Physical performance strongly predicts all-cause mortality risk in a real-world population of older diabetic patients: machine learning approach for mortality risk stratification

Background

Prognostic risk stratification in older adults with type 2 diabetes (T2D) is important for guiding decisions concerning advance care planning.

Materials and methods

A retrospective longitudinal study was conducted in a real-world sample of older diabetic patients afferent to the outpatient facilities of the Diabetology Unit of the IRCCS INRCA Hospital of Ancona (Italy). A total of 1,001 T2D patients aged more than 70 years were consecutively evaluated by a multidimensional geriatric assessment, including physical performance evaluated using the Short Physical Performance Battery (SPPB). The mortality was assessed during a 5-year follow-up. We used the automatic machine-learning (AutoML) JADBio platform to identify parsimonious mathematical models for risk stratification.

Results

Of 977 subjects included in the T2D cohort, the mean age was 76.5 (SD: 4.5) years and 454 (46.5%) were men. The mean follow-up time was 53.3 (SD:15.8) months, and 209 (21.4%) patients died by the end of the follow-up. The JADBio AutoML final model included age, sex, SPPB, chronic kidney disease, myocardial ischemia, peripheral artery disease, neuropathy, and myocardial infarction. The bootstrap-corrected concordance index (c-index) for the final model was 0.726 (95% CI: 0.687-0.763) with SPPB ranked as the most important predictor. Based on the penalized Cox regression model, the risk of death per unit of time for a subject with an SPPB score lower than five points was 3.35 times that for a subject with a score higher than eight points (P-value <0.001).

Conclusion

Assessment of physical performance needs to be implemented in clinical practice for risk stratification of T2D older patients.

Attitudes of Healthcare Workers toward Influenza Vaccination in the COVID-19 Era

Healthcare workers (HCWs) are reluctant to participate in the influenza vaccination program, despite their high risk to contract and diffuse influenza due to professional exposure. The onset of the COVID-19 pandemic could raise HCW flu vaccination adherence. The aim of this study was to assess HCW attitudes toward influenza vaccination in the COVID-19 era. A multicenter observational study was carried out in three Italian hospitals (two in Pesaro and one in Fano, Marche region, Italy). Data about HCW influenza vaccination between 2013 and 2021 were extracted from the vaccination registers. An online questionnaire was sent to HCWs from July to October 2020 to assess their opinion about influenza vaccination in terms of knowledge, attitude, and practice during the COVID-19 pandemic. The number of flu-vaccinated HCWs increased from 3.7% in the 2013−2014 flu season to 53.6% in the 2020−2021 flu season (p < 0.001). About 15% (n = 324) of HCWs responded to the online questionnaire, and 30.5% of them declared that they had changed their minds on flu vaccination after the COVID-19 pandemic, deciding to get vaccinated. The COVID-19 pandemic significantly increased HCWs’ attitudes toward flu vaccination. However, flu vaccination adherence remained low and should be improved.

Immunological Response Against SARS-COV-2 After BNT162b2 Vaccine Administration Is Impaired in Allogeneic but Not in Autologous Stem Cell Transplant Recipients

The efficacy of Covid-19 vaccine in hematopoietic stem cell transplantation (HSCT) recipients is still unknown. We planned a prospective study to evaluate the immune response after the administration of Covid-19 vaccine in HSCT recipients. Fifty patients previously submitted to HSCT (38 autologous and 12 allogeneic) received the mRNA-based SARS-CoV-2 vaccine BNT162b2 (Pfizer-BioNTech). Serum samples of all patients were tested for SARS-CoV-2 IgG against the Spike glycoprotein, 30 days after the second dose of vaccine. Antibody response was compared to a control group of 45 healthy subjects. Of the 50 patients tested, 12 did not develop any antibody response, including 6 patients undergoing autologous (16%) and 6 allogeneic HSCT (50%). Cyclosporine administration in allogeneic recipients and prior administration of Rituximab in the autologous setting correlated with lower antibody titers (p < 0.0003 and p=0.000, respectively). Flow cytometry of peripheral blood samples, performed 30 days after the vaccination, showed a significant correlation between the antibody response to Sars-COV2 and an increased number in CD19+ B lymphocytes (p = 0.0003) and CD56+ natural killer (NK) cells (p = 0.00). In conclusion, prior Rituximab before autologous HSCT and cyclosporine administration after allogeneic HSCT negatively affected the antibody response to Sars-COV2 vaccine, possibly due to their immunosuppressive action on CD20 +B cells and T cells, respectively. The correlation between seroconversion to Sars-COV2 and higher number of CD19 + B cells and CD56+ NK cells, suggests a central role for B and NK cells in the development of COVID-19 immunity after vaccination with a mRNA-based platform.

