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Background: Even during the current Coronavirus Disease 2019 (COVID-19) pandemic, the infection with the Human Immunodeficiency Virus (HIV) continues to pose a major threat, worldwide. In fact, the World Health Organization (WHO) defined the HIV infection as a risk factor for both severe COVID-19, at hospital admission, and in-hospital mortality. Despite this evidence, however, there remains the need for investigating whether SARS-CoV-2 infection could increase the risk of death among people living with HIV (PLHIV). Thus, we conducted a systematic review and meta-analysis to assess the impact of the SARS-CoV-2 infection on the risk of death among PLHIV and HIV- seronegative people., Methods: The literature search was carried out on PubMed, Embase and Web of Science databases, from the inception to February 2022. Epidemiological studies on patients tested positive for SARS-CoV-2 infection, which compared the proportion of deaths between PLHIV and HIV-seronegative people, were considered eligible for the inclusion. The pooled odds ratio (OR) was obtained through meta-analysis of the comparison between PLHIV and HIV-seronegative people. Study quality was assessed by using the Newcastle-Ottawa Quality Assessment., Results: On a total of 1001 records obtained from the literature search, the present systematic review and meta-analysis included 28 studies on 168 531 PLHIV and 66 712 091 HIV-seronegative patients with SARS-CoV-2 infection. The meta-analysis showed no difference in the risk of death between PLHIV and HIV-seronegative patients (OR = 1.09; 95% confidence interval (CI) = 0.93-1.26; P > 0.001). However, a significant heterogeneity was found for this comparison (I 2  = 88.8%, P < 0.001)., Conclusions: Although our meta-analysis suggests no difference in the risk of death of PLHIV with SARS-CoV-2 infection, if compared with HIV-seronegative patients, further research should be encouraged to improve the current knowledge about the impact of SARS-CoV-2 and HIV co-infection., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Legionella pneumophila contamination of water systems is a crucial issue for public health. The pathogen is able to persist in water as free-living planktonic bacteria or to grow within biofilms that adhere to and clog filters and pipes in a water system, reducing its lifespan and, in the case of hospital buildings, increasing the risk of nosocomial infections. The implementation of water management is considered to be the main prevention measure and can be achieved from the optimization of water system architecture, notably introducing new materials and strategies to contrast Legionella biofilm proliferation and so prolong the water system functionality. In this research, we propose a new smart surface against L. pneumophila biofilm formation. This is based on an innovative type of coating consisting of a sulfonated pentablock copolymer (s-PBC, commercially named Nexar™) deposited on top of a polypropylene (PP) coupon in a sandwich filter model. The covering of PP with s-PBC results in a more hydrophilic, acid, and negatively charged surface that induces microbial physiological inhibition thereby preventing adhesion and/or proliferation attempts of L. pneumophila prior to the biofilm formation. The antibiofilm property has been investigated by a Zone of Inhibition test and an in vitro biofilm formation analysis. Filtration tests have been performed as representative of possible applications for s-PBC coating. Results are reported and discussed.

Conventional high throughput methods assaying the chemical state of water and the risk of heavy metal accumulation share common constraints of long and expensive analytical procedures and dedicated laboratories due to the typical bulky instrumentation. To overcome these limitations, a miniaturized optical system for the detection and quantification of inorganic mercury (Hg 2+ ) in water was developed. Combining the bioactivity of a light-emitting mercury-specific engineered Escherichia coli -used as sensing element-with the optical performance of small size and inexpensive Silicon Photomultiplier (SiPM)-used as detector-the system is able to detect mercury in low volumes of water down to the concentration of 1 µg L -1 , which is the tolerance value indicated by the World Health Organization (WHO), providing a highly sensitive and miniaturized tool for in situ water quality analysis.

