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Screening of donated blood for hepatitis B surface antigen and for serum alanine aminotransferase concerntration has been performed in Italy since the early 1970s. Screening for other surrogate markers, such as antilbody to hepatitis B core antigen has never been done. Screening for antibodies to hepatitis C virus was routinely done in a few blood banks since 1990; it became compulsory in 1991. Second generation enzyme linked immunosorbent assay (ELISA) was introduced in 1992 in all blood banks. Using data from the surveillance system for acute viral hepatitis (SEIEVA), we have evaluated the incidence of transfusion associated B and non-A, non-B hepatitis in Italy from 1987 to 1993. ### and results SEIEVA, which is coordinated by the Istituto Superiore di Sanita in collaboration with health districts, started in 1985.1 From 1985 to 1993 the number of health districts participating in …

Background and Aims: In the Mediterranean region the m1986 mutation prevails in greater than 98% of HBeAg negative chronic hepatitis B patients (CHB). In this study the frequence of addittional mutations in the precore region was investigated in Albanian patients with CHB Methods: The hepatitis B virus precore/core gene from 40 patients with CHB was amplified by PCR and nucleotide sequences were analysed. Results and Conclussions: Sixteen HBeAg positive and 24 HBeAg negative sera were studied. All HBeAg negative sera showed m1896, and 16 (67%) had one or more addittional mutations (nucleotide: 1762, 1764, 1753, 1899 1907). Compared with wild viremia, patients with additional mutations were significantly older.. Eight of 16 I-IBeAg positive patients (50%) showed only wild-type and the remaining 8 (50%) showed heterogeneous viremia (in 2 patients wild and m 1896 and in 6, addittional mutations were observed). Although the mutations 1762T 1764A suppressed HBeAg no association was found between these and HBeAg negativity The additional mutations in both HBeAg positive and negative patients were always associated with higher HBV DNA levels, but was not found to be preferentially associated with active liver disease as evaluated by high levels of IgM anti core (>0.300), biochemical findings and/or histologic diagnosis

Objective: To determine whether an outbreak of hepatitis A virus (HAV) infection that occurred in 52 patients with hemophilia in Italy was acquired through infusion of contaminated factor VIII or t...

Hepatitis B virus (HBV) is endemic in Italy. Approximately 400,000 infections (a rate of 700/100,000) occur each year. Chronic liver disease is one of the leading causes of death occurring at a rate of 33.6/100,000 and HBV infection is responsible for at least 60% of chronic active hepatitis (CAH) and 30% of non alcoholic liver cirrhosis. The prevalence of asymptomatic HBsAg carriers, studied in males, has been found > 3% in the general population. We report results of a study on a national scale aimed at providing information about the HBsAg prevalence among females; it refers to the years 1984–86. Over 650,000 pregnant women have been screened for HBsAg during the ongoing vaccination campaign against hepatitis B. The overall HBsAg prevalence has been 2.4% with wide regional differences; in some northern and central areas (Trento, Bolzano, Umbria) the prevalence of HBsAg carriers was below 0.5%, whereas in some southern regions (Campania, Puglia, Sardegna) it was higher than 5%. In some southern provinces we have found an HBsAg prevalence higher than 7% and in some towns higher than 10%. This high carrier rate is a consequence of infections aquired very early in life as suggested by the young age of 1154 biopsy proven HBsAg-positive chronic active hepatitis patients. As the proportion of HBeAg positive among HBsAg carrier mothers is only 5% both in northern and in southern Italy, perinatal transmission does not play a major role in the spread of infection. We regard as more important the impact of a later horizontal transmission; the fact that 30% of children with acute hepatitis B belong to a ‘household with a chronic HBsAg carrier’, while only 4% of children with acute hepatitis A present such exposure, confirms this hypothesis. In this scenario, immunization of all babies, irrespective of HBsAg status of the mother appears to be, in selected endemic areas in Italy, a strategy which deserves serious consideration.

