Hepatitis C refers to the portion of non-A, non-B hepatitis that is parenterally transmitted. No formal classification of the virus has yet been achieved, but it is known to be heterogeneous, a trait with implications for both antiviral therapy and vaccine development. Hepatitis C virus has a nearly uniform distribution around the world. The highest infection rates are found in patients with non-A, non-B hepatitis associated with transfusion, hemophiliacs receiving coagulation factors, intravenous drug users, and renal dialysis patients. Screening for hepatitis C, even using third generation ELISA tests, has not completely eliminated risk of transmission during blood transfusions. Nonpercutaneous routes of transmission have been poorly defined. There is evidence that hepatitis C virus is sexually transmitted, but less efficiently than hepatitis B or HIV. Hepatitis C infections have been found in newborns and in children receiving transfusions, undergoing renal dialysis, or hospitalized. The high percentage of hepatitis C in persons with no history of parenteral exposure has stimulated search for nonparenteral forms of transmission, especially vertical transmission. The resulting data have been contradictory. Results of recent studies using polymerase chain reaction appear to indicate that perinatal transmission occurs, but an elevated viral load of hepatitis C is required to produce infection. The majority of hepatitis C cases are asymptomatic. Normal serum aminotransferase levels may mask persistent infection and progression to cirrhosis. More serious consequences of chronic infection may include persistent acute or chronic hepatitis, with cirrhosis developing in 20-30% of cases, and hepatocellular carcinoma. The most effective treatment of chronic infection, alpha interferon, is associated with a relapse rate of 80-90%. Prevention is thus the most effective intervention to combat hepatitis C.
A retrospective study was conducted of all live births occurring in 1992 at a Dominican Institute of Social Security hospital in Santo Domingo to analyze the association between prematurity, low birth weight, and early neonatal mortality. Stillbirths, infants weighing less than 1000 g or born before 28 weeks of gestation, and those with lethal malformations were excluded. 5142 newborns met the inclusion criteria. 1701 deliveries (33%) were cesarean. 550 of the newborns (10.7%) were low birth weight, and 338 (6.6%) were premature. The early neonatal mortality rate was 17/1000. Low birth weight infants accounted for 66.2% of early neonatal mortality. 10.7% of low birth weight infants died within the first week of life, and their relative risk of early neonatal death was 16.42. 64% of all infants dying in their first week of life were also premature. The specific mortality rate for premature infants was 168.6/1000 live births. The relative risk was 25.32 for premature infants. Low birth weight infants born at term had an early neonatal mortality rate of 24.6/1000 live births, compared to 5.5/1000 for term births of adequate weight.
The body mass index (BMI) is currently the most accepted indicator of body fat for clinical purposes and is useful in definition of overweight or obesity. Most studies of BMI have been done in the United States, and very few anywhere have focused on evolving BMIs of children or adolescents. Data on weight and height of 2015 girls and 2053 boys 18 and younger in Santo Domingo gathered for a different study were used to calculate BMI. The sample children were evaluated in private clinics and health facilities in Santo Domingo and were all healthy and well nourished. Nearly all of the infants were bottle fed. A table presents the smoothed BMIs for the 3rd, 50th, and 97th percentiles separately for boys and girls at birth, 3, 6, 9, 12, 18, and 24 months, and each year through 18. The values corresponding to 120% and 80% of the median values are also shown. The values tended to rise in the first 9 months of life, especially in males. Values declined slowly between 9 months and 7 years and then progressively increased until 14 or 15 years, when the rate of increase slowed considerably. The pattern of slowing at 14 or 15 years resembles the corresponding pattern observed in skin folds.
The World Health Organization has recommended since 1920 that salt for cooking be iodized to ensure adequate iodine intake by the population. The frequent appearance of goiter especially in adolescents in some endemic areas of the Dominican Republic prompted a study of iodine content of salt. Concentrations of iodine were assessed in 12 samples of salt. Three samples were from salt mines and the rest were obtained as "iodized salt" in markets. Iodine was added to six other samples as a control for the laboratory procedure. 50 mothers attending a public children's clinic and 25 attending a private medical practice were interviewed concerning the type of salt they used for cooking. Iodine was not found in the 12 samples but was found in the six controls. 56% of the women stated they used non-refined salt in meal preparation. 16% of the mothers in the public clinic and 44% in the private clinic were aware of the association between iodine and goiter.
A prospective study was conducted of 100 children under five who were treated at the outpatient and emergency services of the Robert Reid Cabral Hospital in Santo Domingo between August 1989 and May 1990 for acute respiratory infection (ARI). The objective was to evaluate the frequency of use of antibiotics in management of ARI. 51 of the children were under one year old. Among the infants under one year, 32 had mild, 15 had moderate, and 4 had severe cases. An antibiotic was prescribed in 35 of 59 cases of mild infection, 34 of 36 cases of moderate infection, and in all 5 cases of severe infection. The most frequently used antibiotic was penicillin, used in 28%, followed by amoxycillin in 17%, ampicillin in 14%, and erythromycin in 8%.
