Patients undergoing hematopoietic stem cell transplantation (HSCT) may experience physical and psychological deterioration that impairs their life satisfaction (LS). This study focused on LS in long-term survivors at 10 or more years after HSCT. Fifty-five patients (39 males, median age 25 years) undergoing allogeneic HSCT for childhood malignant (n = 52) or nonmalignant diseases (n = 3) were enrolled. A control group of 98 young adults (59 males, median age 24 years) was considered. A questionnaire with a modified Satisfaction Life Domain Scale was administered. We assessed such domains as education, employment, leisure time, social relationships, and perception of physical status with a 30-item questionnaire. To investigate the association between the domains and the probability of diminished LS, we performed a logistical procedure using the maximum likelihood method. Predictive factors of LS were adjusted for sociodemographic variables. In the multivariate analysis, the participant's level of LS was not significantly correlated with sociodemographic factors or with HSCT status. The same analysis showed a slight trend in favor of the control group (P = .06) for body perception. Our data suggest that the patients who undergo HSCT in childhood have no significant difference in long-term LS compared with healthy controls.
The clinical significance of single band reactivity (indeterminate pattern) at anti-hepatitis C virus (HCV) second-generation recombinant immunoblot assay (RIBA-2) was investigated in symptomless subjects with normal liver function tests to obtain data for their counseling and clinical management. Serum and hepatic HCV RNA were determined by the nested polymerase chain reaction, and liver histology was evaluated in 40 symptomless blood donors with stable indeterminate RIBA-2 pattern, including 38 reactive to c22-3. All but one had normal alanine aminotransferase (ALT) levels. Two new immunoblot tests, RIBA-3 and INNO-LIA HCV Ab III (LIA-III), which incorporate additional HCV antigens, were also done to assess whether they could identify the viremic subjects. Ten cases (25%, confidence interval 12 to 38) were HCV RNA positive. Three of the HCV RNA-positive and none of the HCV RNA-negative subjects had chronic hepatitis. RIBA-2 strong intensity of reaction (score > 2+) was observed in all the HCV RNA-positive and in 12 HCV RNA-negative subjects. RIBA-3 and LIA-III gave positive results in 9 of 10 and 10 of 10 HCV RNA-positive, but also in 8 of 30 and 24 of 30 HCV RNA-negative subjects. A c-22-3 reactivity score of 4+ by RIBA-3 and E2/NS1 reactivity by LIA-III were both strongly associated with HCV RNA (P < .001). Based on relatively high prevalence of chronic hepatitis in our series (30%), apparently healthy subjects with stable indeterminate RIBA-2 pattern and HCV RNA positivity should be considered for liver biopsy independently of ALT profile.(ABSTRACT TRUNCATED AT 250 WORDS)
To assess the significance of remissions and relapses in idiopathic nephrotic syndrome the outcome of 169 patients was reviewed of them III had either a complete or partial remission. The probability of obtaining a complete remission within 5 years was 44% for the whole group, being significantly higher (P = 0.015) for those patients who had been treated with steroids plus cytotoxic drugs. Of the 74 patients who had complete remission only two showed renal function deterioration over time. Relapse of non-nephrotic proteinuria occurred in 22 patients. Of these, 12 again entered complete remission spontaneously, which persisted in nine until the last observation. Relapse of nephrotic syndrome occurred in 42 of III patients. Six patients showed a moderate renal function deterioration. Of 27 untreated patients, 17 had again a partial or complete remission that persisted in 13 until the last observation. All the 15 patients submitted to treatment again entered remission, which persisted in nine of 11 patients given prednisolone and chlorambucil and only in one of four given steroids alone. In conclusion, (a) the development of complete remission is a good marker of an excellent renal outcome, (b) patients with relapse of non-nephrotic proteinuria usually carry a good prognosis, (c) about half of patients with relapse of nephrotic syndrome show a spontaneous remission, and (d) the chances of a stable remission may be increased by treatment with steroids and cytotoxic agents.
BACKGROUND: Sexual transmission of hepatitis C virus (HCV) can occur, albeit inefficiently, and this represents a possible cause of community‐ acquired infections. This study describes a case of asymptomatic HCV infection acquired by a repeat blood donor from her sexual partner. CASE REPORT: A female repeat blood donor showed anti‐HCV seroconversion and a slight elevation in alanine aminotransferase. She had a normal physical examination and no clinical symptoms. She admitted a sexual partnership with a man with chronic HCV infection. Genotyping showed subtype 3a infection in both. Nucleotide sequence analysis of the hypervariable region of the viral envelope was performed on five clones obtained from the donor and the partner. Five blood donors with subtype 3a infection were analyzed as controls. The mean homology among clones was 99.3 percent (95% CI, 98.9–99.7) in the donor and 96.8 percent (95% CI, 94.4–99.2) in the partner, which suggests a more recent infection in the woman. The mean homology between donor and partner was 93.4 percent (95% CI, 93.1–93.8), which is different from that between donor and controls (76.2%; 95% CI, 73.3–79.1; difference between means, 17.2%; 95% CI, 16.0–18.4). This suggests that the infection was transmitted to the donor from her sexual partner. Sexual intercourse is the most probable route of transmission, because parenteral risk factors were absent. CONCLUSION: Heterosexual transmission of HCV can occur in the absence of a long‐lasting contact, and the infection can be asymptomatic. It remains to be determined whether the sexual partners of HCV‐infected subjects should be deferred from blood donation.
