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Objective: Experts recommended that direct discharge without hospitalization (DDWH) for emergency departments (EDs) able to observe acute heart failure (AHF) patients should be 40%, and these discharged patients should fulfil the following outcome standards: 30-day all-cause mortality 40%. Considering DDWH patients altogether, outcomes A/C were above the recommended standards (4.3%/29.4%), while outcome B was nearly met (B = 10.1%). When analyzing individual EDs, 58.1% of them achieved the outcome B standard, while outcomes A/C standards were barely achieved (19.3%/9.7%). We observed clinically relevant linear/quadratic relationships between higher DDWH and worse outcomes B (weighted R-2 = 0.184/0.322) and C (weighted R-2 = 0.430/0.624), but not with outcome A (weighted R-2 = 0.002/0.022). Conclusions: The EDs of this nationwide cohort do not fulfil the standards for AHF patients with DDWH. High DDWH rates negatively impact ED revisit or hospitalization but not mortality. This may represent an opportunity for improvement in better selecting patients for early ED discharge and in ensuring early follow-up after ED discharge. (c) 2020 Published by Elsevier Ltd on behalf of Japanese College of Cardiology.

Haemotropic Mycoplasma infection among cattle has not been seriously looked into, despite the fact it is associated with poor weight gain and depression. One thousand and forty-five blood samples from apparently healthy cattle from forty-three farms within the entire Peninsular Malaysia were exa­mined over a one-year period. Using polymerase chain reaction to amplify the 16S rRNA gene, the presence of “Candidatus Mycoplasma haemobos” as one of the haemotropic Mycoplasma species that affects cattle in the country was detected. Forty-seven percent of the sampled population was positive for “C. M. haemobos”, with the antigen present in all herds sampled. Breed of cattle, gender, age, production type, physiological status, herd size, management system, farm size, farm age, prophylactic treatment against blood parasites, presence of ticks, frequency of de-ticking, zone, closeness to forest, closeness to waste area, closeness to human settlement and closeness to body of water were all significantly associated (P

Articolul pune în discuţie un caz clinic de boală Pompe forma tardivă la un adolescent în vârstă de 15 ani și 6 luni, internat într-un serviciu de gastroenterologie pediatrică pentru investigarea unei citolize hepatice persistente, fără răspuns la terapia hepatoprotectoare. După excluderea etiologiilor virale, autoimune, metabolice și toxic medicamentoase, s-a suspectat o boală de stocaj, motiv pentru care s-au efectuat teste biochimice şi genetice cu confirmarea glicogenozei tip II (boala Pompe), atât la nivel enzimatic prin deficit al α-glucozidazei (GAA), cât și prin identificarea a două mutații genice aflate pe cromozomul 17q25.2-q25.3.

The article discusses a clinical case of late-onset Pompe disease in a 15-year and 6-month-old adolescent hospitalised in a Paediatric Gastroenterology department to investigate persistent liver cytolysis, without response to hepatoprotective therapy. After excluding viral, autoimmune, metabolic and toxic drug aetiologies, a storage disease was suspected and imposed biochemical and genetic tests which confirmed a type II glycogenosis (Pompe disease), both by α-glucosidase (GAA) deficiency, as well as by the identification of two gene mutations on 17q25.2-q25.3 chromosome.

Background and Aim: Anaplasma infection is a worldwide prevalent condition that causes significant economic losses in affected flocks. This study was conducted to determine the prevalence and clinical signs associated with ovine anaplasmosis as well as the hematological and biochemical changes associated with the disease in natural infection in North Iraq. Materials and Methods: A total of 420 sheep were appropriately examined, and the clinical signs were documented accordingly. Blood samples were collected and subjected to parasitological, hematological, and biochemical analyses. Results: Anaplasma-infected sheep displayed the following clinical signs: Paleness of the mucous membrane, bloody diarrhea, emaciation, pyrexia, jaundice, nasal discharge, coughing, loss of wool, nervous signs, hemoglobinuria, and lacrimation. The prevalence of Anaplasma infection was 66.19%, and female sheep were significantly (p

Interventional digestive endoscopy in the pediatric population is major procedure in the diagnostic and therapeutic algorithm in children with different pathologies in the gastrointestinal spectrum and with a marked evolution in the current medical practice. This article attempts to describe all the situations where this technique is required electively or as a matter of urgency, providing a description of the method, the indications, as well as the complications that may arise. The interventional procedure is performed by a pediatric gastroenterologist or endoscopy technician, sometimes with the assistance of gastroenterologist for adults, under general anesthesia with orotracheal intubation or under conscious sedation. A good prognosis in such cases depends on the patient’s status, the available equipment, the expertise of the pediatric gastroenterologist, as well as on working together in the interdisciplinary team.