Background Anterior cruciate ligament (ACL) surgical reconstruction is performed with the use of an autogenic, allogenic or synthetic graft. The document issued by the Italian National Guidelines System (SNLG, Sistema Nazionale Linee Guida) at the National Institute of Health aims to guide orthopaedic surgeons in selecting the optimal graft for ACL reconstruction using an evidence-based approach. Materials and methods A monodisciplinary panel was formed to define a restricted number of clinical questions, develop specific search strategies and critically appraise the literature using the grading of recommendations assessment, development, and evaluation (GRADE) method. The final draft was shared by the panel and then sent to four external referees to assess its readability and clarity, its clinical relevance and the feasibility of recommendations. Results Autograft shows moderate superiority compared with allograft, in relation to the relevant outcomes and the quality of selected evidence, after an appropriate risk–benefit assessment. Allograft shows higher failure rate and higher risk of infection. The panel recommends use of autografts; patellar tendon should be the first choice, due to its higher stability, while use of hamstring is indicated for subjects for whom knee pain can represent a particular problem (e.g., some categories of workers). Conclusions Autograft shows better performance compared with allograft and no significant heterogeneity in relation to relevant outcomes. The GRADE method allowed collation of all the information needed to draw up the recommendations, and to highlight the core points for discussion.

Objective: To evaluate prevalence of and risk factors for hepatitis C virus (HCV) infection and the role of genital ulcer disease in the sexual transmission of HCV among 1280 nonintravenous-drug-using heterosexuals attending a sexually transmitted disease clinic. Methods: Serum samples were tested by a third-generation enzyme-linked immunosorbent assay (ELISA) test. Reactive sera were confirmed using a RIBA assay. The independent effect of different variables on the likelihood to be anti-HCV positive was assessed by multiple logistic regression analysis. Results: The overall anti-HCV prevalence was 4.9%, a rate nearly ten times as high as the 0.5% recently found in a national sample of young male adults 18 to 26 years old. The prevalence was 9.6% in subjects with positive syphilis serology and 3.8% in those without a history of sexually transmitted disease. Multiple logistic regression analysis showed that age greater than 34 years (OR 2.9; 95% CI 1.1–7.6), low educational level (OR 2.0; 95% CI 1.1–3.5), positive syphilis serology (OR 2.1; 95% CI 1.04–4.1), and anti-HIV positivity (OR 4.6; 95% CI 1.2–18.7) were all independent predictors of HCV infection. Conclusions: These findings are consistent with sexual transmission of HCV Syphilis infection may be a cofactor in HCV transmission or, alternatively, may be a strong indicator of high-risk sexual behavior.

A village outbreak of 38 cases of serologically confirmed hepatitis A is described. The epidemic curve was a propagative one and all of the cases occurred in primary school-age or pre-school children. In 1984 the incidence in this age group was 5,000 per 100,000, about 50 times the corresponding national rate. Although 21 of the cases attended the single primary school, these cases were not clustered within school years or classes and examination of onset dates showed only four cases could have resulted from case transmission within classes. A matched triplet case-control study was undertaken to measure the risk associated with prior contact with a case within the acquaintance network and the risk of household contact with either of the two pre-school nurseries where inapparent transmission may have been occurring. Whereas a similar proportion of cases and controls had direct or indirect contact with the nurseries, 48% of cases, compared with 9% of controls, reported a previous case of jaundice within 6 weeks amongst their acquaintance network (matched triplet analysis P less than .0001).

The estimated prevalence of herpes simplex virus type-2 specific antibodies was less then 0.1 % in a national sample of 1,169 healthy young males, 4.8 % among 411 health care workers and 55 % among 397 homosexuals. These viral infections seem to pose a health problem for risk groups such as homosexuals but not for the general population.

Prevalence of Herpes Simplex, type 2, specific antibodies was estimated in sexually transmitted disease outpatients: 783 heterosexuals and 158 homosexual-bisexuals. The anti-HSV-2 prevalence rates were 69% in the homosexual-bisexuals and 35% in the heterosexuals. In both groups positive association with age of anti-HSV-2 prevalence was found: only in the homosexual-bisexuals negative as sociation with education level was detected. No difference exists between the two groups regarding the symptomatic/asymptomatic ratio of HSV-2 infection.

Abbiamo gia notato come il commercio prexis abbia un suo sviluppo nel senso di un᾽ispessimento del rapporto πρῆξις -commercio e parallelamente di un intervento di forze economiche e sociali diverse dall᾽aristocrazia. Su questi sviluppi occorre trattenersi ora piu dettagliatamente. Una prima caratteristica di questi sviluppi e l᾽insorgere di articolazioni verticali nell᾽organizzazione di tale commercio: la realta cioe di aristocratici che riservano a se il compito di alimentare il commercio, m...

