Seroprevalence of Measles in Pairs of Mothers and Newborns in Southern Greece

Maternal immunoglobulin G (IgG) antibodies that are passively transferred to newborns through the placenta confer protection if they are exposed to measles virus. A measles outbreak occurred in several European countries including Greece, between 2016 and 2018. A prospective study was conducted in the General Hospital of Lakonia, regarding the measles seropositivity status of mother and newborn pairs. IgG antibody titer for measles was measured in serum samples acquired from pairs of mothers and newborns. The samples were analyzed through quantitative enzyme-linked immunosorbent assay, and antimeasles IgG >200 IU/mL was considered to be protective. Demographic data for mothers and neonates and data regarding immunization status of mothers were analyzed. Study population included 206 mothers and their newborns. In total, 12.6% of mothers (n = 26) and 10.7% of newborns (n = 22) did not have protective serology. A statistically significant positive linear association between maternal and neonatal antibodies was found (rho = 0.924) (p = 0.001). Neonates whose mothers were seropositive had higher antibodies [geometric mean concentration (GMC): 804.8 (728.3-889.2)] than neonates whose mothers were seronegative/borderline [GMC: 97.7 (64.2-148.8)] (p = 0.001). In the study area, a significant rate of mothers and newborns was found to have nonprotective measles serology that exceeds the limit required for herd immunity. Vaccination coverage in women of reproductive age should be increased to reduce potential for future measles epidemics.

Parathyroid adenoma in pregnancy: A case report and systematic review of the literature

OBJECTIVE

Primary hyperparathyroidism is a common disorder of the parathyroid glands. Parathyroid adenoma (PA) in pregnancy is a relatively rare disease, whose diagnosis and treatment is a challenging task. The aim of the present study is to present a new case of parathyroid adenoma during pregnancy and to give a detailed account of all reported cases of parathyroid adenoma during pregnancy in the literature.

STUDY DESIGN

A bibliographic research was performed, and characteristics of parathyroid adenomas in pregnancy such as age, gestational week at diagnosis, ionized calcium levels, genetic testing result, symptomatology, radiological method of localization, treatment method, gestational week at operation, and maternal/fetal complications were recorded.

RESULTS

A 34-year-old woman at her 25 weeks' gestation was diagnosed with parathyroid adenoma and was referred to our Surgical Department due to contraindication for conservative treatment. A parathyroidectomy was performed, and the maternal and fetal postoperative period was uneventful. Two hundred eleven cases of parathyroid adenoma in pregnancy were recorded in the literature, and statistical analysis was performed. The median gestational week at diagnosis was 21 ± 9.61 weeks. The mean level of ionized calcium was 2.69 mmol/l [SD = 0.75 (2.55-2.84 95% CI)]. Most cases were familiar (72.4%), while surgery was the preferred treatment option (67.3%). The majority of cases were asymptomatic (21.7%), and the main radiological method applied for localization was ultrasound (63.4%).

CONCLUSION

Parathyroid adenoma in pregnancy is a rare condition. The early diagnosis is of great importance as surgical treatment at the second trimester of pregnancy outweighs the maternal and fetal risks.

Economic evaluation of the treatment of Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) from the national payer perspective: introduction of a new treatment to the patient journey. A simulation of three European countries

Background: The aim of this study was to develop a spending predictor model to evaluate the direct costs associated with the management of ABSSSIs from the National health-care provider's perspective of Italy, Romania, and Spain. Methodology: A decision-analytic model was developed to evaluate the diagnostic and clinical pathways of hospitalized ABSSSI patients based on scientific guidelines and real-world data. A Standard of Care (SoC) scenario was compared with a dalbavancin scenario in which the patients could be discharged early. The epidemiological and cost parameters were extrapolated from national administrative databases (i.e., hospital information system). A probabilistic sensitivity analysis (PSA) and one-way sensitivity analysis (OWA) were performed. Results: Overall, the model estimated an average annual number of patients with ABSSSIs of approximately 50,000 in Italy, Spain, and Romania. On average, the introduction of dalbavancin reduced the length of stay by 3.3 days per ABSSSI patient. From an economic perspective, dalbavancin did not incur any additional cost from the National Healthcare perspective, and the results were consistent among the countries. The PSA and OWA demonstrated the robustness of these results. Conclusion: This model represents a useful tool for policymakers by providing information regarding the economic and organizational consequences of an early discharge approach in ABSSSI management.

