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Frustration and Conflict: Avoidance-Avoidance, Double-Approach Avoidance01:14

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Avoidance-avoidance conflict refers to a psychological situation where a person must choose between two or more unpleasant alternatives. These conflicts are particularly stressful because neither option is desirable. This dilemma is often expressed in sayings like "caught between a rock and a hard place" or "between the devil and the deep blue sea." For instance, individuals who fear dental procedures may find themselves torn between enduring a painful toothache or facing the...
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Enols are a class of compounds where a hydroxyl group is attached to a carbon–carbon double bond, which implies that it is a vinyl alcohol. A carbonyl compound with an α hydrogen undergoes keto–enol tautomerism and remains in equilibrium with its tautomer, the enol form. Usually, the keto tautomer is present in a higher concentration than the enol tautomer due to the higher bond energy of C=O compared to C=C. Moreover, the direction of the keto–enol equilibrium is...
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Narcissistic and avoidant personality traits represent two contrasting patterns of behavior that significantly influence social interactions and self-perception. While individuals with narcissistic disorder seek admiration and validation, individuals with avoidant personality disorder withdraw due to fear of judgment.
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Anti-Nuclear Antibody Screening Using HEp-2 Cells
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To avoid Hep B reactivation, screen before immunosuppression.

Ronan Farrell1, Kyley Leroy2, Frederick Nunes3

  • 1Division of Gastroenterology and Hepatology, Brown University, Providence, RI, USA.

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Universal screening for Hepatitis B virus (HBV) before starting immunosuppressive therapy is recommended. This approach is both sensible and cost-effective, even in areas with low HBV prevalence (0.3%).

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Area of Science:

  • Hepatology
  • Immunology
  • Public Health

Background:

  • Immunosuppressive therapies increase the risk of Hepatitis B virus (HBV) reactivation.
  • HBV reactivation can lead to severe liver damage and complications.
  • Pre-transplant screening protocols are established, but pre-immunosuppression screening is less consistently applied.

Purpose of the Study:

  • To evaluate the clinical utility and cost-effectiveness of universal HBV screening prior to initiating immunosuppressive treatment.
  • To determine if universal screening is justified in low-prevalence populations.

Main Methods:

  • Retrospective analysis of patient data undergoing immunosuppressive therapy.
  • Cost-effectiveness modeling comparing universal screening versus targeted screening.
  • Prevalence data collection from local HBV surveillance.

Main Results:

  • Universal HBV screening identified cases that would have been missed by targeted approaches.
  • The cost-effectiveness analysis demonstrated that universal screening is favorable even at a local HBV prevalence of 0.3%.
  • Early detection allowed for timely intervention and management of HBV carriers.

Conclusions:

  • Universal HBV screening before immunosuppression is a prudent strategy.
  • This approach is cost-effective and improves patient outcomes by preventing HBV reactivation.
  • Implementation of universal screening is recommended regardless of local HBV prevalence.