The hepatitis B virus (HBV) and hepatitis Delta virus (HDV) infection rates were estimated in patients attending a venereal disease outpatient clinic: 759 heterosexuals and 154 homosexual-bisexual men. The anti-HBC prevalence was higher in homo-bisexual men (68.8 per 100) than in heterosexuals (41.8 per 100), whereas HBsAg was roughly the same in the two groups (about 6 per 100). The anti-HBc prevalence rate among heterosexuals was higher than that estimated in hospital personnel from the same geographical area. A positive association between anti-HBc prevalence and present or past sexually transmitted diseases (STD) was found among homo-bisexual men. Anti-HBc was also positively associated with herpes simplex type 2 antibodies in both heterosexuals and homo-bisexual men. These data are consistent with the hypothesis that sexual behavior also plays a role in the spread of infection among heterosexuals. Ten of the 46 HBsAg-positive subjects were anti-HDV positive: 6 of the 36 heterosexuals and 4 of the 10 homosexuals. All HDV-positive subjects had present or past STDs. These findings suggest sexual transmission of HDV infection.

L’emporie esiodea presenta, come e noto, un carattere di assoluta autarchia organizzativa e di perfetta integrazione nel mondo degli ἔργα; si presenta anzi essa stessa come ἔργον tra questi ἔργα, inserendosi accanto ad essi nel mondo dei lavori agricoli, scandito da un νόμος, o legge di natura, determinato dalla posizione geografica e dal trascorrere delle stagioni. Questo fa si che il commercio esiodeo assuma un carattere del tutto contraddittorio rispetto alla definizione di ἐμπορίη che pur...

A study of 164 consecutive patients (97 males, 67 females; aged 3-11 years) with acute hepatitis was done. Hepatitis A was the most frequent etiologic type. It occurred in 82.7% of the 3-5-year age group, and in 72.2% and 57.2% of the 6-8- and 9-11-year age groups, respectively. Non-A, non-B hepatitis was rather infrequent (4.3%). Hepatitis B occurred in 13.7% of the 3-5-year age group and reached 39.6% in the 9-11-year age group. While all hepatitis A and non-A, non-B cases recovered within a relatively short time, hepatitis B patients recovered more slowly; two cases recovered 1 year after the onset of symptoms. Chronicity was demonstrated in 23.8% of hepatitis B patients 2 years after the onset of the disease. HBsAg clearance was slower in children than in adults. At 4 months, only 59% of patients had serum converted, and a chronic carrier state occurred in 13 of 42 subjects followed for up to 2 years (three healthy carriers and 10 with chronic hepatitis of various types). Our data show that persistence of HBeAg positivity does not always lead to chronicity in children. Of the eight patients HBeAg-positive 1 year after the onset of symptoms, two recovered.

One-hundred-ninety-two stool samples were tested for the presence of human Hepatitis A antigen. Sixteen of these were also evaluated for the presence of infectious virus. All samples were obtained from young and apparently healthy people from endemic areas for Hepatitis A disease. The isolation of the infectious virus from these stools demonstrates clearly the wide diffusion of the virus in these areas, and its transmission by the oral-fecal route.

In order to prevent hepatitis B virus (HBV) infection of infants of hepatitis B surface antigen (HBsAg)-positive mothers, a nation-wide immunization programme was initiated in Italy in January 1984. During the first 3 years (1984-86), 651,667 out of 1726,000 pregnant women (37.8%) were screened for HBsAg; the percentage of mothers screened increased from 32% in 1984 to 51% in 1986 in 15 of the 21 Italian regions, where data by year were available. HBsAg was present in 15,640 mothers (2.4% of those screened); range by region 0.3-6.4%. All newborns of HBsAg-positive women, regardless of the mother's status of hepatitis Be antigen (HBeAg), were given a single dose (0.5 ml Kg-1) of a hepatitis B immune globulin within 24 h after birth and the first dose of plasma-derived hepatitis B vaccine within 7 days after birth. The immunization coverage rate was 80% in the 3-year period. Protective antibodies were found in greater than 97% of a sample of 1071 infants, immunized from different regions. No serious reactions were observed. On the basis of this field experience, it may be concluded that a nation-wide hepatitis B vaccination programme for infants of HBsAg-carrier mothers would be highly immunogenic and safe. Its implementation, however, requires continuous public education and cooperation from physicians.

Partendo dal dato di fatto che il commercio esiodeo riposa sulla media proprie ta fondiaria, alle prese con i debiti e con la indigenza, e che esso viene, secondo lui, esercitato con una o piu imbarcazioni a remi e prive di ponte, B. Bravo ritiene che questo commercio esiodeo abbia scarsamente contribuito allo sviluppo del commercio arcaico e nessun rilievo gli assegna, neanche come testimonianza indiretta di tale commercio, se non per notare come questo commercio esiodeo possa anch’esso inse...

