Impact of gender inequality on the educational and career development of young epileptologists in Italy: A survey of the Young Epilepsy Section - Italian chapter

OBJECTIVE

The Young Epilepsy Section-Italian chapter (YES-I) is the Italian section of the International League Against Epilepsy (ILAE)-YES. It was founded in 2019 with the aim of increasing the involvement of young epileptologists within scientific associations and facilitating their educational training. The Education and Career Task Force designed a survey on the impact of gender inequality on the educational and professional growth of young epileptologists.

METHODS

The survey was proposed via QR code during the 43rd National Congress of the Italian League Against Epilepsy (Padua, 8-10 June 2022), and subsequently distributed via email until 7th September 2022.

RESULTS

Of the respondents, 73.6% were female. Of note, 51% of the entire sample answered that they found "no impact" of gender on educational activities (64.3% male against 46.1% female). Only 10% of women stated they have seen very much gender-related inequality in their education or career. However, the majority of our cohort (66%) thought that gender had a negative impact on progression within a scientific society, as well as in female leadership roles in clinical practice (67.9%). Furthermore female medical staff received little work recognition (56.6%). Lastly, 83% of responders did not have children, and only 37.7% declared their colleagues to be empathic in relation to absences for family emergencies.

CONCLUSIONS

Lack of awareness of the gender inequality issue might explain inconsistencies in the findings of our survey. Despite the remarkable progress of women rights over the last century, our survey suggests that disparities in academic and decision-making roles exist also in the epileptology field.

Skip pattern approach toward the early access of innovative anticancer drugs

BACKGROUND

With the rapid development of innovative anticancer treatments, the optimization of tools able to accelerate the access of new drugs to the market by the regulatory authority is a major issue. The aim of the project was to propose a reliable methodological pathway for the assessment of clinical value of new therapeutic innovative options, to objectively identify drugs which deserve early access (EA) priority for solid and possibly in other cancer scenarios, such as the hematological ones.

MATERIALS AND METHODS

After a comprehensive review of the European Public Assessment Report of 21 drugs, to which innovation had previously been attributed by the Italian Medicines Agency (Agenzia Italiana del Farmaco, AIFA), an expert panel formulated an algorithm for the balanced use of three parameters: Unmet Medical Need (UMN) according to AIFA criteria, Added Benefit (AB) according to the European Society for Medical Oncology's Magnitude of Clinical Benefit Scale (ESMO-MCBS) criteria and Quality of Evidence (QE) assessed by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) method. By sequentially combining the above indicators, a final priority status (i.e. EA or not) was obtained using the skip pattern approach (SPA).

RESULTS

By applying the SPA to the non-curative setting in solid cancers, the EA status was obtained by 5 out of 14 investigated drugs (36%); by enhancing the role of some categories of the UMN, additional 4 drugs, for a total of 9 (64%), reached the EA status: 2 and 3 drugs were excluded for not achieving an adequate score according to AB and QE criteria, respectively. For hematology cancer, only the UMN criteria were found to be adequate.

CONCLUSIONS

The use of this model may represent a reliable tool for assessment available to the various stakeholders involved in the EA process and may help regulatory agencies in a more comprehensive and objective definition of new treatments' value in these contexts. Its generalizability in other national contexts needs further evaluation.

Synthetic small-molecule RNA ligands: future prospects as therapeutic agents

RNA is one of the most intriguing and promising biological targets for the discovery of innovative drugs in many pathologies and various biologically relevant RNAs that could serve as drug targets have already been identified. Among the most important ones, one can mention prokaryotic ribosomal RNA which is the target of several marketed antibiotics, viral RNAs or oncogenic microRNAs that are tightly involved in the development and progression of various cancers. Oligonucleotides are efficient and specific RNA targeting agents but suffer from poor pharmacodynamic and pharmacokinetic properties. For this reason, a number of synthetic small-molecule ligands have been identified and studied upon screening of chemical libraries or focused design of RNA binders. In this review, we report the most relevant examples of synthetic compounds bearing sufficient selectivity to envisage clinical studies and future therapeutic applications with a particular attention for the main strategies that can be undertaken toward the improvement of selectivity and biological activity.

