The experiences of mothers who were implementing Kangaroo Mother Care (KMC) at a Regional Hospital in KwaZulu- Natal

Kangaroo Mother Care (KMC) is a fairly new concept to the patients and personnel in the neonatal units in KwaZulu-Natal. Arising from one of the Governmental initiatives, KMC was introduced to KwaZulu Natal in 2001. The personnel at the regional hospital where this study took place, were briefly introduced to this alternate method of care for a low birth weight baby, by means of symposia and in-service training. This study was undertaken to explore the perceptions of mothers for the preparation and experience of KMC and to describe the experiences of the mothers who had implemented KMC. Furthermore, this study sought to determine whether mothers received support during the implementation of KMC and if so, to identify the sources of this support. The lack of documented evidence to problems that mothers may have encountered and management strategies to deal with these, prompted the study. A phenomenological approach was used. The sample was obtained from the neonatal unit of a regional hospital in Durban. The sample comprised of ten mothers who were practicing KMC in the post-natal ward, or mothers who were discharged and were still practicing KMC. Data were collected by means of face-to-face interviews. These interviews provided the researcher with rich, personal and narrative experiences of the carers before and during KMC. The results of this study indicated that KMC was indeed new to most of the mothers and this evoked apprehension, doubt and fear, but once the mothers had tried it and were successful, they felt a sense of joy. Nursing personnel formed part of the supportive environment for the mothers practicing KMC. Recommendations are made for nursing practice, nursing education and nursing research.

Scale-up studies on a defined medium process for pilot plant production of illicicolin by Gliocladium roseum

Illicicolin was cultivated at the 600-L pilot scale for purposes of material generation and process development. The initial medium containing oat flour was difficult operationally as a result of excessive foaming during sterilization, so a new defined medium process (with either glucose or sucrose as the carbon source), developed at the 23-L scale, was scaled up and improved for pilot scale needs. Pilot scale media development efforts focused on exploring the highest concentration of media (1.0 x to 3.0 x) that could be cultivated at the pilot scale and not be limited by mixing or oxygen mass transfer. The process was scaled up successfully and peak titers improved 7.5-fold, from about 200 mg/L in the initial complex medium to 1500 mg/L in the final defined medium.

IL-2-induced tumor necrosis factor (TNF)-beta expression: further analysis in the IL-2 knockout model, and comparison with TNF-alpha, lymphotoxin-beta, TNFR1 and TNFR2 modulation

IL-2 induces the stimulation of inflammatory and immune reactions, and the apoptosis of antigen-activated cells. However, the molecular basis of these pleiotropic functions is largely unknown. We have previously reported that IL-2 induces genes involved in cytoskeleton organization, oncogene regulation and transcriptional control. In an IL-2-dependent cell line, we have also shown that IL-2 induces tumor necrosis factor (TNF)-beta mRNA through the Jak-STAT pathway. Here, we first demonstrate in vitro that IL-2 induces mature and partially spliced TNF-beta mRNA in the splenocytes and lymph node cells of both IL-2(-/-) and IL-2(+/-) mice. Under the same experimental conditions, IL-2 is seen to induce TNF-alpha mRNA. mRNA expression is followed by semiquantitative RT-PCR and this analysis is then extended in vivo by studying different lymphoid organs from IL-2(-/-)animals. Strikingly, the expression of TNF-beta mRNA is noted to be extremely low in the spleens and lymph nodes of IL-2(-/-) mice. Similarly, TNF-alpha, lymphotoxin (LT)-beta, TNFR1 and TNFR2 mRNA levels are also low in the spleens of IL-2(-/-) animals, whereas IFN-gamma and IL-4 mRNA levels remain unaffected in these animals. The experimental values are significantly different (P < or = 0.05) from those of control IL-2(+/-) animals. Western blot analysis of TNF-alpha expression confirmed and extended the results at the protein level. For the first time, we demonstrate that IL-2 directly or indirectly regulates genes of the TNF-TNFR family in secondary lymphoid organs. Furthermore, IL-2(-/-) animals in which thymopoiesis is unaffected show normal expression of these genes. Altogether, our data further define the pleiotropic effects of IL-2 at the molecular level.

