Antibody responses to Bordetella pertussis and other childhood vaccines in infants born to mothers who received pertussis vaccine in pregnancy - a prospective, observational cohort study from the United Kingdom.

The maternal Tdap (tetanus, diphtheria and acellular pertussis) vaccination programme in the United Kingdom has successfully reduced cases of pertussis in young infants. In addition to prevention of pertussis cases, it is also important to investigate the persistence of maternal antibodies during infancy and the possible interference of maternal antibodies with infant responses to vaccines. We recruited mother-infant pairs from vaccinated and unvaccinated pregnancies and measured concentrations of immunoglobulin (Ig)G against pertussis toxin (PTx), filamentous haemagglutinin (FHA), pertactin (Prn), diphtheria toxin (DTx), tetanus toxoid (TTx) Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae in mothers and infants at birth, and in infants at 7 weeks and at 5 months. Thirty-one mother-infant pairs were tested. Tdap-vaccinated women had significantly higher antibody against Tdap antigens, compared to unvaccinated women (DTx, P = 0·01; PTx, FHA, Prn and TTx, P < 0·001). All antibodies were actively transferred to the infants (transfer ratio  > 1) with higher transfer of DTx (P = 0·04) and TTx (P = 0·02) antibody in Tdap-vaccinated pregnancies compared to unvaccinated pregnancies. Infants from Tdap-vaccinated pregnancies had significantly elevated antibodies to all antigens at birth (P < 0.001) and at 7 weeks (FHA, Prn, TTx, P < 0·001; DTx, P = 0.01; PTx, P = 0·004) compared to infants from unvaccinated pregnancies. Infants from Tdap-vaccinated and -unvaccinated pregnancies had comparable antibody concentrations following primary pertussis immunization (PTx, P = 0·77; FHA, P = 0·58; Prn, P = 0·60; DTx, P = 0·09; TTx, P = 0·88). These results support maternal immunization as a method of protecting vulnerable infants during their first weeks of life.

The impact of timing of maternal influenza immunization on infant antibody levels at birth.

Pregnant women and infants are at an increased risk of severe disease after influenza infection. Maternal immunization is a potent tool to protect both these at-risk groups. While the primary aim of maternal influenza vaccination is to protect the mother, a secondary benefit is the transfer of protective antibodies to the infant. A recent study using the tetanus, diphtheria and acellular pertussis (Tdap) vaccine indicated that children born to mothers immunized in the second trimester of pregnancy had the highest antibody titres compared to children immunized in the third trimester. The aim of the current study was to investigate how the timing of maternal influenza immunization impacts infant antibody levels at birth. Antibody titres were assessed in maternal and cord blood samples by both immunoglobulin (Ig)G-binding enzyme-linked immunosorbent assay (ELISA) and haemagglutination inhibition assay (HAI). Antibody titres to the H1N1 component were significantly higher in infants born to mothers vaccinated in either the second or third trimesters than infants born to unvaccinated mothers. HAI levels in the infant were significantly lower when maternal immunization was performed less than 4 weeks before birth. These studies confirm that immunization during pregnancy increases the antibody titre in infants. Importantly, antibody levels in cord blood were significantly higher when the mother was vaccinated in either trimesters 2 or 3, although titres were significantly lower if the mother was immunized less than 4 weeks before birth. Based on these data, seasonal influenza vaccination should continue to be given in pregnancy as soon as it becomes available.

Traumatic pseudoaneurysm of the pulmonary artery: case report and review of the literature.

Pulmonary artery pseudoaneurysm is a very rare but potential complication of chest trauma. These aneurysms are usually produced by penetrating trauma although a few cases have been reported after blunt injury. They should be suspected if there is a persistence of opacity on chest radiograph that when evaluated by contrast-enhanced CT shows an increased opacification of the mass. Diagnosis is confirmed with a pulmonary arteriogram.

Myocardial infarction in men and women under 65 years of age: no evidence of gender bias.

We examined short and long term outcomes of MI in a consecutive series of 169 men and 50 women who were followed for an average of 3.5 years. Similar percentages of men and women were admitted to medical intensive care, received in-patient cardiac rehabilitation, quit smoking at one year, were still smoking, were taking a lipid lowering drug or had returned to work at one year, underwent coronary angiography at 3.5 years or had died by 3.5 years. The lack of gender difference in outcome may reflect an absence of gender bias in the management of men and women with MI in southwest Scotland.

A comparative analysis of surveyors from six hospital accreditation programmes and a consideration of the related management issues.