Neuropsychological profile in Italian children with neurofibromatosis type 1 (NF1) and their relationships with neuroradiological data: Preliminary results

BACKGROUND

Neurofibromatosis type 1 is a genetic disorder associated with cognitive deficits, learning disabilities and behavioral problems. These domains appear to have a still controversial debated association with local areas of T2-hyperintensities on MRI images, called unidentified bright objects (UBOs).

METHODS

A cohort of 36 children (aged 7-11 years) included consecutively, underwent neuropsychological and behavioral assessment to determine their cognitive and neuropsychological profile, and the frequency of specific learning disabilities. MRI examination was used to determine the impact of UBOs' presence, number, and location on the cognitive, neuropsychological and behavioral profile, and also the presence of optic glioma.

RESULTS

The mean full intelligence quotient was 104.6; only one child had mild intellectual disability. Forty one percent of children had a diagnosis of specific learning disabilities and reading was mainly involved. Twenty per cent had attention problems. All children had normal scores in visuo-motor and visuo-perceptual tests. UBOs were present in 94.0% of the MRI examinations. Two children had optic glioma. Children with UBOs in a specific location and children with UBOs elsewhere were statistically compared, no one of the location seemed to have an impact on general cognition measured with full intelligence quotient. The thalamus was associated with problems in calculation and striatum with behavioral problems. An inverse relationship between the number of UBOs and the full intelligence quotient was present, but without a statistical significance.

CONCLUSIONS

In this study, the specific location of UBOs did not seem to influence the general cognitive profile and also the relationship between their number and the full intelligence quotient was not significant; these results are still controversial in literature. Finally, the presence of UBOs in the thalamus and striatum may represent a neuroradiological pattern that influences performances in calculation and behavior respectively in children with Neurofibromatosis type 1.

Abstract P1-10-12: Differential benefit of intra-operative administration of ketorolac on breast cancer disease recurrence according to baseline body mass index

Background:

According to the last estimates, 63% of the women in the US are either overweight or obese. Increased body mass index (BMI) has been recognized as a risk factor for developing breast cancer (BC) and associated with adverse survival. So far, few treatment modalities focusing on the biological features of BC patients with increased adiposity have been evaluated. In cancer patients, elevated leptin levels have been found, among others, to stimulate the Rho GTPase pathway, involved in cell adhesion and motility. Here, using a unique retrospective institutional cohort including a total of 847 BC patients, we aimed at assessing whether the intra-operative administration of ketorolac, a Non-Steroidal Anti-Inflammatory Drug (NSAID), with a recently documented Rho GTPase inhibitory activity, would be associated with an improvement in distant disease recurrence according to BMI. We further assessed in an independent series of 1,009 patients, the effect of intra-operative diclofenac, another NSAID without Rho GTPase inhibitory activity.

Patients and methods:

In the institutional retrospective and consecutive 'ketorolac' series of patients with primary BC surgery, 538 were treated with and 309 without a single-dose (typically 20 mg in patients under 60 kg and 30 mg in patients ≥60 kg) of intra-operative ketorolac. In the 'diclofenac' series, 789 patients were treated with intra-operative diclofenac (75 mg) and 220 without. Competing risk analysis of distant recurrences was done by crude cumulative incidence curves to be interpreted as the cumulative probability of distant metastases as first event and consistently by Fine & Gray semi-parametric models on sub-distribution hazards. Subgroup analyses were conducted according to the Dixon&Simon approach. These analyses were adjusted for standard clinico-pathological variables: NSAID use, tumor size, age, nodal status, grade, ER status, and BMI. The median follow-up time of the ketorolac and diclofenac cohort was 5.7 and 8.0 years, respectively.

Results:

In both cohorts, the administration of the NSAID was associated with younger age at diagnosis, consistent with previous reports. The administration of ketorolac was associated with decreased incidence of distant recurrences both in the unadjusted and adjusted analysis (HRadj= 0.55, 95%CI: 0.35-0.86, p=0.01). Subgroup analyses in patients with BMI<25 and ≥25 (overweight and obese) revealed that the effect was limited to the high BMI group of patients both in the unadjusted and adjusted analysis (HRadj= 0.58, 95%CI: 0.33-0.98). The administration of diclofenac was not associated with decreased incidence of distant recurrences, nor in the global population, neither in the BMI subgroups.

