Accidental transmission of HCV and treatment with interferon

Accidental transmission of contagious pathogens, especially hepatitis C virus (HCV), by needlestick or other means as an occupational hazard for medical staff is of concern. We retrospectively analysed cases of work-related accidental injury with pathogens such as hepatitis B virus (HBV), HCV, syphilis and human immunode?ciency virus (HIV) reported to the centres for disease control at 15 hospitals (total 5776 beds) in the Gunma prefecture, Japan, from December 1990 to August 1993 (24.7 months). There were 416 such cases (16.8 cases/month), with an incidence of 0.2–3.5 accidents per month per hospital. Such accidents occurred in 297 (71.2%) nurses, 98 (23.5%) medical doctors, 13 (3%) laboratory technicians, four (1.0%) hospital maintenance workers, one (0.2%) assistant nurse, one secretary and two others. There were 323 (77.6%) injuries caused by needlestick, 42 (10.1%) from suture needles or surgical knife cuts, 17 (4.1%) from blood splatters from patients into the eyes or mouth, 10 (2.4%) from contact with injured skin and 24 (5.8%) simple skin contacts. Of the pathogens, 60.3% were HCV, 22.6% HBV, 5.8% syphilis, 0.7% HIV and 10.6% were of unknown origin. Four cases (1.6%) of HCV infection were found and treated with one or two courses of interferon therapy, and HCV was subsequently cleared. All four patients were cured with interferon therapy. None of the HBV-injured cases resulted in infection, possibly because of prophylaxis with HB immunoglobulin and HB vaccine. No HIV or syphilis infection was contracted. In summary, chronic HCV infection acquired as an occupational hazard can be cured by appropriate treatment, such as with interferon, after early detection of the infection.     

Successful treatment of retinoic acid syndrome with high-dose dexamethasone pulse therapy in a child with acute promyelocytic leukemia treated with ATRA

A 5 year old female developed femoral pain, fever, and hemorrhagic tendency. She was diagnosed as having acute promyelocytic leukemia (APL). Approximately 2 weeks after the administration of all-trans retinoic acid (ATRA), she developed a high fever, edema, and respiratory distress which met the criteria for retinoic acid syndrome. At first, we tried to treat the patient with oral corticosteroid, however, this approach was unsuccessful. Considering the worsening of her condition, we then chose to administer a large dose of intravenous dexamethasone therapy for 3 days. Immediately after this therapy, she became afebrile, respiratory distress and edema disappeared, and there was a general improvement of the symptoms. All-trans retinoic acid at the reduced dose of 25 mg/m², was continued for an additional 6 weeks and then discontinued. Since the cessation of dexamethasone and ATRA, there has been no relapse of APL in this patient. Although based on only one case, we recommend the intravenous high-dose dexamethasone pulse therapy (13 mg/m² per day, for 3 days) for treating retinoic acid syndrome which develops in pediatric APL patients treated with ATRA.     

In vitro suppression of parathyroid hormone secretion by 22-oxa-calcitriol in human parathyroid hyperplasia due to uraermia

SUMMARY: 22-oxa-calcitriol (OCT), a vitamin D analogue, suppresses parathyroid hormone (PTH) secretion and has less calcaemic activity than 1,25-dihydroxyvitamin D₃ [1,25(OH)₂D₃] in vivo. In this study, we evaluated the effect of OCT on PTH secretion in vitro using human hyperplastic parathyroid tissue obtained during surgery for advanced renal hyperparathyroidism and normal bovine parathyroid glands to compare the effects of 1,25(OH)₂D₃. 22-oxa-calcitriol suppressed PTH secretion by nodular hyperplastic parathyroid tissue and normal bovine tissue in a dose dependent manner, the same as 1,25(OH)₂D₃. We showed the additive effect of extracellular calcium level on suppression of PTH secretion by OCT and 1,25(OH)₂D₃. These results suggest that OCT suppresses PTH secretion, the same as 1,25(OH)₂D₃ not only in normal parathyroid cells but also on hyperplastic parathyroid cells.     

Oral 1,25-dihydroxyvitamin D3 loading test in normal subjects and patients with chronic renal failure under haemodialysis

Summary: The present study was designed to determine the criterion for 1,25-dihydroxyvitamin D₃ (1,25 (OH)₂D₃) loading test in normal subjects and haemodialysis patients. Fourteen normal subjects were administered 1.0 μg of 1,25(OH)₂D₃ per os and serum 1,25(OH)₂D was monitored every hour up to 6 h afterwards under conditions of overnight fasting, and six haemodialysis patients were administered 2.0 μg of 1,25(OH)₂D₃ per os and serum 1,25(OH)₂D was monitored every 2 h up to 12 h afterwards. Peak time of serum 1,25 (OH)₂D varied between 2 and 5 h after administration in normal subjects. However, there was a good correlation between the maximum increment of 1,25(OH)₂D (maxΔ1,25(OH)₂D) and the increment at 4 h after administration (Δ1,25(OH)₂D(4 h)). the peak time of Δ1,25(OH)₂D in six haemodialysis patients was also at 4 h after administration. From these observations, Δ1,25(OH)₂D(4 h) was evaluated in subsequent studies. Twenty-six normal subjects and 24 haemodialysis patients were administered 0.5–2.0 μg of 1,25(OH)₂D₃ per os, according to their bodyweights, under conditions of overnight fasting. Blood samples were drawn for measuring 1,25(OH)₂D prior to and 4 h after administration. Δ1,25(OH)₂D(4 h) showed good correlation with the dose of 1, 25 (OH)2D3 adjusted by bodyweight (ng/kg bodyweight). the ratio of Δ1,25(OH)₂D(4 h) and adjusted dose of 1,25(OH)₂D₃ was more than 2.0 in all normal subjects (range: 1.97?2.89, mean ± SD: 2.38 ± 0.287). Moreover, the ratio of Δ1,25(OH)₂D(4 h) and adjusted dose of 1,25(OH)₂D₃ showed a good reproducibility (CV%= 5.7 Δ 0.32, n=5), and did not depend on the administered dose of 1,25(OH)₂D₃, suggesting that this ratio is a good parameter for the intestinal absorption of 1,25(OH)₂D₃. In haemodialysis patients, the mean ratio of Δ1,25 (OH)₂D(4 h) and adjusted dose of 1,25(OH)₂D₃ was 2.14 Δ 0.489, which was not significantly different from the ratio in normal subjects, suggesting that, fundamentally, there was no impairment of intestinal absorption of 1,25(OH)₂D₃ in these patients. However, low ratios of Δ(4 h) and the dose of 1,25(OH)₂D₃ with low basal levels of 1,25(OH)₂D were observed in some patients (less than 1.5 in four patients), suggesting that there exist haemodialysis patients with malabsorption of 1,25(OH)₂D₃. From these results, the criterion for normal response in 1,25(OH)₂D loading test was proposed, namely, that the ratio of Δ1,25(OH)₂D(4 h) and adjusted dose of 1,25(OH)₂D₃ be more than 2.0.