Alcohol sensing membrane based on immobilized ruthenium(II) complex in carboxylated PVC and surface covalently bonded alcohol oxidase.

Alcohol sensing membranes coated on overhead transparency films for the continuous monitoring of ethanol, propanol and butanol are presented. Alcohol oxidation catalyzed by alcohol oxidase in conjunction with the fluorescence quenching reaction of oxygen-sensitive dye ion-pair, tris(4,7-diphenyl-1,10-phenanthroline) ruthenium(II) didodecylsulphate was chosen for the determination. Alcohol oxidase was immobilized covalently on a plasticized carboxylated poly(vinyl chloride) membrane and the oxygen-sensitive dye ion-pair was entrapped in the same membrane. The sensing membrane relates oxygen consumption, as a result of enzymatic oxidation, to alcohol concentration. Measurements have been performed in air-saturated alcohol standard solutions of pH 7.0. Storage stability, reproducibility and the effect of pH on sensing membrane performance have been studied in detail. The alcohol sensing membrane proposed here is simple to prepare and has a fairly rapid response time of <1 min. It has been successfully applied to the determination of the ethanol contents in various spirits.

Sequential use of intravenous and oral acyclovir in the therapy of varicella in immunocompromised children.

BACKGROUND: Immunocompromised children are at risk for disseminated varicella infections. Standard management involves hospitalization and intravenous acyclovir for 7 to 10 days. This approach is expensive, is inconvenient and may not be necessary. We undertook a pilot study to assess the safety and efficacy of an alternative approach that utilized a combination of intravenous (i.v.) followed by oral (p.o) acyclovir in a cohort of immunocompromised children. METHODS: The cohort consisted of 26 immunocompromised children between the ages of 1.5 and 12.7 years (mean, 6.3). Therapy was commenced with i.v. acyclovir (1500 mg/m2/day in 3 divided doses). Concurrent management included holding or reducing immunosuppressive therapy (by 50%) and administering varicella-zoster immunoglobulin in 69% (11 of 16) of cases where exposure to chickenpox was recognized. Patients were eligible to switch to p.o therapy after receiving a minimum of 48 h of i.v. acyclovir therapy provided they were afebrile; had no new lesions for 24 h; had no internal organ involvement and were able to tolerate oral medications. Patients were observed in hospital for a further 24 h and then discharged provided they remained well. Oral acyclovir was continued for a total of 7 to 10 days (i.v. plus p.o). RESULTS: Of the 26 patients 25 were successfully switched from i.v. to p.o after 4.1 +/- 1.2 days (mean +/- SD) (range, 2.3 to 6) Children had fever for a mean of 2.0 +/- 1.6 days (range, 0 to 5) and developed new lesions for 2.9 +/- 0.7 days (range, 2 to 4). All 25 patients switched to p.o therapy had resolution of their disease and no patient required resumption of i.v. therapy. CONCLUSIONS: The sequential use of i.v. followed by p.o acyclovir is feasible in the treatment of varicella in immunocompromised children and results in a reduction in duration of intravenous therapy and hospitalization.

Electronic measurement of compliance with mercaptopurine in pediatric patients with acute lymphoblastic leukemia.

UNLABELLED: Twenty-four pediatric patients with acute lymphoblastic leukemia (ALL) on maintenance therapy were evaluated for their compliance with taking their prescribed doses of oral mercaptopurine (6-MP). PROCEDURE AND RESULTS: We utilized the Medication Event Monitoring System (MEMS; Aprex Corporation, Fremont, CA) for the study. Compliance was defined as the number of days doses were taken as a percentage of the total number of days doses were prescribed during the study period. The mean age of the patients was 7.3 years (range 2.6-17.2 (years). Patients were evaluated for a mean of 44 days (range 15-94 days). Thirty-three percent of patients (8) took less than 90% and 17% (4) took less than 80% of their prescribed pills. Eight patients were also evaluated for a difference in compliance between morning and evening administration. For the comparison of compliance between a morning vs. an evening schedule a tren toward improved compliance in the evening was found. Five patients had an increase and one patient a decrease in compliance with an evening schedule (differences ranged from 0.2% to 51.3%), with two patients having 100% compliance on both schedules. CONCLUSIONS: Our data raise concern that a significant proportion of pediatric patients are non-compliant with pill taking and demonstrate that the timing of administration of 6-MP in children with ALL may be crucial in some patients and supports the hypothesis that evening administration of 6-MP is associated with a lower risk of relapse.

Berninamycins B, C, and D, minor metabolites from Streptomyces bernensis.

