29 research outputs found
Long-term interferon-alpha treatment of childrenwith chronic hepatitis delta: a multicentre study.
No full textWe assessed the efficacy of prolonged interferon-alpha (IFN) therapy in children with chronic hepatitis caused by hepatitis delta virus (HDV) by treating 26 paediatric cases with IFN-alpha 2b (5 MU m-2, then 3 MU m-2 three times weekly for 12 (medium-term group MTG) or 24 months (long-term group, LTG). Compliance and tolerability were acceptable. At the end of therapy a complete biochemical response [normalization of alanine aminotransferase (ALT)] occurred in 12 children (5/13 in MTG and 7/13 in LTG). A relapse occurred after stopping IFN in 10 cases (five in MTG and five in LTG). Two patients from the LTG had normal liver function tests during 12 months of follow-up. Six of the eight hepatitis B e antigen (HBeAg) positive children lost HBeAg, while all six hepatitis B virus (HBV) DNA positive patients lost HBV DNA during treatment. HBeAg reappeared later in two children. HDV RNA, present in 10/10 cases of MTG before treatment, persisted after 12 months IFN therapy in 3/10. One year after stopping therapy, 8/10 patients were again HDV RNA positive. Two children cleared hepatitis delta antigen (HDVAg) from the liver. No significant improvements in liver histology were seen in both groups. Our experience suggests that IFN-alpha treatment in children with chronic type D hepatitis has a transient effect, and long-term treatment does not appear to induce a greater therapeutic benefit in terms of biochemical and virological respons
Acute pharyngitis in children and adults: descriptive comparison of current recommendations from national and international guidelines and future perspectives
No full textThis study aims to provide a comparison of the current recommendations about the management of acute pharyngitis. A literature search was conducted from January 2009 to 2023. Documents reporting recommendations on the management of acute pharyngitis were included, pertinent data were extracted, and a descriptive comparison of the different recommendations was performed. The quality of guidelines was assessed through the AGREE II instrument. Nineteen guidelines were included, and an overall moderate quality was found. Three groups can be distinguished: one group supports the antibiotic treatment of group A β-hemolytic Streptococcus (GABHS) to prevent acute rheumatic fever (ARF); the second considers acute pharyngitis a self-resolving disease, recommending antibiotics only in selected cases; the third group recognizes a different strategy according to the ARF risk in each patient. An antibiotic course of 10 days is recommended if the prevention of ARF is the primary goal; conversely, some guidelines suggest a course of 5–7 days, assuming the symptomatic cure is the goal of treatment. Penicillin V and amoxicillin are the first-line options. In the case of penicillin allergy, first-generation cephalosporins are a suitable choice. In the case of beta-lactam allergy, clindamycin or macrolides could be considered according to local resistance rates. Conclusion: Several divergencies in the management of acute pharyngitis were raised among guidelines (GLs) from different countries, both in the diagnostic and therapeutic approach, allowing the distinction of 3 different strategies. Since GABHS pharyngitis could affect the global burden of GABHS disease, it is advisable to define a shared strategy worldwide. It could be interesting to investigate the following issues further: cost-effectiveness analysis of diagnostic strategies in different healthcare systems; local genomic epidemiology of GABHS infection and its complications; the impact of antibiotic treatment of GABHS pharyngitis on its complications and invasive GABHS infections; the role of GABHS vaccines as a prophylactic measure. The related results could aid the development of future recommendations. What is Known: • GABHS disease spectrum ranges from superficial to invasive infections and toxin-mediated diseases. • GABHS accounts for about 25% of sore throat in children and its management is a matter of debate. What is New: • Three strategies can be distinguished among current GLs: antibiotic therapy to prevent ARF, antibiotics only in complicated cases, and a tailored strategy according to the individual ARF risk. • The impact of antibiotic treatment of GABHS pharyngitis on its sequelae still is the main point of divergence; further studies are needed to achieve a global shared strategy
Determinants of mother-to-infant human immunodeficiency virus 1 transmission before and after the introduction of zidovudine prophylaxis
No full textBackground: Randomized controlled trials have demonstrated that zidovudine therapy decreases the mother-to-infant transmission of human immunodeficiency virus 1 (HIV-1). Data from large observational studies may provide further important findings on the effectiveness at the population level of combined treatments in decreasing transmission.
Objective: To evaluate time trends in prophylactic interventions and the determinants of transmission both before and after the introduction of antiretroviral prophylaxis, and in treated and untreated mother-infant pairs after 1995.
Design and Setting: Analysis of prospective data on 3770 children born to HIV-1-infected women between 1985 and 1999 and reported to the Italian Register for HIV Infection in Children.