[Nomophobia and the connection anxiety dimensions: a cross-sectional study among students and nurses.]

INTRODUCTION

Nomophobia, a form of behavioral addiction, is uncontrolled, obsessive fear of being disconnected from the mobile phone network. Excessive use of smartphone during care, a source of errors and distractions, is among the top ten risks related to the use of technologies in healthcare. The study aims to investigate the presence of nomophobia among nurses and students of the Degree in Nursing and any differences based on gender, age group and seniority.

METHODS

A cross-sectional quantitative descriptive study conducted at Università Politecnica delle Marche and Azienda Ospedali Riuniti Marche Nord departments; the NMP-Q questionnaire (Nomophobia Questionnaire) was administered to a non-probabilistic sample of nurses and nursing students. The data were analyzed using descriptive and inferential non-parametric statistical measurements.

RESULTS

A total of 280 questionnaires were returned, 141 for students and 139 for nurses. The mean total score for students and nurses was moderate and overlapping (M=79.9 vs. 79.3, p>0.05), with no difference by gender and course year (p>0.05); in the sample of nurses score is higher in men (M=89.8 vs. 76.0, p=0.037), under 30 (M=72.0) and over 50 years (M=83.1, p=0.021). The comparison between the two groups shows higher percentages of moderate nomophobic grade among students (+17pp), mild (+8.2 pp) and severe (+7.4 pp) among nurses, without significant gender differences.

CONCLUSIONS

In the perspective of proper risk management, the level of nomophobia found in both groups should not be underestimated. This study highlights the importance of monitoring the phenomenon, adopting information and awareness-raising policies aimed at healthcare personnel as early as university training: distracting factors associated with the over-use of smartphones in the workplace make nurses, particularly newly graduates and with less expertise, more vulnerable and more exposed to the risk of error.

Analytical Performance of COVID-19 Detection Methods (RT-PCR): Scientific and Societal Concerns

Background. Health and social management of the SARS-CoV-2 epidemic, responsible for the COVID-19 disease, requires both screening tools and diagnostic procedures. Reliable screening tests aim at identifying (truely) infectious individuals that can spread the viral infection and therefore are essential for tracing and harnessing the epidemic diffusion. Instead, diagnostic tests should supplement clinical and radiological findings, thus helping in establishing the diagnosis. Several analytical assays, mostly using RT-PCR-based technologies, have become commercially available for healthcare workers and clinical laboratories. However, such tests showed some critical limitations, given that a relevant number of both false-positive and false-negative cases have been so far reported. Moreover, those analytical techniques demonstrated to be significantly influenced by pre-analytical biases, while the sensitivity showed a dramatic time dependency. Aim. Herein, we critically investigate limits and perspectives of currently available RT-PCR techniques, especially when referring to the required performances in providing reliable epidemiological and clinical information. Key Concepts. Current data cast doubt on the use of RT-PCR swabs as a screening procedure for tracing the evolution of the current SARS-COV-2 pandemic. Indeed, the huge number of both false-positive and false-negative results deprives the trustworthiness of decision making based on those data. Therefore, we should refine current available analytical tests to quickly identify individuals able to really transmit the virus, with the aim to control and prevent large outbreaks.

