Studies on Hepatitis B vaccination in neonates

From 1982-1989, 705 infants born to HBsAg positive mothers entered the Dutch neonatal hepatitis B vaccination program and received passive-active hepatitis B immunization, according to 6 schedules, varying in time of onset vaccination, dose of hepatitis B immunoglobulin (HBlg) and type and dose of vaccine. 118 (17%) of the mothers were also HBeAg positive. This thesis describes the protective efficacy and long-term immunogenicity of passive-active hepatitis B immunization over a period of 10 years. During follow up, 9 infants became HBsAg carriers; 8, all born to HBeAg positive mothers within the first year and another child, born to an HBeAg negative mother at the age of 5 years. No evidence of emergence of escape hepatitis B mutants was found. Protective Efficacy Rate (PER) of passive-active hepatitis B immunization at 12 months follow up was 92% for the total group with no significant differences between groups starting active immunization at birth or at 3 months; groups receiving one or two doses of HBlg or groups receiving plasma-derived or recombinant vaccine. The PER at month 12 in the group with maternal HBV-DNA levels less than 150 pg/ml was 100% and significantly higher than the 68% for the group with HBV-DNA levels above 150 pg/ml. After 5 years of follow up, the group with active hepatitis B immunization starting at birth had significantly more infants with anti-HBs levels less than 10 IU/L (15%) than the corresponding group starting at 3 months (2%). Geometric Mean Titres of anti-HBs were significantly higher in the group, starting at 3 months of age with plasma vaccine than in the corresponding group receiving recombinant vaccine. This program showed that passive-active hepatitis B vaccination can be highly effective in the prevention of neonatal hepatitis B, except for children born to women with high hepatitis B viraemia. Evaluation of vaccine schedules should take into account risk assessment according to maternal HBV DNA levels. The excellent efficacy of delayed active vaccination allows incorporation of hepatitis B vaccine into the standard infant immunization programs for countries with a passive-active immunization strategy for hepatitis B. For long-term protection, dosage of recombinant vaccine with equal immunogenicity to that of plasma vaccine should be considered

Proteção e competência em matéria ambiental : a (des)evolução do Plano Diretor do Município de Osório/RS

O presente estudo aborda o meio ambiente como bem jurídico. A partir da constatação de processos de destruição da natureza, com acidentes de resultados prejudiciais, o meio ambiente passou a receber, nos diversos países, proteção legal. No Brasil, após evolução legislativa, o meio ambiente foi trazido pela Constituição Federal de 1988 como bem jurídico, cuja proteção deve ser exercida por todos entes federados. Dentre as competências legislativas para proteção ambiental, destaca-se a dos Municípios, os quais estão mais próximos das peculiaridades dos casos concretos. O objetivo da pesquisa foi analisar necessidade e as competências para a proteção do meio ambiente, enquanto bem jurídico a ser tutelado, especialmente no que se refere aos Municípios. O estudo foi baseado em pesquisa bibliográfica e documental, com caráter exploratório. Foi possível constatar que, apesar da tutela constitucional, por vezes, as alterações legislativas são tardias e falham na proteção ao meio ambiente, a exemplo do que ocorre com o Plano Diretor do Município de Osório/RS.The present study deals with the environment as a legal good. From the discovery of processes of destruction of the nature, with accidents of harmful results, the environment began to receive, in the several countries, legal protection. In Brazil, after legislative evolution, the environment was brought by the Federal Constitution of 1988 as a legal right, which protection must be exercised by all federated entities. Among the legislative competencies for environmental protection, the municipalities stand out, which are closer to the peculiarities of concrete cases. The objective of the research was to analyze the necessity and the competences for the protection of the environment, considered as a legal right to be protected, especially concerning municipalities. The study was based on bibliographic and documentary research, with an exploratory character. It was possible to verify that, despite constitutional tutelage, sometimes legislative changes are slow and fail to protect the environment, as is the case with City of Osório’s Master Plan

Anti-HBs levels in infants of hepatitis B carrier mothers after delayed active immunization with recombinant vaccine concomitant with DTP-polio vaccine: Is there need for a second dose of HBIg?

The need for an additional dose of hepatitis B immune globulin (HBIg) was studied by comparing infants receiving 1 ml HBIg at birth followed by hepatitis B immunization, concomitant with DTP-polio vaccine, at 3, 4, 5 and 11 months (schedule E), with infants receiving the same schedule with additional HBIg at 3 months (schedule F). The immune response to recombinant hepatitis B vaccine (20 μg) was evaluated in 195 infants born to HBsAg-positive mothers allocated to groups E and F and compared with historic controls who received plasma vaccine (10 μg) according to schedule F. Blood samples were drawn at 0, 3, 4, 6, 11, 12 and 24 months of age. No difference in efficacy between the two schedules was observed; 8 and 6% of infants born to HBeAg-positive HBsAg carrier mothers in groups E and F, respectively, became HBsAg carriers. Passively acquired antibodies at birth remained present for about 5 months in most infants. The seroprotection rates (anti-HBs ⩾ 10 IU l−1) were over 90% at all time points and similar for groups E and F. The titres of anti-HBs attained during the first 6 months were statistically lower (p ⩽ 0.02) for group E than for group F but similar thereafter. Anti-HBs titres in infants receiving the recombinant vaccine were significantly lower than in infants receiving the plasma vaccine (p ⪡ 0.001). Supplemental doses of HBIg in infants receiving a high dose of HBIg (> 200 IU) at birth and the first dose o

Perioral reconstruction after Mohs micrographic surgery: analysis of 108 cases

Introduction: The perioral region is commonly affected by non-melanoma skin cancer. Mohs micrographic surgery is the treatment of choice in this area because it has the highest cure rate and preserves healthy tissue. Several methods are available for restoring the perioral region, and their selection is influenced by the surgical wound characteristics and the surgeon's preference. Objective: Describe the authors’ experience in perioral reconstruction after Mohs micrographic surgery and analyze the repair methods most frequently performed. Methods: Retrospective study of consecutive cases submitted to Mohs surgery and perioral reconstruction. Results: The study included 108 cases from 103 patients. The mean number of Mohs surgery stages was 1.4, and the mean defect size was 16 mm. Primary closure was the most used technique for reconstruction, followed by flaps (mainly V-Y, single advancement, and rotation). The association of repair methods was used in 28.7% of cases, mostly combined with flaps. Four patients had complications (necrosis and graft infection, trapdoor effect, and partial wound dehiscence). Conclusion: Primary closure was the most frequent repair method, followed by flaps. Knowing reconstruction strategies and possibilities of associations is essential for proper restoration of the perioral region, maintaining its function, sensation and aesthetics

Non-A Hepatitis B Virus Genotypes in Antenatal Clinics, United Kingdom

Serostatus for viral e antigen is no longer accurate for inferring potential infectivity of pregnant virus carriers

EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4–15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems