Colonizacion por estreptococo beta hemolitico del grupo B durante el embarazo y prevencion de enfermedad neonatal / Group B streptococcus colonization during pregnancy and prevention of early onset of disease

El estreptococo beta-hemolítico del grupo B (SGB) es uno de los principales agentes causantes de sepsis neonatal precoz. La mortalidad de los afectados oscila entre el 6 y el 20%, y la tasa de secuela neurológica llega al 30%. En 1996 el Centro de Prevención y Control de Enfermedades de Atlanta, el Colegio Americano de Obstetras y Ginecólogos y la Academia Americana de Pediatría sugirieron en consenso que el personal de atención de salud materna-neonatal debía adoptar una estrategia para la prevención de la sepsis por este germen. Los objetivos del presente trabajo prospectivo fueron determinar el porcentaje de colonización por SGB en las pacientes gestantes asistidas del 1° de julio de 2001 al 31 de diciembre de 2002 e implementar un programa de prevención de sepsis neonatal precoz por SGB a través de profilaxis antibiótica intraparto basado en cultivos. Sobre 1756 pacientes, se realizaron cultivos con hisopado vaginal y anal a 1228 (69.9%). El porcentaje de colonización materna por SGB fue del 1.4% (17 pacientes). Se presentó un caso de sepsis neonatal compatible con SGB (0.6‰) en una madre con cultivo negativo. Sólo una paciente portadora de SGB presentó factores de riesgo. Los resultados nos sugieren continuar con la estrategia de prevención basada en cultivos debido a que la mayoría de las pacientes colonizadas no presentaron factores de riesgo. Son necesarios estudios de relación costo-beneficio en nuestro medio para definir si esta estrategia de prevención es aplicable a la realidad sanitaria argentina.

Colonizacion por estreptococo beta hemolitico del grupo B durante el embarazo y prevencion de enfermedad neonatal / Group B streptococcus colonization during pregnancy and prevention of early onset of disease

El estreptococo beta-hemolítico del grupo B (SGB) es uno de los principales agentes causantes de sepsis neonatal precoz. La mortalidad de los afectados oscila entre el 6 y el 20%, y la tasa de secuela neurológica llega al 30%. En 1996 el Centro de Prevención y Control de Enfermedades de Atlanta, el Colegio Americano de Obstetras y Ginecólogos y la Academia Americana de Pediatría sugirieron en consenso que el personal de atención de salud materna-neonatal debía adoptar una estrategia para la prevención de la sepsis por este germen. Los objetivos del presente trabajo prospectivo fueron determinar el porcentaje de colonización por SGB en las pacientes gestantes asistidas del 1º de julio de 2001 al 31 de diciembre de 2002 e implementar un programa de prevención de sepsis neonatal precoz por SGB a través de profilaxis antibiótica intraparto basado en cultivos. Sobre 1756 pacientes, se realizaron cultivos con hisopado vaginal y an

Antiviral activity of amantadine in elderly patients with chronic hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) infection is a worldwide problem of public health. Epidemiological studies have shown a significant higher prevalence of infection in the elderly. Amantadine is an antiviral agent active against the influenza A virus that has been used in cases of chronic hepatitis C. OBJECTIVES: To evaluate the antiviral activity and the safety of amantadine (200 mg daily for 6 months) in elderly patients with chronic hepatitis C. METHODS: The study group consisted of 23 consecutive patients over 65 years suffering from chronic hepatitis C. Aminotransferase (ALT) levels were tested at baseline, at 15 days and then monthly until the end of therapy. HCV genotype was determined at baseline. A quantitative HCV-RNA measurement was performed at baseline, at 15 days and at the 1st, 3rd and 6th month of treatment. RESULTS: 13 males and 10 females were enrolled (mean age 70.1 +/- 3.4 years; range: 65-75). The mean ALT levels did not change significantly during therapy except in 1 patient subsequently returned normal. The HCV-RNA remained detectable in all patients, but a significant difference in response was observed in patients infected by genotype 1b. CONCLUSIONS: Our results confirm the antiviral activity of amantadine against HCV, mainly for genotype 1b with initial high viral load. No consistent effects on aminotransferases were observed.

Clearance kinetics of hepatitis C virus under different antiviral therapies.

Interferon alpha (IFN) has been the standard treatment for hepatitis C virus (HCV) infection. Using the kinetic curves of viral clearance, this study compared three treatment regimes based on IFN alone or in combination with Amantadine or Ribavirin to determine the mechanisms of action and the most suitable way to use these drugs. The early clearance kinetics of HCV were studied in 22 patients with chronic hepatitis C under different antiviral treatments: IFN 3 MU daily (7 pts); IFN 3 MU daily plus Amantadine 200 mg (7 pts); and IFN 3 MU daily plus Ribavirin 1-1.2 gr (8 pts), for 6 months. HCV-RNA was assessed qualitatively and quantitatively on serial samples. The HCV-RNA decay curves suggested a different behaviour of viral clearance induced by the three treatments. While no significant differences were present in the first 6 hours, between 6 to 12 hours Ribavirin induced a rapid decline in the viral load. Amantadine seemed to accelerate it in the third phase (12 to 30 hours) and to provoke a more pronounced viral decline when compared to IFN alone (P < 0.05) or to IFN plus Ribavirin (P < 0.025) (baseline to 30 hours). Thus, while IFN remains the principal antiviral drug, Amantadine upholds the viral decline. Ribavirin, although synergistic with IFN, does not seem to improve the IFN effect during the earliest phase of treatment but probably supports the effects of IFN later on. A new dynamic approach to HCV treatment can therefore be developed.