Endoscopic "Quick" Septoplasty in Preservation Rhinoplasty

BACKGROUND

Preservation rhinoplasty (PR) is revolutionizing rhinoplasty surgery, based on new anatomical studies, advanced tip suture techniques, and refinement of surgical techniques. Septal surgery is a fundamental preparatory stage during PR, especially for the dorsal preservation let/push-down procedure. To increase the predictability of the septoplasty aesthetic effects on the nasal dorsum and further extend the principles of PR to septal surgery, we applied the endoscopic technology to the "quick" septoplasty technique we had already developed in the past decades.

METHODS

One hundred sixty-six patients (41 males, 125 females; mean age, 39.7 years; age range, 18-61 years) were submitted to endoscopic "quick" septoplasty for septal deviation during PR procedure. Preoperative evaluation of the nasal dorsum included external examinations of the size, shape, and orientation of the dorsum. Anterior active rhinomanometry was performed in all patients to determine nasal flow resistance preoperatively and 6 months after surgery. Preoperative and postoperative patients' scores on the Nasal Obstruction Septoplasty Effectiveness questionnaire were compared to assess the improvement of nasal symptoms after surgery. The duration of the septoplasty procedure was measured for all the patients. Standard nasal photographic assessment was performed before and 6 months after surgery.

RESULTS

Postoperatively, 98.8% of our patients displayed an improvement of their nasal breathing function. No complication in terms of septal perforation, nasal infection, or bleeding was noticed. No case of turbinoseptal synechiae or cerebrospinal fluid leak was recorded. The dorsum preservation rhinoplasty procedure was successfully completed in all patients. The mean septoplasty operative time, excluding local anesthesia injection and other surgical procedures associated with septal surgery such as turbinoplasty and rhinoplasty, was 11.41 ± 6.23 minutes (range, 9-31 minutes).

CONCLUSIONS

Our results show that a short surgical time is needed to perform the proposed endoscopic septoplasty procedure. Such a short operative time allows the physician to both correct septal deviations quickly and correct/reduce the cartilaginous hump, thus representing a fundamental element of PR. In addition, the minimal tissue dissection reduces intraoperative nasal edema, favoring intraoperative aesthetic evaluation.

Olfactory Dysfunction in COVID-19 Patients: Prevalence and Prognosis for Recovering Sense of Smell

While olfactory dysfunction associated with coronavirus disease 2019 (COVID-19) has attracted considerable interest, few studies have tracked outcomes at serial time points or beyond 2 weeks. Furthermore, data are conflicting regarding whether COVID-19 severity correlates with degree of olfactory dysfunction. This prospective case-control study analyzed prevalence and severity of subjective loss of smell in outpatients (n = 23) and inpatients (n = 20) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vs healthy controls (n = 25). Olfactory dysfunction was reported more commonly in COVID-19 patients than in healthy controls ( P < .001), and outpatients paradoxically reported loss of smell more commonly than inpatients ( P = .02). Headaches were present in 52% of patients with olfactory dysfunction. Anosmia or hyposmia persisted beyond 5 days but most of the patients recovered by 30 days, suggesting favorable prognosis for olfaction. Differences between inpatients and outpatients are potentially reflective of timeline of olfactory symptoms and contextual factors, underscoring the importance of corroborative objective testing, coupled with careful tracking of temporal relationships.

Successful recovery from COVID-19 pneumonia after receiving baricitinib, tocilizumab, and remdesivir. A case report: Review of treatments and clinical role of computed tomography analysis

The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic, threatening global public health. In the current paper, we describe our successful treatment of one COVID-19 pneumonia patient case with high mortality risk factors. Our experience underlines the importance of the use of a multidisciplinary therapeutic approach in order to achieve a favorable clinical outcome. Further, enhancing the capability of the COVID-19 diagnosis with the use of the chest imaging modalities is discussed.

