results summary, diagnostic criteria used for hepatitis A and hepatitis E infections, and spatial and temporal distribution and patterns of hepatitis A and hepatitis E viruses, China.

Objective To compare the predictive accuracy and clinical utility of five risk scoring systems in the assessment of patients with upper gastrointestinal bleeding. Design International multicentre prospective study. Setting Six large hospitals in Europe, North America, Asia, and Oceania. Participants 3012 consecutive patients presenting over 12 mont...

Supplementary information: Supplementary tables 1 to 5

Supplementary Figure 1: Additional IFNg ELISpot data in HEV Exposed and Unexposed individuals (A) IFN‐ γ ELISpot response to individual peptide pools (A‐I, L‐N), DMSO (negative control) and Concanavlin A (positive control) in immune‐competent, HEV exposed (black dots) and HEV unexposed (open circles) subjects. Each point represents an individuals'...

AIM To conduct a prospective assessment of anti-hepatitis E virus (HEV) IgG seroprevalence in the Western Cape Province of South Africa in conjunction with evaluating risk factors for exposure. METHODS Consenting participants attending clinics and wards of Groote Schuur, Red Cross Children’s Hospital and their affiliated teaching hospitals in Cape...

Following the discovery of HEV in the 1980's, it became apparent that HEV is endemic in a number of developing countries in Asia, Africa and Mexico. In these geographical settings HEV is spread oral faecally by HEV genotypes (gt) 1 and 2, which are obligate human pathogens. Infection occurs oro-faecally, often as a result in the breakdown of fragil...

Aim: Hepatitis E virus (HEV) is endemic in developed countries, but unrecognized infection is common. Many national guidelines now recommend HEV testing in patients with acute hepatitis irrespective of travel history. The biochemical definition of 'hepatitis' that best predicts HEV infection has not been established. This study aimed to determine...

Background and aims: The interplay between host anti-viral immunity and immunopathology during Hepatitis E virus (HEV) infection determines important clinical outcomes. We characterised the specificity, functionality and durability of host T-cell responses against the full-length HEV virus and assessed a novel "Quantiferon" assay for the rapid dia...

Purpose of review: Over the last 10 years, it has become apparent that hepatitis E virus (HEV) is a pathogen of global significance. In contrast to HEV in the developing world, HEV in developed countries is caused by HEV genotypes 3 and 4, which are enzoonotic with a porcine primary host and cause both acute and chronic infection. Chronic infectio...

Unlabelled: There have been large numbers of studies on anti-HEV IgG seroprevalence in Europe, however, the results of these studies have produced high variability of seroprevalence rates, making interpretation increasingly problematic. Therefore, the aim of this study was to develop a clearer understanding of anti-HEV IgG seroprevalence in Europe...

Introduction: Anti-thrombotics (antiplatelets and anticoagulants; ATs) have been identified as risk factors for upper gastrointestinal bleeding (UGIB). However few international studies have evaluated their effect on patient outcome. We aimed to assess the effects of AT use on outcome in patients with high-risk UGIB requiring endoscopic therapy. Me...

Background Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies. Study Countries were asked to nominate experts and to complete a standardised questionnaire about the epidemiological situati...

Introduction Anti-thrombotics (antiplatelets and anticoagulants; ATs) have been identified as risk factors for upper gastrointestinal bleeding (UGIB). However few international studies have evaluated their effect on patient outcome. We aimed to assess the effects of AT use on outcome in patients with high-risk UGIB requiring endoscopic therapy. Me...

Introduction Weekend admissions have been associated with higher mortality. For upper gastrointestinal haemorrhage (UGIH) some studies show significantly increased mortality and less early endoscopy while the UK UGIH audit reported no difference. We studied whether out of hours (OOH) admissions were sicker and/or had higher mortality. Methods Pros...

Until recently, hepatitis E virus (HEV) was thought not to occur in developed countries. It is now clear that locally acquired HEV is common in such settings. HEV infection acquired in these areas differs from that in developing countries in a number of important aspects: it is caused by genotype 3 (and 4 in China and Japan), it mainly affects midd...