Showing papers by "University of the Philippines Manila published in 2009"

A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Abstract: The rate of death was 1.5% before the checklist was introduced and declined to 0.8% afterward (P = 0.003). Inpatient complications occurred in 11.0% of patients at baseline and in 7.0% after introduction of the checklist (P<0.001). Conclusions Implementation of the checklist was associated with concomitant reductions in the rates of death and complications among patients at least 16 years of age who were undergoing noncardiac surgery in a diverse group of hospitals.

Caesarean section in four South East Asian countries: reasons for, rates, associated care practices and health outcomes

Abstract: Caesarean section is a commonly performed operation on women that is globally increasing in prevalence each year. There is a large variation in the rates of caesarean, both in high and low income countries, as well as between different institutions within these countries. This audit aimed to report rates and reasons for caesarean and associated clinical care practices amongst nine hospitals in the four South East Asian countries participating in the South East Asia-Optimising Reproductive and Child Health in Developing countries (SEA-ORCHID) project. Data on caesarean rates, care practices and health outcomes were collected from the medical records of the 9550 women and their 9665 infants admitted to the nine participating hospitals across South East Asia between January and December 2005. Overall 27% of women had a caesarean section, with rates varying from 19% to 35% between countries and 12% to 39% between hospitals within countries. The most common indications for caesarean were previous caesarean (7.0%), cephalopelvic disproportion (6.3%), malpresentation (4.7%) and fetal distress (3.3%). Neonatal resuscitation rates ranged from 7% to 60% between countries. Prophylactic antibiotics were almost universally given but variations in timing occurred between countries and between hospitals within countries. Rates and reasons for caesarean section and associated clinical care practices and health outcomes varied widely between the four South East Asian countries.

Infectious Complications Associated with Monoclonal Antibodies and Related Small Molecules

Abstract: Summary: Biologics are increasingly becoming part of routine disease management. As more agents are developed, the challenge of keeping track of indications and side effects is growing. While biologics represent a milestone in targeted and specific therapy, they are not without drawbacks, and the judicious use of these “magic bullets” is essential if their full potential is to be realized. Infectious complications in particular are not an uncommon side effect of therapy, whether as a direct consequence of the agent or because of the underlying disease process. With this in mind, we have reviewed and summarized the risks of infection and the infectious disease-related complications for all FDA-approved monoclonal antibodies and some related small molecules, and we discuss the probable mechanisms involved in immunosuppression as well as recommendations for prophylaxis and treatment of specific disease entities.

Management of endometrial cancer in Asia: consensus statement from the Asian Oncology Summit 2009

Abstract: Summary Endometrial cancer is one of the gynaecological cancers that carries good overall prognosis because it is often detected at early stages of disease. The International Federation of Gynecology and Obstetrics replaced clinical staging with surgical staging in 1988 and updated the system in 2009. Controversies remain regarding the recommended screening protocol for women with a high risk of endometrial cancer, the role and benefit of retroperitoneal lymph-node dissection, the necessity of ovarian resection, the benefit and type of adjuvant radiation therapy, and the safety of hormone-replacement therapy after treatment. This article reviews the available evidence for optimum management of endometrial cancer and how management strategies can be applied in Asian countries with different levels of health-care resource availability and economic development. An overview of the literature for endometrial-cancer screening, diagnosis, and management is discussed. Consensus statements are formulated on the basis of basic, limited, enhanced, and maximum health-care resource availability, using the framework provided by the Breast Health Global Initiative.

Prevalence of urinary and faecal incontinence and nocturnal enuresis and attitudes to treatment and help-seeking amongst a community-based representative sample of adults in the United Kingdom.

