Reactivity to B cell epitopes within hepatitis C virus core protein and hepatocellular carcinoma.

Our aim was to investigate the existence of an association between B cell responsiveness to hepatitis C virus (HCV) core protein and progression of liver disease. In fact, the persistence of HCV infection is permitted by avoidance of viral clearance, despite chronic inflammation in the liver; this process ends with the development of hepatocellular carcinoma in many patients. On the basis of computerized prediction of antigenicity of the genomic sequence of HCV core protein, three 15-mer peptides (named Q15V, R15P, and G15V) were synthesized to be used as antigens in an enzyme immunoassay. Sera from 97 patients (65 males and 32 females) were tested: 43 patients had mild chronic liver disease (steatofibrosis, chronic persistent, or chronic active hepatitis) and 54 had cirrhosis, which was complicated by hepatocellular carcinoma (HCC) in 19. Seventy-six patients were positive to anti-HCV testing by second generation ELISA and 21 were negative. Rates of positivity for synthetic peptides in anti-HCV-positive versus anti-HCV negative patients were as follows: 53 of 76 and 0 of 21 for anti-Q15V; 41 of 76 and 0 of 21 for R15P; and 67 of 76 and 2 of 21 for G15V. Rates of positivity to anti-Q15V and anti-G15V were similar among diagnostic groups (Pearson's chi 2, 1.97, P > 0.10 and 0.45, P > 0.10), whereas anti-R15P antibodies were detected at a significantly lower rate in patients with HCC (2/13) in comparison to mild chronic liver disease (22/35) and cirrhosis (17/28) (Pearson's chi 2, 9.42, P < 0.01). We conclude that anti-R15P antibodies are uncommon in anti-HCV-positive patients with HCC. During the course of chronic HCV infection, anti-R15P testing might help to identify a subgroup at higher risk to develop HCC.

Identification of Listeria species by a semi-nested polymerase chain reaction.

Three primers derived from the lap gene were used to distinguish Listeria monocytogenes from L.innocua and other Listeria species. L. monocytogenes and L. innocua yielded a PCR product of 600 and 300 bp, respectively, whereas a typical pattern of three amplimers was observed with L. ivanovii, L. seeligeri and L. welshimeri.

IgM antibody response to the hepatitis C virus core protein in intravenous drug users.

To verify whether a solid-phase enzyme immunoassay for serum IgM antibodies to the hepatitis C virus (HCV) core protein (IgM anti-HCVcore) might be proposed as a surrogate test for serum HCV RNA, we studied 86 anti-HCV antibody-positive intravenous drug users. Serum HCV RNA was demonstrated by RT-PCR with primers derived from the 5' non-coding and the core region. IgM anti-HCVcore antibodies were found in 62/86 (72%) subjects; circulating HCV RNA was detected by the 5' noncoding assay in 53/86 samples (62%) and by the core region assay in 35/86 samples (41%). IgM anti-HCVcore reactivity was associated with core HCV RNA seropositivity (p < 0.05) but not with 5' noncoding HCV RNA seropositivity (p = NS). Patients infected by HCV type 1a were more-often positive for IgM anti-HCVcore (p < 0.05) and for core HCV RNA (p = 0.005) than patients infected by other HCV genotypes. IgM anti-HCVcore reactivity was significantly more common in subjects positive for core HCV RNA (p < 0.005) and in subjects aged > 30 years (p < 0.05). In conclusion, the IgM anti-HCVcore assay frequently tests positive in intravenous drug users, particularly when infected by HCV 1a, but is not a surrogate of testing for serum HCV RNA.

Factors influencing hospital infection control policies in Italian hospitals.

A study was undertaken to determine the resources available in Italian hospitals for the control of nosocomial infections and the factors favouring a successful approach. During January-May 2000 a questionnaire about infection control was sent to the hospital health director of all Italian National Health System hospitals treating acute patients and with more than 3500 admissions in 1999. An active programme was defined as a hospital infection control committee (HICC) meeting at least four times in 1999, the presence of a doctor with infection control responsibilities, a nurse employed in infection control and at least one surveillance activity and one infection control guideline issued or updated in the past two years. There was a response rate of 87.5% (463/529). Almost fifteen percent (69/463) of hospitals had an active programme for Infection Control and 76.2% (353/463) had a HICC. Seventy-one percent (330/463) of the hospitals had a hospital infection control physician and 53% (250/463) had infection control nurses. Fifty-two percent (242/463) reported at least one surveillance activity and 70.8% (328/463) had issued or updated at least one guidance document in the last two years. The presence of regional policies [odds ratio (OR) 8.7], operative groups (OR 4.2), at least one full-time nurse (OR 4.6) and a hospital annual plan which specified infection control (OR 2.1) were statistically associated with an active programme in the multivariate analysis.

[Pathology of alcoholism. Experiences and treatment possibilities]. / Patologia alcool-correlata. Esperienze e possibilità operative.

In the present study, the state of art of alcohol-related pathology is described, and the most credited etiological theories reviewed. An effort has been made to apply theory to the daily practice of the health practitioner and the social worker, who operate in the field. Particular emphasis has been given to the experience in the County of Dolo, Italy, where alcohol-related problems have been successfully dealt with by the Alcoholism Unit of the local General Hospital.

[Availability, consumption of alcoholic beverages and alcohol-related mortality in Italy]. / Disponibilità, consumi di bevande alcoliche e mortalità alcool correlata in Italia.