Seroprevalence of HIV and HCV infections in Alexandria, Egypt

During the years 1992-1994, we tested 948 individuals from different population groups for HIV-1 and HIV-2 infections by ELISA and WB and for HCV infection by ELISA. Repeated ELISA reactivity for HIV was found in 2.12% of blood donors, 2.95% of fire brigade personnel and 1.61% of prisoners. Western blotting studies, however, showed that these samples were non-reactive or indeterminate to either HIV-1 or HIV-2. In contrast, anti-HCV antibodies were detected in 39% of fire brigade personnel, 31.4% of prisoners and 20.8% of blood donors. The analysis of risk factors for acquiring HCV infection showed a strong association between a past history of parenteral therapy for schistosomiasis and anti-HCV seropositivity (p < 0.0001). The implementation of preventive strategies is at the moment the mandatory choice to stop a further spread of the HCV infection. Meanwhile the same preventive measures could avoid spreading of the HIV disease.

Care requirements of people with ARC/AIDS in Rome: non-hospital services

In Italy, care for people with AIDS (PWA) is centred on hospital services. However, other services are beginning to develop, both in the form of residential facilities and of home care. It seems, therefore, important to define the type of non-hospital services that should be supplied on the basis of AIDS patients' real needs. The aim of this paper is to contribute to the definition of care requirements by administration to 92 persons with ARC/AIDS of a questionnaire on Functional Multidimensional Evaluation to assess the demand for services in relation to the state of health and socio-economic situation of those interviewed. The pattern that emerged was one of severe socio-economic difficulties (most of the patients were drug addicts) and of major functional impairment (about 60% of those interviewed were not self-sufficient as far as Instrumental Activities of Daily Living were concerned). Among the main problems: difficulties of finding accommodation (almost 9% of those interviewed have no fixed abode) and economic difficulties; the demand for services was characterized by a lack of self-sufficiency. The most frequently required social services were help with preparation of meals, household chores and assistance with transport; the most frequently required health service was physiotherapy, which is also the least available. The study supplies useful information for the planning of non-hospital services in Italy and in other western countries with similar epidemiological situations.

Hepatitis A in Italy: epidemiology and suggestions for control

Seroepidemiologic and surveillance data show that hepatitis A is declining in both Northern and Southern Italy, in the latter the decline has been more recent. Every year about two thousand cases of acute disease occur. Shellfish consumption and travel to endemic areas are at present the most important risk factors in Italy. Use of immunoglobulin is effective in controlling outbreaks and preventing hepatitis A among travellers. Active immunization for travellers to endemic areas will be recommended, when a vaccine will be available. Adequate cooking of shellfish is at present the only advisable measure to prevent the risk represented by their consumption. Acute morbidity and the occurrence of outbreaks suggest the need to keep our attention on hepatitis A infection in Italy.

Effect of inhibitors of cytoplasmic structures and functions on rabies virus infection in vitro

The effect in vitro of some cytoplasmic structure and function inhibitors on the different stages of rabies virus infection was investigated. Treatment of fibroblasts (CER) and human neuroblastoma cells (IMR-32) with substances acting on low pH intracellular compartments (methylamine and monensin) prevented rabies virus genome delivery in the cytosol. An early inhibition of viral infection was also obtained in the presence of B and D cytochalasins and trifluoperazine which interact with microfilament structures. Treatment with colchicine and vinblastine did not affect rabies multiplication, suggesting that microtubules are not involved in this process. However, the multiplication of prebound virions did not take place in the presence of inhibitors of oxidative phosphorylation (sodium azide and CCCP) and of glycolysis (2-deoxy-D-glucose) indicating that rabies virus replication is largely energy-dependent in both host cells examined.

[The fate of pathogens in waste-waters]

A large variety of pathogenic organisms capable of transmission by the faecal-oral route may be found in wastewaters. Among the bacteria Salmonella, Shigella, Vibrio cholerae, Yersinia and Campylobacter are the important agents of concern. Also the human enteric viruses (Poliovirus, Coxsackievirus, Echovirus, Hepatitis A virus, Rotavirus) have been shown to be present in domestic waste and may not be completely removed by conventional sewage treatment processes, including chlorination. Discharge of sludge and raw wastewaters in coastal waters is, therefore, potentially hazardous to human health. Enteric viruses generally survive longer than faecal indicator bacteria in water receiving waste and they are detected in seawater which meets current standards for shellfish harvesting. The survival of viruses in seawater depends on a large variety of physico-chemical and biological factors. Viral inactivation process is very complex in nature but it can be interesting to study this phenomenon for better evaluating the true extent of health risk of viruses present in the coastal waters.

Multiple logistic function versus Mantel-Haenszel procedure in the analysis of risk factors for prevalence of hepatitis A antibodies

Multiple logistic function and Mantel-Haenszel procedure are compared in their ability to control confounding in a large set of data. In this specific application substantial equivalence is found between the two techniques. When both techniques are applicable and data are not sparse, the authors prefer stratification, which is simpler and free of assumptions.