Prevention of Cytomegalovirus infection and disease in Kidney Transplantation

Hippokratia 2003; 7(2):51-58

G Vergoulas
Organ Transplant Unit, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

In transplantation of utmost importance are the interactions among immunologically active cells capable of responding to and destroying foreign tissues, the immunosuppressive therapy aimed at controlling these cells and certain infectious agents that are modulated by both factors.
Cytomegalovirus acquisition by humans (HCMV) is more common in lower socioeconomic groups. Natural routes of transmission include intrauterine, perinatal, and horizontal in childhood and in the sexually active people. Other routs of transmission are solid organ transplantation, blood transfusion and semen used for in vitro fertilization.
The post-transplant immunocompromised state provides an environment in which HCMV can exert its full pathogenic potential. HCMV disease is a major cause of morbidity and mortality in solid organ transplantation. It is also associated to an increased risk of opportunistic infections, allograft injury and higher transplantation costs. HCMV infection also seems to increase the risk of acute and chronic rejection of the allograft via immune - mediated vascular injury. Recent evidence suggests that influence of HCMV disease on graft survival is apparent only in patients with zero HLA-DR matches and it calls for new prophylaxis treatment and allocation strategies.
In solid organ transplantation the term "cytomegalovirus infection" refers to asymptomatic HCMV infection and the term "cytomegalovirus disease" refers to symptomatic HCMV infection. Disease manifestations appear most frequently between the end of the 1st and the end of the 4th month after transplantation and include interstitial pneumonitis, hepatitis, gastrointestinal disease, arthritis, chorioretinitis, leukopenia and pyrexial debilitating illness, whose incidences and relative frequencies vary among transplant groups under consideration. In the absence of antiviral prophylaxis, the risk of symptomatic infection is highest in heart - lung recipients (39 %) and lowest in kidney transplant recipients (8%). As many as 70 – 80 % of kidney transplant recipients may show laboratory evidence of HCMV infection after renal transplantation and a significant number develops tissue invasive disease with considerable morbidity and occasional mortality. Recently it has been suggested that within the first three months after transplantation 20 % to 60 % of the recipients develop HCMV disease, with a mortality rate 1% to 4%. Therefore, prophylaxis with antiviral therapy has been recommended in patients at risk.

Read PDF

Read more...

Can intrauterine surgery improve the quality of life of cleft lip and palate patients?

Hippokratia 2003; 7(2):59-80

N.A Papadopulos, M. A Papadopoulos
Dpt of Plastic and Reconstructive Surgery, Klinikum rechts der iIsar, Technical University, Munich, Germany
Dpt of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece

Abstract

It has already been shown that some congenital anomalies are amenable to intrauterine surgical correction, which may be life-saving. However, postoperative premature labour and its extreme invasiveness are considered as major drawbacks for "open" intrauterine surgery, mainly due to the performed hysterotomy. More recently the merger of fetoscopy and advanced video-endoscopic surgery leave to expect a possible application of the feto-endoscopic surgical approaches in the future also by non life-threatening conditions, such as the cranio-facial malformations (i.e. cleft lip and palate).
The intrauterine intervention presents the following advantages: (a) scarless wound healing in mid-gestation, (b) interruption of the malformation's cascade of detrimental secondary effects (no occurrence of secondary maxillary growth restrictions), (c) reduction or minimal need of secondary corrections or additional post-natal treatments, and (d) minor morbidity, at least when the endoscopic approach is applied. These advantages would lessen the psychological and financial burden of multiple surgeries and therapies for the young patient with a cleft lip and palate, the patient's family, and the society in general.
Nevertheless, further research is needed to make intrauterine procedures safer, and to achieve such results that would minimize or even eliminate the need of additional post-natal treatments. This way it could be possible to provide a better quality of life to these patients and their families.

Read PDF

Read more...

Severe acute respiratory syndrome (SARS): A new emerging disease in the 21st century

Hippokratia 2003; 7(2):81-83

M Raptopoulou-Gigi
2nd Dpt Internal Medicine, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

SARS need to be regarded as a particularly serious threat for several reasons:
a. the disease has no vaccine and no treatment
b. the virus comes from a family notorious for its frequent mutations making the prospects for vaccine development questionable
c. all available diagnostic tests have limitations
d. epidemiology and pathogenesis of the disease are poorly understood
e. the disease concentrates in hospital staff: the human resource vital to control
f. a significant proportion of patients requires intensive care
g. the incubation period of 10 days allows spread via air travel between any two cities in the world The mean incubation period of the disease is estimated to be 4-6 days, and the time from onset of clinical symptoms to admission to hospital between 3-5 days.
The estimated fatality rate is reported to be 13.2 % for patients 60 years old, suggesting that age is strongly associated with the outcome of the disease, whereas early admission to hospital seems not to alter outcome.

Read PDF

Read more...

The Attitude of Physicians towards Continuing Medical Education in Greece

Hippokratia 2003; 7(2):84-92

P.N Ziroyanis, Th Katostaras, T Mousiama
Dpt Nephrology, State General Hospital of Athens "Gennimatas", Athens, Greece, Dpt of Nursing, University of Athens

Abstract

The aim of this study was the estimation of the attitude of Greek physicians on the issue of Continuing Medical Education (CME).
Four hundred - fifteen physicians (professors, private office practitioners, consultants/senior registrars, registrars and others) participating in a medical congress answered a questionnaire of five points: a) the kind of scientific educational activity preferred, b) the selection criteria of scientific subjects, c) who must undertake the expenses, d) the ways that CME can be more effective and e) the extend to which printed and electronic press is being used as a means of CME.
The answer in question a was discussions with experts (>82%), clinical tutorials (> 81%) and lectures (> 81%). The answer in b was the health needs of population (>92%) and the educational needs of the doctors (> 92%). The answer in c was scientific societies (> 87%) and public health services (> 73%). The answer in d was the establishment of obligatory attendance (> 82%), more CME events in district areas (> 80%) and more educational CME events (> 73%).
In conclusion Greek physicians believe that the discussion with experts is crucial for their education, subject selection must be based primarily on the health needs of the population and the educational needs of the doctors, and the attendance must be obligatory at least for a minimum number of scientific events. Also there is a preference for CME activities in district areas.

Read PDF

Read more...

Assays for the detection of human cytomegalovirus infection

Hippokratia 2003; 7(2):93-96

I Fryda - Mihailidi
Microbiology Dpt, Hippokratio General Hospital, Thessaloniki, Greece

Abstract

In tissue and organ transplantation the imunosuppresive therapy produces an environment that human cytomegalovirus (HCMV) can exert its full pathogenicity. In the immunocompromised host HCMV disease is a serious cause of morbidity and mortality. Early treatment of HCMV disease, or preemptive therapy is mandatory for the patient and the graft. Organ transplant centers must be supported by laboratories capable to trace routinely the replication of HCMV. The methods used today are described in this technical note and include non-molecular assays (pp 65 antigenemia assay) and molecular assays (CMV - DNA quantitative PCR assay).

Read PDF

Read more...

Current Issue 20 (2)