Immunization coverage, infant morbidity and infant mortality in Freetown, Sierra Leone.

The study, which is based on data from a household level health survey conducted in 1990 in Freetown, Sierra Leone, examines the coverage of an Expanded Program on Immunization (EPI), infant mortality, and infant morbidity among children in Greater Freetown, capital of Sierra Leone. The results of the study indicate that there was a decline in infant mortality in the recent period of the survey, 1988-89, compared to earlier periods. This decline seemed to have been the result of immunization coverage, which considerably increased by 1989-90, reaching above 70% of the children under age 5. The study further reveals that the increased immunization coverage of children and their mothers might have considerably reduced the incidence of tetanus. While reduction of tetanus might have played the leading role in the latest reduction in infant mortality, the incidence of diarrhea, measles, and malaria continued to be high, suggesting that the increase in the quality and quantity of basic immunizations, oral therapy for diarrheal disease, and provision of chloroquine and improved drugs for malaria disease could further reduce most of the deaths from these prevailing diseases among children under age 5.

Cerebrovascular accident patients: an interdisciplinary/multidisciplinary audit.

OBJECTIVES: To develop appropriate standards to assess the intervention with cerebrovascular accident (CVA) patients by allied health professionals; to establish baseline data with which subsequent information collected could be compared. METHOD: Retrospective criteria auditing of hospital files was undertaken to evaluate whether the allied health professionals were meeting the expected clinical standards for patients admitted with a diagnosis of CVA. RESULTS: Written documentation in hospital files did not meet expected standards in all criteria and varied between professions. The data obtained provided a baseline against which future results could be measured. It was expected that subsequent evaluations would provide improved results. All departments agreed that meeting clinical standards was important and it was agreed to repeat the audit in one year and to include some outcome standards using patients' perceptions of service provision.

Generation of human lymphokine-activated killer cells following brief exposure to high dose interleukin 2.

Current laboratory lymphokine-activated killer (LAK) cell activation procedures require culture of peripheral blood mononuclear cells (PBMC) in the presence of 1000-1500 units/ml of interleukin 2 (IL-2) for 3-7 days. However, we have observed that a brief exposure (15 min-1 h) of PBMC to a high concentration of IL-2 results in the maturation of LAK precursor cells to cytolytic effector cells over the course of 1-3 days. These IL-2-pulsed LAK cells express cytolytic activity comparable to that of nonpulsed PBMC (cultured continuously in IL-2) at 3 days of culture. The acquisition of cytolytic activity followed the same kinetics for both pulsed and nonpulsed mononuclear cells and was maintained when tested at day 7. The pulsed LAK cells were capable of significantly lysing 11 different tumor targets tested and flow cytometric analysis revealed that pulsed LAK cells were phenotypically similar to nonpulsed LAK cells. Serum obtained from cancer patients undergoing IL-2/LAK cell therapy did not inhibit the maturation of the pulsed mononuclear cells into LAK cells. Interestingly, only PBMC obtained from cancer patients receiving in vivo IL-2 infusions could be induced to generate the same levels of cytolytic activity as those in nonpulsed cells using this pulse procedure. PBMC obtained from healthy, normal donors could not be pulsed to the same levels of activation as nonpulsed LAK cultures. Our study demonstrates that for the generation of maximum LAK cell cytolytic activity, LAK cell precursors must be primed in vivo with IL-2. Implementation of this procedure could eliminate the high cost of cell culture which normally accompanies IL-2/LAK cell therapy. Such an approach could make IL-2/LAK cell therapy more accessible for cancer patients.