Main Outcome Measures: Logistic regression random effects models were used to estimate crude and adjusted odds ratios for several factors potentially influencing vertical transmission for 2periods-1985 through 1995 (January 1, 1985, through December 31,1995) and 1996 through 1999 (January 1, 1996, through December 31, 1999), and between treated and untreated children after 1995.
Results: The transmission rate was 15.5% in the 19851995 period and 5.8% in the 1996-1999 period. By 1999, prophylactic interventions had greatly increased. Antiretroviral treatment (ART) usage was 89.9%, (55.1% combination ART) and the elective cesarean delivery rate was 81.3%. In multivariate analysis, only elective cesarean delivery was associated with a lower risk of mother-to-infant transmission before 1995. After 1995, nonbreastfeeding and receipt of ART were protective whereas elective cesarean delivery was not significantly protective in multivariate analysis. Transmission risk was reduced by 76% with an incomplete zidovudine regimen, 88% with a complete regimen, and 93% when the mother received combination ART. In the 1996-1999 period, the transmission rate for nonbreastfeeding mother-infant pairs was 8.6% with elective cesarean delivery, 4.4% with any ART, and 2.4% with these interventions combined
LOW PREVALENCE OF SELECTIVE IgA DEFICIENCY IN INFECTED CHILDREN BORN TO HIV-SEROPOSITIVE MOTHERS: AN IN VIVO MODEL FOR SPECULATION ON SELECTIVE IgA DEFICIENCY PATHOGENESIS
No full textAnecdotal reports of restored immunoglobulin production in individuals with common variable immunodeficiency after acquiring HIV infection suggest that perturbation of the immune system occurring during HIV infection may force some underlying functional defects. These findings raise intriguing questions about the pathogenesis of common variable immunodeficiency. No study has investigated the possible influence of HIV infection on the development: of selective IgA deficiency, a primary immunologic defect genetically related to common variable immunodeficiency. IgA serum levels were evaluated in a large cohort of children born to HIV-infected mothers from 1985 to 2006. To avoid differences possibly due to different follow-up durations we considered only infected and noninfected children aged over 4 years at last-follow-up. The study included 1,157 non-infected children and 964 infected children, aged >= 4 years at last-follow-up and with availability of two or more serum IgA determinations over six months of age. No child displayed immunoglobulin values compatible with diagnosis of common variable immunodeficiency. However, 0/964 infected children vs. 5/1157 noninfected children had selective IgA deficiency (P=0.048). It may be speculated that several immunological alterations, occurring simultaneously in perinatal HIV infection, surpass the functional defect exhibited in some children with selective IgA deficiency. Our data may shed light on the pathogenesis of selective IgA deficiency
Lower mother to child HIV-1 transmission in boys is independent of type of delivery and antiretroviralprophylaxis
No full textThe relationship between infant's gender and rate of HIV-1 mother-to-child transmission (MTCT) was evaluated in a prospective cohort of 4151 children (2166 boys and 1985 girls) born to HIV-1-infected mothers enrolled in the Italian Register for HIV Infection in Children. Logistic regression models were performed to estimate crude odds ratios (ORs) and adjusted odds ratios (AORs) and 95% CIs for factors potentially influencing MTCT separately for the period 1985-1995 and the period 1996-2001. To evaluate rates of MTCT by gender in specific subgroups, separate logistic regression models by mode of delivery and antiretroviral prophylaxis were performed. Among children born in 1985-1995, 15.5% boys (95% Cl: 13.6-17.7) and 17.9% girls (95% Cl: 15.7-20.3) were infected (P = 0.1181). After 1995, a lower proportion of boys (3.1% [95% CI: 2.0-4.4]; AOR: 0.43 [95% Cl: 0.26-0.71], P = 0.0008) than girls (AOR: 6.3%, 95% CI: 4.8-8.1) was infected. Lower AORs for boys persisted independently of elective cesarean delivery (AOR: 0.31, 95% Cl: 0.14-0.71); other than elective cesarean (AOR: 0.38, 95% Cl: 0.19-0.78) and antiretroviral prophylaxis (zidovudine monotherapy (AOR: 0.11, 95% CI: 0.03-0.38); none (AOR: 0.43, 95% CI: 0.21-0.90). No difference was observed when combined therapy in the mother was administered (AOR: 1.14, 95% CI: 0.30-4.32), but results were likely to be biased by the very low rate of infected children in this group. A lower proportion of HIV-1-infected boys in children born after 1995 was found. Factor(s) intrinsic to gender (rather than type of delivery or maternal antiretroviral prophylaxis) may be involved, because the risk of infection in boys was lower independent of interventions. A possible explanation is that, among infected fetuses, more girls survive up to the end of pregnancy and may take advantage of the benefits of preventive strategies
