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Biomedical subjects

E Sagnelli

Publications and source records attributed to E Sagnelli.

83 records · Page 5Linked to original sources
PubMedDate not supplied

Azathioprine treatment in a patient with HBsAg-positive acute viral hepatitis complicated by bridging necrosis.

A patient with HBsAg-positive subacute hepatitis who presented a progressively deteriorating clinical condition was treated with azathioprine (100 mg/day) for eight months. Although the clinical symptoms disappeared and the biochemical abnormalities decreased, the disease nevertheless progressed to chronic active hepatitis. Moreover, azathioprine favoured hepatitis B virus replication since titers of HBsAg, HBeAg and Dane-particle-associated core-antigen, as detected by radioimmunoassay, increased during treatment. In all, this drug was only of moderate use to our patient.

Adult↗
PubMedDate not supplied

Hepatitis C virus infection in households of anti-HCV chronic carriers in Italy: a multicentre case-control study.

To test the hypothesis that households of anti-HCV positive subjects might be at increased risk of HCV infection, a case-control study was carried out comparing 518 family members of 205 anti-HCV positive subjects (index carriers) with 281 family members of 100 anti-HCV negative subjects (index controls), consecutively observed in ten gastroenterology units in different Italian regions. The index carriers were age and sex matched to the index controls and their households were similar with respect to the main sociodemographic characteristics. Anti-HCV antibodies were found in 6.9% (36/518) of household members of index carriers and in 3.2% (9/281) of household members of index controls (p < 0.05). The results of multiple logistic regression analysis showed that being over 50 years of age was the sole independent predictor for a household contact of the likelihood of being anti-HCV positive (O.R. 3.6; C.I. 95% = 1.5-8.2). Being in the household of an anti-HCV index carrier was marginally associated to anti-HCV positivity (O.R. 2.0; C.I. 95% = 0.9-4.6). No association was found for sex, area of residence, family size, lowest level of schooling, or any type of family relationship. These findings are not in compliance with the statement that household contacts of HCV carriers are at increased risk of HCV infection. The 3.2% anti-HCV prevalence rate observed among household contacts of anti-HCV negative index controls may suggest that the true anti-HCV prevalence in the general population in Italy is nearly 2.5 times as high as the 1.3% found in Italian blood donors.

Adolescent↗
PubMedDate not supplied

Treatment of HBsAg-positive chronic active hepatitis with corticosteroids and/or azathioprine. A prospective study.

204 patients with biopsy-proven CAH were observed for at least one year with periodic examinations including a second liver biopsy for each patient. Patients were assigned at random to a group left untreated or treated with either azathioprine 100 mg daily, or prednisolone (Dutimelan 8 15), or prednisolone plus azathioprine 50 mg daily. The outcome, assessed on clinical, biochemical and histological parameters, was correlated to the presence or absence of HBeAg and its antibody. No treatment was effective in HBeAg-positive patients whereas, among anti-HBe-positive patients, those who were treated with the association of steroids and azathioprine more frequently showed improvement and less frequently deteriorated (p less than 0.01) than untreated patients. Thus, HBsAg/anti-HBe-positive patients with CAH may be treated with the combination of these drugs, even though many side-effects may occur and there are frequent relapses after discontinuation of treatment.

Adolescent↗
PubMedDate not supplied

Clinical expression of 'silent' hepatitis B virus infection in a patient with visceral leishmaniasis.

A 69-year-old male was hospitalized in January 1999 because of visceral leishmaniasis. He had also suffered from anti-hepatitis C virus (HCV)-positive chronic hepatitis for years. All serum hepatitis B virus (HBV) antigens and antibodies were negative except for anti-HBc. The patient was treated with amphotericin B cholesteryl sulfate (2 mg/kg twice a day for 7 days, iv). Fever disappeared on the 3rd day of treatment, the clinical condition improved rapidly and the patient recovered. In May 1999 the patient developed icteric HBsAg-negative acute hepatitis (aspartate aminotransferase 722 U/l; alanine aminotransferase 988 U/l). Anti-HBc IgM was positive and HBV-DNA was detected in serum by PCR. Anti-HAV IgM was negative. A serum sample obtained on presentation and stored at -80 degrees C was retrospectively tested and found positive for HBV-DNA. In July 1999, complete remission of acute hepatitis and seroconversion to anti-HBs was observed. We suppose that a moderate depression of the immune system, probably associated with leishmaniasis, may have enhanced HBV replication in the patient who had an HBsAg-negative 'silent' HBV infection. Restoration of the immune system after successful antiprotozoan therapy might have induced cell-mediated necrosis of the HBV-infected hepatocytes and seroconversion to anti-HBs.

Aged↗
PubMedDate not supplied

Long-term lymphoblastoid interferon-alpha therapy for non-cirrhotic chronic hepatitis C: an Italian multicentre study on dose and duration of IFN alpha treatment.