Abstract: Summary Aim: To determine relative prevalence in the same population of urinary incontinence (UI), faecal incontinence (FI) and nocturnal enuresis (NE). To explore attitudes and behaviours relating to help-seeking and beliefs about incontinence prevalence, impact, causes and treatments. Design: Online survey. Subjects: A total of 1040 community-based adults in the UK, representative in terms of age, gender, region and socio-economic status. Outcomes: Prevalence of UI, FI and NE; help-seeking behaviour and beliefs; beliefs about cause, impact and treatment of incontinence. Results: Twenty-three per cent (n = 239) reported UI, 11% (n = 110) FI and 6% (n = 57) NE. Of those known to have sought help, 77% did so from a general practitioner (GP). Of those with no incontinence, 75% said they would seek help from a GP, while 23% said they did not know who they would seek help from. Many were unsure whether treatments were available. Around 90% recognised the serious personal impact of incontinence. Conclusions: This survey suggests that, relative to UI, the prevalence of FI and NE may be higher than previous UK studies. That the majority of those who had sought help did so from a GP, and that those with no incontinence thought that they would do so if affected, underlines the importance of GP education in the diagnosis and management of incontinence and the need to raise public awareness of other sources of help. That many respondents were unsure of treatment options and yet aware of the impact of incontinence underlines the importance of awareness-raising.

Faecal contamination of drinking water in a Brazilian shanty town: importance of household storage and new human faecal marker testing.

Abstract: Worldwide, contaminated drinking water poses a major health threat, particularly to child development. Diarrhoea represents a large part of the water-related disease burden and enteric infections have been linked to nutritional and growth shortfalls as well as long-term physical and cognitive impairment in children. Previous studies detailed the frequency of infection and the consequences for child health in a shanty town in north-east Brazil. To determine the frequency of contaminated water, we measured faecal contamination in primary drinking water samples from 231 randomly selected households. Risk for contamination was compared across source and storage types. Nearly a third of the study households (70/231: 30.3%) had contaminated drinking water; the source with the highest frequency of contamination was well water (23/24: 95.8%). For tap water, the type of storage had a significant effect on the susceptibility to contamination (chi(2) = 12.090; p = 0.007). The observed pattern of contamination demonstrated the relative potential contributions of both source and storage. With evidence that supports the inclusion of source and storage in water quality surveys, this study, like others, suggests that contaminated drinking water in storage vessels may be an important factor for the documented diarrhoea disease burden in the Brazilian shanty town.

Genetic diversity and population structure of Plasmodium falciparum in the Philippines

Abstract: In the Philippines, malaria morbidity and mortality have decreased since the 1990s by effective malaria control. Several epidemiological surveys have been performed in the country, but the characteristics of the Plasmodium falciparum populations are not yet fully understood. In this study, the genetic structure of P. falciparum populations in the Philippines was examined. Population genetic analyses based on polymorphisms of 10 microsatellite loci of the parasite were conducted on 92 isolates from three provinces (Kalinga, Palawan, and Davao del Norte) with different malaria endemicity. The levels of genetic diversity and the effective population sizes of P. falciparum in the Philippines were similar to those reported in the mainland of Southeast Asia or South America. In the low malaria transmission area (Kalinga), there was a low level of genetic diversity and a strong linkage disequilibrium (LD) when the single-clone haplotype (SCH) was used in the multilocus LD analysis, while in the high malaria transmission areas (Palawan and Davao del Norte), there was a high level of genetic diversity and a weak LD when SCH was used in the multilocus LD analysis. On the other hand, when the unique haplotypes were used in the multilocus LD analysis, no significant LD was observed in the Kalinga and the Palawan populations. The Kalinga and the Palawan populations were, therefore, estimated to have an epidemic population structure. The three populations were moderately differentiated from each other. In each area, the level of genetic diversity correlates with the local malaria endemicity. These findings confirm that population genetic analyses using microsatellite loci are a useful tool for evaluating malaria endemicity.

