Prevention of vertical transmission of hepatitis B virus infection

Hepatitis B virus (HBV) is the leading cause of chronic viral hepatitis. Annually, almost two million children younger than 5 years acquire the infection, mostly through vertical or horizontal transmission in early life. Vertical transmission of HBV is a high efficacy phenomenon ranging, in the absence of any preventive interventions, from 70% to 90% for hepatitis e antigen positive mothers and from 10% to 40% for hepatitis e antigen-negative mothers. Maternal viraemia is a preeminent risk factor for vertical transmission of HBV. Maternal screening is the first step to prevent vertical transmission of HBV. Hepatitis B passive and active immunoprophylaxis at birth together with antiviral treatment of highly viraemic mothers are the key strategies for global elimination of HBV infection. Strategies are needed to promote implementation of birth-dose vaccination and hepatitis B immunoglobulins in low- and middle-income countries where the prevalence of the infection is at the highest

Pengaruh Gerak Makan Dan Kecepatan Putaran Terhadap Aus Pahat HSS Pada Pengeboran Baja ASTM A1011 Menggunakan Pelumas Minyak Goreng

Pahat HSS yang digunakan dalam proses pengeboran memiliki umur dan tidak dapat digunakan secara terus menerus. Banyak faktor yang mempengaruhi umur pahat diataranya keausan pahat. Untuk menentukan keausan pahat pahat bor biasanya operator mesin hanya melakukan secara visual atau meraba pada bagian ujung mata pahat. Cara ini yang sering dilakukan pada dunia industri dikarenakan keterbatasan alat dan efisiensi waktu dalam proses produksi. Dalam penelitian ini pengaruh kecepatan putaran (n), gerak makan (f) terhadap terbentuknya keausan tepi pahat HSS, dianalisis dengan dua metode, yaitu metode kualitatif (grafik) dan metode kuantitatif (statis) dengan metode analisis variasi (ANOVA). Dalam penelitian ini, proses pengeboran menggunakan pahat HSS dan material uji baja ASTM A1011 dengan ketebalan material 10 mm. Dalam proses pengujian, gerak makan (f) yang digunakan adalah 0,1 mm/rev, 0,18 mm/rev,0,24 mm/rev sedangkan kecepatan putaran (n) yang digunakan adalah 443 rpm, 635 rpm, 970 rpm. Dari hasil pengujian secara kualitatif didapat bahwa peningkatan gerak makan (f) akan meningkatkan keausan tepi pahat HSS. Begitu pula peningkatan nilai kecepatan putaran (n) akan meningkatkan keauasan tepi pahat HSS. Dari metode ANOVA ( pengujian kuantitatif) dengan menggunakan program diperoleh hasil bahwa kecepatan putaran (n), dan gerak makan (f) secara bersama-sama mempunyai pengaruh timbulnya keausan pahat, namun secara signifikan hanya gerak makan yang berpengaruh terhadap timbulnya keausan tepi pahat HSS. Pada penelitian ini gerak makan (f) mempunyai pengaruh paling besar terhadap timbulnya keausan tepi yaitu 50,01% sedangkan kecepatan putaran hanya berpengaruh sebesar 37,42% terhadap timbulnya keausan tepi pahat HSS

Disappointing long-term results of the artificial anal sphincter for faecal incontinence

Faecal incontinence can severely affect quality of life, but as it has no influence on life expectancy, the long-term efficacy of any treatment must be taken into account.Most reports on new treatments for faecal incontinence describe short-term results and are rarely followed by a later review of the same group of patients; the few long-term reviews of traditional surgery are disappointing. The authors evaluated long-term outcome after implantation of an artificial bowel sphincter (ABS) (ActiconTM Neosphincter ABS; American Medical System, Minnetonka, Minnesota, USA) to determine whether the results tend to worsen with time. In the present study, obstructed defaecation was a frequent problem that led several patients to deactivate the pump. Together with the manometric findings of low anal canal resting pressure, even with the device activated, this suggests that the ABSmay function as a passive obstacle to the passage of faeces in the long term, like Thiersch’s sling, rather than as a dynamic sphincter. Furthermore, the ABS, like any foreign matter placed in the human body, may displace or erode, either to the rectum or to the perineum. Overall, the present study shows that the results of anal sphincter replacement using an ABS dynamic prosthesis deteriorate with time and that the long-term results may not be as good as reported previously