Conclusion:

The fact that only ketorolac but not diclofenac was associated with a significant reduction of distant recurrences in BC patients with elevated BMI could be explained by the specific Rho GTPase inhibitory effect of the R-enantiomer of ketorolac, absent in diclofenac. While this study is limited by its retrospective nature, it suggests a potentially important repositioning of ketorolac in the intra-operative treatment of BC patients with elevated BMI. A prospective study is on its way.

Citation Format: Desmedt C, Demicheli R, Fornili M, Bachir I, Duca M, Viglietti G, Piccart M, Sotiriou C, Sosnowski M, Forget P, Biganzoli E. Differential benefit of intra-operative administration of ketorolac on breast cancer disease recurrence according to baseline body mass index [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-10-12.

Compliance with Breast and Cervical Cancer Screening Programs in Women: Results from a Population-Based Study

Aims and background

Women's adherence to mammography and PAP test screening guidelines is a fundamental topic regarding women's health. The aim of the study was to evaluate the knowledge and compliance to breast and cervical cancer screening programs in women living in three Italian towns, where a public screening program, consisting of free mammography every two years and free PAP test every three years, is ongoing.

Methods

An anonymous survey was mailed to a random sample of women. Eight 120-min focus discussions with groups of women exploring perceptions, knowledge and practices were carried out after analysis of the returned surveys.

Results

Replies were received from 1345 women (response rate, 27%). Almost every woman knew of the screening program, but women's practice of mammography was age-dependent: up to 72% of the women performed it before the age of 50. Conversely, the age of the first PAP test was rather late: up to 70% of the women performed it at over 30 years of age. Women with a lower educational level reported being screened less than those with a higher level. During the group discussions, women's perceptions, knowledge and beliefs regarding cancer and screening, together with aspects of the health care system, appeared to strongly influence the preventive practices. Many women deplored being infrequently instructed by health professionals.

Conclusions

Despite the limitations of the study due to the low response rate, we believe that health professionals should invest on encouraging factors and reduce the deterring factors to optimize screening practices.

Compliance with breast and cervical cancer screening programs in women: results from a population-based study

AIMS AND BACKGROUND

Women's adherence to mammography and PAP test screening guidelines is a fundamental topic regarding women's health. The aim of the study was to evaluate the knowledge and compliance to breast and cervical cancer screening programs in women living in three Italian towns, where a public screening program, consisting of free mammography every two years and free PAP test every three years, is ongoing.

METHODS

An anonymous survey was mailed to a random sample of women. Eight 120-min focus discussions with groups of women exploring perceptions, knowledge and practices were carried out after analysis of the returned surveys.

RESULTS

Replies were received from 1345 women (response rate, 27%). Almost every woman knew of the screening program, but women's practice of mammography was age-dependent: up to 72% of the women performed it before the age of 50. Conversely, the age of the first PAP test was rather late: up to 70% of the women performed it at over 30 years of age. Women with a lower educational level reported being screened less than those with a higher level. During the group discussions, women's perceptions, knowledge and beliefs regarding cancer and screening, together with aspects of the health care system, appeared to strongly influence the preventive practices. Many women deplored being infrequently instructed by health professionals.

CONCLUSIONS

Despite the limitations of the study due to the low response rate, we believe that health professionals should invest on encouraging factors and reduce the deterring factors to optimize screening practices.

HIV-1 diversity in Romania

OBJECTIVES

To evaluate the prevalence and the dynamics of HIV-1 subtypes in Romanian adults and children, and to investigate the origins of the nosocomial epidemic.

DESIGN

A total of 1000 serum and plasma samples, from adults (n = 579) and children (n = 421) who were diagnosed as being HIV-1-infected during 1990-1997 in 39 of the 41 Romanian districts, were serotyped. Viral DNA was isolated from blood samples of 84 patients and the viruses were genotyped.

METHODS

Serotyping was performed with a peptide subtype-specific enzyme immunoassay (SSEIA), based on in vitro competition for antibody binding between the representative V3 peptides of the different clades (A-F). Proviral HIV-1 DNA was genotyped by heteroduplex mobility assay or by sequence analysis of the C2-V3 env region.