Legionella is able to remain in water as free-living planktonic bacteria or to grow within biofilms that adhere to the pipes. It is also able to enter amoebas or to switch into a viable but not culturable (VBNC) state, which contributes to its resistance to harsh conditions and hinders its detection in water. Factors regulating Legionella growth, such as environmental conditions, type and concentration of available organic and inorganic nutrients, presence of protozoa, spatial location of microorganisms, metal plumbing components, and associated corrosion products are important for Legionella survival and growth. Finally, water treatment and distribution conditions may affect each of these factors. A deeper comprehension of Legionella interactions in water distribution systems with the environmental conditions is needed for better control of the colonization. To this purpose, the implementation of water management plans is the main prevention measure against Legionella . A water management program requires coordination among building managers, health care providers, and Public Health professionals. The review reports a comprehensive view of the state of the art and the promising perspectives of both monitoring and disinfection methods against Legionella in water, focusing on the main current challenges concerning the Public Health sector.

Biological contamination is a typical issue in water treatment. Highly concentrated microbial suspensions in a water flow may cause filter occlusion and biofilm formation, affecting the lifespan and quality of water purification systems and increasing the risk of nosocomial infections. In order to contrast the biofilm formation, most of the conventional strategies rely on the water chemical modification and/or on the use of filters functional coatings. The former is unsafe for huge chemicals spilling required; therefore, we focus on the second approach and we propose the use of a sulfonated pentablock copolymer (s-PBC, commercially named Nexar™) as innovative multifunctional coating for improving the performance of commercial water filters. S-PBC-coated polypropylene (PP) samples were tested against the pathogen Pseudomonas aeruginosa . The covering of PP with s-PBC results in a more hydrophilic, acid, and negatively charged surface. These properties avoid the adhesion and proliferation attempts of planktonic bacteria, i.e., the biofilm formation. Inhibition tests were performed on the as-modified filters and an evident antibacterial activity was observed. The results point out the possibility of using Nexar TM as coating layer for filters with antifouling properties and a simultaneous ability to remove bacteria and cationic dyes from water.

Background: Postural control is a very important function in everyday life. However, assessing postural control with commonly used measurement instruments (MIs) is limited due to deficits in their psychometric properties. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a comprehensive and multidimensional MI for assessing postural control in persons with limited balance function, such as individuals after stroke. Despite the increasing use of the Mini-BESTest worldwide, no German version is available., Research Question: Is the German version of the Mini-BESTest (GVMBT) comprehensible and valid for measuring postural control in individuals after stroke?, Methods: The Mini-BESTest was translated and cross-culturally adapted, following established guidelines. It was pilot-tested with ten participants. This observational measurement and validation study was conducted at one point and included 50 participants with subacute and chronic stroke (mean age: 64.58 ± 13.34 years/ 34 men/ 16 women). Convergent validity was investigated using 1) the Berg Balance Scale (BBS) and 2) the Timed "Up & Go" (TUG). The MIs were evaluated for normal distribution with the calculation of skewness, kurtosis and Q-Q-Plots. Spearman correlation coefficients and Bland Altman analysis were used to examine the relationship between the MIs. The internal consistency was assessed using Cronbach's alpha., Results: Comprehension of the GVMBT was confirmed. The GVMBT correlated significantly with the BBS (r s  = 0.93) and the TUG (r s  = - 0.85). Bland Altman analysis revealed low absolute differences. The GVMBT demonstrated no significant floor or ceiling effects and showed excellent internal consistency (Cronbach's α =  0.90)., Significance: The GVMBT has excellent validity and internal consistency. Due to this and its specific subcategories, the GVMBT is recommended for the use in research and clinical practice. Further psychometric properties should be evaluated., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Purpose: To analyse the postoperative foveal avascular zone (FAZ) area, superficial vessel density (SVD) and deep vessel density (DVD) and their correlation with functional (best-corrected visual acuity, BCVA) and anatomical outcomes (foveal macular thickness, FMT) after surgery for rhegmatogenous retinal detachment (RRD) repair., Method: Patients with RRD eyes, successfully treated with a single pars plana vitrectomy (PPV) with gas tamponade and a minimum 12 months follow-up, were re-examined. Foveal avascular zone (FAZ) area, SVD, DVD and FMT were evaluated by using optical coherence tomography angiography (OCTA) and compared to fellow eye., Results: Fifty-six patients with macula-on and 37 with macula-off RRD were included in the study. In both groups, no difference in FMT and FAZ area was found compared to fellow eyes. In macula-on RRD eyes, a lower parafoveal DVD (p = 0.001) was detected; FAZ area was related to FMT (p = 0.025), and the postoperative BCVA was correlated with parafoveal DVD (p = 0.010) and FAZ area (p = 0.003). In macula-off RRD eyes, lower parafoveal SDV (p = 0.012), and foveal and parafoveal DVD (p = 0.012 and p < 0.001, respectively) were observed. BCVA was related to FAZ area (p = 0.012), foveal SVD (p = 0.005) and parafoveal DVD (p = 0.010)., Conclusion: Rhegmatogenous retinal detachment eyes successfully treated with PPV had lower vessel density in the superficial and deep retinal plexus compared to fellow healthy eyes; BCVA was related to FAZ area and vessel density., (© 2019 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The hospital environment has been suggested as having an important role in the transmission of health care-associated infections. The aim of this work is to clarify the possible role of visitors in environmental contamination at our hospital. The microbial load was determined by Rodac plate contact on flat surfaces and by swabs on uneven surfaces. A total of 137 samples were taken from four different areas of the hospital unit. The results were divided into two groups according to the types of subjects that most often frequented those environments. We found that the transmission of health care-associated infections (HAIs) occurs mainly in areas where visitors are not allowed.