The aims of the study were to evaluate the long-term efficacy and tolerability of different doses of interferon-alpha (IFN alpha) and different durations of treatment in chronic hepatitis C by comparing 3 or 6 mega units (MUs) three times weekly given for either 12 or 24 months, and the possibility of obtaining a response in non-responder patients by increasing the dose or by administering IFN daily. A total of 504 patients with non-cirrhotic chronic hepatitis C enrolled in a multicentre study were consecutively assigned to receive either 3 (255 patients) or 6 MU (249 patients) of lymphoblastoid IFN alpha 3 times a week (tiw). At the 12th month of therapy, patients with normal aminotransferase (AMT) in both groups were either given IFN for an additional 12 months with an unmodified or halved dose, or else discontinued therapy. For patients with unmodified AMT levels after 6 months of therapy, the IFN dose was doubled in the 3-MU group, while it was administered at 3 MU daily in the 6-MU group. When no improvement was achieved, therapy was discontinued; otherwise it was prolonged until the 18th month. Patients were followed up for 12 months after discontinuing IFN. Of the 255 patients enrolled at 3 MU, therapy was stopped during the first 6 months in 36 patients (14.1%) because of side effects, and in 24 (9.4%) because of lack of cooperation. Of the remaining 195 patients at the 6th month of therapy, 119 (61%) had normal and 76 (39%) unmodified AMT levels; 14 of the 76 normalized AMT after doubling the dose of IFN, but only 5 (6.6%) had a sustained response. Of the 119 patients with normal AMT, 40 discontinued IFN at the 12th month (schedule A), 39 remained at 3 MU tiw (schedule B) and 40 were given a dose of 1.5 MU tiw (schedule C) for an additional 12 months. At the end of follow-up, 23/40 (57.5%) patients in schedule A, 31/39 (79.5%) on schedule B and 29/40 (72.5%) on schedule C still had normal AMT (A vs. B p = 0.04). In an intention-to-treat analysis, the sustained response rate for patients enrolled at 3 MUs, including the 5 initial non-responders, was 34.5%. Of the 249 patients enrolled at 6 MU, therapy was discontinued during the first 6 months for 39 (15.7%) because of side effects, and for 27 (10.8%) because of lack of cooperation. Of the remaining 183 patients at the 6th month of therapy, 110 (60%) had normal and 73 (40%) unmodified AMT levels. Of the 73 patients, 55 accepted the daily regimen and 8 of them (14.5%) showed a sustained response. Of the 110 patients with normal AMT, 32 (29.1%), despite normalization of AMT, spontaneously discontinued IFN or reduced the dose because of a poor quality of life, while 78 continued with 6 MU until the 12th month, when therapy was discontinued for 28 (schedule A1); 24 patients were given an unmodified dose (schedule B1) and 26 a halved dose (schedule C1) for an additional 12 months. At the end of follow-up, 18/28 (64.3%) patients on schedule A1, 19/24 (79.2%) on schedule B1 and 19/26 (73.1%) on C1 still had normal AMT (p = NS). In an intention-to-treat evaluation, the sustained response rate for patients enrolled at 6 MU, including the 8 from the daily treatment, was 25.7% (64/249). HCV viraemia was undetectable 1 year after discontinuation of IFN in 72.6% of patients with a sustained response. Sustained response was observed in 36.4% of patients with minimal, 46.6% of those with mild, and 33.3% with moderate or severe histological activity (p = NS). The rate of sustained response was lower in patients with genotype 1b (23.6%) than in those with genotype 2a (67.8%, p = 0.002) or genotype 3 (50%, p = 0.03), irrespective of the histological activity. In conclusion, 6 MU IFN alpha are no more effective than 3 MU in inducing a sustained response in treatments of both 12 and 24 months. A 24-month treatment is more effective than a 12-month treatment in maintaining a biochemical response after discontinuation of IFN. In terms of efficacy, compliance and cost, 3 MU for 24 months app

Adolescent↗
PubMedDate not supplied

Immunosuppressive therapy of HBsAg-positive chronic active hepatitis in childhood: a multicentric retrospective study on 139 patients.

We analyzed retrospectively the effect of immunosuppressive therapy in 139 children with HBsAG-positive chronic active hepatitis (CAH) observed in four liver units in Italy from 1974 to 1982. All children had been observed for at least 12 months. Of these 139 patients, 38 were treated with steroids (prednisolone or prednisone from 1 to 2 mg/kg daily), 78 with combination therapy (prednisolone or prednisone 1 mg/kg daily in combination with azathioprine, 2 mg/kg daily) and 23 were not treated. The outcome of the disease was assessed by evaluating clinical, biochemical, and histological parameters on the basis of preselected criteria. Untreated patients deteriorated more frequently than those treated with steroids (34.8% versus 13.2%, p less than 0.05) or those receiving combination therapy (34.8% versus 10.3%, p less than 0.01). Remission or improvement was observed more frequently in steroid-treated and combination-treated patients than in the untreated ones (p less than 0.001 and p less than 0.01, respectively). At the end of the study, only one untreated patient had died of liver failure. Remission was observed in about 10% of patients in the two groups of treatment, but in the untreated one, this event never occurred. Although this study is retrospective and presents some shortcomings, the data clearly indicate that steroid and combination therapy are not deleterious, and are possibly helpful, to children with HBsAg-positive CAH.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenal Cortex Hormones↗
PubMedDate not supplied

Diagnosis of HCV related acute hepatitis by serial determination of IgM to HCV: a preliminary observation.