RESULTS

SSEIA showed that 93% of the samples from horizontally infected children were serotype F, 1% were serotype B, and the remaining 6% were uninterpretable. In vertically infected children, 74% of strains were serotype F, 10% were serotype A, 3% were serotype B, and 3% were serotype E. Serotype F was also the dominant subtype in adults (68%), but serotypes A, B, C, D and E were also detected. SSEIA gave indeterminate results in 7% of cases. A strong correlation (90%) between serotyping and genotyping for subtype F was found. Analysis of the relative incidence of the different serotypes over a 7-year period (1990-1997) showed a stable distribution.

CONCLUSIONS

Subtype F largely dominates the epidemiology of HIV-1 infection in both children and adults in Romania, although other major subtypes are present. The predominance of subtype F in Romania may be a future potential source of HIV-1 variability in Europe.

Human immunodeficiency virus type 1 subtype F reverse transcriptase sequence and drug susceptibility

We sequenced and phylogenetically analyzed the reverse transcriptase (RT) regions of the pol genes of 14 human immunodeficiency virus type 1 (HIV-1) isolates from Romanian patients, which were classified as subtype F on the basis of env gene structure. The RT sequences showed that the strains clustered phylogenetically and were equidistant from other HIV-1 subtypes as shown by the neighbor-joining and maximum-likelihood methods, allowing us to define HIV-1 subtype F according to the pol classification. The subtype F RT sequences differed from reported group M RT sequences by 10.94% (for nucleotides) and 7.6% (for amino acids). Phenotypic analysis of subtype F susceptibility to three classes of antiretroviral compounds showed an increase in the 50% inhibitory concentration of the tetrahydroimidazo[4,5,1-jk] [1,4]-benzodiazepin-2-(1H)-one and -thione (TIBO) derivate R82913 for one strain which was naturally resistant to this compound. This first report of subtype F pol sequences confirms the perfect correlation between the phylogenetic positions determined by env and pol analyses and suggests that virus variability might influence the efficacy of antiretroviral treatments. This finding warrants a global evaluation of the phenotypic and genotypic susceptibility of HIV-1 subtypes to antiretroviral drugs.

[The prevalence of HBsAg in hospitalized children as a marker of hepatitis B virus infection]

The aim of this study was to determine the prevalence of hepatitis B surface antigen (HBsAg) in hospitalised children, as specific marker for hepatitis B virus (HBV) infection. Our study group consists of 517 children, 68 of them diagnosed with chronic hepatitis. For HBsAg determination we used an ELISA test (Labsystems); for some children we also tested by ELISA the following markers: the antibodies and anti-hepatitis C virus (HCV) antibodies. From 517 children 24.28% were HBSAg positive and 75% of children with chronic hepatitis were positive for the same marker. Almost 100% of chronic active hepatitis (CAH) patients was positive for HBSAg.

CONCLUSIONS

1. The prevalence of HBsAg was much higher as compared with the healthy population prevalence; it is a clear prove that HBV infection has an important role in chronic hepatitis appearance. 2. For all HBsAg positive patients, it is necessary to determine other markers like HBeAg-anti-HBe antibodies system as well as markers for other viral hepatitis (HDV, HCV). 3. The anti-HBV infection vaccine will reduce significantly the prevalence of HBV and HDV infections; 4. Biological molecular technique, like PCR will be necessary in our country, in the future, even the price is so high, to monitoring the IFN treatment for chronic infection as unique solution for these patients.

[The specific serological profile in hepatitis B virus infection in children]

Hepatitis B virus infection (HBV) has a very well known specific serologic profile. In the last years the molecular biology methods reveal some "particular serological profiles" by genomic mutation. One particular profile consists in the absence of anti-HBc total antibodies simultaneously with the presence of HBsAg. Our tested group consists of 372 children aged 0.1 to 15 years. The presence of HBsAg was determined by ELISA "sandwich" and confirmed by neutralisation test. For HIV infection we used two ELISA tests (competitive and indirect) and the Western Blot test for confirmation. Of the total, there were 13 children HBsAg positive and without anti-HBc antibody (3.49% respectively), 7 of the 13 children (53.8%) were dystrophic and 4 were HIV positive (30.76%). From 372 cases, 104 were HBsAg positive (27.9%) and 53 (14.2%) of them had chronic hepatitis.