Cancer survival discrepancies in developed and developing countries: comparisons between the Philippines and the United States

Abstract: Despite the availability of population-based cancer survival data from the developed and developing countries, comparisons remain very few. Such comparisons are important to assess the magnitude of survival discrepancies and to disentangle the impact of ethnic background and health care access on cancer survival. Using the SEER 13 database and databases from the Manila and Rizal Cancer Registries in the Philippines, a 5-year relative survival for 9 common cancers in 1998–2002 of Filipino-American cancer patients were compared with both cancer patients from the Philippines, having the same ethnicity, and Caucasians in the United States, being exposed to a similar societal environment and the same health care system. Survival estimates were much higher for the Filipino-Americans than the Philippine resident population, with particularly large differences (more than 20–30% units) for cancers with good prognosis if diagnosed and treated early (colorectal, breast and cervix), or those with expensive treatment regimens (leukaemias). Filipino-Americans and Caucasians showed very similar survival for all cancer sites except stomach cancer (30.7 vs 23.2%) and leukaemias (37.8 vs 48.4%). The very large differences in the survival estimates of Filipino-Americans and the Philippine resident population highlight the importance of the access to and utilisation of diagnostic and therapeutic facilities in developing countries. Survival differences in stomach cancer and leukaemia between Filipino-Americans and Caucasians in the United States most likely reflect biological factors rather than the differences in access to health care.

Monitoring genotoxicity among gasoline station attendants and traffic enforcers in the City of Manila using the micronucleus assay with exfoliated epithelial cells

Abstract: Some types of occupations involve high levels of exposure to potentially genotoxic gaseous and particulate substances from internal combustion engines used in motor vehicles. These occupational exposures may contribute to the development of many illnesses, usually through chromosomal change mechanisms that include strand breakage, deletions, sister chromatid exchange and non-disjunction. To determine the effect of occupational exposure in gasoline station attendants and traffic enforcers, the micronucleus test was used. Exfoliated oral mucosa cells from 18 gasoline station attendants, 18 traffic enforcers and 18 control subjects in the City of Manila were examined for micronucleated cell (MNC) frequency. Analysis of buccal cells showed that MNC frequencies in exposed individuals were significantly greater than in control subjects (p ≤ 0.05). However, between gasoline station attendants and traffic enforcers, MNC frequencies of the two exposed groups exhibited no significant difference. No relation was also found between MNC frequency and any of the factors such as age, smoking habits, alcohol habits and working period. This was further confirmed in the multiple regression analysis which showed that only occupational exposure was a good predictor of MNC frequency. The results of this study suggest that gasoline station attendants and traffic enforcers, compared to the control individuals, are at a greater risk of chromosomal damage. For the assessment of chromosomal damage, the study, development, and standardization of tests are recommended for public institutions concerned with matters regarding environmental quality and community health.

A new isolate of hepatitis B virus from the Philippines possibly representing a new subgenotype C6.

Abstract: Hepatitis B virus (HBV) genotypes and subgenotypes show distinct geographical prevalence. A genotyping analysis of 28 samples from asymptomatic HBV carriers from the Philippines gave a distribution of HBV genotypes as expected from a previous study: 54% B (15/28), C5 18% (5/28), 14% D (4/28), 7% A1 (2/28). In addition, 7% (2/28) of the samples showed a double infection with genotypes B and D. One of the isolates sequenced completely, ph105, did not group into one of the known subgenotypes after phylogenetic analysis. Ph105 formed a separate clade in genotype C. With a genome length of 3,215 nt. and a serological subtype adr, ph105 exhibited the main features of most genotype C strains. However, ph105 differed by 4.1–7.2% from HBV subgenotypes C1 to C5 when comparing the nucleotide sequence of whole genomes. With only 4.1% difference ph105 was most closely related to subgenotype C2. SimPlot analysis gave no indication for recombination with known HBV genotypes. Ph105 fulfils all criteria for a new subgenotype C6. J. Med. Virol. 81:983–987, 2009. © 2009 Wiley-Liss, Inc.

Early ERCP in acute gallstone pancreatitis without cholangitis: a meta-analysis.

