Inmunoterapia pasiva con anticuerpos policlonales equinos (suero equino hiperinmune) para el tratamiento de pacientes con COVID-19 / Passive immunotherapy with equine polyclonal antibodies (hyperimmune equine serum) for the treatment of patients with COVID-19

INTRODUCIÓN: El presente informe es producto del trabajo colaborativo de la Comisión Nacional de Evaluación de Tecnologías de Salud (CONETEC), dependiente del Ministerio de Salud de la Nación y creada por RM N° 623/2018. La CONETEC realiza evaluaciones y emite recomendaciones a la autoridad sanitaria sobre la incorporación, forma de uso, financiamiento y políticas de cobertura de las tecnologías sanitarias desde una perspectiva global del sistema de salud argentino. En sus evaluaciones y recomendaciones, la CONETEC tiene en cuenta criterios de calidad, seguridad, efectividad, eficiencia y equidad, evaluados bajo dimensiones éticas, médicas, económicas y sociales. Sus resultados son consensuados mediante discusiones públicas y ponderados a través de un marco de valor explícito, con la participación de todos los actores involucrados en el proceso de toma de decisiones en salud. Los informes y recomendaciones de esta comisión surgen de este proceso público, transparente y colaborativo, siendo de libre consulta y acceso para toda la sociedad. El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de anticuerpos policlonales equinos (suero equino hiperinmune) para el tratamiento de pacientes con COVID-19. OBJETIVO El objetivo del presente informe es evaluar parámetros de eficacia, seguridad y conveniencia de anticuerpos policlonales equinos (suero equino hiperinmune) para el tratamiento de pacientes con COVID-19. METODOLOGÍA: Realizamos una evaluación "viva" (con un proceso de actualización continua) de una tecnología sanitaria, basada en evidencia proveniente de revisiones sistemáticas "vivas" de referencia y guías de práctica clínica de alta calidad metodológica para brindar parámetros actualizados y balanceados que sean de utilidad para la toma de decisiones en los diferentes niveles de gestión. RESULTADOS: Se identificó una revisión sistemática que cumple con los criterios de inclusión del presente informe. Adicionalmente se identificaron otras dos revisiones sistemáticas con adecuado proceso de desarrollo pero ninguna contestó la pregunta pertinente al presente informe. La revisión sistemática identificada incluyó un estudio aleatorizado con un total de 243 pacientes aleatorizados a suero equino hiperinmune o placebo. Se realizaron múltiples análisis de subgrupo incluyendo uno que comparó pacientes según su severidad al comienzo del estudio. Ninguno de estos análisis mostró resultados que sugieran un efecto diferencial en los subgrupos comparados. CONCLUSIONES: El cuerpo de evidencia disponible hasta el momento muestra que existe incertidumbre en el efecto de los anticuerpos policlonales equinos (suero equino hiperinmune) sobre la mortalidad y el ingreso en ventilación mecánica. El uso de anticuerpos policlonales equinos (suero equino hiperinmune) podría impactar positivamente en el tiempo de mejoría clínica, pero podría no incrementar la proporción de pacientes que alcanzan la recuperación clínica que lleva al alta hospitalaria. Los anticuerpos policlonales equinos (suero equino hiperinmune) podrían no asociarse a afectos adversos severos. La incertidumbre sobre el efecto de la tecnología evaluada sobre los desenlaces críticos para pacientes hospitalizados con COVI-19 (mortalidad y requerimiento de ventilación invasiva) determina que la certeza en los efectos de suero equino sobre la salud de pacientes con COVID-19 sea muy baja. A pesar que la tecnología se produce en Argentina lo que facilitaría su acceso, encontramos barreras relacionadas con una amplia población objetivo y elevado costo comparativo de esta intervención que podrían acarrear problemas de producción y afectar la distribución equitativa en situaciones de alta demanda. No identificamos recomendaciones con el rigor metodológico apropiado para ser incluidas en el informe.