CONCLUSIONS

1. The particular serologic profile requires the testing of all serological markers specific for HBV. 2. This particular serologic profile is correlated with HIV positive status and dystrophy.

[The prevalence of anti-hepatitis C virus antibodies in children from social assistance units in the county of Iaşi]

The aim of this study was to determine the prevalence of anti-HCV antibody (Ab) in association with specific markers for hepatitis A virus (HAV) and hepatitis B virus (HBV). We investigated 127 children from two orphanages from Iaşi District (77 males--60.6%). An ELISA kit, IInd generation (Diagnostic Pasteur) was used for anti-HCV determination. Hepatitis B surface antigen (HBsAg) and anti-HAV/total antibodies were diagnosed by ELISA competitive and "sandwich" type respectively (Wellcome-Murex). 16.8% from all children was "repeated reactive" for anti-HCV Ab test; majority of them (88.9%) had a positive result for anti-HAV/total Ab and 30.7% were "carriers" for HBsAg.

IN CONCLUSION

(1) the prevalence of anti-HCV Ab is more than 3 fold, comparative with the 4.5% value from blood donors in our region; (2) the high level for HBsAg as marker for an HBV infection requires to test the children's liver function to select and monitor them for IFN treatment purposes; (3) for HAV, which is never involved in chronic infection, even if the vaccination is now available, the cost/benefit ration, suggests that the unspecific prevention methods still keep their value.

[HIV infection in a seronegative child diagnosed by isolation of the virus. The significant immunological and epidemiological signs]

HIV-1, subtype F was isolated from a seronegative child aged 2.5 yr. ELISA tests (Behring HIV-1 + 2, Abbott HIV-1 + 2, Wellcozyme HIV-1 Recombinant, Clonatec HIV-1 + 2, Genelavia Mixt), and also rapid tests (Abbott Pack, Serodia) were all negative, although some of them presented borderline reactivities. Western Blot (Cambridge Biotech) revealed an undetermined profile (traces of anti-gp160 plus anti-p24). A new WB test (Sanofi Dg. Pasteur) performed at a higher serum concentration (1/25) revealed a complete antibody profile, despite the very low intensity of bands. A new serum sample prelevated 6 month later was completely negative on all tests used. Both samples, were negatives in WB for HIV2 and HTLVs. A heparinised blood sample was used for the co-cultivation of PBMC and was proven to be positive in the 14th day of culture. The isolated DNA from end-culture cells was subjected to PCR amplifications for Heteroduplex Mobility Assay direct subtyping (primers ES7 and ES8) and for the investigation of genotypic sensitivity to AZT (primers A/NE1). Lymphocyte populations phenotyping revealed leukocytosis (> 15,000/mL) with a predominance of the CD8+ subset CD4/CD8 ratio was < 1. Plasmatic HIV-1 load (measured by bDNA--Chiron) did not reached detectable levels of HIV-1 RNA. p24 Ag assay (EIA-Coulter) revealed a detectable p24 antigenemia only in the first serum sample and only after acid dissociation. So, this patient may present an integrated HIV-1 infection until now "silent".

Multiple false-positive reactions in anti-CD4 ELISA testing of dystrophic children

BACKGROUND

Anti-CD4 autoantibodies are present in up to 10% of HIV infected patients and, until present, they were not recorded in other pathological circumstances.

AIM

To test the presence of anti-CD4 autoantibodies in HIV-infected children, using an indirect ELISA test.

DESIGN

Cross-sectional controlled study.

PATIENTS AND METHODS

The study group: 9 HIV infected dystrophic children--3 AIDS (P2A), 6 P1C. Control groups: 9 HIV seronegative dystrophic children; 14 HIV seronegative eutrophic patients presenting chronic hepatopathies, or dialysed patients.

METHODS

1. Indirect ELISA using as antigen sCD4 molecules; 2. Western blot (sCD4); 3. "Antigenic displacement": sera preincubation with sCD4, followed by indirect ELISA.

RESULTS

Indirect ELISA revealed anti-CD4 reactivities in all the dystrophic patients (9 HIV+ and 9 HIV-). WB sCD4 did not confirmed none of these reactivities. Sera preincubation with sCD4 did not significantly modified ELISA CD4 reactivities.