Development of a bioconversion process for production of cis-1S,2R-indandiol from indene by recombinant Escherichia coli constructs

Recombinant Escherichia coli cells expressing the toluene dioxygenase (TDO) genes from Pseudomonas putida convert indene to cis-1S,2R-indandiol, a potentially important intermediate for the chemical synthesis of the HIV-1 protease inhibitor, Crixivan. A bioconversion process was developed through optimization of medium composition and reaction conditions at the shake-flask and 23-1 fermentor scales. A cis-1,2-indandiol productivity of approx. 1000 mg/l was achieved with construct TDO123, which represents a 50-fold increase over the initial titer. Varying the bioconversion conditions did not change the enantiomeric excess (e.e.) for the 1S,2R enantiomer from about 30%, suggesting that toluene dioxygenase intrinsically converts indene to 1S,2R- and 1R,2S-indandiols at a ratio of 2:1. Further inclusion of the Pseudomonas dehydrogenase gene in construct D160-1 led to the production of chirally pure cis-1S,2R-indandiol (e.e. > 99%) as a result of the selective degradation of the 1R,2S enantiomer, with the overall yield (650 mg/l) proportionally reduced. A single stage process was developed for D160-1 and scaled up to the 23-1 fermentor, achieving a cis-1S,2R-indandiol titer of 1200 mg/l.

Microbial conversion of indene to indandiol: a key intermediate in the synthesis of CRIXIVAN

Indene is oxidized to mixtures of cis- and trans-indandiols and related metabolites by Pseudomonas putida and Rhodococcus sp. isolates. Indene metabolism is consistent with monooxygenase and dioxygenase activity. P. putida resolves enantiomeric mixtures of cis-1,2-indandiol by further selective oxidation of the 1R, 2S-enantiomer yielding high enantiomeric purity of cis-(1S, 2R)-indandiol, a potential intermediate in the synthesis of indinavir sulfate (CRIXIVAN), a protease inhibitor used in the treatment of AIDS. Molecular cloning of P. putida toluene dioxygenase in Escherichia coli confirmed the requirement for the dihydrodiol dehydrogenase in resolving racemic mixtures of cis-indandiol. Rhodococcus sp. isolates convert indene to cis-(1S, 2R)-indandiol at high initial enantiomeric excess and one isolate also produces trans-(1R, 2R)-indandiol, suggesting the presence of monooxygenase activity. Scale up and optimization of the bioconversions to these key synthons for chiral synthesis of potential intermediates for commercial manufacture of indinavir sulfate are described.

Secondary metabolite scale-up to minimize homolog impurity levels

A mutant strain of Streptomyces hygroscopicus was found to produce up to 9.0 units/L of an immunoregulant precursor, immunomycin, with up to 3.5% of a lower homolog impurity under either dual fed-batch or batch conditions. Glycerol and valine were key nutrients influencing productivity and impurity levels. Soybean oil was successfully substituted for glycerol as a carbon source to minimize shot additions to batch culture. The remainder of the production medium was composed largely of defined components with the exception of yeast extract. Valine limitation increased lower homolog formation while decreasing higher homolog formation; excess valine decreased lower homolog formation below 2-3% while increasing higher homolog formation. Higher homolog formation in the presence of valine seemed to be slower than lower homolog formation in the absence of valine. Valine was believed to be the major butyrate precursor; consequently its availability influenced the impurity profile. A preliminary cost analysis suggests that elimination of added valine from the cultivation and replacement of glycerol with soybean oil can result in a 6.6-fold reduction in media costs relative to the original fed-batch process. Copyright 1998 John Wiley & Sons, Inc.

Congenital dermoid cyst of the tongue

True dermoid cysts of the oral cavity are rare, usually presenting as midline swellings in the floor of the mouth and occasionally elsewhere in the oral cavity. This report describes the diagnosis and management of a congenital dermoid cyst of the lateral aspect of the body of the tongue in a 10-year-old girl. The theories of the pathogenesis of this cyst during embryogenesis of the tongue are also reviewed.