Terapia con plasma de convalecientes en pacientes Covid-19 en la Provincia de Buenos Aires / Convalescent plasma therapy in COVID-19 patients, in the Province of Buenos Aires

Resumen Se trata de un estudio multicéntrico de cohorte retrospectivo, observacional, desde 15/5 a 1/7, 2020, en 272 pacientes COVID-19 internados en hospitales de la provincia de Buenos Aires, incluidos en un programa de acceso expandido de plasma de convalecientes de COVID-19. Nuestros objetivos fueron analizar letalidad y sus factores de riesgo independientes, y evaluar la evolución favorable, definida como alta hospitalaria, permanencia en sala (PISO), o alta de la UTI. Los pacientes fueron estratificados en 4 subgrupos: ingreso a PISO (n = 100) con neumonía y/o requerimiento de oxígeno; a UTI (n = 87); a UTI con requerimiento de ventilación mecánica (UTI-VM; n = 56), y a UTI-VM con shock séptico (UTI-VM-SS; n = 29). La letalidad total a los 28 días fue 26.1%, (71/272), para PISO 14.0%; UTI, 18.4%; UTI-VM, 44.6%; y UTI-VM-SS, 55.2%. El tiempo medio de supervivencia (días): 25.6 ± 0.6 (PISO); 25.3 ± 0.7 (UTI); 20.8 ± 1.2 (UTI-VM) y 18.2 ± 1.8 (UTIVMSS). Los predictores independientes de letalidad fueron VM, shock séptico y peso. Se registró una evolución favorable en 81.4% de los pacientes en PISO; 70.9% en UTI, 39.6% en UTI-VM, y en 27.6% de UTI-VM-SS. La gravedad al ingreso, edad, peso y frecuencia cardíaca fueron predictores independientes de evolución. No se registraron efectos adversos graves. Por falta de un grupo control, no fue posible evaluar la eficacia del plasma de convaleciente. La letalidad (26%) fue mayor que en otros ensayos clínicos con plasma convaleciente; esto podría deberse a mayor proporción de aquellos con VM y shock séptico en nuestra cohorte.

Abstract This is a preliminary, multicenter, retrospective cohort study, including 272 consecutive patients with COVID-19 admitted to hospitals in Buenos Aires Province, between May 15th and July 1st, 2020, included in an expanded access program to convalescent plasma. Our objectives were to analyze mortality and its independent risk factors, and to assess the occurrence of a favorable evolution, defined as hospital discharge, or stay at the ward, or transfer from ICU to ward. Patients were stratified into 4 subgroups: admission to the ward with pneumonia and/or oxygen requirement (WARD; n = 100); ICU admission (ICU; n = 87); ICU admission with requirement of mechanical ventilation (ICU-MV; n = 56), and ICU-MV plus septic shock (ICU-MV-SS; N = 29). Mortality at 28 days was 26.1% for the entire group, 14.0% for WARD group, 18.4% for ICU, 44.6% for ICU-MV, and 55.2% for ICU-MV-SS. Mean survival time (days) was 25.6±0.6 (WARD); 25.3±0.7 (ICU); 20.8±1.2 (ICU-MV) and 18.2 ± 1.8 (ICU-MV-SS). Independent predictors of mortality were MV, septic shock and weight. A favorable evolution occurred in 81.4% of WARD patients; in 70.9% of ICU; in 39.6% of ICU-MV and in 27.6% of ICU-MV-SS patients. Severity of illness on admission, age, weight and heart rate were independently associated with evolution. No major adverse effects were recorded. The lack of a control group precluded the estimation of efficacy. However, our 26% mortality rate was higher than that of the treatment arm of clinical trials comparing plasma with usual treatment, which might be ascribed to higher proportion of patients with MV and septic shock in our cohort.