Can Tangier disease cause male infertility? A case report and an overview on genetic causes of male infertility and hormonal axis involved

Tangier disease is an autosomal recessive disorder caused by mutations in the ABCA1 gene and characterized by the accumulation of cholesteryl ester in various tissues and a near absence of high-density lipoprotein. The subject in this investigation was a 36-year-old Italian man with Tangier disease. He and his wife had come to the In Vitro Fertilization Unit, Pesaro Hospital (Azienda Ospedaliera Ospedali Riuniti Marche Nord) seeking help regarding fertility issues. The man was diagnosed with severe oligoasthenoteratozoospermia. Testosterone is the sex hormone necessary for spermatogenesis and cholesterol is its precursor; hence, we hypothesized that the characteristic cholesterol deficiency in Tangier disease patients could compromise their fertility. The aim of the study was to therefore to determine if there is an association between Tangier disease and male infertility. After excluding viral, infectious, genetic and anatomical causes of the subject's oligoasthenoteratozoospermia, we performed a hormonal analysis to verify our hypothesis. The patient was found to be negative for frequent bacteria and viruses. The subject showed a normal male karyotype and tested negative for Yq microdeletions and Cystic Fibrosis Transmembrane Conductance Regulator gene mutations. A complete urological examination was performed, and primary hypogonadism was also excluded. Conversely, hormonal analyses showed that the subject had a high level of follicle stimulating hormone and luteinizing hormone, low total testosterone and a significant decline in inhibin B. We believe that the abnormally low cholesterol levels typically found in subjects with Tangier disease may result in a reduced testosterone production which in turn could affect the hormonal axis responsible for spermatogenesis leading to a defective maturation of spermatozoa.

[Intentional roundings in general medical practice: the experience of the Azienda Ospedali Riuniti Marche Nord (Italy).]

INTRODUCTION

The "intentional roundings" are planned rounds, conducted at regular intervals by nursing staff to anticipate care, comfort, hospitality and psychological needs of hospitalized users. These purposes are achieved with a structured way to make observations and carry out activities for well-being and patient safety, documenting what was done with a structured ad hoc form. In the United Kingdom, as well as in the USA, intentional rounding is an established model of care that improve the safety of provided care, to reduce the occurrence of preventable events, address proactively basic caring needs, and that increase users and staff satisfaction.

OBJECTIVE

Implementing in a medical pilot unit the care model named "intentional rounding".

METHODS

The care team carried intentional rounds every two hours, in a systematic and documented manner. All patients received admission informations about the organizational method and were invited to participate by completing a satisfaction questionnaire at discharge. At the end of the experimental period organizational impact have been investigated, specifically users and hospital staff satisfaction.

RESULTS

About privacy, courtesy, nurse support and quality of care provided, level of satisfaction of patients and caregivers reached high percentage of approval (90-99%). Nurses and other healthcare personnel have perceived they delivered either a safer and most satisfying healthcare (90-94%) as well as inter- and intra-professional dynamics communications (95%). Value of roundings have been less appreciated concerning the optimization about the worktime management (79%). Calls to the bell have had a notable change of their reasons unlikely about the quantity.

CONCLUSIONS

Intentional roundings affects very positively to users satisfaction level and to the perception of the quality of care provided; the care team, though express the need to make some changes for a real implementation, recognize the proactivity of intentional roundings as an added value.

Mutational analysis of mitochondrial DNA in Brugada syndrome

BACKGROUND

Brugada syndrome (BrS) is a primary electrical disease associated with an increased risk of sudden cardiac death due to ventricular fibrillation. This pathology has nuclear heterogeneous genetic origins, and at present, molecular diagnostic tests on nuclear DNA cover only 30% of BrS patients. The aim of this study was to assess the possible involvement of mitochondrial (mt) DNA variants in BrS since their etiological role in several cardiomyopathies has already been described.

METHODS AND RESULTS

The whole mt genome of BrS patients was sequenced and analyzed. A specific mtDNA mutation responsible for BrS can be excluded, but BrS patient d-loop was found to be more polymorphic than that of control cases (P=0.003). Moreover, there appears to be an association between patients with the highest number of variants (n>20) and four mt Single Nucleotide Polymorphism (SNPs) (T4216C, A11251G, C15452A, T16126C) and the most severe BrS phenotype (P=0.002).

