Επιδημιολογική μελέτη οροθετικών εγκύων και νεογνών που γεννήθηκαν την περίοδο της οικονομικής κρίσης 2011-2018

Η μελέτη της διαχείρισης της πρόληψης της κάθετης μετάδοσης του ιού της επίκτητης ανοσοανεπάρκειας (HIV) στην περίοδο της οικονομικής κρίσης και της μετανάστευσης είναι ο κεντρικός άξονας αυτής της διπλωματικής εργασίας. Αναλύονται δεδομένα αναδρομικής καταγραφής από το αρχείο του Νοσοκομείου «Έλενα Βενιζέλου», όλων των περιπτώσεων τοκετών οροθετικών μητέρων κατά τη χρονική διάρκεια 2011-2018. Tο δείγμα μας περιλαμβάνει τα 65 νεογνά που γεννήθηκαν από 63 οροθετικές μητέρες (συμπεριλαμβάνονται 2 δίδυμες κυήσεις). Οροθετικές μητέρες ελληνικής καταγωγής είναι οι 31/63 (47%). Μητέρες με ιστορικό χρήσης ουσιών είναι οι 19/63 (30,1%) και μητέρες με προέλευση από χώρες που ο ιός ενδημεί είναι 20/63 (31,7%). Με βάση τον εθνικό σχεδιασμό και τα διεθνή πρωτόκολλα έχει χορηγηθεί τριπλή αγωγή στις εγκύους, που είχαν παρακολούθηση και συμμόρφωση. Διαχρονική παρακολούθηση στην κύηση είχαν 41/63 (65%) των οροθετικών μητέρων. Όλα τα νεογνά της μελέτης, 65 σε αριθμό, αναλόγως των παραμέτρων κινδύνου από τη μητέρα, έλαβαν μονή, διπλή ή τριπλή αγωγή. Μόνο ένα νεογνό 1/65 (1,5%) παρουσίασε θετικό ιικό φορτίο HIV κατά τη γέννηση. Διενεργείται μια προσέγγιση της καταγραφής των περιπτώσεων οροθετικής μητέρας νεογνού διαχρονικά, μέσω των φορέων παρακολούθησης στη χώρα μας. Μέσα από αυτό το πρίσμα προβάλλονται οι ανάγκες που έχουν διαμορφωθεί στην ομάδα των οροθετικών εγκύων και των νεογνών τόσο στον ελληνικό πληθυσμό όσο και στην ομάδα των μεταναστών και των προσφύγων. Η μελέτη μεταξύ άλλων αναδεικνύει ότι οι μητέρες που μολύνθηκαν μετά την εφηβεία τους όπως οι χρήστριες ενδοφλεβίων ουσιών, καθώς αυτές είναι για βραχύ διάστημα φορείς, δύναται με κατάλληλη αγωγή και παρακολούθηση να έχουν μη ανιχνεύσιμο φορτίο πριν τον τοκετό, εξαλείφοντας σχεδόν τον κίνδυνο για κάθετη μετάδοση. Διακρίνονται οι μητέρες με μεγαλύτερο χρονικό διάστημα φορείας του ιού λόγω καταγωγής από ενδημική χώρα, καθώς αυτές είναι πιο πιθανό να έχουν προσβληθεί κατά τη γέννησή τους (κάθετη μετάδοση) και να φέρουν δια βίου έστω χαμηλό ιικό φορτίο. Οι μητέρες αυτές διατηρούν θετικό ιικό φορτίο προ του τοκετού σε ποσοστό 61% και μικρότερη διάρκεια θεραπείας στο εγγύς διάστημα πριν γεννήσουν σε ποσοστό 38%. Η μελέτη αυτή αναδεικνύει το ζήτημα της προσβασιμότητας στις Μονάδες Υγείας, που αποκτά καίρια σημασία για τη Δημόσια Υγεία και αφορά στους ευαίσθητους και τους μετακινούμενους πληθυσμούς, κατά την περίοδο της οικονομικής κρίσης 2011-2018. Προχωρούμε στις προτάσεις που αφορούν στο σχεδιασμό επιμέρους Υπηρεσιών Υγείας.This study aims to focus at the management of the vertical transmission prevention of HIV during the period of financial crisis and immigration. Retrospectively, the cohort of all the HIV positive mothers and their newborns, that gave birth during the years 2011-20018 at “Helena Venizelou”, a central maternity hospital of Athens, was studied. Our sample consists of 65 neonates born to 63 HIV positive mothers (2 couples of twins). Among them, of Greek origin are 31/63 (47%) mothers, with history of intravenous substance use 19/63 (30,1%) and mothers originating from regions were HIV is endemic 20/63 (31,7%). According to the international protocols and our national strategy, combined triple regiment is provided to all pregnant HIV positive women, provided that they have had follow up and compliance. Follow up evaluation have had 41/63 (63%). Every neonate from the 65 included in this study received a single regiment, or combination of two or three drugs depending on the mother’s risk factors. All but one neonate, did 1/65 (1,5%) have positive HIV PCR at birth. We attempt to give an insight into the HIV mother-neonate group national registry. Through this approach, concern regarding the demands of the HIV positive Greek population and the currently immigrating population is arising. The present study, among others, shows that the mothers that have acquired HIV after their adolescence, such as via intravenous substance use, since they are for a short period of time HIV carriers, are more likely to reach viral clearance before labor if proper treatment and follow up is provided. On the other hand, those mothers that originate from endemic regions is more possible to have acquired the virus from their own birth. So, being carriers throughout their lives they retain positive, even low viral load, till their pregnancy and labor. It appears that these mothers are more likely to have positive viral load before labor, shorter follow up period and shorter duration of treatment close to time of labor. Thus, as demonstrated during the 2011-2018 economic crisis, accessibility to Health Care Services becomes crucial for migrating populations, therefore we proceed to the proposals based on realistic needs, which can attribute to the design of appropriate Health Services infrastructures