Endoscopia digestivă intervenţională în populaţia pediatrică este o etapă esenţială în algoritmul diagnostic şi terapeutic la copiii cu diferite patologii din sfera gastrointestinală, cu o marcată evoluţie în practica medicală curentă. Articolul de faţă descrie situaţiile în care tehnica este necesară în mod electiv sau în urgenţă, cu descrierea metodei, a indicaţiilor, dar şi a complicaţiilor care pot surveni. Procedura intervenţională se practică de către gastroenterologul sau endoscopistul pediatru, asistat uneori de gastroenterologul pentru adulţi, sub anestezie generală cu intubaţie orotraheală sau sedare conştientă. Un prognostic bun în aceste cazuri depinde de statusul pacientului, de aparatura disponibilă, de experienţa gastroenterologului pediatru, dar şi de colaborarea cu echipa interdisciplinară.

Congenital choledochal cysts are more frequently diagnosed in children under the age of 10, occurring prevailingly in female patients. We are presenting a case of choledochal cyst in a 7-month-old male baby, which had a sudden onset with scleral-cutaneous jaundice and lack of appetite. Abdominal ultrasound revealed a transonic, hyperreflective formation located in the topography of the main bile duct, dilated intrahepatic bile ducts, and laboratory tests revealed a severe syndrome of hepatic cytolysis and cholestasis. The diagnosis was confirmed using cholangiopancreatic MRI performed in an emergency regime and required surgical intervention. Therefore, the differential diagnosis of cholestasis syndromes must rule out choledochal cyst irrespective of the patient’s age due to the complications and risk of malignization.

Chistul congenital de coledoc este mai frecvent diagnosticat la copiii până la 10 ani, afectând preponderent persoanele de sex feminin. Prezentăm un caz de chist coledocian la un sugar de sex masculin în vârstă de 7 luni, care a debutat brusc cu icter sclerotegumentar şi inapetenţă. Ecografia abdominală a evidenţiat o formaţiune transsonică, hiperreflectogenă, cu localizare pe topografia coledocului, căi biliare intrahepatice dilatate, iar examenele de laborator au decelat un sindrom sever de citoliză hepatică şi colestază. Diagnosticul a fost confirmat cu ajutorul IRM colangiopancreatic efectuat în urgenţă şi a impus intervenţia chirurgicală. Diagnosticul diferenţial al sindroamelor de colestază trebuie să excludă şi chistul coledocian, indiferent de vârsta pacientului, din cauza complicaţiilor şi riscului de malignizare.

Background: Physical examination remains the cornerstone in the assessment of acute heart failure. There is a lack of adequately powered studies assessing the combined impact of both systolic blood pressure (SBP) and hypoperfusion on short-term mortality. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in 3 time periods between 2011 and 2016. Logistic regression models were used to assess the association of 30-day mortality with SBP ( Results: Among 10 979 patients, 1143 died within the first 30 days (10.2%). There was an inverse association between 30-day mortality and initial SBP (35.4%, 18.9%, 12.4%, and 7.5% for SBPP P P -for-interaction =0.043. Conclusions: Hypoperfusion confers an incremental risk of 30-day all-cause mortality not only in patients with low SBP but also in normotensive patients. On admission, physical examination plays a major role in determining prognosis in patients with acute heart failure.