Abstract: Context Early ERCP was reported to result in recovery from acute gallstone pancreatitis. To date, several RCTs comparing it to conservative treatment have yielded different results. Objective We conducted a meta-analysis to determine the effect of early ERCP on the morbidity and mortality of acute gallstone pancreatitis without cholangitis. Methods We searched the following databases up to January 11 th , 2008: the Cochrane Library, MEDLINE, EMBASE, the Australasian Medical Index, Latin American Caribbean Health Sciences Literature, and the Health Research and Development Information Network. References were scrutinized. Authors were contacted. There were no restrictions regarding language, publication date or publication status. Results Seven RCTs were retrieved, but only two RCTs involving 177 treated patients and 163 control patients were included. A meta-analysis on morbidity was inconclusive (RR=0.95, 95% CI: 0.74-1.22). Meta-analysis on mortality only showed a trend in favor of conservative management (RR=1.92, 95% CI: 0.86-4.32) for both mild and severe pancreatitis. Conclusions There is a trend towards more mortality from early ERCP with or without sphincterotomy in the setting of acute gallstone pancreatitis without cholangitis. However, more studies are needed. In the meantime, early ERCP should not be carried out unless there is at least a slight suspicion of cholangitis or persistent ampullary obstruction.

Deletion mutants of AP-1 adaptin subunits display distinct phenotypes in fission yeast.

Abstract: Adaptins are subunits of the heterotetrameric (beta/mu/gamma/sigma) adaptor protein (AP) complexes that are involved in clathrin-mediated membrane trafficking. Here, we show that in Schizosaccharomyces pombe the deletion strains of each individual subunit of the AP-1 complex [Apl2 (beta), Apl4 (gamma), Apm1 (mu) and Aps1 (sigma)] caused distinct phenotypes on growth sensitivity to temperature or drugs. We also show that the Deltaapm1 and Deltaapl2 mutants displayed similar but more severe phenotypes than those of Deltaaps1 or Deltaapl4 mutants. Furthermore, the Deltaapl2Deltaaps1 and Deltaapl2Deltaapl4 double mutants displayed synthetic growth defects, whereas the Deltaaps1Deltaapl4 and Deltaapl2Deltaapm1 double mutants did not. In pull-down assay, Apm1 binds Apl2 even in the absence of Aps1 and Apl4, and Apl4 binds Aps1 even in the absence of Apm1 and Apl2. Consistently, the deletion of any subunit generally caused the disassociation of the heterotetrameric complex from endosomes, although some subunits weakly localized to endosomes. In addition, the deletion of individual subunits caused similar endosomal accumulation of v-SNARE synaptobrevin Syb1. Altogether, results suggest that the four subunits are all essential for the heterotetrameric complex formation and for the AP-1 function in exit transport from endosomes.

Dengue haemorrhagic fever or dengue shock syndrome in children.

Abstract: Introduction Dengue haemorrhagic fever and dengue shock syndrome are major causes of hospital admission and mortality in children. Up to 5% of people with dengue haemorrhagic fever die of the infection, depending on availability of appropriate supportive care. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of supportive treatments for dengue haemorrhagic fever or dengue shock syndrome in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2008 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 13 systematic reviews or RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding blood component transfusion to standard intravenous fluids; adding carbazochrome sodium sulfonate, corticosteroids, or intravenous immunoglobulin to standard intravenous fluids; adding recombinant-activated factor VII to blood component transfusion; colloids; crystalloids; and intravenous fluids.

Modeling of retention of adrenoreceptor agonists and antagonists on polar stationary phases in hydrophilic interaction chromatography: a review.

Abstract: Retention prediction models for reversed-phase liquid chromatography (RPLC) have been extensively studied owing to the fact that RPLC remains the most widely used chromatographic technique especially in the field of pharmaceutical and biomedical analyses. However, RPLC is not always the method of choice for the analysis of some compounds that have high polarity. Hydrophilic interaction chromatography (HILIC) has been gaining interest in the last few years as an alternative option to RPLC for the analysis of polar and hydrophilic analytes. HILIC is a variant of normal-phase liquid chromatography, but utilizes water in a water-miscible organic solvent as the eluent in conjunction with a hydrophilic stationary phase. The present review aims to summarize recent contributions on the development of retention prediction models for a group of basic analytes, namely, the adrenoreceptor agonists and antagonists, on different polar stationary phases. The use of multiple linear regression and artificial neural networks in model building is highlighted.