On the basis of the W.H.O. guide lines the relevant parameters for the study of alcoholism in Italy have been identified. The production and utilization of alcoholic substances is very high, then appears to have reached a plateau about ten years ago. Likewise, consumption has not increased since a few years. Hospital admissions for symptoms related to alcoholism are no more available after the closure of all mental hospitals in 1978. Alcohol-related deaths seem to be stable, as well as cause specific death rates for cirrhosis .

[Assessment of the consumption of alcoholic beverages by the secondary-school student population of Trieste]. / Valutazione del consumo di bevande alcoliche nella popolazione studentesca della città di Trieste.

The results are reported of an epidemiological survey aimed at assessing alcohol consumption among the secondary school population of Trieste in three different age groups (13-14, 15-16, 18-19). The data obtained on a representative sample of Trieste students reveal an alarming situation as regards alcohol consumption especially among the younger elements, possibly due to peer pressure. Primary prevention involving health education in schools is advocated as a way of halting a worrying trend towards alcoholism even among the very young.

Epidemiological study on knowledge, attitudes and behaviour of health care workers with respect to HIV infection.

To analyse knowledge, perception of risk, attitudes and behaviour towards HIV infection among health workers in two hospitals in the North-East of Italy, we sent all health care workers who were working in direct contact with patients an anonymous self-administered questionnaire covering personal and occupational data, perception and knowledge of risk, behaviour in routine activities, attitudes towards and care of HIV patients. The response rate was 70.06%. The perception of the risk of acquiring HIV infection was influenced by occupational qualification, by work unit and by having cared for a HIV-positive patient. Scientific knowledge about transmissibility of HIV infection was poor and 11.3% of the staff did not know the Universal Precautions. 28.3% behaved correctly in recapping needles, but with patients considered not at risk 29.9% did not use any protection in drawing venous blood. A significant portion of staff showed low willingness to care for HIV-positive patients. We found a high mean perception of the risk of contracting HIV infection through occupational exposure; health workers overestimated the specific risk and wrong behavioural attitudes persisted. To conclude, more attention should be paid to educational programs for health workers.

[Seroepidemiologic research on the antipoliomyelitic immunity in adult unvaccinated subjects]. / Ricerche sieroepidemiologiche sull'immunita' antipoliomielitica in soggetti adulti non vaccinati

The Authors carried out a serological research on the polimyelitis viruses in 727 adult subjects who had not been vaccinated orally. The results of the titration of the neutralizing antibodies showed that the situation of immunity with respect to poliomyelitis is still satisfactory. However, the difficulty of making an exact estimation of the duration of the state of immunity to poliomyelitis, and the persistent, though reduced, circulation of wild polioviruses are such that a continuous epidemiological control is advisable.

Persistence of poliovirus-neutralizing antibodies 2-16 years after immunization with live attenuated vaccine. A seroepidemiologic survey in the mainland of Venice.

A seroepidemiological survey was conducted on subjects who had received a full vaccination course with live attenuated poliovirus 2-16 years before. For strains 1 and 2 prevalence of seropositives and median values dropped gradually during the first 10 years; strain 3 showed a much earlier decline. Environmental displacement of wild poliovirus by the attenuated, less immunogenic strain might eventually induce a 'gap', should complacency hamper needed vaccination efforts.

[Infections caused by hepatitis virus A and B in hospital personnel. Prevalence of antibodies against hepatitis virus A, HBsAg, anti-HBs and anti-HBc]. / Infezioni da virus epatitici "A" e "B" in personale ospedaliero. Prevalenza di anti-HAV, HBsAg, anti-HBs, anti-HBc.

In order to evaluate the risk of hepatitis A and B virus infection among hospital staff in our area, 584 medical and paramedical employees of the Hospital of Ferrara (Italy) were studied for the presence of anti-HAV, HBsAg, anti-HBs and anti-HBc serum. HAV infection was found to be less frequent among medical and nursing staff than the general population, matched for age (78.6% vs 72.2%) indicating that HAV spread within the hospital is irrelevant. However, the evidence of HBV infection is higher in hospital staff than in the general population (37.6% vs 23.0%) with a maximum prevalence in surgeons and in the operating-theatre staff, followed by nurses (both from surgical and medical wards) and physicians. The prevalence in auxiliary staff is not significantly higher than in the general population. The incidence of antibodies against HBV (anti-HBs and anti-HBc) increases with age and duration of employment, while the prevalence reaches a maximum during the initial years. The anti-HBc testing allowed for the detection of further 10% of subjects evidencing previous HBV infection.

Hepatitis B vaccine: immune response in student nurses. A fifteen-month follow-up.

The authors describe a 15-month follow-up of twenty-nine nurse students vaccinated against hepatitis B with Hevac B Pasteur. At three months all subjects were anti-HBs positive, with a geometric mean titre (GMT) of 1187 mIU/ml. At the time of booster dose (T14) GMT had fallen to 380 mIU/ml; after one month (T15) GMT had risen again to 9332 mIU/ml. Such a high antibody level suggests a long lasting protection.

Identification of four epitopes in hepatitis C virus core protein.

We identified four epitopes in hepatitis C virus core protein by using the algorithm of Jameson and Wolf. G15V (amino acids [aa] 31 to 45) appears to be the immunodominant epitope, since it was able to detect antibodies to the core protein in all 40 patients and in 44 of 45 recombinant immunoblot assay-confirmed positive blood donors. This epitope is associated with a low frequency of false-positive results, as found with 522 negative blood donors. A strong reactivity was also observed with the Q15V epitope (aa 7 to 21), although this was associated with low specificity. Occasional reactivity to the R15P (aa 49 to 63) and P15R (aa 99 to 113) epitopes was observed. Q15V and G15V detected antibodies to core protein earlier than the other two epitopes.