Purpose: To analyse the effects of intravitreal dexamethasone implant (DEX) in patients with diabetic macular oedema (DME) unresponsive to ranibizumab treatment, in relation to the inflammatory optical coherence tomography (OCT) retinal features, subfoveal neuroretinal detachment (SND) and hyperreflective retinal spots (HRS)., Methods: Patients with DME poorly responsive to three injections of ranibizumab were treated with DEX. Best-corrected visual acuity (BCVA) and central macula thickness (CMT, measured by Spectralis SD-OCT) were assessed at baseline and at 1, 3, and 6 months., Results: Overall, 44 eyes were included in the study. In the whole group, mean BCVA (baseline 51.5 ± 8.3 letters) increased significantly at 1 month (to 56.9 ± 8.8 letters; Tukey HSD p = 0.017) and was 55.5 ± 8.8 letters at 3 months (Tukey HSD p = 0.128). Central macula thickness (CMT) reduced significantly at 1 and 3 months (417 ± 149 μm and 469 ± 128 μm, respectively, both Tukey HSD p < 0.001 versus baseline). Subgroup analysis showed a significant BCVA increase at 1 month in eyes with SND + HRS (from 51.2 ± 9.2 to 58.2 ± 9.0, p = 0.029), and a trend to BCVA increase in eyes with HRS (from 52.3 ± 6.4 to 56.8 ± 7.9, p = 0.080), with a significant CMT decrease in both groups (p < 0.001). No changes of either parameter were found in eyes without SND and HRS., Conclusion: Spectral domain OCT is useful in identifying some inflammatory features in DME. Among DME eyes 'poorly responsive' to ranibizumab, those with SND and HRS responded better to DEX implants than those without these features., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)

The purpose of this study was to investigate the antibacterial effect of 71 organic Sicilian honeys of different botanical origins against Staphylococcus aureus [American Type Culture Collection (ATCC) 9144™] and Pseudomonas aeruginosa (ATCC 27853™). The antimicrobial activity was determined by means of an agar diffusion assay from the estimation of the diameter of the inhibition zone produced by the honeys. S. aureus was more inhibited than P. aeruginosa (chi-square value 11.2698, P value 0.000788). In particular, a statistically significant inhibition growth against S. aureus was exhibited by the polyfloral (chi-square value 6.1714, P value 0.012983) and the eucalyptus honeys (chi-square value 4, P value 0.0455). Results partially suggest Sicilian organic polyfloral and eucalyptus honeys as possible alternatives to antimicrobial agents when S. aureus resistance causes failure of initial conventional antibiotic treatment.