Total pesticide exposure calculation among vegetable farmers in Benguet, Philippines.

Abstract: This was a cross-sectional study that investigated pesticide exposure and its risk factors targeting vegetable farmers selected through cluster sampling. The sampling size calculated with 𝑃=.05 was 211 vegetable farmers and 37 farms. The mean usage of pesticide was 21.35 liters. Risk factors included damaged backpack sprayer (34.7%), spills on hands (31.8%), and spraying against the wind (58%). The top 3 pesticides used were pyrethroid (46.4%), organophosphates (24.2%), and carbamates (21.3%). Those who were exposed to fungicides and insecticides also had higher total pesticide exposure. Furthermore, a farmer who was a pesticide applicator, mixer, loader, and who had not been given instructions through training was at risk of having higher pesticide exposure. The most prevalent symptoms were headache (64.1%), muscle pain (61.1%), cough (45.5%), weakness (42.4%), eye pain (39.9%), chest pain (37.4%), and eye redness (33.8%). The data can be used for the formulation of an integrated program on safety and health in the vegetable industry.

Capecitabine-Based Chemoradiotherapy with Adjuvant Capecitabine for Locally Advanced Squamous Carcinoma of the Uterine Cervix: Phase II Results

Abstract: Objectives. Cisplatin-based chemoradiotherapy is the standardtreatmentforlocallyadvancedcervicalcancer but causes considerable toxicity. Capecitabine and radiotherapy show preclinical synergy and clinical activity. The activity, tolerability, and oral administration of capecitabine make it an attractive adjunctive therapy. Methods. In this phase II study, patients with untreated International Federation of Gynecology and ObstetricsstageIIB–IIIBcervicalcancerreceivedcapecitabine, 825 mg/m 2 twice daily (Monday–Friday), during radiation (45 Gy per 25 fractions external-beam radiotherapy and 26 Gy high-dose rate brachytherapy to point A, maximum 8 weeks), followed by six cycles of capecitabine, 1,000 mg/m 2 twice daily (days 1–14 every 21 days). Results. The overall response rate in 60 patients was 88% (95% confidence interval [CI], 77.4%–95.2%), including complete responses (CRs) in 80% of patients. The 1-year progression-free and overall survival rates were 86% (95% CI, 77%–95%) and 95% (95% CI, 89%–100%), respectively. At 23 months, 76% of patients were progression free (95% CI, 65%–88%) and CR was maintained in 90% (95% CI, 81%–99%) of the 48 patients achieving a CR. There were three grade 3 or 4

Exporting simulation technology to the Philippines: a comparative study of traditional versus simulation methods for teaching intravenous cannulation.

Abstract: This study examines effectiveness of a donated Laerdal Virtual I.V. simulator when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students in the Philippines. Forty novice Filipino medical students viewed an instructional video on how to start intravenous lines and were then randomly divided into two groups of twenty. The "Traditional" group observed an IV insertion on an actual patient performed by an experienced practitioner, and then subsequently performed an IV on an actual patient which was videotaped. The "Simulation" group practiced the Virtual I.V. simulator until they successfully completed level three using the "doctor" setting. These students then performed an IV on an actual patient which was videotaped. The videotapes for both groups were reviewed by two pre-trained (Inter-rater reliability of > or =0.84) observers who were blinded to the group using a previously validated checklist for IV insertion. Students trained on the Virtual I.V. showed significantly greater success in successfully starting an IV on an actual patient (40% VS. 15%, p<0.05), decreased constrictive band time (p<.05), increased raw score on the check list (p<.03), and decreased overall time to start an IV (p<.05). The technology was well received but wider application in the non western world is limited by lack of in country company support and the relative expense.