Berninamycins B, C, and D were isolated from fermentation of Streptomyces bernensis and their structures were studied with 13C NMR and FAB mass spectrometry. Berninamycin B has a valine unit in its cyclic peptide loop instead of the beta-hydroxyvaline unit found in berninamycin A. Berninamycin D has two fewer dehydroalanine units attached to the carboxyl carbon of the pyridine ring. Based on FAB-MS results, berninamycin C is postulated to have only one dehydroalanine unit attached to the carboxyl carbon of pyridine. The biogenesis of berninamycins B, C, and D is discussed.

Early discharge of pediatric febrile neutropenic cancer patients by substitution of oral for intravenous antibiotics.

In an open, prospective pilot study of pediatric cancer patients, 23 episodes of fever and neutropenia were treated with intravenous and then oral antibiotics. After 72 hours, patients were changed from intravenous to oral antibiotics if the following criteria were met: negative blood cultures, temperature 38.0 degrees C or lower for 24 hours, absolute neutrophil count less than 0.5 x 10(9)/L, and absence of clinical sepsis. Three patients (13%) had recurrent fever. Intravenous antibiotics were reinstituted in two of these three patients, and oral antibiotics were continued in the third. Fever was believed to be related to relapsed leukemia in one of the three patients. No focus of infection was defined in the other two, and both had good clinical outcomes. The study suggests that this approach to therapy is feasible and can be safely used for selected patients who are anticipated to have a short duration of neutropenia.

Lymphoid blast crisis of B-lineage phenotype with monosomy 7 in a patient with juvenile chronic myelogenous leukemia (JCML).

We studied a patient with juvenile chronic myelogenous leukemia (JCML) whose terminal course was characterized by transformation to acute lymphoblastic leukemia. Karyotypic studies identified monosomy 7 in leukemic myelomonocytic marrow cells during the chronic phase and in the lymphoblasts during the transformation phase. Our ability to sustain the transformed lymphoblasts in culture allowed us to characterize them further. CD19, HLA-DR, and CD10 were present, consistent with a pre-B acute lymphoblastic leukemia phenotype. CD14 (My-4) and CD13 (My-7) were negative. Rearrangement of immunoglobulin heavy- and light-chain genes identified monoclonal populations of cells of the B lineage. This case provides further evidence that JCML is a clonal disease of pluripotent stem-cell origin.

Evaluation of the immunogenicity of attenuated feline calicivirus vaccines by ELISA.

An ELISA test was developed to measure the levels of IgG antibody in specific-pathogen-free (SPF) cats immunised with two doses of an attenuated feline calicivirus (FCV) vaccine. All eight vaccinates were protected from virus challenge, but four out of five non-vaccinates were not. There was a significant difference in respect of protection from virus challenge between SPF cats with and without three-fold or greater increase in antibody units (P = 0.01). Each serum absorbance was standardised against the reference positive which has an arbitrary value of 100 antibody units. In SPF cats, the 99% confidence level for seropositivity to FCV was determined as greater than or equal to 2.5 antibody units. The results suggest that the sensitive ELISA test can be used to monitor the antibody status of SPF cat colonies prior to FCV vaccine trials, and to measure the immunogenicity of attenuated FCV vaccines. Thus, the ELISA test may replace the need for virus challenge, with consequent reduction in animals used in future FCV vaccine trials.

Pertussis (whooping cough) toxin and Bordetella pertussis whole-cell antibody levels in a healthy New Zealand population.

Enzyme linked immunosorbent assay (ELISA) tests were used to measure IgG antibody levels to Bordetella pertussis whole-cell and to pertussis toxin in a healthy New Zealand population. The percentage of individuals with measurable antibody to B pertussis whole-cell increased from 47.3% in the 5 year olds to 93.0% in the 40-49 age group, from which the percentage with antibody dropped to 88.7% in the 50-65 age group. The percentage of persons with antibody to the toxin increased with age from 17.5% in the 5 year olds to 67.0% in the 40-49 age group, from which the percentage of individuals with antibody dropped to 45.4% in the 50-65 age group. Similarly, the percentage of persons with antibody to both B pertussis whole-cell and pertussis toxin increased with age from 15.5% in the 5 year olds to 63.0% in the 40-49 age group, and then the percentage with antibody to whole-cell and toxin dropped to 45.4% in the 50-65 age group. The percentage of individuals with antibody to pertussis toxin is generally markedly lower than the percentage of persons with antibody to B pertussis whole-cell across the age range. Suggestions are made as to how to improve herd immunity for pertussis.