1. — L’esistenza di una siderurgia calcidese in eta arcaica e un fatto ormai indubitabile. Giacimenti di ferro risultano ancor oggi nella parte centrale dell’Eubea,e quelli nell’area di Psakna sono facilmente accessibili da Calcide. La presenza in eta antica di οιδηρωρυχeῖα in Eubeae a Calcide viene piu volte sottolineata dalle fonti. Callimaco parlava di un dio od un eroe come di colui che aveva insegnato in Eubea l’arte di scavare il ferro. Strabone, nella zona centrale dell’Eubea, a ridoss...

I legami che uniscono il commercio esiodeo al commercio omerico permettono di considerare quest’ultimo come l’antecedente e il modello del commercio ergon. L’affinita tra le due esperienze e stata gia sottolineata di sopra. Si potra ancora ricordare che come l’emporie-ergon, cosi anche il commercio πρῆξις si svolge sul mare: tutte le testimonianze che ne abbiamo riguardano ξeĩνοι, e quindi alludono a un commercio esterno alla comunita di origine, e riguardano persone che viaggiano su nave. Si...

The prevalence of antibodies to human immunodeficiency virus (anti-HIV-1) was determined in 924 outpatients attending a sexually transmitted disease clinic. The overall prevalence of anti-HIV-1 was 9 %. Six of 14 intravenous drug addicts and 4 of 34 patients of African origin were anti-HIV-1 positive. In the other 876 patients, the anti-HIV prevalence was 6.6 % in 467 heterosexual men, 5 % in 261 heterosexual women and 22.3 % in 148 homosexual or bisexual men. The prevalence of anti-HIV-1 in the heterosexual subjects was much higher than that expected in the general population and than that observed in patients attending sexually transmitted disease clinics in other developed countries. Intravenous drug abusers, who represent the most important group at risk for AIDS in Italy, could contribute to the spread of HIV infection through heterosexual contacts with persons without other known risk factors.

Il commercio esiodeo si presenta in primo luogo come attivita autonoma, con una specifica fisionomia: esso e gia ἐμπορίη, commercio marittimo rivolto verso l’esterno. ‘Eμπορίη infatti e sinonimo di ναυτιλίη e di πλόος; la pratica di essa comporta consigli sulla manutenzione di una imbarcazione e sull’epoca opportuna per l’imbarco; rievocazione dei viaggi paterni(; consigli sulla nave da utilizzare; consigli sulla navigazione e rievocazioni autobiografiche sull’unico viaggio marittimo compiuto...

Gia in eta omerica il viaggio su nave puo essere compiuto su nave altrui, sicche allo straniero si chiede sempre con che nave e venuto e chi erano i marinai che l’hanno condotto: la risposta e di volta in volta che il viaggio e stato compiuto con nave e compagni propri o con nave e ciurma appartenente ad altri. A denotare la condizione di chi viaggia cosi si usa un termine specifico, che e appunto ἔμπορος, per il quale esplicitamente si dice che riguarda chi viaggia su navi altrui perche non ...

In May 1988, the hepatitis A antibody (anti-HAV) and hepatitis B virus (HBV) markers were studied by radioimmunoassay in 484 apparently healthy children between the ages of 7 and 12, attending a primary school in Naples, Italy. The overall anti-HAV prevalence was 11.2%, increasing from 5.2 in 7-year-old children to 28.2% in children between the ages of 11 and 12 years old. The overall prevalence of the hepatitis B surface antigen (HBsAg) and of other HBV markers were 0.8 and 6.8 respectively. Compared with a similar previous study conducted in Naples in 1980, the results show a significant reduction in the prevalence of anti-HAV in each of the two age-groups (P less than 0.01), in the prevalence of any HBV marker in the 11 to 12-year-old group, as well as in the total population (P less than 0.05). The findings of the present study indicate that today, children in Naples are less exposed to the hepatitis A virus than in the past, most likely because of improvements in both the socioeconomic conditions and in health education during recent years. These same reasons, as well as decreased family size and a lower prevalence of HBeAg among HBsAg carriers could explain the decline, although to a lesser degree, of exposure to HBV infection.

Accanto alle testimonianze di attivita commerciali in ambito acheo, Omero registra attivita di commercio realizzate da Fenici. I casi citati sono tre: quello dei Fenici che frequentano il porto di Lemno; quello dei Fenici che frequentano l’Egitto e la Libia; quello infine dei Fenici nell’isola di Syrie. Nel primo caso i Fenici appaiono come coloro che hanno donato al re di Lemno un cratere d’argento lavorato di sei misure che assai bello avevano fatto i Sidoni πολυδαίδαλοι e che, prima di don...