Altres ajuts: Ministerio de Sanidad; Fondo Europeo de Desarrollo Regional (FEDER); Fundació La Marató de TV3 (2015/2510); Novartis; Orion Pharma. Aims: To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs (ANHD), the variables related to ANHD prescription and their relationship with outcomes. Methods: We included consecutive HFpEF patients (left ventricular ejection fraction ≥50%) discharged after an AHF episode from 45 Spanish hospitals whose chronic medications and treatment at discharge were available. Patients were classified according to whether they were discharged with or without ANHD, including beta-blockers (BB), renin-angiotensin-aldosterone-system inhibitors (RAASi) and mineralcorticosteroid-receptor antagonists (MRA). Co-primary outcomes consisted of 1-year all-cause mortality and 90-day combined adverse event (revisit to emergency department -ED-, hospitalization due to AHF or all-cause death). Secondary outcomes were 90-day adverse events taken individually. Adjusted associations of ANHD treatment with outcomes were calculated. Results: We analyzed 3,305 patients with HFpEF (median age: 83, 60% women), 2,312 (70%) discharged with ANHD. The ANHD most frequently prescribed was BB (45.8%). The 1-year mortality was 26.9% (adjusted HR for ANHD patients:1.17, 95%CI=0.98-1.38) and the 90-day combined adverse event was 54.4% (HR=1.14, 95%CI=0.99-1.31). ED revisit was significantly increased by ANHD (HR=1.15, 95%CI=1.01-1.32). MRA and BB were associated with worse results in some co-primary or secondary endpoints, while RAASi (alone) reduced 90-day hospitalization (HR=0.73, 98%CI=0.56-0.96). Conclusion: 70% of HFpEF patients are discharged with ANHD after an AHF episode. ANHD do not seem to reduce mortality or adverse events in HFpEF patients, only RAASi could provide some benefits, reducing the risk of hospitalization for AHF.

Ectoparasitism is the most devastating parasitic condition of poultry after coccidiosis. The present study was conducted to identify the risk factors associated with avian ectoparasitism in Osun State, Nigeria. Data was obtained from avian species presented at the major Veterinary Hospitals in Osun State between January 2006 and December 2015. A total of 4,584 avian species were presented in the period under review. Of the presented birds, 2,665 (58.14%) were young, while 1,919 (41.86%) were adults. One thousand nine hundred and ninety four (43.50%) were male and 2,590 (56.50%) were female. More birds (2,868, 62.57%) were presented during the wet season compared to the dry season (1,716, 37.43%). Turkeys 2,088 (45.55%) were the most frequently presented bird type, followed by layers 1,476 (32.20%) and local chickens 1,020 (22.25%). A total of 324 (7.07%) avian species were diagnosed for ectoparasitic infestations, of which lice infestation was the most prevalent (216, 4.71%) followed by flea infestation (72, 1.57%), tick infestation (24, 0.52%) and mite infestation (12, 0.26%). There was no defined pattern in the yearly and monthly prevalence of ectoparasite infestations. Age, sex, seasons and species were significantly associated (P

BACKGROUND Animal trypanosomiasis (Surra) caused by Trypanosoma evansi (T. evansi) is known to be one of the important haemoprotozoan parasites that causes great economical loss on animal production due to mortality and loss of condition. METHODS A cross-sectional study was designed to evaluate the prevalence and risk factors associated with T. evansi infection among cattle in Peninsular Malaysia. Polymerase chain reaction (PCR) was employed on 1045 blood samples collected from 43 farms. A well-structured questionnaire was used to collect data on risk factors associated with T. evansi prevalence. The RoTat 1.2 set of primers was used to amplify products of 205 base pair. RESULTS The overall prevalence was found to be 17.9% (187/1045; 95% CI = 15.66-20.31). Trypanosoma evansi was detected among cattle in all the States of Peninsular Malaysia. Breeds of cattle and closeness to waste area, where the risk factors significantly (p

Objective: To study the outcomes of patients with acute heart failure (AHF) presenting renal dysfunction (RD) or hyperkalaemia (Hk) alone or in combination. Method: We analysed the data of the EAHFE registry, a multicentre, non interventionist cohort with prospective follow-up of patients with AHF. Four groups were defined based on the presence or not of RD or Hk alone or in combination. The primary endpoint was 30-day all-cause mortality. Results: A total of 11,935 of the 13,791 patients included in the EAHFE registry were analysed. Of these, 5088 (42.6%) did not have RD or Hk (NoRD-NoHk), 150 (1.3%) had no RD but had Hk (NoRD-Hk), 6012 (50.4%) had RD but not Hk (RD-NoHk) and 685 (5.7%) had both RD and Hk (RD-Hk). Thirty-day all-cause mortality was greatest in the RD-Hk group with an adjusted Hazard Ratio (HR) of 2.44 (confidence interval 95% [CI95%] 1.67-3.55; p < 0.001) and in the RD-NoHk group with an adjusted HR of 1.34 (CI95% 1.04-1.71; p = 0.022). There were no significant differences in in-hospital mortality and reconsultation at 30 days for HF. For the combined endpoint of 30-day all-cause mortality the adjusted HR was 1.33 (CI95% 1.04-1.70); (p = 0.021) for the RD-Hk group. Conclusions: The association of 30-day all-cause mortality with the presence of RD and Hk in patients presenting AHF at admission is greater than in those without this combination.