CONCLUSIONS

False positive results (FPR) rate following testing of the presence of anti-CD4 in dystrophic children recommends prudence for the interpretation of such tests. "Antigenic displacement" could be an accessible and easy to perform method in order to eliminate the FPR.

[The clinical and immunological correlations between the p24 antigenemia levels and those of anti-p24 antibodies in HIV-seropositive children]

The influence of HIV I p24 antigen immune complexing with anti-p24 antibodies of the assessment of their respective levels in HIV-positive sera was studied. ELISA tests were used for evaluating anti-p24 and p24 antigenemia, with or without acid dissociation. We have observed that: 1. p24 antigenemia usually coexisted with low anti-p24 levels, an inverse correlation between these two parameters being traced; acid dissociation increased the percentage of p24 positive sera, especially when anti-p24 titers are low; 2. on contrary, after acid dissociation, p24 Ag remain undetectable in 55.56% of patients presenting high titers and 29.41% of those with low levels of anti-p24; acid dissociation do not increase anti-p24 titers. Whereas the first group of observations suggests that p24 Ag and anti-p24 Ab may be involved in immune complexes, the second set indicates that p24 Ag and Ab were not inevitably linked in such complexes. So, they may be indicative for two distinct biological phenomena.

[The isolation and subtyping of the human immunodeficiency virus (HIV) from children in Moldova. The evidence for subtype F]

HIV epidemic related to nosocomial transmission in Romanian nursed children represents up to now more than 50% of paediatric AIDS cases in Europe. Although the sources of this epidemic are obscure, HIV-1 subtype F, a minor form in Brasil and Africa, realised a founder effect in this risk group, thus becoming the major form in Romanian epidemic. This study presents the results of the virus isolation from HIV-infected children in Northeast Romania. Heteroduplex mobility assay (HMA) was performed in order to establish HIV-1 viral subtype for 6 isolates. All tested HIV-1 strains were proved to belong to F subtype. So, our study confirm that HIV-1 subtype F is responsible for the epidemic in the risk group of Romanian nosocomially infected children.

[The determination of the prevalence of antibodies to the hepatitis C virus (anti-HCV) and of the serum levels of C-reactive protein in chronic dialysis patients]

The chronic dialysis patients are subject at risk for the hepatitis C virus (HCV) infection. Among these subjects, the hemodialysis-induced and increased synthesis of IL6 which suggest an acute phase response. 58 chronic dialysis patients were tested for presence of anti-HCV antibodies; 45 (77.58%) presented this serological marker. None of the 15 nursing subjects tested presented anti-HCV. C reactive protein (CRP) levels were measured in 41 patients. Elevated levels were detected in 5 (12.19%) patients. Such a high prevalence of anti-HCV reveals the hemodialysis to be a risk factor for the HCV infection. CRP levels measured by Mancini method lack the sensitivity for a more accurate interpretation.

CONCLUSION

1. the high anti-HCV prevalence among hemodialysis patients emphasize the opportunity of blood testing also for serological markers in ante-transfusional screening. 2. the immunoturbidimetry method for CRP testing may be a better assay in order to establish significant correlations.

Hypothesis of transition in two ways from atrial fibrillation to sinus rhythm

A hypothesis of transition from atrial fibrillation to sinus rhythm in close relation with monophasic action potential duration is proposed. The first way: the prolongation of the right atrial refractoriness reduces the wave fronts below a critical number and their collision terminates the arrhythmia. The second way: progressive shortening of refractoriness at a critical level with block and collision of wave fronts.

[The presence in pregnant women of the risk factor of serum antibodies against 9 viruses with significance in materno-infantile pathology and the transfer of these antibodies to the newborns]

Indirect enzyme immunoassay, performed with Labsystems (Helsinki) kits, in 30 mothers and their newborns, revealed that 100% of parturient women present IgG antibody to hepatitis A (HAV), herpes simplex 1, and measles viruses, constantly transferring these antibodies to their newborns. 78.6% of the women had IgG to rubella (German measles) virus, passively transmitting them to their offsprings. Serological markers (HBsAg and anti-HBc) of hepatitis B virus infection were present in 42% of the investigated women, anti-HBc being also present in the serum of the newborns. Between the identified risk factors (in the past obstetrical history, current pregnancy, labor and early postnatal period) and the spectrum of IgG antibodies present in mothers no significant correlations were revealed. The same obvious lack of correlation between IgG antibodies and risk factors in the neonate (prematurity, low birth weight, malformations) was also found. However, the presence of IgG anti-measles (2 case), IgM anti-rubella (1 case) and IgM and HAV (4 cases) was associated, in the same order, with interstitial pneumonia, hepatosplenomegaly and death, icterus neonatorum, cardiovascular and neurologic malformations. Neither mothers nor their offsprings presented anti-HIV antibodies, suggesting that in the investigated patients no perinatal transmission had occurred.