Introduction: The purpose of this study was to investigate the antibacterial effect of 71 locally produced honeys from different botanical sources collected from apiarist's open markets in Sicily., Methods: Antimicrobial activity was determined against Escherichia coli (ATCC 25922) and Salmonella serovar Infantis (ATCC 1523) by an agar-diffusion assay from the estimation of the diameter of the inhibition zone produced by the honeys. Statistically) significant differences (P < .000) regarding inhibition were observed for the honeys tested., Results: The chestnut and polyfloral honey samples exhibited the largest and highest inhibition (diameter of the inhibition zone > 25 mm) against both E. coli and S. Infantis. The honey of oregano origin showed intermediate or low activity against E. coli and S. Infantis, respectively. Prickly pear and erica honeys showed no antimicrobial activity against the two reference strains., Discussion: The results may partially suggest the usefulness of the Sicilian honeys on treating multi-resistant enterobacteria. In light of the enormous potential for application of honey in the clinical practice, it is important that research continues not only into those honeys well recognized as antimicrobial, but also into other locally produced and yet untested honeys.

Molecular epidemiology at local scale in Sicily (Italy) of ampicillin resistance in Salmonella spp. isolates from municipal wastewater (n = 64) and clinical specimens (n = 274) is described in comparison with previously examined Escherichia coli isolates (n = 273) from wastewater. High prevalence of antibiotic resistance (28.9%) with highest resistance rates against ampicillin (22.7%) was observed in E. coli isolates. Different resistance rates were observed in Salmonella according to the serovars, with prevalences of the same order in both wastewater and clinical isolates belonging to the same serovar (e.g., 91.7% ampicillin resistance in wastewater isolates vs. 70.8% in clinical isolates of the Salmonella serovar Typhimurium and 0% ampicillin resistance in both wastewater and clinical isolates of the Salmonella serovar Enteritidis). The beta-lactam resistance gene bla(TEM) was present in both wastewater and clinical Salmonella spp. isolates, with the exception of Salmonella enterica serovar Typhimurium isolates with a typical six-drug resistance pattern AmpChlSulTeStrSp that had the bla(PSE-1) gene. The bla(TEM) gene was present in all the E. coli isolates but one had the bla(SHV) gene. Several E. coli and some Salmonella isolates were positive for class 1 integrons with variable regions of 1.0 or 1.5 kb containing aadA1, dfrA17-aadA5, or dfrA1-aadA1 gene cassettes, whereas Salmonella serovar Typhimurium isolates with the six-drug resistance pattern were positive for both 1.0 and 1.2 kb integrons. Polymerase chain reaction replicon typing demonstrated the presence of multireplicon resistance plasmids in several isolates of E. coli, containing two to four of the replicons IncF, IncI1, IncFIA, and IncFIB, whereas other isolates showed resistance plasmids with only IncF, IncP, or IncK replicons. Replicon IncI1 was detected in one Salmonella isolate, whereas other isolates belonging to different serovars had IncN replicons. Analysis of isolates from wastewater can be a useful epidemiologic tool to monitor the prevalence of antibiotic resistance and genetic elements related to antibiotic resistance in Salmonella clones circulating in the human population.