Skin and Soft Tissue Infections in Patients with Solid Tumours

Background. Skin and soft tissue infections (SSTIs) in cancer patients represent a diagnostic challenge, as etiologic diagnosis is often missing, and clinical assessment of severity is difficult. Few studies have described (SSTIs) in patients with solid tumours (STs). Patients and Methods. Records of patients with ST and SSTI, cared for at the University Hospital of Heraklion, from 2002 to 2006 were retrospectively studied. Results. A total of 81 episodes of SSTIs, occurring in 71 patients with ST, have been evaluated. Their median age was 65 years (34–82). The most common underlying malignancy was breast cancer in 17 patients (24%). Most episodes (89%) occurred in nonneutropenics. Cellulitis/erysipelas was the most common clinical presentation (56; 69%). Bacterial cultures were possible in 29 (36%) patients. All patients received antimicrobial therapy, while in 17 episodes (21%) an incision and drainage was required. Treatment failure occurred in 20 episodes (25%). Five patients (7%) died due to sepsis. None was neutropenic. Severe sepsis on admission (=0.002) and prior blood transfusion (=0.043) were independent predictors of treatment failure. Conclusion. SSTIs can be life threatening among patients with ST. Early diagnosis and appropriate treatment are of the utmost importance, since sepsis was proven a significant factor of unfavourable outcome

Complement-Mediated Neutralization of Dengue Virus Requires Mannose-Binding Lectin

Mannose-binding lectin (MBL) is a key soluble pathogen recognition protein of the innate immune system that binds specific mannose-containing glycans on the surfaces of microbial agents and initiates complement activation via the lectin pathway. Prior studies showed that MBL-dependent activation of the complement cascade neutralized insect cell-derived West Nile virus (WNV) in cell culture and restricted pathogenesis in mice. Here, we investigated the antiviral activity of MBL in infection by dengue virus (DENV), a related flavivirus. Using a panel of naïve sera from mouse strains deficient in different complement components, we showed that inhibition of infection by insect cell- and mammalian cell-derived DENV was primarily dependent on the lectin pathway. Human MBL also bound to DENV and neutralized infection of all four DENV serotypes through complement activation-dependent and -independent pathways. Experiments with human serum from naïve individuals with inherent variation in the levels of MBL in blood showed a direct correlation between the concentration of MBL and neutralization of DENV; samples with high levels of MBL in blood neutralized DENV more efficiently than those with lower levels. Our studies suggest that allelic variation of MBL in humans may impact complement-dependent control of DENV pathogenesis

Update on current views and advances on RSV infection (Review).

Respiratory syncytial virus (RSV) infection represents an excellent paradigm of precision medicine in modern paediatrics and several clinical trials are currently performed in the prevention and management of RSV infection. A new taxonomic terminology for RSV was recently adopted, while the diagnostic and omics techniques have revealed new modalities in the early identification of RSV infections and for better understanding of the disease pathogenesis. Coordinated clinical and research efforts constitute an important step in limiting RSV global predominance, improving epidemiological surveillance, and advancing neonatal and paediatric care. This review article presents the key messages of the plenary lectures, oral presentations and posters of the '5th workshop on paediatric virology' (Sparta, Greece, 12th October 2019) organized by the Paediatric Virology Study Group, focusing on recent advances in the epidemiology, pathogenesis, diagnosis, prognosis, clinical management and prevention of RSV infection in childhood

The Role of Humoral Innate Immunity in Hepatitis C Virus Infection

Infection with Hepatitis C Virus (HCV) causes chronic disease in approximately 80% of cases, resulting in chronic inflammation and cirrhosis. Current treatments are not completely effective, and a vaccine has yet to be developed. Spontaneous resolution of infection is associated with effective host adaptive immunity to HCV, including production of both HCV-specific T cells and neutralizing antibodies. However, the supporting role of soluble innate factors in protection against HCV is less well understood. The innate immune system provides an immediate line of defense against infections, triggering inflammation and playing a critical role in activating adaptive immunity. Innate immunity comprises both cellular and humoral components, the humoral arm consisting of pattern recognition molecules such as complement C1q, collectins and ficolins. These molecules activate the complement cascade, neutralize pathogens, and recruit antigen presenting cells. Here we review the current understanding of anti-viral components of the humoral innate immune system that play a similar role to antibodies, describing their role in immunity to HCV and their potential contribution to HCV pathogenesis

Extraintestinal manifestations in an infant with microvillus inclusion disease: Complications or features of the disease?

Microvillus inclusion disease (MVID), a rare severe congenital enteropathy characterized by intracytoplasmic microvillous inclusions and variable brush border atrophy on intestinal epithelial cells histology, is associated with defective synthesis or abnormal function of the motor protein myosin Vb encoded by the MYO5B gene. Although MYO5B gene is expressed in all epithelial tissues, it is unclear so far whether organs other than intestine are affected in MVID patients. We report a case of an infant with MVID who presented liver dysfunction, hematuria, and Pneumocystis jiroveci pneumonia during the course of the disease. It is discussed whether extra-intestinal manifestations in this patient are secondary consequences of MVID or might be features of the disease associated with altered MYO5B function. Conclusions: MVID is classically included in the differential diagnosis of congenital diarrhea of secretory type. Recent advances in our knowledge regarding the role of myosin Vb in the pathophysiology of MVID is expected to clarify the clinical spectrum of the disease and the possible primary involvement of organs other than intestine