[Seroepidemiological data on the circulation of influenza virus in Moldova in 1991-1992]

OBJECTIVES

1. To establish the predominant circulating antigenic subtypes of influenza viruses in the epidemic season (19911992). 2. To evaluate the efficiency of seroepidemiological method in determining the circulating antigenic subtypes and its practical consequences.

METHODS

Our study consist of 1082 patients with acute respiratory disease or their contacts. Antigens prepared at "Cantacuzino Institute", C.D.C. Atlanta and from viral strains isolated in our laboratory were used. Hemagglutination-inhibiting Test was preceded by the elimination of the unspecific inhibitors with IO4K M/90. Significant titers were considered those > 1/10.

RESULTS

Were assessed by determining the number of antibody carriers, their ratio and geometrical mean of the reciprocal value of H.I. antibody titers.

CONCLUSIONS

1. In the winter of 1991 and 1992 A/H3N2 infections and in the spring 1991 and 1992 A/H1N1 virus prevailed, while B virus circulated by the end of spring 1992 epidemic season. 2. The decrease in 1992 of A/Iaşi/1/69 (H3N2) activity at the same time with high titers against A/Iaşi/1/76 (H3N2) and A/Iaşi/1/80 (H3N2) suggests a marked antigenic drift occurring in this interval 3. Serological method for determining the presence of hemagglutination inhibiting antibodies seemed enough and compulsory for detecting the etiological agent of acute respiratory disease, and an epidemic outbreak. 4. The circulation of three distinct antigenic subtypes determines the options for composition of anti-influenza vaccine.

[A seroepidemiologic and virological study of the presence of arboviruses in Moldavia in 1961-1982]

In Romania, St. Drăgănescu et al., Miszkolczy et al., based on clinical and epidemiological observations, affirmed the possible presence of "tick-borne encephalitis (TBE)". However, critical retrospective evaluation of certain others' papers published through 1958-1971 reveal some uncommon features. By way of example: a very high incidence of CF- and HI-antibodies in acute and chronic CNS illnesses as well as in general population; replication in nucleus and maturation in mitochondria of a strain of "TBE virus" isolated from a patient CSF; isolation of "group B arbovirus" from Ixodes persulcatus on Romanian territory. As known, this tick was not identified in Romania, "no tick-borne Flavivirus isolated outside the U.S.S.R. proved to be a strain of RSSE virus" and "no arbovirus (Alpha- and Flavivirus or Bunyavirus) was ever detected in nucleus". Based on the HI reaction with West Nile (WN) virus, strain Egypt 101, human, domestic and wild vertebrates sera, treated with acetone for removal of nonspecific inhibitors, were tested as part of a control study, in Moldavia in 1961. WN virus was selected for its capacity to crossreact in the HI test with many members of the family Flaviviridae, genus Flavivirus (formerly Group B arboviruses), including the agents of Central European encephalitis. In order to avoid the interference of nonspecific inhibitors, a new single radial haemolysis test for the assay of antibodies to haemagglutinating arboviruses was calibrated in 1979. The seroepidemiological study performed on all 19.853 sera (10.698 human, 6.452 domestic mammals, 2.477 wild small rodents and 226 migrating aquatic birds) pointed out a very low circulation of Flaviviruses in the investigated area. The attempts to isolate such viruses from Ixodes ricinus on suckling mice yielded a single strain of Kemerovo (genus Orbivirus) virus. The need of extending the study to other viruses transmitted by arthropods and rodents, and mainly on the haemorrhagic fever with renal syndrome, an illness already clinically identified in Moldavia, is emphasized. Final consideration of viability (specificity, sensitivity, accuracy and precision) of the tests used and the need for continuous quality control is also presented.