Porcine xenograft treatment of superficial partial-thickness burns in paediatric patients.

OBJECTIVE: Porcine xenograft (PX) has become a valuable part of the armamentarium of treatment options in a US paediatric burn centre. The use in adult patients has been well described in the burn literature, but there is minimal literature describing its use in children. The objective of this article is to describe a three-years' experience with PX use in paediatric burns. METHOD: A retrospective medical record review of patients with superficial partial-thickness burns treated with PX admitted to a paediatric burn centre between February 2009 and November 2012. RESULTS: A total of 164 patients met the inclusion criteria. Burn total body surface area (TBSA) ranged from 0.5% to 28%. After the placement of PX, significant decreases were seen in the need for narcotic analgesics and burn dressing changes. Only four of 164 patients (2.4%) developed infections, although only one of these infections was at the site of the xenograft. CONCLUSION: PX appears to reduce pain and eliminate the need for procedural intravenous sedation in many patients. This can make burn wound care more child-friendly and shorten hospital length of stay. The complication rate is low and manageable. The authors believe that PX is an effective and safe treatment for superficial partial-thickness burns in children. DECLARATION OF INTEREST: P. M.Glat, is a paid consultant and speaker for Mölnlycke Health Care, the manufacturer of EZ Derm.

Clinical evaluation of a silver-impregnated foam dressing in paediatric partial-thickness burns.

OBJECTIVE: Mepilex Ag, a silver-impregnated foam dressing, was introduced to our institution in 2007 and our outcomes in the treatment of paediatric burns were observed to improve significantly. In order to confirm these observations, we wanted to evaluate the results of using the silver-impregnated foam dressing in partial-thickness paediatric burns. METHOD: In this retrospective study, the St. Christopher's Hospital burn registry was used to identify subjects, who were otherwise in excellent health at baseline, over an18-month period. Outcomes included length of stay, intravenous narcotic use, and time to healing. No direct comparative studies were performed. This was followed by a non-comparative prospective study involving 22 paediatric patients, aged 1-4 years, with partial-thickness burns. This was a sub-study of a larger randomised controlled trial involving adults with partial-thickness burns, comparing the silver-impregnated foam dressing with Silvadene. RESULTS: In the retrospective part of the study, the silver-impregnated foam dressing was used successfully for the treatment of partial-thickness paediatric burns, with few complications and infections, allowing a shorter hospital stay, fewer dressings, and less pain medication than for historical controls. In the non-comparative prospective study, of 22 paediatric patients 50% healed completely within 1 week of treatment. The mean length of stay was 3.77 days and the mean number of dressings used was 1.64. Although narcotic usage was not assessed, patient surveys showed stinging or burning to be recorded as 'never' in 13 patients, 'rarely' in 8 patients, and 'sometimes' in 1 patient. CONCLUSION: The silver-impregnated foam dressing is effective and safe for use in partial-thickness paediatric burns, eliminating the need for daily dressings. DECLARATION OF INTEREST: The study was supported by an educational grant from Mölnlycke Health Care.

The influence of age and Rhodococcus equi infection on CD1 expression by equine antigen presenting cells

There is a distinct age-associated susceptibility of horses to Rhodococcus equi infection. Initial infection is thought to occur in the neonatal and perinatal period, and only foals less than 6 months of age are typically affected. R. equi is closely related and structurally similar to Mycobacterium tuberculosis, and causes similar pathologic lesions. Protective immune responses to M. tuberculosis involve classical major histocompatibility complex (MHC)-restricted T cells that recognize peptide antigen, as well as MHC-independent T cells that recognize mycobacterial lipid antigen presented by CD1 molecules. Given the structural similarity between these two pathogens and our previous observations regarding R. equi-specific, MHC-unrestricted cytotoxic T lymphocytes (CTL), we developed 3 related hypotheses: (1) CD1 molecules are expressed on equine antigen presenting cells (APC), (2) CD1 expression on APC is less in foals compared to adults and (3) infection with live virulent R. equi induces up-regulation of CD1 on both adult and perinatal APC. CD1 expression was examined by flow cytometric analysis using a panel of monoclonal CD1 antibodies with different species and isoform specificities. RESULTS: Three CD1 antibodies specific for CD1b showed consistent cross reactivity with both foal and adult monocyte-derived macrophages (MDM). CD1b and MHC class II expression were significantly higher on adult MDM compared with foals. R. equi infected MDM showed significantly lower expression of CD1b, suggesting that infection with this bacterium induces down-regulation of CD1b on the cell surface. Histograms from dual antibody staining of peripheral blood mononuclear cells also revealed that 45-71% of the monocyte population stained positive for CD1b, and that the majority of these also co-expressed MHC II molecules, indicating that they were APC. The anti-CD1 antibodies showed no binding or minimal binding to bronchoalveolar lavage (BAL)-derived macrophages.

