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Biomedical subjects

R Schvarcz

Publications and source records attributed to R Schvarcz.

49 records · Page 3Linked to original sources
PubMed1990

Early antibiotic treatment of reactive arthritis associated with enteric infections: clinical and serological study.

OBJECTIVE: To find out whether a 10-14 days' course of antibiotics early in the course of reactive arthritis associated with enteric infections could reduce the severity and duration of the disease and whether the antibody response in patients with reactive arthritis associated with yersinia infection differed between those treated and those not treated with the antibiotics. DESIGN: Prospective multicentre trial in which patients were randomised to treatment or no treatment with antibiotics. Patients were seen at three and six weeks and three, six, nine, 12, and 18 months after their first visit. SETTING: Departments of infectious diseases in three hospitals in Linköping, Malmö, and Stockholm, Sweden. PATIENTS: 40 Consecutive patients who had had symptoms of reactive arthritis associated with enteric infection for less than four weeks. INTERVENTIONS: 20 Patients were allocated to treatment with antibiotics and 20 patients did not receive antibiotics. All patients received non-steroidal anti-inflammatory drugs, and four also received intra-articular steroid injections after at least six weeks' observation. MAIN OUTCOME MEASURES: Arthritic symptoms assessed clinically and by using Ritchies' index; blood measurements reflecting inflammatory activity; serum IgG, IgM, and IgA antibody titres; HLA tissue type. RESULTS: No difference was observed concerning duration of arthritis, grade of inflammation, and number of joints affected between patients treated and those not treated with antibiotics. Furthermore, there was no significant difference between the two groups in erythrocyte sedimentation rate and haptoglobin, IgG, and IgA concentrations. All values had returned to normal within three months. No patient developed chronic arthritis, but sustained slight arthralgia occurred in three patients. The HLA-B27 antigen was found in 23 (58%) of the patients, and its presence did not affect clinical outcome. The IgG, IgM, and IgA antibody responses were similar in patients treated with antibiotics and those not treated. CONCLUSION: Short term antibiotic treatment has no beneficial effect on the clinical outcome of reactive arthritis associated with enteric infection.

Adult↗
PubMed1990

Therapy of chronic post-transfusion non-A, non-B hepatitis with interferon alfa-2b: Swedish experience.

Thirty-three Swedish patients with chronic post-transfusion non-A, non-B hepatitis entered a randomized trial of interferon alfa-2b treatment (INTRON A, Schering-Plough Corporation) (3 million units, three times weekly, subcutaneously for 36 weeks). Twenty-two patients (67%) were reactive for antibodies against hepatitis C virus. Nineteen patients completed the course of therapy; 11 (58%) had a complete response with normalization of serum alanine aminotransferase levels, compared to none of the 12 controls (p less than 0.001). Four treated patients with chronic active hepatitis were non-responders. Non-responders had a significantly higher mean body weight than responders (p less than 0.05) and tended to have a longer duration of prior disease. During the 10-month follow-up period post treatment, 4/11 (36%) complete responders had a sustained response and three (75%) of these four were reactive for antibodies against hepatitis C virus, whereas 7/11 (64%) relapsed, of whom four (57%) were reactive for antibodies against hepatitis C virus. All patients who were treated again responded but relapsed once more after retreatment was stopped. We conclude that the majority of patients with chronic post-transfusion non-A, non-B hepatitis will respond to 9 months' interferon alfa-2b treatment, but that only one of three responders will have a sustained response 10 months post treatment. Reactivity for antibodies against hepatitis C virus is not predictive of the outcome of therapy.

Adult↗
PubMed1990

Autoimmune chronic active hepatitis: changing reactivity for antibodies to hepatitis C virus after immunosuppressive treatment.

Thirty-three patients fulfilling stringent criteria for autoimmune chronic active hepatitis (CAH) were tested for antibodies against hepatitis C virus (anti-HCV) with an enzyme immunoassay. Eleven of the 33 (33%) patients were anti-HCV-reactive in a serum drawn before initiation of immunosuppressive therapy. Anti-HCV-reactive patients had significantly higher median s-IgG level (32.3 g/l) than nonreactive patients (23.5 g/l) (p less than 0.01). When in remission with normalized s-IgG levels as a result of the immunosuppressive therapy, only 1 of the 11 initially reactive patients was still reactive. Sera from patients with acute autoimmune CAH and high s-IgG levels may be nonspecifically reactive for anti-HCV.

Adolescent↗
PubMed1989

A randomized controlled open study of interferon alpha-2b treatment of chronic non-A, non-B posttransfusion hepatitis: no correlation of outcome to presence of hepatitis C virus antibodies.

33 patients with biopsy-proven chronic non-A, non-B posttransfusion hepatitis (NANB PTH) were randomized 2:1 to treatment with interferon alpha-2b (Introna) or to controls. The treatment group received 3 MU interferon 3 times weekly subcutaneously for 36 weeks. 22/33 (67%) patients were reactive for antibodies against hepatitis C virus (anti-HCV). 11/19 (58%) treated patients versus none of the 12 controls had a complete response with normalization of serum alanine aminotransferase levels (p less than 0.001). Another 4/29 (21%) treated patients had a partial response which was also seen in 4/12 (33%) controls; 4 treated patients were nonresponders, all with chronic active hepatitis. Nonresponders had a significantly higher mean weight than responders (p less than 0.05) and tended to have a longer duration of their disease before therapy. During the 6-month follow-up period post treatment 4/11 (36%) complete responders had a sustained response and 7/11 (64%) relapsed. All who were retreated responded again. We conclude that a majority of patients with chronic NANB PTH will respond to 9 months interferon alpha-2b treatment, but that only 1 out of 3 will have a sustained response 6 months post treatment, and that the reactivity for anti-HCV was not correlated to the outcome of therapy.