Aditivos alimentares na dieta de bovinos confinados / Feed additives in feedlot diets

O objetivo do presente trabalho foi avaliar o efeito da inclusão do preparado de anticorpos policlonais (PAP) e/ou da monensina sódica (MON) sobre o desempenho, as características da carcaça, o perfil de ácidos graxos da carcaça (PAG) e a concentração de lipoproteínas sanguíneas (CLS) de bovinos confinados. O delineamento experimental foi inteiramente ao acaso, em arranjo fatorial 2 x 2, com medidas repetidas no tempo, sendo os fatores a inclusão ou não de MON e PAP avaliados em dois períodos, em que 72 bovinos machos da raça Brangus, não castrados, foram alocados em 24 baias (três animais/baia), totalizando seis repetições por tratamento. Não foi observado efeito (P>0,05) da inclusão do PAP para nenhuma das varáveis de desempenho e características de carcaça. Contudo, foi observado efeito (P<0,05) da inclusão de MON, em que animais que receberam MON apresentaram maiores ganho de peso diário (1,666 vs. 1,552), ganho de peso total (179,95 vs. 167,68), peso vivo final (474,86 vs. 459,61), peso de carcaça quente (248,46 vs. 240,20), melhor conversão alimentar (5,57 vs. 5,79) e reduzido custo para ganhar um quilo de peso vivo (3,06 vs. 3,18). Ainda não foi observado efeito principal (P>0,05) dos aditivos para o PAG e a CLS. Assim, a inclusão do PAP não foi boa alternativa à substituição da MON. Por outro lado, a inclusão do PAP não afetou negativamente os itens estudados.

This study was designed to test the effects of polyclonal antibody preparation (PAP) against several rumen bacteria and/or monensin (MON) on feedlot performance, carcass characteristics, fatty acid profile and blood lipoprotein concentrations in yearling bulls. Seventy-two Brangus yearling bulls were distributed in a completely randomized design with 2 x 2 factorial arrangements of treatments with six replications; factors were the inclusion or not of PAP or MON, measured over two phases. No significant (P>0.05) PAP main effects were observed for any of the feedlot performance and carcass trait variables. However, significant (P>0.05) MON main effects were observed, where animals receiving MON had higher (P<0.05) average daily gain (1.666 vs. 1.552), total weight gain (179.95 vs. 167.68), final body weight (474.86 vs. 459.61), hot carcass weight (248.46 vs. 240.20), better feed: gain ratio (5.57 vs. 5.79) and better cost to gain one kilo of body weight (3.06 vs. 3.18). No significant (P>0.05) main effects due to feed additives were observed for carcass fatty acid profile and blood lipoprotein concentrations. Therefore, the inclusion of PAP was not a good alternative to replace MON. On the other hand, feeding PAP did not negatively impact the items studied.

Aplicaciones terapéuticas de las inmunoglobulinas humanas en Pediatría / Therapeutic applications of human immunoglobulines in Pediatrics

En la actualidad existen diversos productos farmacéuticos constituidos por inmunoglobulinas (fundamentalmente IgG), purificadas por diversos métodos, lo que implica que pueden ser administradas por diversas vías (intramuscular, intravenosa y subcutánea). Estos productos tienen un amplio espectro de indicaciones en diversas enfermedades. Las inmunoglobulinas son los efectores finales de la respuesta inmune humoral, por lo que sus indicaciones fundamentales incluyen la terapia de reemplazo en enfermedades que cursan con déficit en la producción de anticuerpos, las situaciones en que se necesita de manera inmediata la presencia de anticuerpos neutralizantes, como en las terapias posexposición, y en enfermedades que cursan con disrregulación de la respuesta inmune

There are presently several pharmaceuticals made up of immunoglobulines (fundamentally IgG) purified by several methods, which means that they can be administered by different routes (intramuscularly, intravenously and subcutaneously). These products have a wide spectrum of prescriptions for several diseases. The immunoglobulins are the final effectors of the humoral immune response, so their fundamental prescriptions cover replacement therapies in diseases with antibody production deficit, situations requiring immediate presence of neutralizing antibodies such as post-exposure therapies, and diseases with immune response deregulation