The aim of the present study was to ascertain frequency and persistence of Candida spp. oral and urinary carriage in asymptomatic, HAART-naive HIV-seropositive subjects who had not undergone therapy with antimycotic drugs, and whose CD4+ lymphocyte count was greater than 200/microl. Oral carriage was the most common Candida spp. carriage (63.0% of the subjects), while candiduria was more rarely observed (6.5%). C. albicans was recovered from the majority of the subjects examined (56.5%), followed by C. krusey (4.3%), C. tropicalis (2.2%) and C. dubliniensis (2.2%). C. albicans was also isolated from two urinary carriers (4.3%) and C. glabrata from another one (2.2%). The same C. albicans clone was repeatedly isolated from 14 out of 15 oral carriers while the same clone of C. dubliniensis was repeatedly isolated from one carrier, as shown by the persistence of RAPD fingerprint of serial isolates during one year of follow-up. Since persistence of Candida spp. carriage may influence the development of clinical candidiasis in immunocompromised hosts, monitoring of the carrier status could be useful for preventing clinical thrush in HIV-seropositive subjects.

Unlabelled: INTRODUCTION. ERCP has brought real progress in the study and treatment of pancreatic and biliary diseases, because of its ambivalence as diagnostic and therapeutic procedure. Among its complications, perforations occur in fewer than 1% of patients, but are associated with a mortality rate of 16% -18%., Case Reports: CASE 1- F, 89 years old with obstructive jaundice by choledocholithiasis submitted to ERCP plus ES, during which occurs type II lesion; the partial removing of stones from choledochus during the procedure allow us to opt for a conservative treatment, with resolution on post-ERCP day 12. CASE 2- F, 53 years old with recurring cholangitis and post-cholecystectomy stenosis of choledochus already treated by stenting; for the occurrence of type I lesion during ERCP, the patient undergoes surgery in emergency with healing in postoperative day 23. CASE 3- M, 84 years old with lithiasic cholecystitis, obstructive jaundice, lung emphysema and ischemic heart disease; after percutaneous cholecystostomy in emergency, we attempt to ERCP with evidence of type I lesion. Because of comorbility, we opt for a conservative treatment, not resolving, and then proceed to surgery. Exitus for cardio-respiratory complications. CASE 4- M, 89 years old with obstructive jaundice; ERCP is suspended for respiratory complications and then a PTC is perform; during it we note a type IV lesion, which is treated conservatively with resignation in day 12. CASE 5- F, 68 years old with cholecystitis and choledocholithiasis; during ERCP plus SE a type II lesion occurs with worsening signs of acute abdomen. Because of clinical conditions and the impossibility of carrying out stones from choledochus by endoscopy, we opt for a surgical treatment in emergency. Exitus for respiratory complications., Discussion: Because of the controversy exists on what should be the management of perforations as adverse events of ERCP plus ES (immediate surgery or conservative therapy), we can only hope an eclectic approach based on the anatomical and clinical peculiarity of each case.

The Authors refer about two cases of retained rectal foreign bodies by trans-anal introduction as consequence of anal eroticism: a deodorant aerosol-can cap and a sizeable phallic object. These reports represent an occasion to talk about the etiology (the wide variety of foreign bodies) and the motivations (eroticism or sadism, clumsy diagnostic and therapeutic procedures, true or presume accidents) responsible for this pathological condition and to consider every therapeutic options employed during the past years, without forgetting that, despite difficulties, non-surgical extraction is to prefer, if possible, because of the negative prognostic implications often related to the surgical treatment. The Authors finally confirm, because of the severity of this pathological condition - with negative outcomes especially in that cases with complete or incomplete perforative complications (produced during introduction through the anus or during several attempts of extraction of the object or caused by its long staying in the rectum because of the patient's denial of medical care) - the surgeons can't put aside possible indication for surgical treatment.

Introduction: Lung cancer metastases of small bowel are rare (1,1%), often with few or not symptoms. This aspecific onset and the difficult physical-instrumental approach to small bowel, led often to diagnosis at autopsy. This is not true for intestinal metastases that cause complications (haemorrhage, obstruction, perforation); in this cases emergency surgery leds to the diagnosis., Case Report: We describe a case of a male 56 years old patient with acute abdomen due to perforation (X-ray and CT). He refers, about 6 months before, an upper right lobectomy for lung cancer, followed by adjuvant chemo-radiotherapy, because the presence of brain and bone metastases. During the emergency surgery we found out a perforation of the Treitz tract, treated with intestinal resection and immediate end-to-end anastomosis with manual suture. Histological examination shows the perforation of the intestinal wall tract with lung cancer metastases., Conclusions: Our case shows that any acute abdomen in patient with lung cancer can be considered as expression of intestinal metastases. Negative prognosis of this complication imposes to surgeons only a local treatment.