Adult↗
PubMed1989

Interferon alpha-2b treatment of chronic posttransfusion non-A, non-B hepatitis: interim results of a randomized controlled open study.

32 patients with biopsy-proven chronic non-A, non-B posttransfusion hepatitis and raised aminotransferase levels since more than 1 year were randomized 2:1 to treatment with interferon alpha-2b, Introna, or to controls. The interferon group received 3 MU interferon 3 times weekly subcutaneously. Interim results 12 weeks after randomization showed that 14/21 (67%) patients in the treatment group had normalized their serum alanine aminotransferase levels whereas none of 11 patients in the control group had (p less than 0.001). If interferon alpha-2b is only suppressive during ongoing therapy or curative will be shown later during continued follow-up.

Adult↗
PubMed1988

Alpha interferon treatment of chronic non-A, non-B hepatitis caused by intravenous gammaglobulin.

Two patients with hypogammaglobulinemia and chronic active non-A, non-B hepatitis caused by intravenous gammaglobulin substitution were treated long-term with alpha-2b interferon (Introna). Both achieved normal aminotransferase levels within 2-12 weeks after initiation of interferon therapy. One patient was rebiopsied after 6 months of therapy and showed some degree of improvement in the liver inflammatory activity. The beneficial effects warrant a randomized controlled study.

Aged↗
PubMed1983

Community-acquired Legionella micdadei (Pittsburgh pneumonia agent) infection in Sweden.

The first case of Legionella micdadei (Pittsburgh Pneumonia Agent) infection in Sweden is presented. A previously healthy 68-yr-old man fell ill with diarrhoea, fever, and mental confusion. Subsequently chest roentgenography revealed pneumonic infiltrates and a seroconversion to L. micdadei was shown. No source or transmission of infection was established. The only notable event was that the patient had been drinking rain-water from a barrel 1 day prior to his illness. An alimentary route of infection was considered.

Aged↗
PubMedDate not supplied

Treatment of chronic replicative hepatitis B virus infection with short-term continuous infusion of foscarnet.

Three patients with chronic replicative hepatitis B virus infection were treated for 7 days with a continuous intravenous infusion of foscarnet (trisodium phosphonoformate) after an initial bolus dose of 20 mg/kg body weight. Although the dose was calculated from a nomogram, approximately only half the intended plasma concentration (500 microM/l = 150 micrograms/l) was achieved. The levels of s-ALAT, HBV-DNA and DNA-polymerase changed only marginally during the treatment and 24-week follow-up period. All three patients remained HBsAg and HBeAg positive during treatment and follow-up. There were no severe side-effects. We conclude that foscarnet treatment with the dose regimen given in this study had no or only a minor antiviral effect in patients with chronic replicative HBV infection. It remains to be explored if higher doses, longer treatment periods or the use of foscarnet in combination regimen are more effective.

Adult↗
PubMedDate not supplied

Nosocomial transmission of hepatitis C virus.

The nosocomial transmission of hepatitis C involving three subjects participating in a research project in a Swedish hospital is described. One person contracted acute hepatitis C and another participant had an asymptomatic seroconversion. A temporal relationship between participation in the experiments and seroconversion for hepatitis C, and virology with phylogenetic analyses, suggest that they most probably contracted hepatitis C from a third subject who unknowingly had chronic hepatitis C. Faulty nursing and procedural routines were identified as the probable cause of the transmission. Our findings reinforce the need for medical personnel to strictly adhere to universal precautions worked out to prevent the transmission of blood-borne viruses and underline the importance of a continuous supervision of nursing and procedural routines, even in hospitals with well-educated staff and presumably high standards.

Antibodies, Viral↗
PubMedDate not supplied

Changes of serum neopterin, beta 2-microglobulin and interferon-gamma in patients with chronic hepatitis C treated with interferon-alpha 2b.

OBJECTIVES: Treatment with interferon (IFN) reduces viral replication and normalizes aminotransferase levels in a significant percentage of patients with non-A, non-B hepatitis or hepatitis C. Soluble immune activation markers were evaluated in patients with hepatitis. PATIENTS AND METHODS: Serum concentrations of soluble immune activation markers neopterin and beta 2-microglobulin (B2M) were compared to endogenous IFN-gamma levels in 17 patients with chronic hepatitis C before, during and after 9-months of treatment with IFN-alpha 2b. RESULTS: Before therapy some patients had increased concentrations of the studied variables. During therapy neopterin and B2M concentrations further increased whereas IFN-gamma decreased. IFN-gamma and neopterin levels were correlated before but not during therapy. The correlations between neopterin and B2M were significant throughout the study. CONCLUSION: The data indicate that IFN-gamma decreases during treatment and IFN-alpha 2b appears to enhance formation of neopterin and B2M.

Adult↗