PURPOSE: To gather data on how accreditors manage surveyors, to compare these data and to offer them to the accreditors for improvement and to the scientific community for knowledge of the accreditation process and reinforcement of the credibility of these processes. DATA SOURCE: The data were gathered with the aid of a questionnaire sent to all accreditors participating in the study. RESULTS: An important finding in this comparative study is the different contractual relationships that exist between the accreditors and their surveyors. CONCLUSION: Surveyors around the world share many common features in terms of careers, training, work history and expectations. These similarities probably arise from the objectives of the accreditors who try to provide a developmental process to their clients rather than an 'inspection'.

Human immunodeficiency virus and lung cancer.

BACKGROUND: The association of human immunodeficiency virus (HIV) infection with lung cancer remains unclear. The presence of multiple risk factors in patients with HIV infection makes it difficult to identify a direct cause-effect relationship. METHODS: A retrospective study of patients with lung cancer who were diagnosed, treated and followed at Harlem Hospital Center, New York, between January 1990 and December 1994 was performed. Eleven HIV-seropositive and 116 HIV-indeterminate patients with histologically proven lung cancer were identified. The two groups were compared with regard to age, sex, race, predisposing factors, stage of presentation, histological type of the tumours and survival. RESULTS: HIV-infected patients with lung cancer were predominantly male smokers who were significantly younger than the control HIV-indeterminate patients with lung cancer. Although adenocarcinoma was seen more frequently in the HIV-seropositive group, the difference was not statistically significant. Survival in HIV-infected patients was shorter than that in HIV-indeterminate patients, suggesting that the cancer may be more aggressive in HIV-infected patients or that the progression of immunoincompetence in these patients may influence survival. CONCLUSION: A direct cause-effect relationship between lung cancer and HIV infection is difficult to establish in the presence of other risk factors, but the incidence of lung cancer may be increasing in HIV-infected men.

Schistosomiasis: an unusual cause of right lower quadrant abdominal pain.

Schistosomiasis, although unusual in North America, is a common disease worldwide. Symptoms vary depending on the species involved. Immigrants from endemic regions are the commonly affected patients found in North America. In most cases, schistosomiasis does not present with right lower quadrant pain. Even in endemic regions, this form of presentation is uncommon. In the United States, most cases of right lower quadrant pain often will be treated as appendicitis. Questions remain unanswered as to whether the schistosomes cause appendicitis or are found incidentally in these cases. Stool and urine specimens may be helpful in making a diagnosis. Most cases require operative intervention to rule out appendicitis and to obtain tissue for histopathologic diagnosis. Praziquantel is effective in eradicating infestations.

Accreditation programs for hospitals: funding and operation.

Accreditation is a formal process by which an authorized body assesses and recognizes an individual, an organization (like a hospital), a program, or a group as complying with requirements such as standards or criteria. This article analyses and compares the activity and funding of six health care accrediting bodies which operate in five different countries, and which in 1994, accredited over 5000 health centres. The data included in this article could be useful for other institutions who wish to commence accreditation programmes for health care organizations.

Sarcoidosis of the breast: case report and chart review.

Sarcoidosis is a systemic disease of unknown etiology affecting all organ systems. Breast involvement accounts for less than 1 per cent of cases. In most cases systemic symptoms precede the finding of breast involvement. Involvement of the breast as the primary manifestation of this disease is a rare occurrence. A review of the literature shows a total of 29 cases published in the English language literature between 1921 and 1993. In these cases, less than a third had the breast as the primary organ involved. All cases of sarcoid breast disease presented as breast masses. Biopsy was done in most cases to rule out a malignant breast lesion. In four of the cases reviewed, sarcoid lesions and malignancy coexisted. Pathological features of sarcoidosis are typical for noncaseating lesion; however, differentiation from tuberculosis may be difficult. The PPD and Kviem test should be performed to help come to a diagnosis. Patients with primary breast involvement are highly likely to have subclinical pulmonary disease. Pulmonary function testing, serum lysozyme, and serum angiotensin-converting enzyme levels are helpful in assessing activity of the disease, and directing therapy. We present a case of sarcoidosis of the breast as the primary manifestation of sarcoidosis, and a review of the literature to illustrate these points.

The role of transjugular liver biopsy in fulminant liver failure: relation to other prognostic indicators.