Stature, weight, and body mass among young US children born at term with appropriate birth weights.

OBJECTIVE: To describe weight, stature, and body mass index (BMI) changes occurring before the age of 7 years, which may influence the prevalence of overweight in adolescence and adulthood. METHODS: Regression models predicting height and weight at ages 2 months to 6. 75 years were based on the third National Health and Nutrition Examination Survey. Birth certificate data were used to adjust ethnic-specific models for birth weight for gestational age. RESULTS: Attained height is higher for non-Hispanic black children than for either non-Hispanic white or Mexican American children (P 85th percentile than either non-Hispanic white or black children (boys = 25.6%, SE = 2.7 compared with 14.1%, SE = 1.7 and 16.5%, SE = 1.7, respectively; girls = 21.9%, SE = 3.6 compared with 13.0%, SE = 1.7 and 13.7%, SE = 2.2, respectively). For non-Hispanic whites and Mexican Americans and for non-Hispanic black boys, BMI decreased slightly between ages 2 and 6.75 years; BMI for non-Hispanic black girls did not. CONCLUSION: Size differences before the age of 7 years may influence later ethnic-specific overweight prevalence, independent of prenatal influences.

Genetic adjuvants.

In 1992, the era of DNA vaccines began with the report of antibody production upon intradermal injection of mice with a plasmid vector expressing a foreign antigen (1). A rapid succession of subsequent manuscripts showed stimulation of immune responses, including cytolytic T cells, upon inoculation of expression-vectors specific for antigens derived from viruses, bacteria, protozoa and tumor-associated antigens (2-7). Plasmid DNA can be applied through various routes of injection including: intradermal, intramuscular, subcutaneous, intravenous, or directly on mucosal membranes (1,2,8,9). The most commonly used methods of inoculation involve the use of DNA-coated gold beads propelled into the skin by a gene gun or intramuscular inoculation of the vector in saline solution.

Dominican, Mexican, and Puerto Rican prostitutes: drug use and sexual behaviors.

PIP: HIV-related behaviors are reported in three groups of Hispanic prostitutes recruited in the US: 77 Dominicans recruited in the Washington Heights/Inwood section of New York City; 151 Mexicans recruited in El Paso, Texas; and 48 Puerto Ricans recruited in East Harlem, New York City, during 1989-91 in streets and brothels. Ethnographic interviews were conducted with a subsample of subjects (10 Puerto Ricans, 20 Mexicans, and 20 Dominicans) to examine the cultural meaning of risk behaviors. Structured interviews based on the NIDA AIDS Initial Assessment were conducted with the subjects to describe demographic characteristics and summarize levels of risk behaviors. Qualitative data showed that for the Mexican women in El Paso poverty, violence, drug dealing and transport, tourist clients, and an environment of illegality were the realities more than for the Dominican and Puerto Rican prostitutes. The Dominican sample in New York City transported to their new environment strong family values and proscriptions against drug use as well as prostitution in brothels on account of poverty-related motivations for the support of their children. The Puerto Rican women reflected acculturation evolved in two locations, as well as illicit drugs, violence, and abuse. 92% of the Dominican women, 71% of the Mexican women, and only 25% of the Puerto Rican women were born in their native countries. Only 10% of the Puerto Ricans, 36% of the Mexicans, and 53% of the Dominicans always used condoms. 58% of the Puerto Ricans, 21% of the Mexicans, and 13% of the Dominicans reported ever having a sexually transmitted disease (p 0.001). Of those tested by the project, only 2% of the Mexicans vs. 8% of the Dominicans were HIV positive. Among drug-addicted Puerto Ricans, the HIV seroprevalence rate was 40-50%. 79% of the Puerto Rican prostitutes were sex partners of iv drug users. For effective prevention, cultural diversity must be taken into account.^ieng

HIV risk behaviors among Dominican brothel and street prostitutes in New York City.

Latina women are overrepresented among AIDS cases in the United States. To assist in developing appropriate prevention and intervention programs, information regarding HIV risk behaviors is needed on the many diverse Latina subgroups. This study examined sociodemographic characteristics and HIV risk behaviors of Dominican female prostitutes, comparing those who worked primarily in brothels with those who were street workers. A total of 77 Dominican prostitutes (54 brothel; 23 street) were recruited in New York City to participate in a structured interview and were offered HIV testing. Ethnographic interviews were conducted with a subscale. Results indicated that there were many significant differences in demographics and risk behaviors between the two groups, and those working in brothels engaged in lower levels of risk behaviors. In addition, those working in brothels had closer ties to the Dominican and Spanish cultures. Implications for AIDS prevention efforts are discussed.

