RESUMEN
BACKGROUND: Rotavirus (RV) causes a high proportion of acute gastroenteritis (AGE) cases, especially among children under the age of five years old. This surveillance study was undertaken to study the incidence and severity of rotavirus gastroenteritis (RVGE) in primary care settings in Bulgaria over a one-year period. METHODS: In this prospective, observational study of AGE cases in children under five years of age presenting in the primary care setting over a one year period, stool samples were collected and tested for RV using a rapid visual immunochromatographic test kit. After the first visit, parents monitored their child for about two weeks and reported the symptoms experienced by the child during the follow-up period to the physician in a follow-up phone call. The percentage of RVGE cases among AGE was calculated and the severity of AGE (according to the 20-point Vesikari scale) was assessed by the physician based on the symptoms reported by the parents. The seasonality of RVGE was also studied. RESULTS: The proportion of RVGE among the 624 AGE cases examined was 25.5%. Severe AGE was experienced by 81.8% RV-positive and 54.6% RV-negative children (p-value <0.001) and a third of all severe AGE cases occurred in RV-positive patients. A multivariate logistic regression analysis of the determinants of hospitalization indicated that severity of disease and RV-positivity were the statistically significant variables explaining hospitalization of AGE cases; even controlling for severity, RV-positive patients were more often hospitalized than RV-negative ones. RVGE cases occurred throughout the year, with peaks during August and September. CONCLUSION: Our study emphasizes that RV is an important cause of AGE in children under five presenting in primary care settings in Bulgaria and a disproportionately high proportion of severe AGE cases may be attributed to RV infections. TRIAL REGISTRATION NUMBER: NCT01733849.
RESUMEN
BACKGROUND/AIMS: To evaluate the clinical course and effect of antiviral treatment in chronic active hepatitis C with coexisting occult hepatitis B infection. METHODOLOGY: Basic liver enzymes, histological activity of hepatitis (Ishak score), biochemical and virological response rate at the end of treatment and 6 months later of 30 patients (15 of them positive for hepatitis B core antibody in serum) with chronic active hepatitis C are compared. All patients were treated with Interferon alpha-2b 3ME three times weekly and oral Ribavirin 1000/1200 mg daily for six months. RESULTS: The pure hepatitis C group demonstrates markedly higher biochemical and histological (necroinflammatory) activity. After treatment the pure hepatitis C group shows normalization of serum ALT in 73% (vs. 66% in hepatitis B core antibody-positive patients); loss of detectable HCV-RNA in serum in 47% (vs. 35%) and sustained biochemical response 6 months later in 28% vs. 40% respectively. CONCLUSIONS: Patients with circulating hepatitis B core antibodies might develop some degree of immune tolerance against hepatitis C virus, with less advanced hepatolysis and necroinflammation even in the presence of HCV viremia and worse virological therapeutic response, associated with frequent sustained ALT normalization.