Early and accurate diagnosis and prognosis of patients with fulminant liver failure is of critical importance for optimum management. We investigated the role of transjugular liver biopsy in the management of patients with fulminant liver failure and assessed its value in comparison with the recently proposed King's College criteria. Sixty-one patients with fulminant liver failure, ages 2 to 82 yr, were retrospectively analyzed. The main outcome measures were survival vs. death or progression to orthotopic liver transplantation. Transjugular liver biopsy was successful in 60 of 61 patients, with a mean core tissue length of 2.1 cm. There were eight minor complications, all of which were managed conservatively. Biopsy specimens were evaluated for degree of fibrosis, percentage of hepatocellular necrosis and presence of bile duct proliferation, hepatocellular mitotic figures and binucleate hepatocytes for each of the 54 specimens available for analysis. In 34 of 54 patients (63%), the presumed clinical diagnosis was confirmed by transjugular liver biopsy. In 11 patients the procedure served to clarify clinical uncertainty, whereas in 9 of 54 (16.7%) the diagnosis was altered after transjugular liver biopsy. The percentage of necrosis was the only histological parameter that appeared to have significant discriminatory prognostic value, with only 2 of 19 survivors having greater than 70% necrosis. Twenty-one of these biopsy specimens were reviewed by two pathologists, and their degree of correlation for the various features was assessed. Almost perfect concordance was found between the two pathologists on the percentage of hepatocellular necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Real time ultrasound, arterial pulsation and neonatal cerebral infarction.

This paper describes an infant whose cranial ultrasound scan showed marked unilateral cerebral arterial pulsation and enlargement without other abnormality. Subsequent computerized tomogram showed extensive cortical infarction in an area not readily accessed by ultrasound. It is concluded that the real time dimension of cranial ultrasound is of diagnostic value in the absence of demonstrable parenchymal or intraventricular abnormality.

Performance characteristics and solution properties of surfactants in shampoos.

Synopsis A brief analysis is made of the main types of surfactants used in shampoos and bubble baths. The requirements of a modern shampoo are discussed as are the means by which these can be achieved by the use of a number of selected additives such as the traditional alkanolamides, and the newer amine oxides, amido amine betaines and alkyl amine betaines. In particular, such aspects as the achievement of viscosity control, foam generation, shelf life stability and safety are examined. The physical chemistry of the behaviour in solution of several selected non-ionic and amphoteric nitrogen containing surfactants is discussed and how these affect viscosity modification and foam generation. Mention is also made of the chemistry of the new highly concentrated anionic surfactants and the benefits that they give the formulator. Finally, the attributes of imidazoline derived surfactants are outlined with special reference to their mildness and foaming ability.

Improved colorimetric method for determining nitrate and nitrate in foods.

A method is described for determining nitrate and nitrite in cured meat products, cheeses, and vegetables. The nitrite is determined colorimetrically by diazotization of sulfanilic acid and subsequent coupling with N-(1-naphthyl)-ethylenediamine. The concentration of nitrate plus nitrite is determined similarly but after reduction of the nitrate to nitrite on a cadmium column. The difference of the 2 values is a measure of the nitrate concentration. The main improvements are replacing the Griess reagent, which contains a carcinogen, with a mixture of sulfanile acid and N-(1-naphthyl)-ethylenediamine, providing for adjustment of pH of the sample suspension during extraction and digestion by heating, and maintaining constant pH by controlled addition of buffers and acids during color development. The method was successfully applied to the analysis of 15 samples of meat products, 23 cheeses, and 6 different vegetables. The average recovery of sodium nitrite added at levels ranging from 10 to 30 ppm was 95% and recovery of sodium nitrate added at levels from 30 to 400 ppm was 94% (corrected for cadmium column efficiency).

Recent studies in Canada on the analysis and occurrence of volatile and non-volatile N-nitroso compounds in foods.

The present paper briefly summarizes the research activities of the Food Research Laboratories, Canadian Health Protection Branch, during the past two years. Data presented indicate that traces of nitrosamines, mainly nitrosodimethylamine and nitrosodiethylamine, can occur in cheese. Several new analytical methods are presented for the determination of non-volatile nitroso compounds, such as nitrosohydroxypyrrolidine, nitrosodiethanolamine, nitrosoproline, nitrosohydroxyproline and nitrosoglyphosphate (a nitrosated herbicide). It is shown that all of the above compounds, even the very polar nitrosoglyphosphate, can be converted to volatile derivatives and then analysed by GLC-MS or by conventional GLC using a specific (such as P-photometric) detector. Traces of nitrosohydroxypyrrolidine have been detected in a few samples of cooked bacon. Contrary to previously reported findings, no significant levels of nitrosoproline were detected in the 6 samples of raw bacon analysed.