Antibodies against electronegative LDL inhibit atherosclerosis in LDLr-/- mice

In order to determine the effect of antibodies against electronegative low-density lipoprotein LDL(-) on atherogenesis, five groups of LDL low receptor-deficient (LDLr-/-) mice (6 per group) were immunized with the following antibodies (100 µg each): mouse anti-LDL(-) monoclonal IgG2b, rabbit anti-LDL(-) polyclonal IgG or its Fab fragments and mouse irrelevant monoclonal IgG and non-immunized controls. Antibodies were administered intravenously one week before starting the hypercholesterolemic diet (1.25 percent cholesterol) and then every week for 21 days. The passive immunization with anti-LDL(-) monoclonal IgG2b, polyclonal antibody and its derived Fab significantly reduced the cross-sectional area of atherosclerotic lesions at the aortic root of LDLr-/- mice (28.8 ± 9.7, 67.3 ± 17.02, 56.9 ± 8.02 µm² (mean ± SD), respectively) compared to control (124.9 ± 13.2 µm²). Vascular cell adhesion molecule-1 protein expression, quantified by the KS300 image-analyzing software, on endothelium and the number of macrophages in the intima was also decreased in aortas of mice treated with anti-LDL(-) monoclonal antibody (3.5 ± 0.70 per field x 10) compared to controls (21.5 ± 3.5 per field x 10). Furthermore, immunization with the monoclonal antibody decreased the concentration of LDL(-) in blood plasma (immunized: 1.0 ± 1.4; control: 20.5 ± 3.5 RLU), the amount of cholesterol oxides in plasma (immunized: 4.7 ± 2.7; control: 15.0 ± 2.0 pg COx/mg cholesterol) and liver (immunized: 2.3 ± 1.5; control: 30.0 ± 26.0 pg COx/mg cholesterol), and the hepatic content of lipid hydroperoxides (immunized: 0.30 ± 0.020; control: 0.38 ± 0.15 ng/mg protein). In conclusion, antibodies against electronegative LDL administered intravenously may play a protective role in atherosclerosis.

Avaliação da imunidade passiva em bezerros nascidos de vacas imunizadas com vacina contra rotavírus / Evaluation of passive immunity in calves born from cows immunized with anti-rotavirus vaccine

Com o objetivo de monitorar a imunidade passiva em bezerros alimentados com colostro de vacas imunizadas e não imunizadas com vacina contra rotavírus, foram determinados títulos de anticorpos em amostras de sangue e colostro de 26 vacas da raça Holandesa no dia do parto e de seus bezerros, à zero, às 24, 48 horas e aos sete, 14, 21, 28 dias de idade, pelo ensaio imunoenzimático. Tanto no soro sangüíneo como no colostro, os títulos dos isótipos IgG, IgG1 e IgG2 foram mais elevados no grupo dos animais vacinados, porém somente no colostro o aumento foi significativo. Os bezerros alimentados com o colostro das vacas vacinadas apresentaram títulos mais altos dos isótipos IgG, IgG1, IgG2, IgA e IgM, após a ingestão do colostro, sendo constatado aumento significativo apenas para os títulos do isótipo IgG2. Amostras positivas para rotavírus foram detectadas nos dois grupos experimentais a partir dos sete dias de idade. A vacinação materna não protegeu efetivamente os bezerros das infecções naturais por rotavírus, pois, apesar de aumentar os títulos séricos de anticorpos anti-rotavírus nos animais vacinados, não foi capaz de impedir a ocorrência da rotavirose nos bezerros alimentados com o colostro das vacas imunizadas.

Passive immune response in calves fed colostrum from immunized and nonimmunized cows by anti-rotavirus vaccine was monitored. Titers of antibodies were determined by immunoenzymatic assay in blood and colostrum sampled at parturition day from 26 Holstein cows as well as in blood from their calves collected at 0, 24, and 48 hours and seven, 14, 21, and 28 days after birth. In serum and colostrum, IgG, IgG1, and IgG2 antibody titers were higher in vaccinated animals; however, this increase was only significant in colostrum. The calves fed colostrum from vaccinated cows showed higher IgG, IgG1, IgG2, IgA, and IgM isotypes titers after the ingestion of colostrum, being evidenced significant increase only for IgG2 titers. Positive samples for rotavirus were detected in both experimental groups since seven days after birth. Results showed that maternal vaccine failed to protect effectively the calves from natural infections by rotavirus, though it increased the anti-rotavirus antibody titers in vaccinated animals, but was not capable to impair the occurrence of rotaviruses in the calves fed colostrum from immunized cows.