CONCLUSIONS

The high substitution rate found in BrS patient mtDNA is unlikely to be the primary cause of the disease, but it could represent an important cofactor in the manifestation of the BrS phenotype. Evidence suggesting that a specific mtDNA allelic combination and a high number of mtDNA SNPs may be associated with more severe cases of BrS represents the starting point for further cohort studies aiming to test whether this mt genetic condition could be a genetic modulator of the BrS clinical phenotype.

Platelet and white blood cell counts during therapy with different types of alpha interferon in patients with chronic viral hepatitis. Investigators of the Alpha Interferon Study Group of Piemonte, Italy

BACKGROUND

Platelet and white blood cell counts decrease in chronic viral hepatitis patients treated with alpha interferon.

AIM

To analyse whether delta negative variations in platelets and white blood cells are influenced by type, dose and duration of alpha interferon treatment, we studied 340 consecutive patients (mean treatment 8 months, range 4-18 months).

PATIENTS AND METHODS

A total of 204 (60%) patients were treated with recombinant alpha interferons (30% alpha-2a and 30% alpha-2b), 64 (19%) with N3.leukocytic and 72 (21%) N1.lymphoblastoid natural interferons. Median age and male/female ratios were comparable in the 3 groups (41, 41 and 43 years and 2.3, 2.6 and 2.5, respectively). The lowest platelets and white blood cells counts were observed between the 2nd and the 4th month of therapy in all patients. Age, sex, aetiology and duration of interferon therapy did nor influence the platelets and white blood cells reduction rates. The decrease was lower for patients treated with N3.leukocytic interferon than for the other interferons. A significant difference was observed between interferon doses when the groups treated with 3 or 9-10 MIU were compared. However, dose or cirrhosis-related bias are ruled out by similar proportions of cirrhosis and patients treated with 3 MIU in the 3 groups of patients treated with different types of interferon.

CONCLUSIONS

The type of interferon appears to represent a major cause of the different haemopoietic toxicity. The lowest toxicity of N3.leukocytic interferon may have clinical implications for the choice of interferon in patients with low baseline platelets and white blood cells counts. These findings prompt prospective studies on larger series of patients.

Reduced fibrinolytic potential one year after kidney transplantation. Relationship to long-term steroid treatment

Thromboembolic complications constitute an important risk in renal transplant patients, in whom a hypercoagulable state is associated with immunosuppressive treatment, and the presence of hypercoagulability and hypofibrinolysis specifically with cyclosporine. Hypercorticism secondary to steroid treatment has been associated with a thrombophilic state and the presence of a reduced fibrinolytic potential in particular. The aims of this study were to first evaluate the fibrinolytic potential by the venous occlusion (VO) test in 19 renal transplant (RT) patients, and then compare these findings with those obtained in similar groups of normal subjects and patients with Cushing's disease. The following tests were carried out before and after the VO test: euglobulin lysis time and t-PA and PAI-1 activities and antigen. Compared with normal controls, RT and Cushing's patients both showed a similar significant increase in PAI-1 activity and concentration. The VO test revealed a similar impairment in fibrinolytic potential in both the RT and Cushing groups. High and pathological PAI-1 levels before and after the VO test were consistent with a defective fibrinolytic potential due to the inhibitory effect of PAI-1 on plasminogen activation. A hypofibrinolytic state was found in 68.4% of RT patients. Our results suggest that an imbalance in the fibrinolytic system is a typical feature of RT patients one year after transplantation. Steroids appear to be the immunosuppressive drug mainly involved in determining thromboembolic risk after renal transplantation.