Chronic hepatitis C. New therapeutic strategies.

BACKGROUND: Aim of this work was to evaluate the early viral decay induced by a daily therapy with alfa-interferon (IFN) and the presence of any synergistic effects of amantadine and ribavirin. METHODS: Twenty patients with a diagnosis of chronic hepatitis C were randomly assigned to receive a course of treatment with: IFN 3MU daily (6 pts); or IFN 3MU daily plus amantadine 200 mg (7 pts): or IFN 3MU daily plus ribavirin 1-1.2 g (7 pts) for 6 months. Blood samples were drown at baseline, at 6, 12, 24, 30 and 48 hrs after the first dose of IFN; at 3, 7, 15 days and at every month. Serum was separated within two hours from the collection and stored at -80 degrees C until use. Viraemia was evaluated qualitatively by the Cobas Amplicor (cut-off 1.00E+02 copies/ml) (Roche Diagnostics, Monza, Milan, Italy) and quantitatively by the Cobas Amplicor Monitor (cut-off 1.00E+03 copies/ml). The HCV genotype was determined for each patient by Inno-LiPA HCV II (Innogenetics, Ghent, Belgium). Liver function tests were evaluated at baseline, at 7 and 15 days and at every month. RESULTS: The analysis of the decay curves showed the presence of a three phase decline in the viraemia. At the end of therapy 7 out of the 20 patients (35%) had normal ALT and undetectable HCV-RNA (2 out of 6 in the IFN group: 33.3%, 3 out of 7: 42.8%; 2 out of 7: 28.6%, in the IFN plus amantadine and IFN plus ribavirin groups respectively). CONCLUSIONS: IFN is the major antiviral effector in the early stage of therapy. The observation of the kinetic curves shows a tendency for the ribavirin to induce a slightly steeper slope of decay in the first 48 hrs, while amantadine seems to induce a slightly deeper abatement of circulating viraemia after 48 hrs.

Chronic hepatitis induced by Jin Bu Huan.

BACKGROUND/AIMS: Jin Bu Huan and other Chinese herbal products are widely taken remedies. They have been developed as a natural alternative to traditional drugs in the treatment of various ailments. Their ability to induce several side effects such as acute hepatitis has already been described. We report a case of chronic hepatic damage following administration of Jin Bu Huan Anodyne tablets. METHODS: The patient, a 49-year-old man, developed biochemical signs of liver damage 2 months after beginning Jin Bu Huan intake (3 tablets/daily) including biopsy-proven chronic hepatitis with moderate fibrosis. Virological, autoimmune, metabolic or other hepatotoxic causes were excluded. Liver function impairment was resolved by discontinuing Jin Bu Huan intake. CONCLUSIONS: This case reinforces the already known hepatotoxicity of this product and should make us think more about the uncontrolled use of alternative products.

Misoprostol: una nueva alternativa para el tratamiento del aborto incompleto / Misoprostol: a nuew alternative for theMisoprostol: a new alternative for the incomplete abortion treatment

El objetivo de este trabajo es determinar la eficacia del uso del misoprostol oral, como alternativa al legrado evacuador en el aborto incompleto. Se estudio prospectivamente un grupo de 47 pacientes con diagnóstico clínico y ecográfico de aborto incompleto del primer trimestre

Misoprostol: una nueva alternativa para el tratamiento del aborto incompleto / Misoprostol: a nuew alternative for theMisoprostol: a new alternative for the incomplete abortion treatment

El objetivo de este trabajo es determinar la eficacia del uso del misoprostol oral, como alternativa al legrado evacuador en el aborto incompleto. Se estudio prospectivamente un grupo de 47 pacientes con diagnóstico clínico y ecográfico de aborto incompleto del primer trimestre(AU)

[Atmospheric pollution and chronic respiratory diseases in the blast-furnace areas of iron-works]. / Inquinamento atmosferico ed affezioni respiratorie croniche nella zona altoforni di uno stabilimento siderurgico.

An epidemiologic research together with a study on the environmental pollution were carried out in order to evaluate the risk of chronic respiratory diseases of blast furnace workers. The environment study was performed mainly using personal samplers given to workers with different jobs. Observations on 222 work shifts have shown that the total dust concentration to which cast workmen, maintenance men and blast furnace service men were exposed, marginally exceed the TLV values. Furthermore the level of respirable dusts for blast furnace service men was found slightly excessive. The average SO2 concentration was largely below the TLV values. However this gas could be found in excess for very short periods during the work. The epidemiologic study, conducted on a cohort of blast furnace area workers against a control group cohort, indicated a moderate prevalence of pneumoconiosis and chronic bronchitis amongst blast furnaces workers. The clinic and radiological pictures do not seem to go beyond the initial stages.