An update on cardiovascular disease epidemiology in South East Asia. Rationale and design of the LIFE course study in CARdiovascular disease Epidemiology (LIFECARE)

Abstract: Summary The burden of cardiovascular disease (CVD) is likely to increase dramatically in Asia over the next several decades. In this paper, we review the existing data on CVD epidemiology in Asia, with a focus on the INTERHEART study and the Asia Pacific Cohort Studies Collaboration. Existing data suggests that much of CVD may be preventable through reduction in the levels of well-established CVD risk factors and that these findings are likely to be relevant to Asian populations. However, these studies have several important limitations. These include a lack of longitudinal studies with collection of repeated measures of CVD risk factors and the environmental factors that may result in the age-related increase in the levels of these risk factors. As such, the natural history of the development of CVD risk factors such as obesity, diabetes, hypertension and dyslipidemia in Asia, and their relationship in terms of duration and timing of exposure to various environmental influences is currently unknown. In addition, there is a paucity of data related to psychosocial factors that may be involved in the pathogenesis of CVD, either directly or through effects on other CVD risk factors. Finally, little data is available with regards to the impact of CVD and its attendant risk factors on health related quality of life and health care utilization. This information is crucial for the design and evaluation of evidence based programs for primary prevention. We have designed a LIFE Course Study in CARdiovascular disease Epidemiology (LIFECARE) involving 12,000 individuals in four South East Asian countries to address these data needs.

Comparison of pesticide exposure and physical examination, neurological assessment, and laboratory findings between full-time and part-time vegetable farmers in the Philippines.

Abstract: Objectives This study aimed to compare the work practices and health effects of pesticide exposure between full-time and part-time vegetable farmers.

Phytochemical survey and pharmacological activities of the indole alkaloids in the genus Voacanga Thouars (Apocynaceae) - an update.

Abstract: Numerous species of the Apocynaceous genus Voacanga Thouars have been demonstrated to elaborate a host of indole alkaloids that display various structural complexities and a wide array of biological activities. Monoterpenoid indole alkaloids are nitrogenous metabolites borne from the biosynthetic union of tryptophan and the terpene-derived iridoid, secologanin. As a genus is closely related to Tabernaemontana, representative species of Voacanga were reported to contain the vobasine, vallesamine, eburnane, iboga and aspidosperma–type indole alkaloids. A lot of these compounds are associated with analgesic, CNS, antimicrobial, anti-ulcer, cytotoxic, antioxidant and antimalarial activities. Voacanga is a small taxon with 12 species that are mainly found in tropical Africa and Malesia except for V. grandifolia which extends to Australia. This comprehensive review compiles the phytochemical and pharmacological explorations that have been undertaken on Voacanga in relation to its indole alkaloids.

Bacterial and fungal organisms in otitis externa patients without fungal infection risk factors in Erzurum, Turkey

Abstract: AIM: To describe the bacterial and fungal organisms in otitis externa patients without other risk factors for fungal infections. STUDY DESIGN: Cross sectional cohort descriptive study. MATERIALS AND METHODS: Ear swabs were obtained from 362 patients aged 1 to 55 years old with clinically diagnosed otitis externa in Erzurum, Turkey, between January 2006 and April 2007, and cultured for aerobic and anaerobic bacteria and fungi, using EMB, 5% sheep's blood, chocolate agar, anaerobic blood agar plate, thioglycollate broth and sabaroud agar using standard microbiological technique to diagnose isolates. RESULTS: 219 cultures were positive and a total of 267 isolates were obtained. Of the isolates, 68.16% (n: 182) were aerobic or facultative bacteria, 1.12 % (3) were anaerobic bacteria, 30.71 % (82) were fungi and 17.5 % (38) were polymicrobial infections. CONCLUSION: Fungal organisms especially Candida species may be isolated from ears of otitis externa patients without fungal infection risk factors such as ear self-cleaning, local antimicrobial, antifungal or corticosteroid drops or systemic antimicrobial or antifungal agents within the preceding week. Bacterial and fungal cultures may be recommended, and anti-fungal agents may be added, to treatment regimens in patients with otitis externa.