OBJECTIVE: To verify whether serial determination of titre of IgM to HCV core protein (HCV IgM) may be useful to distinguish acute hepatitis C (AHC) from reactivation of chronic hepatitis C (r-CHC), we studied 18 consecutive patients with AHC (identified by seroconversion to anti-HCV) and 15 consecutive patients who had been anti-HCV positive for at least one year at the time of reactivation. METHODS: Samples of serum were obtained from all patients on hospitalisation and every 5 days during the follow-up and stored at -80 degrees C: 54 samples of serum for the AHC group and 41 for the r-CHC group. Titres of HCV IgM were calculated as Index values by a commercially available enzyme immunoassay (HCV-IgM EIA 2.0, Abbott Laboratories, North Chicago, IL, USA). RESULTS: No difference was observed between the two groups of patients as regards age, sex, risk factors for the acquisition of HCV infection, clinical and biochemical data on presentation, prevalence of cases with detectable viremia or distribution of HCV genotypes. HCV IgM was detected with an Index value of 350 or more in only 1 (6.7%) in the r-CHC group and in 17 (94.4%) in the AHC group (p<0.01). Moreover, during the early phase of the illness we observed a wide variation in the HCV IgM Index values in AHC and consistent values in r-CHC. CONCLUSIONS: Our data indicate that AHC is characterised by high and variable titres of HCV IgM during the acute phase of the illness, which may be considered diagnostic, whereas in r-CHC the IgM titre remains stable and rarely reaches a high level.

Acute Disease↗
PubMedDate not supplied

Clinical presentation and natural history of chronic persistent hepatitis. A multicentre retrospective study on 1197 cases.

To obtain data on the clinical presentation and the course of the disease of biopsy-proven chronic persistent hepatitis (CPH), we coordinated a multicentre retrospective study on 1197 patients observed in 16 liver units throughout Italy from 1975 to 1985. Most patients were asymptomatic and CPH was often diagnosed either after a chance finding of liver enlargement, or increased serum aminotransferases and/or HBsAg antigenemia. Of the 1197 patients, 534 (44.6%) were HBsAg-positive and 663 (55.4%) were HBsAg-negative. HBeAg was tested in 356 of the 534 positive cases and detected in 58.4% of them. This percentage was higher (80%) in patients under 20. Hepatitis delta virus infection (HD-Ag in liver tissue and/or anti-HD in serum) was detected in 28 (14.7%) of the 191 patients tested on presentation. Liver function tests showed mild hepatic involvement in both HBsAg-positive and negative cases, a pronounced derangement being observed only in patients with HDV infection. A second liver biopsy was performed in 212 patients (144 HBsAg positive and 68 HBsAg negative) and the outcome of the disease was evaluated only in these 212 patients. Of the 144 HBsAg-positive cases followed-up from one to ten years (median 4 years), 47 recovered, 70 remained unchanged and 27 developed chronic active hepatitis or cirrhosis. Clearance of HBsAg was uncommon even in patients who recovered. Being under 15 years of age favourably affected the course of the disease, while HDV infection was correlated to an unfavourable outcome. Among those patients who were HBeAg positive on presentation and who underwent a second affect the outcome. Of the 68 HBsAg-negative clearly affect the outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

[Epidemiological evaluations of human immunodeficiency virus, herpes simplex virus type 1 and 2 and cytomegalovirus infections in drug addicts].

Eighty-eight drug addicts from the "BAN Center" in Torre Annunziata (Naples) and 88 normal subjects pair-matched for age and sex were tested for IgG to human immunodeficiency virus (HIV), herpes simplex virus (HSV) type 1 and 2 and cytomegalovirus (CMV). A high prevalence of subjects with antibodies to HSV-1 and CMV (80.7% and 65.9%) were recorded in the control group testifying to the high level of these infections in Campania. Prevalences were higher in drug addicts, and drug abuse was identified as a risk factor for the acquisition of CMV infection (odds ratio = 2.3). Moreover, drug addiction is also a risk factor for HSV-2 and HIV infection as demonstrated by the observation that drug abusers were anti-HSV-2 (9.1 vs. 1.1%, odds ratio = 6.16) or anti-HIV (11.4 vs. 0%, odds ratio = 23.6) positive more frequently than normal controls. Thus, drug addiction is a risk factor for the acquisition of HIV, HSV-2 and CMV infections. This is probably due to similar habits, frequent among drug addicts from our geographic area and uncommon in the normal population, such as tattooing, needle-sharing needlestick and unsafe sex. Some of these habits, such as unsafe sex and tattooing, seem to be, per se, risk factors for the acquisition of both HIV and CMV infections. The data also suggest that HIV infection was probably introduced in Campania more recently than in northern and central Italy where the prevalence of anti-HIV positive cases among drug addicts is definitely higher.

Acquired Immunodeficiency Syndrome↗