Treatment of chronic anti-HBe-positive hepatitis B with interferon-alpha

We studied the prevalence of long-term responders to interferon-alpha (IFN-alpha) treatment (undetectable levels of serum IgM anti-HBc, HBV-DNA and normal ALT values for 3 years) in 53 anti-HBe-positive chronic hepatitis B patients. Forty-two of them were treated with (6-18 MU) alpha-2a-recombinant-IFN t.w. for 4-6 months, and the remaining 11 with 10 MU of lymphoblastoid-IFN thrice weekly for 6 months. At the end of treatment, HBV-DNA levels were undetectable and ALT values within the normal range in 34 of 53 patients (60%); IgM anti-HBc levels decreased in all the 34 patients, falling below 10 PEI U in 2/34 (6%). Response to treatment was maintained throughout the follow-up (mean 3 years, range 2-7 years) in five patients (9.4%). The remaining 29 patients experienced HBV reactivation within median follow-up of 6 months (range 1-22 months; 90% of cases within 12 months). Overall 4/9 long-term responders (44.4%) cleared serum HBsAg. In conclusion, chronic anti-HBe-positive hepatitis B has a lower IFN treatment response rate than the HBeAg-positive form; however, among long-term responders, the incidence of serum HBsAg clearance is comparable in the two forms. Because of the high rate of relapses, stringent monitoring criteria (HBV-DNA, IgM anti-HBc and ALT monthly tested for at least 12 months) are mandatory.

Intramuscular natural beta interferon in the treatment of chronic hepatitis B: a multicentre trial. Italian Hepatitis B Study Group

A randomized controlled multicentre trial was undertaken to assess the effectiveness of natural IFN beta (Frone) administered by intramuscular injection to chronic hepatitis B patients. Sixty-five HBsAg and HBeAg carriers with chronic hepatitis and intrahepatic HBcAg histologically proven by immunohistochemistry were included in the study. Fifty-nine patients completed the study: 30 of them (mean age 27 years, range 14-55 years, 16M/14F) were treated with 5 Million Units (MU)/m2 of Frone three times weekly for six months and 29 (mean age 28 years, range 14-59 years, 18M/11F) were not treated. The 2 groups of patients were similar in their clinical and histological (CAH/CPH ratio 25/5 and 20/9) characteristics. In the treated patients, a significant reduction in viremia was observed starting from the 6th month of the follow-up (p < 0.01), accompanied by a significant reduction of serum aminotransferase levels (p < 0.005). At the end of therapy serum HBeAg was undetectable in 7 of 30 (23%) treated patients and in 1 of 29 (3%) controls. Six months after the end of treatment 8 of 30 (26%) treated patients and 5 of 29 (17%) controls were HBeAg negative. A significant difference (p < 0.05) was observed in the rate of anti-HBe seroconversion between the 2 groups starting from the 8th month of follow-up. Mild side effects, namely fever < 38 degrees C and asthenia were observed in 20% and 37% of treated patients. In conclusion natural beta interferon given intramuscularly is effective in HBeAg positive patients suffering from chronic hepatitis B with optimal compliance.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis B virus unable to secrete e antigen and response to interferon in chronic hepatitis B

BACKGROUND

Anti-hepatitis e antigen-positive chronic hepatitis B is a progressive liver disease associated with precore mutant hepatitis B virus (HBV) and poor response to interferon. Therefore, precore mutant HBV may behave as an interferon-resistant virus. The relations between the prevalences of wild-type and precore mutant HBVs in baseline viremias and response to interferon were analyzed.

METHODS

Sera from 115 patients (59 treated and 56 untreated, followed up for 30 months) were tested using a quantitative oligonucleotide hybridization assay.

RESULTS

Spontaneous or interferon-induced recoveries were observed in 28.5% (6 of 21) and 47.3% (18 of 38) or in 0% (0 of 35) and 19% (4 of 21) of the patients with wild-type prevalent or mutant prevalent HBVs, respectively. Relapses occurred in 85.7% (12 of 14) and 19.4% (4 of 21) of treated patients with prevalent precore mutant and prevalent wild-type HBV, respectively (P = 0.0001). High precore mutant HBV levels (> 20% of total viremia) were associated with the lack of permanent response to interferon (P = 0.01).

CONCLUSIONS

Precore mutant HBV can influence the response to interferon when it reaches significant serum levels (> 20% of total viremia). Therefore, chronic hepatitis B should be treated as early as possible in its natural history before precore mutant HBV is selected as a prevalent virus.