Bedside diagnosis of outpatient childhood urinary tract infection using three-media dipslide culture test

Abstract: To determine the accuracy of a three-media dipslide test, the Uricult Trio, for the diagnosis of childhood urinary tract infections (UTIs), we collected urine specimens from children at the outpatient department. Two hundred consecutive patients presenting with symptoms of UTI were examined. Randomly voided, midstream, clean-catch and catheterized samples were used. Each was tested by routine laboratory culture and the dipslide test. The subjects’ ages ranged from 4 months to 7 years, with a median age of 5 years. There were 112 (56%) boys and 86 (43%) girls. Of the subjects, 98 (49%) showed urine culture results indicating significant bacteriuria. There was complete agreement in 70 cases (35%). The sensitivity and specificity of the dipslide were 68% and 82%, respectively. The positive and negative predictive values were 81% and 71%, respectively. The likelihood ratio for a positive test was 3.7, while for a negative test it was 0.39. The specificity, using Escherichia coli special agar, increased to 85% and the negative predictive value to 93%. The Uricult Trio dipslide method was technically simple and could be applied in the outpatient setting. Further studies are required, however, before it can be recommended as a routine diagnostic tool.

Description of a New Hepatitis B Virus C6 Subgenotype Found in the Papua Province of Indonesia and Suggested Renaming of a Tentative C6 Subgenotype Found in the Philippines as Subgenotype C7

Abstract: Hepatitis B virus (HBV) genotypes (2, 4, 5, 7-9) and subgenotypes (11, 13, 14, 16-18) are important factors that influence the course of the disease and the outcome of treatment. Because of the clinical importance of the HBV classification, an accurate assignation of newly found subgenotypes to their respective clades and an unambiguous nomenclature are needed. A new HBV subgenotype should differ from previously established by at least 4%, and the segregation into a new clade should be supported by robust bootstrapping data (3). In the June 2009 issue of the Journal of Clinical Microbiology, a new C6 subgenotype of HBV found in the Papua province of Indonesia (C6 Papua-Indonesia) is described (15). However, a tentative C6 subgenotype found in the Philippines (C6 Philippines) has already been published contemporaneously (1). To keep up with an unambiguous system of HBV subgenotypes, it is important to analyze if C6 Papua-Indonesia and C6 Philippines are identical or map to different clades. Using methods described by Cavinta et al. (1) and published sequences from Utsumi et al. (15), we made a phylogenetic analysis using whole genomes that clearly showed that both C6 groups mapped to different clades (Fig. ​(Fig.11). FIG. 1. Phylogenetic tree of complete HBV genomes of genotypes A to H. An alignment of complete sequences was performed with ClustalW using the program DNASTAR. The alignment was further analyzed by bootstrapping with 500 replicates, using the neighborhood-joining ... C6 Papua-Indonesia and C6 Philippines differed by 5.1% from each other and diverged by at least 4.1% from the other HBV subgenotypes (Table ​(Table11). TABLE 1. Nucleotide distance between proposed subgenotypes C6 Philippines and C6 Papua-Indonesia of HBV and other reference genotype strains from the database Thus, both contemporaneously described subgenotypes (1, 15) fulfill all criteria for having new and separate subgenotypes. Because the designation C6 has been claimed for partial sequences found in the Papua province of Indonesia already (6), we suggest that the subgenotype C6 found in the Papua province of Indonesia shall keep the designation C6, whereas the tentative subgenotype from the Philippines shall be called C7. To avoid similar confusion in the future, we have suggested a procedure that would involve the International Committee for Taxonomy of Viruses to allot new genotype/subgenotype designations (10).