Measures Against de novo Hepatitis B in Our Institution / 日本農村医学会雑誌

　　Serious aggravation of de novo hepatitis B caused by revitalization of the hepatitis B virus in HBs antigen negative, HBs antibody or HBc antibody positive patients has recently been reported. The incidence of de novo hepatitis B infection which occurs in patients undergoing immunosuppression or chemotherapy develops at times into a medical lawsuit. To cope with the situation, the Ministry of Health, Labour and Welfare (MHLW) issued the guideline for the management of hepatitis B infective occurring in patients treated with immunosuppressive therapy or chemotherapy (the revised edition). In our institution, the Chemotherapy Committee discussed our measures against de novo hepatitis B, and determined to carry out the in-hospital examination of the HBc antibody to provide reliable safe and speed medicine.　　During the investigation period, HBc antibody was examined for confirmation of anamnesis of Hepatitis B in patients receiving chemotherapy, immunosuppressive medicine, examination of infectious disease before blood transfusion and examination of viral hepatitis. In our institution, the number of cases which are adapted for the MHLW guideline (the revised edition) was 15 of 218 examples, and as a result HBs antigen negative, HBs antibody or HBc antibody positive patients, who could not be found in the routine screening for HB infection turned out to be not a few.　　Since it was expected that the number of patients undergoing immunosuppression and chemotherapy would continue to increase in the future, the necessity for observance of guideline was suggested to provide relief, safety in medical treatment.

Utility of Procalcitonin in Septicemia Tests / 日本農村医学会雑誌

　　Procalcitonin (PCT) is a diagnostic marker of severe bacterial infection and sepsis. Sepsis can lead to shock, multiple organ dysfunction syndrome, DIC and death, thus making the early diagnosis of sepsis very important. Many markers (e.g., CRP, blood culture, endotoxin) of infection largely lack in clinically important property. Therefore, clinical PCT-level measurement has been accepted worldwide in the last five years. Our hospital reports PCT within 30 minutes after the collection of blood samples all day long. In this study, we assess the clinical utility of PCT for early diagnosis and treatment with specimens tested by both PCT and blood cultures. PCT assay and blood culture demonstrated the diagnostic concordance rate stood at 58.96%. We presume that the cause of its discrepancy is a lack of sensitivity of blood culture and an increase in PCT by the invasiveness of other factors. On the other hand, patients with PCT‹0.5 ng/mL are unlikely to suffer from severe bacterial infection and sepsis. Thus, PCT could be one of Vital Signs and useful for early diagnosis in the emergency care.