Transplantation of warm ischemia damaged kidneys: an experimental study in pigs

This study evaluated renal function and histological and oxidative injury in transplanted kidneys harvested after prolonged warm ischemia in pigs. In 8 donor pigs, kidneys were perfused in situ 120 min after cardiac arrest. One of each pair of kidneys was used for histological and biochemical studies while the other was transplanted into a recipient undergoing bilateral nephrectomy. In 6 cases, renal function was satisfactory 14 days after transplantation. Histologically, a reversible acute tubular necrosis was observed with partial recovery at the 14th postoperative day. A moderate oxidation was revealed by decreased glutathione and increased malondialdehyde levels. In spite of this ischemic injury, these findings suggest that kidneys harvested after prolonged warm ischemia can still recover after transplantation, and that non-heart-beating donors may be considered as an alternative organ source for kidney transplantation.

Treatment of chronic hepatitis B with beta interferon given intramuscularly: a pilot study

In a pilot study aimed to test the therapeutic potential of beta interferon (IFN) given intramuscularly we treated 4 patients with HBeAg positive chronic hepatitis B with a progressively increased dosage of beta IFN (from 5 to 9 million units daily) for 1 month and with 9 million units for 5 additional months, thrice weekly. In 3 of the 4 patients, serum HBV-DNA decreased during therapy and remained undetectable in 2 who seroconverted from HBeAg to anti-HBe while in 1 patient viraemia rebounded to pretreatment levels during the follow-up. In the remaining patient serum HBV-DNA fluctuated during treatment. These results suggest that beta IFN given intramuscularly has a potential therapeutic efficacy in patients with chronic hepatitis B and prompt further clinical trials in a larger number of patients.

Cuddler Program provides soothing answers

Volunteer cuddler programs have the potential to enhance the human caring aspects of complex technological nursing care provided premature infants. Nurse researchers have identified the value of human touch and stimulation to the development of premature infants. Although the fragile premature infant may not always appear to respond overtly, the weight gain, and social and mental development of the cuddled babies give testimony to the effectiveness of human attention. The infants' improved well-being and subsequent earlier hospital discharge as a result of cuddling are convincing rationale to implement a cuddler program. A well administered hospital volunteer program is an excellent resource for cuddlers. Volunteers tend to be readily attracted to a neonatal nursery and their services have proven to be safe and therapeutic. After determining the type of service needed, nurse administrators and directors of volunteer programs may team together to develop their strategy. A literature review about cuddler programs and the development of the premature infant contain valuable information of research findings and experience of other nurses. Staff nurse and physician involvement in the program are essential for overall success as well as identifying an effective person to coordinate the plan. The team of planners need a program development and implementation schedule, a volunteer job description and a training plan. Orientation of all nursing staff to the program may occur simultaneously with volunteer recruitment. Evaluation of a cuddler program utilizing predetermined criteria should occur at scheduled intervals.(ABSTRACT TRUNCATED AT 250 WORDS)

Natural course and response to interferon of chronic hepatitis B accompanied by antibody to hepatitis B e antigen

The course of chronic hepatitis B was studied in 30 patients who had antibody to hepatitis e antigen and hepatitis B virus DNA in the serum and hepatitis B core antigen in the liver. Over a 2-year period, no patient experienced a sustained spontaneous remission of disease, and follow-up liver histology revealed worsening of the disease in four patients. After 2 years of observation, 24 patients were allocated randomly to one of two groups: 12 patients served as untreated controls and 12 received recombinant human alpha-interferon-2a in a dose of 9 million units intramuscularly three times weekly for 16 weeks. Patients who remained viremic after 16 weeks received 3 million units three times weekly for an additional 8 weeks. Abnormal amino-transferases and serum hepatitis B virus DNA persisted without appreciable changes in all untreated patients. Hepatitis B virus DNA rapidly became undetectable and serum aminotransferases fell to normal in eight treated patients. After the end of treatment, hepatitis B virus DNA became detectable once again in seven patients, in six of whom a peak of aminotransferases (range: 256 to 850 units per liter) ensued; subsequently, hepatitis B virus DNA disappeared, and serum aminotransferases again fell to normal in two of the seven. Overall, hepatitis B virus DNA was no longer detectable in serum and liver histology improved in three treated patients.(ABSTRACT TRUNCATED AT 250 WORDS)