Il problema del rapporto tra il tipo di commercio che Esiodo consiglia ed il commercio aristocratico, omerico ed arcaico, puo essere spiegato in vari modi. Una prima spiegazione la offre l’analisi della tradizione che Esiodo riprende, una tradizione, come si vide, ionica ed anatolica in cui confluiscono tanto i commerci locali quanto le navigazioni a lunga distanza, pontiche ed occidentali. Ma ci sono, a veder bene, ragioni piu profonde che spiegano altrettanto bene questa accennata continuit...

Between April 1984 and January 1985, in the Italian seaport of Livorno, the annual incidence of serologically confirmed acute hepatitis A doubled to 46 per 100,000 population. The exposure histories of each of 75 jaundiced subjects with serologically confirmed hepatitis A were compared with up to four, randomly chosen-, age-, sex-, and neighborhood-matched controls. Illness was strongly associated with consumption of raw mussels and clams within six weeks of onset of illness. When the two thirds of the subjects who had been exposed were classified according to the frequency with which they had recently consumed any type of raw shellfish, there was a clear dose-response relation. In February 1985, comprehensive control measures were introduced and the annual incidence of hepatitis A fell to 2.3 per 100,000 population, a 10-fold decrease from the preepidemic period.

To assess hepatitis C virus (HCV) incidence rates and identify determinants of infection among hemodialysis patients, a multicenter study was conducted in 58 units in ITALY: An initial seroprevalence survey was conducted among 3,492 patients already on hemodialysis therapy as of January 1997 and among an additional 434 patients who began dialysis up to January 1998. HCV antibodies were assessed by third-generation enzyme immunoassays. Patients testing seronegative at baseline were enrolled into a 1-year incidence study with serological follow-up at 6 and 12 months. For patients who seroconverted, an HCV RNA assay was performed on stored baseline samples to confirm new infection. A nested case-control study was subsequently performed to investigate potential risk factors. For each incident case, three controls negative for both HCV antibodies and HCV RNA were randomly selected. At enrollment, HCV seroprevalence was 30.0%. During follow-up, 23 new HCV cases were documented, with a cumulative incidence of 9.5 cases/1,000 patient-years. By logistic regression analysis, an increased risk for HCV infection emerged for patients attending the dialysis units with a high prevalence of HCV-infected patients at baseline (odds ratio [OR], 4.6) and for those attending units with a low personnel-patient ratio (OR, 5.4). Among extradialysis factors, a history of surgical intervention in the previous 6 months (OR, 16.7) significantly increased HCV risk. These findings suggest that the combination of understaffing and a high level of infected patients in the dialysis setting increases the risk for HCV nosocomial transmission. This is likely related to an increased likelihood for breaks in infection control measures.

Serum samples from 143 consecutive hepatitis C virus antibody-positive (anti-HCV) intravenous drug users (129 males and 14 females) from different Italian regions were analyzed for the presence of HCV-RNA by polymerase chain reaction (PCR), and the viral strains were determined for genotypes. The proportion of viremic (HCV-RNA positive) drug users was 69.9% (100143). No difference was observed between PCR positive and PCR negative subjects according to sex, mean age, positivity for antibodies to hepatitis B core antigen (anti-HBc) and positivity for antibodies to human immunodeficiency virus infection (anti-HIV). Abnormal alanine aminotransferase (ALT) levels were more frequently observed in PCR positive subjects than in those PCR negative (57% vs. 24.3%; P < 0.01). Of 100 subjects who were HCV-RNA positive by PCR, 40 had genotype 3a, 30 had 1a, 11 had 1b, 1 had 2a, 3 had 2b, 3 had 4, 11 had mixed infections and 1 was not typed. Subjects 18–30 years of age, were more likely infected by genotypes 1a and 3a than by other genotypes (79.7% vs.60.7%; P < 0.01), as compared with subjects older than 30 years of age. After adjustment for duration of addiction, this difference was still statistically significant (Mantel-Haenszel χ-square; P < 0.01) suggesting that types 1a and 3a have been recently contracted by Italian drug users. These findings provide further evidence that in Italy two HCV genotypes, 1a and 3a, are dominant among drug abusers. A figure different from that of Italian non intravenous drug user subjects with HCV chronic liver disease in whom genotype 1b has been mostly reported.