Absence of experimental cross-protection induced by a Trypanosoma cruzi-like strain isolated from bats / Ausência de proteção cruzada experimental induzida por uma cepa Trypanosoma cruzi-like isolada de morcego

This study evaluated the possibility of inoculation and reinoculation with a trypanosomatid isolated from bats that is morphologically, biologically and molecularly similar to Trypanosoma cruzi, to protect against infection by virulent strains. Non-isogenic mice were divided into 24 groups that received from zero to three inoculations of Trypanosoma cruzi-like strain RM1, in the presence or absence of Freund’s adjuvant, and were challenged with the VIC or JG strains of Trypanosoma cruzi. Parasitemia and survival were monitored and animals were sacrificed for histopathological analysis. Animals immunized with Trypanosoma cruzi-like strain RM1 presented decreased parasitemia, independently of the number of inoculations or the presence of adjuvant. In spite of this reduction, these animals did not present any protection against histopathological lesions. Severe eosinophilic infiltrate was observed and was correlated with the number of inoculations of Trypanosoma cruzi-like strain RM1. These findings suggest that prior inoculation with this strain did not protect against infection but, rather, aggravated the tissue inflammatory process.

Este trabalho avaliou a possibilidade da inoculação e reinoculação de um tripanossomatídeo isolado de morcego, morfológica, biológica e molecularmente semelhante ao Trypanosoma cruzi, na proteção contra a infecção por cepas virulentas. Camundongos não-isogênicos foram divididos em 24 grupos, que receberam de zero a três inóculos da cepa RM1 de Trypanosoma cruzi-like, na presença ou ausência de adjuvante de Freund e desafiados com as cepas de Trypanosoma cruzi VIC ou JG. Acompanhou-se a parasitemia e a sobrevida e os camundongos foram sacrificados para análise histopatológica. Os animais imunizados com a cepa RM1 de Trypanosoma cruzi-like apresentaram redução da parasitemia, independente do número de inóculos ou presença de adjuvante. Apesar dessa redução, os animais não apresentaram proteção contra lesões histopatológicas e observaram-se intensos infiltrados eosinofílicos que foram correlacionados com o número de inóculos da cepa RM1 de Trypanosoma cruzi-like. Sugere-se que a inoculação prévia dessa cepa, ao invés de proteger contra a infecção, agravou o processo inflamatório tecidual.

Acidente por cascavel (Crotalus sp) em Ponta de Pedras, Ilha do Marajó, Pará - relato de caso / Snakebite by the rattlesnake (Crotalus sp) in Ponta de Pedra, Marajó Island, Pará - a case report

Objetivo: relatar um caso de envenenamento por Crotalus sp, atendido no Hospital Pronto Socorro Municipal(HPSM) Humberto Maradei em Belém-Pará, ocorrido no ano de 2007. Relato do caso: paciente do sexo masculino, 19 anos, picado em membro inferior direito quando caçava com seu pai em um campo aberto. presentou manifestações clinicas após 12 horas do acidente. Na presença dos sintomas como ptose bipalpebral, oftalmoplegia, artralgia e mialgia é que a vítima procurou atendimento médico no Hospital de Ponta-de-Pedras, Ilha-do-Marajó e logo depois foi transferida para o HPSM de Belém. O acidente foi classificado como moderado e complementado a soroterapia específica. Os exames apresentaram os seguintes resultado: CPK: 9.616 U/L; LDH: 3.578 U/L; AST: 729 UI/ml; ALT: 340 UI/ml; uréia, creatinina e tempo de coagulação dentro dos valores de referência. Após a soroterapia e medidas sintomáticas o paciente evolui m melhora clinica, recebendo alta curado, após alguns dias. Considerações Finais: alertar aos profissionais da área de saúde sobre a importância do envenenamento e da conduta a ser tomada em caso de acidente ofídico em especial por cascavel.