A total of 273 Escherichia coli isolates from raw and treated municipal wastewaters were investigated to evaluate the frequency and persistence of antibiotic resistance and to detect the occurrence of conjugative R plasmids and integrons. The highest resistance rates were against ampicillin (22.71%), tetracycline (19.41%), sulfamethoxazole (16.84%) and streptomycin (14.28%). Multiple antibiotic resistance was present in 24.17% of the isolates. Several multiple antibiotic-resistant isolates proved to be able to transfer en bloc their resistance patterns by conjugative R plasmids with different molecular sizes and restriction profiles. Class 1 integrons of 1 or 1.5 kbp were found in 5 out of 24 representative multiresistant E. coli isolates. Although wastewater treatments proved to be effective in eliminating Salmonella spp. and in reaching WHO microbiological standards for safe use of wastewater in agriculture, they were ineffective in reducing significantly the frequency of plasmid-mediated multiple antibiotic resistance in surviving E. coli. Since multiple antibiotic-resistant bacteria carrying integrons and conjugative R plasmids can constitute a reservoir of antibiotic-resistance genes in wastewater reclaimed for irrigation, risks for public health should be considered. Bacterial strains carrying R plasmids and integrons could contaminate crops irrigated with reclaimed wastewater and transfer their resistances to the consumers' intestinal bacteria.

Introduction: GISTs, a new nosological entity recently described, represent a peculiar model of solid tumor: the identification of the molecular mechanism responsible for the oncogenesis led to the development of a new drug (imatinib) active on the specific molecular target, represented by the product of the mutated proto-oncogene c-kit which is a tyrosine kinase receptor that becomes constitutively active by mutation. Surgical resection, nevertheless, is still the primary treatment and it has to be as complete as possible. These two treatments can be integrated. GISTs are not uniformly kit-positive, and they can be alternatively due to mutations of the PDGFRA gene or, in patients with neurofibromatosis type 1 (NF-1), to generally isolated mutations of the NF-1 gene., Patients and Methods: We describe 3 cases of kit-positive GISTs of the small intestine (SISTs), complicated and emergency surgically treated: case 1--53 years, female, with small bowel obstruction and concomitant acute intestinal bleeding; case 2--71 years, male, with NF-1 and acute intestinal bleeding; case 3--47 years, male, with perforation of the Treitz tract. The first two cases have been treated with intestinal resection and immediate mechanical anastomosis; the third one with resection of the pedunculated tumor at its base, where is situated the perforation too., Conclusions: SISTs (20-30%), with little or no symptoms in the initial phases, show notable diagnostic difficulties. Their aspecific and late clinical presentation--typical of this site and of the pathology that we are talking about--and the difficult physical-instrumental approach to small bowel limit the possibility of an accurate diagnosis and expose the patient to potentially fatal acute complications and to risks related to emergency surgery treatment that decreases the possibility of a radical resection.