The 1985 national immunisation survey: diphtheria, tetanus, and pertussis (whooping cough)

In April 1985 a national immunisation survey was conducted in which sera were collected from almost 3000 randomly selected children throughout New Zealand. The sera collected were from about 1000 new school entrants (mean age 5 years), 1000 standard 3 students (mean age 10 years), and 1000 form 4 students (mean age 15 years). The sera were tested for diphtheria and tetanus immunity and antibody to pertussis by enzyme-linked immunosorbent assay (ELISA) tests. The percentage of those immune to diphtheria decreased with age from 73.1% in the 5 year olds to 53.7% in the 15 year olds. The percentage of those immune to tetanus decreased with age from 66.9% in the 5 year olds to 54.6% in the 10 year olds but then increased to 64.0% in the 15 year olds. While more than 71.0% of the 10 and 15 year olds had measurable antibody to pertussis, only a low 54.4% of the 5 year olds did. The proportion immune to diphtheria and tetanus in both Maoris and Europeans was approximately similar in all three age groups. More Maoris (78.9%) than Europeans (66.1%) had antibody to pertussis. When the data had been standardised for age and ethnic group the percentage with antibody to pertussis and immunity to diphtheria was highest in the southern region, while for tetanus immunity the percentage immune was highest in the northern and southern regions. We conclude that a sizeable pool of new school entrants (mean age 5 years) without antibody to pertussis is accumulating at a time when pertussis still persists.(ABSTRACT TRUNCATED AT 250 WORDS)

Antibody level of New Zealand children immunized with the triple vaccine DTP (diphtheria-tetanus-pertussis).

Enzyme-linked immunosorbent assay (ELISA) tests were used to measure IgG antibody levels in 2638 New Zealand children who had been immunized with the triple vaccine DTP. The percentage of children immune to diphtheria decreased with age. The percentage of children immune to tetanus varied from 67.1 to 55.0%. The percentage of children with measurable antibody to pertussis increased with age. The mean percentages of children with measurable antibody or immunity to one or more DTP components were 34.2% (with 3 components), 34.4% (2 components), and 78.1% (1 component). It appears the immunization strategy for diphtheria and tetanus is satisfactory for herd immunity in New Zealand children. However, the current pertussis strategy may not be providing adequate immunity to 5-year-olds in this country.

A survey of virus infections in New Zealand, 1982-6.

Between 1982 and 1986 virus infections were identified in 16,372 cases. These identifications were based on virus isolation and/or serological evidence of infection by the main virus diagnostic laboratories at Auckland, Waikato, Christchurch and Dunedin hospitals, and at the National Health Institute. The most frequent virus identifications reported were herpes simplex (46.7%), rotavirus (11.8%), respiratory syncytial virus (5.7%), and adenovirus (5.6%). During this period of surveillance, the most prominent feature has been the high incidence of herpes simplex which reached a peak in 1983 but which has abated only slightly since. Significant trends and virus outbreaks or epidemics were detected with the regular reporting of monthly virus identifications in the New Zealand Virus Report (NZVR); these included a measles epidemic in Auckland in 1984/85, major influenza A outbreaks in 1983, 1985 and 1986, the respiratory syncytial virus epidemic in the winter of 1986, the increased incidence of rotavirus predominantly in young infants and children during the winter months, outbreaks of enterovirus type 71 and parainfluenza type 3 infections in 1986, and rubella in 1984.

Diphtheria, tetanus, pertussis: antibody detection in New Zealand.

Enzyme-linked immunosorbent assay (ELISA) tests were developed to detect IgG antibodies to diphtheria, tetanus, and pertussis in a healthy New Zealand population. Sera from 551 healthy persons aged 6-65 years from different areas in New Zealand were tested. Immunity to diphtheria decreased steadily from 97.1% in the 6-9 age group to 47.6% in the 60-65 age group. Immunity to tetanus varied from 88.6% in the 6-9 age group to 83.3% in the 20-29 age group, whence the level decreased with age to 57.1% in the 60-65 age group. In the teenage and adult groups more than 87.6% have antibodies to pertussis while in the 60-65 group it was 66.7%. There was great variation in the level of measurable antibody to pertussis in all age groups.

Detection of tetanus toxoid antibodies in human sera in New Zealand by ELISA.

An enzyme-linked immunosorbent assay (ELISA) incorporating the sensitive biotin-streptavidin system was developed to detect IgG antibodies to tetanus toxoid in human serum. Serum samples obtained from 557 normal persons aged 1-65 years from different areas in New Zealand were tested. The proportion of those immune ranged from 60-93% in males, and from 46-86% in females. In the 1-9 years age group 85% were immune. The indirect ELISA is suitable for serological surveys as it is simple to perform, economical and reproducible.

Detection of diphtheria toxin antibodies in human sera in New Zealand by ELISA.