Process optimization for large-scale production of TGF-alpha-PE40 in recombinant Escherichia coli: effect of medium composition and induction timing on protein expression

The effects of medium composition and induction timing on expression of a chimeric fusion protein TGF-alpha-PE40 (TP-40) in Escherichia coli strain RR1 were examined using a complex medium at several fermentor scales. Two distinctive phases in E. coli catabolism were identified during fermentation based on preferential utilization between protein hydrolysate and glycerol. Maximum specific and volumetric productivities were achieved by inducing the culture when the cells were switching substrate utilization from protein hydrolysate to glycerol. By increasing the yeast extract concentration in the production medium, initiation of the catabolic switch was delayed until high cell mass was achieved. The final titer of TP-40 at the 15-L fermentation scale was doubled from 400 mg L-1 to 850 mg L-1 by increasing the yeast extract concentration from 1% to 4% (w/v) and delaying the time of induction. This fermentation process was rapidly scaled up in 180-L and 800-L fermentors, achieving TP-40 titers of 740 and 950 mg L-1, respectively.

Role of arachidonic acid metabolites in tumor growth inhibition by nonsteroidal antiinflammatory drugs

PURPOSE

A murine model of squamous cell carcinoma (SCC) was used to determine the role of arachidonic acid (AA) metabolites in the growth of SCC of the head and neck.

MATERIALS AND METHODS

C3H/HeJ mice bearing SCC (SCC VII) were treated with cyclooxygenase inhibitors (piroxicam and nabumetone) or a 5-lipoxygenase inhibitor (ketoconazole). Growth curves were established, and final tumor weights were measured. Following sacrifice, tumor tissue homogenates were assayed for prostaglandin E2 (PGE2) and 12-hydroxyeicosatetraenoic acid (12-HETE) by enzyme-linked immunosorbent assay (ELISA), and leukotriene B4 (LTB4) by radioimmunoassay (RIA). Inflammatory cell infiltrate was assessed histologically.

RESULTS

A significant inhibition of tumor growth (P = .001) and final tumor weight (P = .002) was noted in mice treated with piroxicam and nabumetone. Inhibition of tumor growth was associated with increased tumor tissue levels of PGE2 (P = .04) and lymphocytic infiltration (P = .07). Significant inhibition of tumor growth (P = .002) and final tumor weight (P = .05) was also noted in mice treated with ketoconazole.

CONCLUSION

These data suggest that both cyclooxygenase and lipoxygenase metabolites of AA affect tumor growth in this model and that inhibition of tumor growth by inhibitors of AA metabolism may be caused by an enhanced inflammatory cell response at the tumor site.

Long-term immunosuppression without corticosteroids after orthotopic liver transplantation: a positive therapeutic aim

Long-term treatment with corticosteroids after orthotopic liver transplantation (OLT) may cause adverse effects, particularly hypertension, diabetes, and bone disease. The results of steroid withdrawal from long-term immunosuppression in 114 patients after OLT was reviewed. Initial treatment was with corticosteroids, azathioprine, and cyclosporine A in 76.3% and with antithymocyte globulin in 17.5%. Corticosteroids were stopped in 96 patients (84.2%) during mean follow-up of 6.7 +/- 3.9 months, and acute rejection subsequently developed in 8. By comparison 7 of 18 patients, in whom corticosteroids were continued, developed acute rejection. Six of these had received blood group (ABO)-compatible nonidentical grafts. Rates for retransplantation in the steroid withdrawal and nonwithdrawal groups were 4.2% and 22.2%, respectively, and mortality in the two groups was 14.6% and 44.4%, respectively. Azathioprine was not given or withdrawn in 28 patients in the group from which corticosteroids were also withdrawn, with no adverse effect. Diabetes mellitus improved following corticosteroid withdrawal, but there was no improvement in hypertension. We conclude that corticosteroids can be safely withdrawn in the majority of patients after OLT.

Alprazolam-induced hypomania

OBJECTIVE

There are reports of alprazolam-induced hypomania/mania. Here is a case report of a patient who developed hypomania during treatment with alprazolam, but not with diazepam, another benzodiazepine derivative.

CLINICAL PICTURE

The illness was of 2 months' duration and the patient received a diagnosis of anxious depression. Following treatment with alprazolam, the patient developed hypomania characterised by euphoria, overactivity, overtalkactivity, racing thoughts, oversocialisation, enhanced self-confidence and disturbed sleep.

TREATMENT

Hypomania subsided when alprazolam was withdrawn. There was no recurrence with fluoxetine or diazepam that ameliorated the primary condition.

OUTCOME

The patient was symptom-free on follow-up.

CONCLUSIONS

Alprazolam can induce hypomania/mania and, perhaps, it differs from other benzodiazepines in its mode of action. Clinicians have to be alert to the possibility of their patients developing hypomania/mania while on alprazolam.