This study evaluated the presence and extent of contamination with Legionella spp. in the hot water distribution systems of three hospitals in Catania (Italy). In total, 291 hot water samples were collected between September 2002 and August 2005 and these were examined in order to monitor the hospital distribution systems and evaluate the efficacy of decontamination measures. L. pneumophila was detected at variable concentrations up to over 10000 UFC/L at several collection sites in some hospital buildings and branches of the water distribution system while other buildings/branches were found to be free of contamination. The most frequently isolated serogroup was L. pneumophila serogroup 3, occasionally associated with serogroups 4, 5 and 6. Molecular typing of Legionella strains by pulsed-field gel electrophoresis of genomic DNA restriction fragments identified four different genotypes, each recovered from a different branch of the distribution system. Decontamination procedures, including shock hyperchloration and two different thermal shock methods, performed between October 2003 and August 2005, led to only temporary reductions in contamination. In fact, previous concentrations of the same L. pneumophila serogroup were found within 3 to 8 months of decontamination. In order to prevent and monitor Legionella infections, sterilizing filters were installed in water taps of all wards with high-risk patients and urinary antigen testing was performed on all patients diagnosed with nosocomial pneumonia. No cases of Legionella pneumonia were identified in 2005.

Naltrexone is a pure narcotic antagonist with optimum pharmacologic properties for the long-term management of opiate addiction. The above study confirms the usefulness of naltrexone for the prevention of relapse in subjects who have been weaned from narcotics. However, the short follow up does not yet permit evaluation of its medium and long-term efficacy. The better course and outcome of treatment are significantly related to certain characteristics and types of addicts. It may be said that by assuring complete, albeit time-limited, remission the antagonist allows the addict to open a window through which to face the world, and offers the therapist the possibility to apply all the instruments at his disposal in an effective manner.

IPH is an uncommon disease affecting mainly children and adults and has usually a poor prognosis. The basic pathogenesis of the disorder is unknown; many theories have been advanced, but none is proved. A case of IPH in a 35 years old male presenting the atypical feature of a myeloperoxidase deficiency is reported. This unusual feature may be compatible with a generalized redox systems deficiency, which leads, via an impaired flow of iron into alveolar macrophages, to the pulmonary fibrosis.

Hepatitis B virus (HBV) is the commonest cause of liver disease world-wide, with an estimated 200 million chronically infected individuals. The prevalence of HBV is particularly high in parts of Africa, Far East and South-East Asia. The worldwide distribution of HBV infection with the consequence of chronic liver disease and primary hepatocellular carcinoma implies the need for an efficient and safe vaccine. Three vaccines are today available: HB-VAX (M.S.D.), HEVAC-B (Ist. Pasteur, Paris) and Engerix-B (Smith-Kline Biological) and the first international experience proves that they are harmless, immunogenic and protective. The possibility of eliminating hepatitis B depends on mass vaccination in the high carrier areas of the third world and this in turn depends on supplies of inexpensive vaccine. The present work reports results obtained in Italy in 16 volunteers with high risk, who received HEVAC-B vaccine. Blood samples of the subjects were also tested for HBSAg/IgM complexes.

Rheumatoid Arthritis (RA) is a progressive disease of unknown aetiology which may be caused by faulty immune mechanisms. Early diagnosis and correct treatment can be extremely effective. Fast and lasting results can only be obtained by an appropriate combination of NSAID and DMARD drugs which both reduce subjective symptoms and halt the progression of the disease.

True vitamin B12/folate deficiency is more common than is currently appreciated; it appears in many guises and the classic hematological features of megaloblastic anaemia are often absent. The single most reliable predictor of megaloblastic anaemia is serum vitamin B12/folate concentration, but this determination in a screening program for all patients is difficult in terms of laboratory overload and cost. Early recognition of nutritional anaemias is, however, mandatory and we undertook this study to explore the possibility of identifying, on a demographic basis or because of routine laboratory results, a group of subjects at risk for vitamin B12/folate deficiency. Results obtained in simultaneous radioassay of serum B12 and folate levels and erythrocyte folate concentration in 1.200 hospitalized patients are presented. Coexisting iron deficiency was excluded by ferritin assay. We found no significant difference between males and females and no correlation between serum folate and B12 concentrations and aging. Low serum folic and cobalamin levels were found in 53% of patients with macrocytosis and elevated MCH, even in the absence of anaemia. These observations suggest that increased MCV and MCH may be present before a related anaemia and that serum folate and cobalamin levels must be monitored early in these patients to prevent a deficiency.