Objective: report a case of snake envenomation by Crotalus sp, taken care of in the Hospital Pronto Socorro Municipal (HPSM) Humberto Maradei in Belém-Pará, occurred in the year of 2007. Case Report: man, 19 years old, was bitten in the right inferior member when he was hunting with his father in an open field. He presented clinical manifestatiom after 12 hours of the accident. In the presence of the symptoms such as ptosis bipalpebral, ophthalmoplegia, arthralgia and myalgia that the victim looked for medical attendance in the Hospital de Ponta-de-Pedras, Ilha-do-Marajó and soon was transferred to the HPSM of Belém. The accident was classified as moderate and complemented with the specific serumtherapy. The examinations presented the following results: CPK: 9,616 U/L; LDH: 3,578 U/L; AST: 729 UI/ml; ALT: 340 UI/ml; urea, creatinine and coagulation time inside the values of reference. After the serumtherapy and symptomatic procedures the patient evolved with clinical improvement, receiving, discharge cured after some days. Final Considerations: to alert professionals of the health area about the importance of the poisoning and the conduction that have to be taken in case of ofídico accident, specially for rattlesnake.

Caracterización preliminar de la inmunidad pasiva natural en granjas porcicolas y evaluación de un sistema para incrementar la transferencia de anticuerpos / Preliminary characterization of the passive natural immunity in farms porcicolas and evaluation of a system to increase the transference of antibodies

Se determinó la transferencia pasiva de inmunidad natural en lechones de dos granjas porcícolas comerciales. Para ello se tomaron muestras de sangre a 221 lechones a las 24 horas de nacidos y a 21 cerdas madres. Los lechones de cada granja fueron divididos en dos grupos uno experimental y uno control. El primer grupo se manejo de acuerdo con las normas usuales para cada granja, mientras que a las madres de los lechones del segundo grupo se les aplicó un producto inmunomodulador a base de LPS y Propionibacterium granulosum. Los sueros obtenidos fueron analizados por las técnicas de electroforesis sobre acetato de celulosa, inmunoelectroforesis, inmunodifusión radial cuantitativa y prueba de turbidez con sulfato de Zinc. La concentración de proteína total fue determinada con el refractómetro de Golberg. Se analizan los resultados obtenidos y se discute la importancia de la adecuada transferencia pasiva de inmunidad natural y el posible uso del inmunomodulador en granjas comerciales con problemas de morbimortalidad neonatal.

High dose intravenous immunoglobulin therapy in neonatal immune hemolytic jaundice

Isoimmune hemolytic jaundice due to blood group [ABO] and Rhesus [Rh] incompatibility is an important problem in the neonatal period. A controlled study was conducted to assess the role of high dose intravenous immunoglobulin [HDIVIG] therapy in neonatal immune hemolytic jaundice. Newborn patients with ABO and/or Rh incompatibilities proved by significant hyperbilirubinemia [>15mg/dl], positive direct Coombs' test and high reticulocytic count [>6%] were randomly assigned to receive either conventional treatment measures alone, including phototherapy and exchange transfusion if needed [control group, n=10 newborns] or phototherapy with high dose i.v. immunoglobulin [1gm/kg] over 4 hours [study group, n=30 newborns] as soon as the diagnosis was established. One of the 30 patients in the HDIVIG group required exchange transfusion, while this became necessary in 3 of 10 patients in the control group [p<0.001]. The duration of phototherapy and hospitalization, in terms of hours were significantly shorter in the HDIVIG group [p<0.001]. No adverse effects of HDIVIG therapy were observed. The use of HDIVIG therapy in newborns with ABO and/or Rh hemolytic disease reduces hemolysis, serum bilirubin levels, the need for blood exchange transfusion and the duration of hospitalization

Improved serological response to human diploid cell rabies vaccine when given simultaneously with antirabies hyperimmune globulin