Enterocytozoon bieneusi is an emerging opportunistic pathogen infecting humans, and both domestic and wild pigs are known to harbour zoonotic genotypes. There remains a paucity of information on the prevalence and epidemiology of this enteropathogen in Southeast Asia. The present study was undertaken to determine the molecular prevalence and risk factors associated with E. bieneusi infection among commercially farmed pigs in Malaysia. Faecal samples were collected from 450 pigs from 15 different farms and subjected to nested PCR amplification of the ribosomal internal transcribed spacer (ITS) gene of E. bieneusi. Phylogenetic analysis involved 28 nucleotide sequences of the ITS region of E. bieneusi. An interviewer-administered questionnaire provided information on the animal hosts, farm management systems and environmental factors and was statistically analysed to determine the risk factors for infection. The prevalence of E. bieneusi infection was relatively high (40.7%). The highest prevalence (51.3%) was recorded among the piglets, while the adults showed the lowest level of infection (31.3%). Multivariate analysis indicated that age of the pigs, distance of the farm from human settlement and farm management system were significant risk factors of infection. Three genotypes (EbpA, EbpC and Henan-III) detected among the pigs are potentially zoonotic. The high prevalence of E. bieneusi among locally reared pigs, the presence of zoonotic genotypes and the spatial distribution of pig farms and human settlements warrant further investigation on the possibility of zoonotic transmission.

Enteric protozoa infection among cattle may pose a threat to productivity and survival leading to negative impacts on the livestock industry. A number of these pathogens are also known to be zoonotic and are of public health concern. Despite the importance of these enteric protozoa to both animal and human health, there remains a paucity of published information on the epidemiological risk factors that may be associated with bovine cryptosporidiosis in Southeast Asia. The present study was undertaken to determine the molecular prevalence and associated risk factors for Cryptosporidium infection among beef and dairy cattle in Peninsular Malaysia. Faecal samples were collected from 824 cattle in 39 farms (526 beef and 298 dairy) situated in 33 locations throughout the country, and subjected to PCR detection for Cryptosporidium using primers targeting the 18S SSUrRNA gene. Epidemiological variables including host, environment and management factors were subjected to univariate and multivariate logistic regression analyses to determine the potential risk factors for infection. The prevalence of Cryptosporidium among the cattle was 12.5%, with significant difference in the infection rate among the various breeds. There was no significant effect of gender, and both the beef and dairy cattle were at similar odds for infection. The younger cattle had a significantly higher infection rate compared to the older animals. Multivariate analysis revealed that deworming practice, distance to human settlement, geographical location (zone) and farm management system were significant risk factors associated with Cryptosporidium infection. The cattle that were reared on farms located in the northeast of the country, closest (≤200 m) to human settlements, reared extensively, and dewormed every four months were at highest risk of infection. The present study constitutes the first attempt to analyze the multivariable epidemiological risk factors involved in bovine cryptosporidiosis in Malaysia and in Southeast Asia. It is envisaged that the data obtained will facilitate better control and prevention measures for Cryptosporidium infection among cattle in the region. Due to the potential zoonotic nature of the infection, serious steps should be instituted for animal treatment and biohazard waste management on local cattle farms. Keywords: Cryptosporidium, Cattle, Risk factors, Peninsular Malaysia

Background: The aim of this study was to describe the prevalence and prognostic value of the most common triggering factors in acute heart failure. Methods: Patients with acute heart failure from 41 Spanish emergency departments were recruited consecutively in three time periods between 2011 and 2016. Precipitating factors were classified as: (a) unrecognized; (b) infection; (c) atrial fibrillation; (d) anaemia; (e) hypertension; (f) acute coronary syndrome; (g) non-adherence; and (h) two or more precipitant factors. Unadjusted and adjusted logistic regression models were used to assess the association between 30-day mortality and each precipitant factor. The risk of dying was further evaluated by week intervals over the 30-day follow-up to assess the period of higher vulnerability for each precipitant factor. Results: Approximately 69% of our 9999 patients presented with a triggering factor and 1002 died within the first 30 days (10.0%). The most prevalent factors were infection and atrial fibrillation. After adjusting for 11 known predictors, acute coronary syndrome was associated with higher 30-day mortality (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.02–3.42), whereas atrial fibrillation (OR 0.75; 95% CI 0.56–0.94) and hypertension (OR 0.34; 95% CI 0.21–0.55) were significantly associated with better outcomes when compared to patients without precipitant. Patients with infection, anaemia and non-compliance were not at higher risk of dying within 30 days. These findings were consistent across gender and age groups. The 30-day mortality time pattern varied between and within precipitant factors. Conclusions: Precipitant factors in acute heart failure patients are prevalent and have a prognostic value regardless of the patient’s gender and age. They can be managed with specific treatments and can sometimes be prevented.