An enzyme-linked immunosorbent assay (ELISA) was developed to detect IgG antibodies to diphtheria toxin in human serum. Serum samples obtained from 557 normal persons aged 1-65 years from different areas in New Zealand showed maximum antibody levels in the 1-9 years age group (95.1%) and the least in the 60-65 years age group (38.1%). The indirect ELISA is suitable for seroepidemiological survey study as it is simple to perform, economical and precise.

Coxsackie B virus-specific IgM responses in coronary care unit patients.

An enzyme-linked immunosorbent assay (ELISA) test using polyvalent antigens and antisera was used to detect Coxsackie B virus-specific IgM responses in 329 patients admitted to the Coronary Care Unit, Wellington Hospital, New Zealand over a 12-month period. The sera of 30 of 153 (19.6%) patients with acute myocardial infarction (AMI), 16 of 98 (18.4%) with chest pain, and 7 of 46 (15.2%) patients with arrhythmia were positive for Coxsackie B virus-specific IgM. Four of 12 (25%) patients with heart failure were also positive. Over the same period, 178 sex- and age-matched normal blood donors were also studied. Eleven of 178 (6.2%) matched blood donors were positive for Coxsackie B virus-specific IgM. The rates of occurrence of Coxsackie B virus-specific IgM in patients with AMI and in a group of matched controls showed a significant difference (chi 2 = 5.64, p = 0.02).

Coxsackie B virus infections in New Zealand patients with cardiac and non-cardiac diseases.

From 1979 to 1981, a total of 910 cardiac patients and 776 noncardiac patients were studied and compared for evidence of coxsackie B virus infections. Of 78 cardiac patients with coxsackie B infection, 30 had pleurodynia, 18 myocarditis, and 20 pericarditis. The age-adjusted rates of infection per 100 cases of defined category were 7.2, 13.3, and 7.0, respectively. Of 69 noncardiac patients with coxsackie B infection, 27 presented with pyrexia of unknown origin, 14 with upper respiratory tract infection, and 9 with meningitis. The age-adjusted rates of infection per 100 population were 10.6, 11.0, and 8.4, respectively. The sex-specific, age-adjusted rates for both cardiac and noncardiac patients were generally higher in male than female. For cardiac patients, the highest percentage with coxsackie B virus infection occurred in the 20-39-year age group, while in the noncardiac group, it was the 0-19-year age group. Coxsackie B2 and B4 were the two most prevalent serotypes found in both cardiac and noncardiac patients. Coxsackie B infections occurred mainly during summer and autumn. The level of coxsackie B immunity in 1,020 normal persons aged 1-60 years and from all 18 health districts of New Zealand was studied. The geometric mean titre of antibody from these normal persons was highest for serotypes B2 and B4. The least prevalent type antibody was B6 where 970(95.1%) of normal persons tested had no antibody to this serotype. The percentage of normal persons with antibody-type present were 30.4, 63.4, 54.1, 71.3, and 51.8 for B1-5, respectively.

Coxsackie B virus infection in acute myocardial infarction and adult heart disease.

Over a 12-month period, 329 patients admitted to the Coronary Care Unit, Wellington Hospital, New Zealand, were studied for evidence of Coxsackie B virus infection. Fifteen patients (9.8%) with acute myocardial infarction (AMI), three (6.5%) with arrhythmia, and three (25%) with heart failure had serological evidence of Coxsackie B virus infection. During the same period, two control groups were also studied, and the rates of Coxsackie B infection in these groups were compared with that of patients with AMI. The standardised morbidity ratio (SMR) of Coxsackie B infection was 96 for patients with AMI compared with 104.5 for the first control group--that of patients with miscellaneous diseases other than cardiac. The difference between these groups was not significant (P greater than 0.1). However, the SMR of 91.3 for patients with AMI was very high compared with that of 0.0 for the second control group, which consisted of healthy blood donors.

The role of coxsackie B viruses in heart disease in New Zealand.

Sera from 622 patients received in a 20-month period were examined for coxsackie B neutralising antibody to serotypes 1--6. Two hundred and thirty-four of the total 622 were patients with a cardiac symptomatology, and 388 formed a comparable group of non-cardiac cases. There were 141 (60 percent) seropositive patients in the cardiac group, 34 percent and 29 percent of which respectively had antibody to B4 and B2. The clinical data provided on these 141 patients indicated that 33 (23 percent) had acute myocarditis, and 59 (42 percent) had acute pericarditis; 41 (29 percent) were recorded as having acute pleurodynia or Bronholm disease while eight (6 percent) had other indications of cardiac disease. Amongst the cardiac patients the highest prevalence of seropositivity was found in the 20--39 age group and 67 percent of these were males.