Background. The prevention of rabies in Mexico continues to be an importan goal for the health sector. Although the prevalence of this disease continues to fall, between 1990 and 1995 a total of 238 cases were registred (an average of 40 cases annually), with a mean annual incidence of 0.04 cases per 100,000 inhabitants and a mortality of almost 100 percent, so that it is important to rely on highly effective vaccines with few side effects. The objective of this work was to evaluate seroconversion and tolerance to the human diploid cell antirabies vaccine administered to individuals with a history of exposure to rabies, to compare these results with those reported in the literature for the Fuenzalida vaccine, a rabies vaccine produced in the brain tissues of suckling mice, and to find the role antirabies hyperimmune gamma globulin plays in the concentration of post-vaccination antibody concentrations. Methods. An analytical transverse study was carried out in 40 children and adults with a history of rabies exposure who were given a complete, five-dose intramuscular schedule of the human diploid cell rabies vaccine. Subjects were followed daily, and local and systemic signs and symptoms were recorded. Two blood samples (at baseline-and at the end of the ELISA technique, were measured. Results. Adverse side effects produced by the human diploid cell antirabies vaccine, such as frequency of pain, erythema itching, and regional adenopathy were fewer than those reported in the literature for the Fuenzalida vaccine (p < 0.05), and of induration and local pain (p <0.05) in relation to the latter vaccine. All patients seroconverted, producing geometric mean antibody titers of 6.22 IU/mL, an arithmetic mean titer of 9.66 IU/mL with a SD of 9.1 IU/mL. The level of tolerance to the diploid cell vaccine was good and its adverse effects were minimal and fewer than those reported for the Fuenzalida rabies vaccine. Patients receiving the diploid cell vaccine plus antirabies hyperimmune gamma globulin developed higher antibody titers (measured by ELISA test) at the end of the vaccination schedule than those only receiving the vaccine. Conclusions. These results are important in order to achieve an adequate and opportune level of protection provided by prophylactic vaccine to patients with exposure to rabies

Preparation of a potent anti-scorpion-venom-serum against the venom of red scorpion (Buthus tamalus).

A number of children and adults, especially pregnant women succumb to the sting by red Scorpion (Buthus tamalus) in Konkan region--particularly on the coastal line. No specific antiserum or any other antidote is available to treat a victim of scorpion bite and hence the need to prepare a potent antiserum. Red Scorpion (B. tamalus) venom is a mixture of a number of protein moieties and neurotoxins of low molecular weight. Therefore, the venom is poor in antigenic composition and it is difficult to get antibodies specific to neutralise lethal factor/factors. Using Bentonite as an adjuvant and extending the period of immunization a potent antiserum has been prepared capable of neutralising the lethal factor/factors. In vivo testing carried out in albino mice, guinea pigs, dogs and langurs confirms this finding and shows that the antiserum is quite effective in neutralising the scorpion venom to save the life of envenomated animals.

A randomized double-blind sham-controlled study of intrathecal human anti-tetanus immunoglobulin in the management of tetanus.

BACKGROUND: Tetanus is a major cause of mortality and morbidity in developing countries. Various modalities of treatment to prevent progression of the disease and alter its outcome have been tried. This study was designed to evaluate the role of intrathecal human anti-tetanus immunoglobulin (TIG) in the management of tetanus. METHODS: Thirty-six adult patients presenting to an university-affiliated teaching hospital were stratified based on the severity of disease into mild and severe disease, and subsequently randomly allocated to receive either 250 i.u. of TIG intrathecally or a sham procedure mimicking the lumbar puncture. RESULTS: In mild tetanus, TIG administration significantly retarded the rate of progression (p = 0.05), reduced the duration of hospital (p = 0.01) and intensive care unit stay (p = 0.05), need for tracheostomies (p = 0.03) and the dose of sedatives required for control of spasms (p = 0.01). In mild tetanus, the mortality rates were 20% and 30% in the treated and control groups, respectively. CONCLUSION: We suggest that TIG is useful in reducing the morbidity, progression of disease and mortality in patients presenting with mild tetanus.