Animal trypanosomiasis (Surra) caused by Trypanosoma evansi (T. evansi) is known to be one of the important haemoprotozoan parasites that causes great economical loss on animal production due to mortality and loss of condition. A cross-sectional study was designed to evaluate the prevalence and risk factors associated with T. evansi infection among cattle in Peninsular Malaysia. Polymerase chain reaction (PCR) was employed on 1045 blood samples collected from 43 farms. A well-structured questionnaire was used to collect data on risk factors associated with T. evansi prevalence. The RoTat 1.2 set of primers was used to amplify products of 205 base pair. The overall prevalence was found to be 17.9% (187/1045; 95% CI = 15.66–20.31). Trypanosoma evansi was detected among cattle in all the States of Peninsular Malaysia. Breeds of cattle and closeness to waste area, where the risk factors significantly (p

Bovine anaplasmosis is a major concern to cattle farming in most parts of the world. Anaplasmosis negatively impacts the profitability of cattle farming by reducing the production, reproduction, and draft ability of cattle. Here, we report results from a one-year cross sectional study to determine the epidemiology and the risk factors for Anaplasma marginale infection of cattle in Peninsular Malaysia. Examination of one thousand and forty five blood samples of apparently healthy cattle from forty-three farms in all the states of Peninsular Malaysia by polymerase chain reaction (PCR) assay revealed an overall prevalence of A. marginale infection of cattle of 72.6%, showing high endemicity of this heamoprotozoan among cattle in the country. Cattle breeds, production type, herd owner, herd size, management system, farm size, farm age, prophylactic treatment against blood parasites, presence of ticks, frequency of deticking, zones, closeness to forest, closeness to waste area, closeness to human settlement and closeness to body of water were the risk factors significantly associated (P 0.05) with the detection of A. marginale in cattle. Results of this first molecular study on the epidemiology and risk factors for A. marginale infection of cattle from all the states of Peninsular Malaysia suggest policies and strategies for the prevention and control of the parasite to improve profitability of cattle farming in the country.

Romania is a European Union (EU) country with poor resources and all underfinanced components of the deconstructed healthcare system are competing for the same limited funds. Palliative care must compete with other serious healthcare issues, including the highest EU incidences for tuberculosis, infant mortality, and uterine cervix cancer mortality. Therefore, the evolution of palliative care in Romania was largely the result important input from non-governmental organizations, which are now the main providers of palliative care services, including education on the subject. Palliative care has changed in Romania over the past 20 years for a number of reasons, including motivated people, two national associations, annual conferences, a new physician subspecialty, standards of care, online journals, a new opioid law, and a dedicated subcommittee of the Ministry of Health. We consider that the most viable solution for now and in the near future should be the implementation of small autonomous teams that will ...

Purpose This randomized study assessed whether the best overall response rate (ORR) of cetuximab combined with oxaliplatin, leucovorin, and fluorouracil (FOLFOX-4) was superior to that of FOLFOX-4 alone as first-line treatment for metastatic colorectal cancer. The influence of KRAS mutation status was investigated. Patients and Methods Patients received cetuximab (400 mg/m2 initial dose followed by 250 mg/m2/wk thereafter) plus FOLFOX-4 (oxaliplatin 85 mg/m2 on day 1, plus leucovorin 200 mg/m2 and fluorouracil as a 400 mg/m2 bolus followed by a 600 mg/m2 infusion during 22 hours on days 1 and 2; n = 169) or FOLFOX-4 alone (n = 168). Treatment was continued until disease progression or unacceptable toxicity. KRAS mutation status was assessed in the subset of patients with assessable tumor samples (n = 233). Results The confirmed ORR for cetuximab plus FOLFOX-4 was higher than with FOLFOX-4 alone (46% v 36%). A statistically significant increase in the odds for a response with the addition of cetuximab to FOLFOX-4 could not be established (odds ratio = 1.52; P = .064). In patients with KRAS wild-type tumors, the addition of cetuximab to FOLFOX-4 was associated with a clinically significant increased chance of response (ORR = 61% v 37%; odds ratio = 2.54; P = .011) and a lower risk of disease progression (hazard ratio = 0.57; P = .0163) compared with FOLFOX-4 alone. Cetuximab plus FOLFOX-4 was generally well tolerated. Conclusion KRAS mutational status was shown to be a highly predictive selection criterion in relation to the treatment decision regarding the addition of cetuximab to FOLFOX-4 for previously untreated patients with metastatic colorectal cancer.