Is the American health care delivery system ready for change?

In October 1992, the American College of Physician Executives sponsored a study tour to Berlin, Germany, and Amsterdam, Holland. Meetings were held with government officials, third-party payers, and providers, and on-site visits were made at hospitals, clinics, and academic centers. The purpose was to study the health care delivery system in those countries and to share some insights with the countries' hosts on the U.S. system. In a series of reports that began in the July issue of the journal, 5 of the 10 study tour participants describe their impressions of the tour and of the health care systems in the countries that were visited. In this final report, the implications of the German and Dutch systems for reform of the U.S. health care system are discussed.

A rapid, reliable method of evaluating growth and viability of intraerythrocytic protozoan hemoparasites using fluorescence flow cytometry.

Fluorescence flow cytometry was employed to assess the potential of a vital dye, hydroethidine, for use in the detection and monitoring of the viability of hemoparasites in infected erythrocytes, using Babesia bovis as a model parasite. The studies demonstrated that hydroethidine is taken up by B. bovis and metabolically converted to the DNA binding fluorochrome, ethidium. Following uptake of the dye, erythrocytes containing viable parasites were readily distinguished and quantitated. Timed studies with the parasiticidal drug, Ganaseg, showed that it is possible to use the fluorochrome assay to monitor the effects of the drug on the rate of replication and viability of B. bovis in culture. The assay provides a rapid method for evaluation of the in vitro effect of drugs on hemoparasites and for analysis of the effect of various components of the immune response, such as lymphokines, monocyte products, antibodies, and effector cells (T, NK, LAK, ADCC) on the growth and viability of intraerythrocytic parasites.

A rapid, reliable method of evaluating growth and viability of intraerythrocytic protozoan hemoparasites using fluorescence flow cytometry

Fluorescence flow cytometry was employed to assess the potential of a vital dye, hydroethiedine, for use in the detection and monitoring of the viability of hemoparasites in infected erythrocytes, using Babesia bovis as a model parasite. The studies demonstrated that hydroethidine is taken up by B. bovis and metabolically converted to the DNA binding fluorochrone, ethidium. Following uptake of the dye, erythrocytes contamine viable parasites were readily distinguished and quantitated. Timed studies with the parasiticidal drug, Ganaseg, showed that it is possible to use the fluorochrome assay to monitor the effects of the drug on the rate of replication and viability of B. bovis in culture. The assay provides a rapid method for evaluation of the in vitro effect of drugs on hemoparasites and for analysis of the effect of various components of the immune response, such as lymphokines, monocyte products, antibodies, and effector cells (T, NK, LAK, ADCC) on the growth and viability of intraerythrocytic parasites

A cluster analysis of learning disabled children.

Cluster analysis was employed with the intent of describing more homogeneous subgroups of learning disabled (LD) children. The parents and teachers of 29 children placed in special education as learning disabled completed questionnaires concerning demographic information regarding the families; birth, medical, and developmental histories regarding the children were also included. Variables for the analysis were those found, by means of discriminant analysis in an earlier study, to be significantly related to LD as opposed to regular education children. The presence of developmental delays (speaking or walking later than expected), birth order, and sex of the children were influential in the definition of the clusters.

Influenza vaccine in unprimed children: improved immunogenicity with few reactions following one high dose of split-product vaccine.

Thirty-one unprimed children and young adults received an influenza A/USSR/77 vaccine containing 43 microgram of hemagglutinin. Their HAI antibody response was compared to that in 92 age-matched individuals from the 1978 national influenza immunization trial who received 10 and 4 microgram HA vaccines. A dose-related antibody response was observed after the first vaccine doses in the 7- to 12- and 13- to 25-year-old groups. An HAI titer greater than or equal to 40 was present in 81% and 93% of 43 microgram HA recipients, in 38% and 43% of 10 microgram HA recipients, and in 24% and 12% of 4 micrograms HA recipients respectively. The antibody response to the 43 microgram HA dose was significantly higher than was the response to the 10 and 4 microgram HA doses. The local and systemic side effects were not significantly different among the three vaccine groups and the placebo group. Thus, a high dose of influenza A/USSR/77 split-product vaccine given to unprimed children and young adults stimulated presumably protective levels of antibody and was free of a significant incidence of side effects.