Analise critica sobre o uso das vacinas conjugadas contra o Haemophilus influenzae do tipo b em diferentes paises / Critical analysis about the use of Haemophylus influenzae type b conjugate vaccines in different countries

O Haemophylus influenzae do tipo b (Hib) e um dos principais agentes causadores de doencas invasivas em criancas, tais como meningite, epiglotite, pneumonia e bacteremia. Desde 1987, as vacinas conjugadas contra o Hib vem sendo amplamente utilizadas em diversos paises desenvolvidos, e o sucesso da imunizacao pode ser comprovado pelo rapido desaparecimento das infeccoes graves causadas pelo Hib, apos a introducao da vacinacao de rotina contra o Hib para todas as criancas com idade entre 2 meses e 5 anos. Neste artigo, a autora apresenta uma revisao sobre o impacto epidemiologico da vacinacao contra o Hib, em 4 paises desenvolvidos - Finlandia, Estados Unidos, Inglaterra e Suecia - e analisa as dificuldades relacionadas a introducao desta vacina nos paises em desenvolvimento

Viral hepatitis prophylaxis

As hepatites virais agudas säo as causas mais comuns de ictericia e insuficiência hepática aguda, enquanto que as hepatites virais crônicas säo as maiores causadoras de cirrose hepática e carcinoma hepatocelular. Levando em consideraçäo a morbimortalidade dessas lesöes, sua profilaxia se torna imperativa. No presente trabalho revisam-se as medidas gerais e as imunoprofilaxias passivas e ativas contra os virus das hepatites A, B e febre amarela, assim como, abordam-se as medidas gerais contra os virus das hepatites C, D e E

Evaluación de una vacuna experimental contra ojo azul en cerdos mediante las pruebas de inmunogenicidad, inocuidad, potencia y medición de la inmunidad pasiva en lechones / Evaluation of the passive immune response and protection confered by a blue eye inactivated vaccine in pigs

El ojo azul (OA) es una enfermedad de etiología viral que se caracteriza por producir encefalitis en lechones, falla reproductiva y opacidad corneal. Sin embargo, todavía no se cuenta con una vacuna para prevención y control de esta enfermedad. EL objetivo de este estudio fue evaluar la respuesta inmune y la protección conferida por una vacuna inactivada contra OA. Para la prueba de inmunogenicidad e inocuidad se usaron 10 cerdos destetados, fueron vacunados a las 6 y 8 semanas de edad. Se midió la respuesta inmune humoral por la prueba de sueroneutralización (SN) frente a 100 dosis infectantes cultivo celular 50 por ciento (DICC 50 por ciento) por ml del paramyxovirus de ojo azul cepa 1987 (POA-87). Los resultados de la prueba de SN indicaron que la media de anticuerpos fue de 1:32. No se presentaron reacciones locales o generalizadas, ni aumento en la temperatura de los cerdos vacunados y no vacunados en contracto (mezclados). Se midieron los niveles de Acs por SN cada mes y 6 meses después de la primera aplicación de la vacuna. Se realizó una prueba intradérmica (ID) observándose en la zona de inoculación una reacción de hipersensibilidad tipo IV en 3 de los 7 cerdos inoculados con POA-87 purificado. Además fueron vacunadas 6 hembras gestantes a las 4 y 2 semanas preparto, se midió la respuesta inmune humoral en el suero y calostro de las hembras y se determinó el grado de inmunidad pasiva transmitida, midiendo los niveles de Igs en el suero de los lechones a los 4, 28, y 38 días de edad. En este caso, la media de Acs por SN fue mayor a 1:16, con disminución del 85 por ciento a los 28 días y del 100 por ciento a los 38. En la prueba, de potencia se utilizaron 2 cerdas gestantes, una recibió dos aplicaciones de vacuna antes del parto. El desafío de las dos camadas se hizo a los cuatro días posparto; se observó mortalidad del 100 por ciento en los lechones de la hembra no vacunada, y protección del 71.4 por ciento en los lechones de la madre vacunada. La SARH señala como requisito mínimo un 80 por ciento de protección; sin embargo, de acuerdo con los resultados y análisis comparativos realizados se concluye que la vacuna inactivada contra el paramixovirus del ojo azul (POA) en cerdos, objeto de esta investigación, deberá ser sometida a un estudio con un mayor número de animales para comprobar que este biológico puede alcanzar una protección mayor al 80 por ciento y que es apta para el control de la enfermedad del Ojo Azul