Prevalência dos marcadores das hepatites B e C em adolescentes de Itajaí-SC
No full textDissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências de Saúde. Programa de Pós-Graduação em FarmáciaAs infecções pelo HBV e pelo HCV são dois preocupantes problemas de saúde pública, que infectam o fígado causando necrose e inflamação do tecido hepático. Quando a infecção persiste, favorecem a progressão para cirrose e carcinoma hepatocelular. No Brasil, a prevalência do HBV em geral é moderada (2% a 7%), com baixa taxa de infecção no Sul, média taxa de infecção no Nordeste e Sudeste, e uma alta prevalência na região da Amazônia, no Espírito Santo e no oeste de Santa Catarina. Atualmente, poucos dados são disponíveis da prevalência e dos fatores de risco ao HBV e do HCV no Brasil, principalmente em indivíduos vacinados contra a hepatite B. Além disso, o conhecimento da prevalência desses vírus é crucial a fim de antecipar impactos futuros nos sistemas de saúde e permitir um adequado gerenciamento dos recursos financeiros. O objetivo do presente estudo foi determinar a prevalência dos marcadores da hepatite B (HBsAg, anti-HBc e anti-HBs) e da hepatite C (anti-HCV) em estudantes voluntários com idade entre 10 a 15 anos. Participaram do estudo um total de 410 estudantes e foi verificado o documento de vacinação de 353. As amostras de sangue foram coletadas e as concentrações do HBsAg, anti-HBc, anti-HBs e anti-HCV foram determinadas. Os 4 marcadores foram analisados através da metodologia de imunoensaio enzimático de micropartículas (MEIA-Abbott AxSym System Laboratories). Os resultados mostram que a prevalência do HBsAg foi 0.5% (2/410), e a prevalência do anti-HBc foi 1% (4/410). A prevalência total do anti-HBs foi 81,22% (333/410), sendo que em 36,10% (148/410) dos adolescentes as concentrações de anti-HBs foram < 10 UI/L e em 45,12%(185/410) foram = 10 UI/L. A prevalência do anti-HBs em estudantes que receberam 3 ou 4 doses da vacina foi 94,48% (325/344), atingindo a cobertura vacinal proposta pelo Ministério da Saúde. Nenhuma prevalência do anti-HCV foi observada. Os resultados do estudo mostram que na população de 10 a 15 anos de idade residentes no município de Itajaí, Santa Catarina, a prevalências dos marcadores HBsAg, anti-HBc e anti-HCV é baixa. Além disso, a elevada cobertura vacinal e a prevalência do marcador anti-HBs demonstram o êxito do programa de vacinação instituído em 1993, que deve ser mantido e ampliado, mas, também, que outras formas de prevenção devem ser desenvolvidas a fim de prevenir a transmissão do HBV e do HCV. Infection by HBV and HCV is a worldwide public health problem, which infect and result in necrosis and inflammation in the liver. When the infection persists, contribute to progression liver cirrhosis and hepatocellular carcinoma. In Brazil, prevalence of HBV is moderate (2% to 7%), with low infection rate in Southern, middle rate in Northeast and Southeast, and high prevalence in the Amazon region, in the Espírito Santo, and in west of Santa Catarina. Little data are available on the seroprevalence and of risk factors for HBV and HCV infections in Brazil, mainly who had received hepatitis B vaccine. Knowing the prevalence of HBV and HCV in the general population is crucial for anticipating their future impact on the health system and for ensuring an adequate allocation of financial resources. The present study aimed to determine the prevalence of HBV (HBsAg, anti-HBc and anti-HBs) and HCV (anti-HCV) markers in voluntary students to aged 10 to 15 years. A total of 410 students participated in the study and 353 students vaccination document was check. Blood samples were collected and were tested four serological markers through Microparticle Enzyme Immunoassay (MEIA-Abbott AxSym System Laboratories). The results show that the overall HBsAg prevalence was 0.5% (2/410) and anti-HBc prevalence was 1% (4/410). The overall prevalence of anti-HBs was 81,22% (333/410), 36,10% (148/410) adolescent had anti-HBs concentrations < 10 IU/L and 45,12%(185/410) had anti-HBs concentrations = 10 IU/L. The prevalence of anti-HBs in vaccinated student that received 3 or 4 doses series was 94,48% (325/344) achieving the vaccination coverage goal of Health Department. None anti-HCV prevalence was observed. The results from study indicate that the prevalence of HBV and HCV markers was low in voluntary adolescents from Itajaí, Santa Catarina, aged from 10 to 15 years old. Moreover, the high vaccination coverage and prevalence of anti-HBs markers show the success of the vaccination program against hepatitis B initialized in 1993, that need to be maintained and expanded, but also that other prevention forms should be developed to prevent the HBV and HCV transmission