The dose makes the poison: A case report of acquired methemoglobinemia

Background: Methemoglobinemia (MET) should be suspected in cases where cyanosis is not associated with signs and symptoms of lung and/or heart disease, or in a cyanotic child exhibiting discrepancies in the partial pressure of oxygen in the arterial blood, the blood oxygen saturation, and the clinical assessment. Case presentation: A 10-month-old girl was taken to the Pediatric Emergency Department for the acute, sudden development of significant peroral cyanosis associated with gray pigmentation of the skin. The problem was evidenced approximately one hour after she ingested a homemade puree of mixed vegetables, mainly composed of potatoes and chards that had been prepared three days before and had been kept in the refrigerator since then. Physical examination revealed that the child was very pale, conscious, and without respiratory distress. Oxygen saturation of hemoglobin in the arterial blood (SpO2) was 94%. Respiratory, cardiovascular, and abdominal evaluations did not reveal any signs of disease. A venous blood sample showed chocolate-colored blood with a pH of 7.404, a partial pressure of CO2 (pCO2) of 40.6 mmHg, a partial pressure of oxygen (pO2) of 21.3 mmHg, a bicarbonate level of 24 mmol/L, and an oxygen saturation (SO2%) of 47.7%. CO-oximetry carried out simultaneously identified a methemoglobin level of 22%. MET was suspected, and oxygen via nasal cannula at a rate of 4 L/min was given with only a slight increase in oxygen saturation (96%). Slow intravenous injection of methylene blue 1 mg/kg over a period of 5 minutes was initiated. The peripheral oxygen saturation (SpO2) gradually improved to 100% over the next 20 minutes. Forty minutes later, venous blood gas analysis showed a methemoglobin level of 0.9% with a complete resolution of cyanosis; supplemental oxygen via nasal cannula was therefore discontinued. During the next 36 hours, the patient remained hemodynamically stable with good oxygenation on room air. Conclusions: This case report shows that recognition of acquired MET in a child with sudden cyanosis onset requires a high index of suspicion. In daily activities, there is a need to pay particular attention when homemade vegetable soups for child alimentation are prepared. The consumption of vegetable soups must occur immediately after preparation. Storage in a refrigerator must last no more than 24 hours and if longer storage is needed, vegetable soups should be frozen

Nocardiosis in a Kidney-Pancreas Transplant

34-year-old man with chronic renal and pancreas failure in complicated diabetic disease received a kidney-pancreas transplantation. On the 32nd postoperative day, an acute kidney rejection occurred and resolved with OKT3 therapy. The patient also presented refractory urinary infection by E. Fecalis and M. Morganii, and a focal bronchopneumonia in the right-basal lobe resolved with elective chemotherapy. During the 50th post-operative day, an intense soft tissue inflammation localized in the first left metatarsal-phalangeal articulation occurred (Figure 1) followed by an abscess with a cutaneous fistula and extension to the almost totality of foot area. The radiological exam revealed a small osteo-lacunar image localized in the proximal phalanx head of the first finger foot. From the cultural examination of the purulent material, N. Asteroides was identified. An amoxicillin-based treatment was started and continued for three months, with the complete resolution of infection This case is reported for its rarity in our casuistry, and for its difficult differential diagnosis with other potentially serious infections

Home management of children with COVID-19 in the Emilia-Romagna region, Italy

In most children, coronavirus disease 2019 (COVID-19) is a mild or moderate disease. Moreover, in a relevant number of cases, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains totally asymptomatic. All these findings seem to suggest that otherwise healthy children with suspected COVID-19 might be managed in the community in most cases, thus avoiding hospital admission and closely related medical, social and economic problems, including overwhelming hospitals. Unfortunately, home management of children with suspected COVID-19 rarely occurs, and many children with suspected or laboratory-confirmed SARS-CoV-2 infection are frequently hospitalized irrespective of the severity of disease. To evaluate the role of community health houses (CHHs) in the management of children with COVID-19, 1,009 children with suspected SARS-CoV-2 infection were studied in Emilia-Romagna Region, Italy. Among them, 194 (19.2%) resulted positive for SARS-CoV-2. The majority (583, 58%) were tested at home by CHHs, while 426 (42%) were brought to the hospital for testing. The patients who were managed in the hospital had a significantly lower median age than those who were managed at home (2 vs. 12 years, p < 0.001). Exposure to SARS-CoV-2 cases within the family was significantly more frequent among those who were managed at home (82 vs. 46%, p < 0.05). The clinical findings were similar between the children who were managed at home and those who were managed in the hospital. Only one of the children managed at home (0.7%) required hospitalization; in comparison, 26 (48%) of those whose swab samples were taken at the hospital were hospitalized. Our research shows for the first time the importance of CHHs in the management of COVID-19 in children; because of the high frequency of mild to moderate cases, management by CHHs can reduce the care load in hospitals, providing enormous advantages on the familial, medical, social, and economic levels. These findings could be useful for suggesting a territorial rather than hospital-based strategy in pediatrics in the case of a new wave of the epidemic