4035 Background: FOLFOX-4 is a standard first-line treatment for patients (pts) with mCRC. The IgG1 monoclonal antibody cetuximab has proven activity in combination with cytotoxic chemotherapy. Excellent response rates (RRs) have been reported with first-line cetuximab and FOLFOX-4. This randomized, controlled study was conducted to compare RRs of FOLFOX-4 + cetuximab vs FOLFOX-4. Methods: Pts with previously untreated epidermal growth factor receptor (EGFR)-expressing mCRC not resectable with curative intent were eligible. They were randomized 1:1, stratified by ECOG performance status (PS) (0–1 vs 2), to either Group A (cetuximab 400 mg/m2 initial dose then 250 mg/m2/week plus FOLFOX-4 every 2 weeks [oxaliplatin 85 mg/m2 day (d) 1; FA 200 mg/m2 d1, 2; 5-FU 400 mg/m2 bolus + 600 mg/m2 infusion over 22 h, d1, 2]) or Group B (FOLFOX-4 only). The primary objective was the best confirmed RR assessed by independent review; secondary objectives were progression- free survival (PFS), overall survival (OS), the R0 resection rate after metastatic surgery of curative intent and safety. Results: Between July 2005 and March 2006, 337 pts were randomized and treated in more than 70 centers in Europe. 181 (53.7%) pts were male; the median age of all pts was 61.0 years [24–82]; 305 (90.5%) pts had an ECOG PS of 0 or 1, and 32 (9.5%) of 2. The best overall confirmed RR was 45.6% in A and 35.7% in B. For pts with ECOG PS 0–1, RR was 49.0% in A and 36.8% in B (Odds Ratio 1.648, 95%CI [1.043- 2.604]). PFS and OS results are not yet available. The most common grade 3/4 adverse events were neutropenia (27.6% in A; 31.5% in B), diarrhea (7.1 and 6.0%), leucopenia (7.1 and 5.4%) and rash (9.4%, in A only). Conclusions: The addition of cetuximab increased the RR of FOLFOX-4 in first-line treatment of mCRC. Grade 3/4 adverse events, with the exception of skin rash, were not significantly more frequent in the cetuximab arm. No significant financial relationships to disclose.

8145 Background: Based on our previous research we hypothesized that three important mechanisms underlie serosal effusions and extensive loco-regional edema of locally advanced malignancies: active vasodilation gradually evolving from local to regional aspects, and increased secretion of autacoids and aldosteron. Hence, vasoconstrictor drugs, autacoid antagonists, and spironolactone should oppose the process. Method: 25 patients (pts) with both tumors of various types and locations, and serosal effusions or locoregional edema for which antitumor treatments were inapplicable or had previously failed, were treated for 3–27 weeks with ergotamine 0.5 mg once daily and t.i.d. propranolol 20–40 mg, ibuprofen 200 mg, cyproheptadine 2 mg, ranitidine 150 mg, and spironolactone 25–50 mg. Pts with pain or on vasodilating drugs were excluded while dexametasone for anorexia and local wound care were allowed. Regression with =50% of either serosal effusions (i.e. at least doubling the interval of instrumental draining)...

SummaryThe determination of subtypes for the HBs antigen and the search for the HBe antigen were used to confirm the risk of contamination for a spouse or for the family of patients who have viral hepatitis.The presence of the HBs antigen of the same subtype as that of the patient or the corresponding anti-HBs antibody of this subtype shows the spread of the virus to other members of the family.Many of the index-cases were positive for HBe antigen.