Spontaneously transformed rat pancreatic epithelial oval cells give rise to ductal type adenocarcinomas

Oval epithelial cells that proliferate in the pancreas of the rats maintained on a copper-deficient diet are considered as stem cells with a potential to differentiate into hepatocytes. We isolated these oval cells from a copper-deficient rat and maintained these as a cell line in our laboratory. During 13th passage, oval cells showed increased growth and cellular pleomorphism and were analyzed for spontaneous transformation by anchorage-independent growth in soft agar and tumorigenicity in nude mice. Oval cells formed large colonies in soft agar and developed tumors in nude mice after subcutaneous transplantation. The tumors, by light and electron microscopy, showed features of well differentiated ductal-type adenocarcinomas. The phenotypic properties of these tumors included expression of neutral mucins, keratin filaments, carcinoembryonic antigen and glutathione S-transferase-pi and absence of gamma-glutamyltranspeptidase. The results of this study demonstrate that spontaneously transformed oval cells can form typical ductal-type adenocarcinomas. These observations are of particular interest, since bonafide ductal adenocarcinomas have not been described in the rat pancreas before.

Omeprazole inhibits growth of cancer cell line of colonic origin

The direct effects of omeprazole on colonic cells has not been evaluated. Controversy exists regarding the potential adverse effects of omeprazole on cell proliferation. In order to mimic the in vivo situation in the patient treated with omeprazole, proliferation cell culture experiments were performed, monitoring directly the effects of gastrin and omeprazole both alone and in combination. Three colonic cancer cell lines were used, two with neuroendocrine features (NCI-H716, LCC-18) and one (DLD-1) not known to have these features. In these in vitro proliferation experiments, only the NCI-H716 colorectal cancer cell line responded to omeprazole by decreased proliferation (P < 0.05). The effect was concentration dependent shown for all doses of omeprazole used. Gastrin had a statistically significant effect on increasing proliferation in the NCS-H716 cell line alone but only at the highest concentration (10(-6) M). Omeprazole has a cytostatic effect on one of three colorectal cancer cell lines but the mechanism for this effect of omeprazole and its potential role in treatment awaits elucidation.

Psychotherapy and childhood sexual abuse

Childhood sexual abuse may have a significant impact on psychological well being in later life. In this report, we describe 5 women who had a variety of psychological symptoms that were related to childhood sexual trauma. These factors were explored during psychotherapy. Persistent feeling of depression, anxiety and problems in socio-sexual functioning, were prominent. Therapy varied from counselling and ventilation, to prolonged dynamically oriented therapy.

The WHO Oral Health goals for the year 2000 in South Africa

This paper outlines a policy to attain the WHO Oral Health goals for the year 2000 by the implementation of primary and secondary prevention. The Republic of South Africa (RSA) with its complex political and social formation and an interesting mix of 1st and 3rd world populations provides the space for challenging and innovative approaches.

Cryptococcal peritonitis in a CAPD patient

A 50-year-old diabetic woman with end-stage renal disease, who had been on continuous ambulatory peritoneal dialysis for 8 months, developed peritonitis caused by Cryptococcus neoformans var. neoformans. The patient was completely asymptomatic and infection was confirmed by detection of budding yeast cells in Gram-stained smears of turbid peritoneal fluid. The infection was cleared after intravenous fluconazole with delayed removal of the catheter. Fluconazole may be a suitable alternative drug in treating cryptococcal peritonitis.

Does trans-lesion synthesis explain the UV-radiation resistance of DNA synthesis in C. elegans embryos?

Over 10-fold larger fluences were required to inhibit both DNA synthesis and cell division in wild-type C. elegans embryos as compared with other model systems or C. elegans rad mutants. In addition, unlike in other organisms, the molecular weight of daughter DNA strands was reduced only after large, superlethal fluences. The molecular weight of nascent DNA fragments exceeded the interdimer distance by up to 19-fold, indicating that C. elegans embryos can replicate through non-instructional lesions. This putative trans-lesion synthetic capability may explain the refractory nature of UV radiation on embryonic DNA synthesis and nuclear division in C. elegans.

Acute myocardial infarction, non-bacterial thrombotic endocarditis, and disseminated intravascular coagulation in a severe hemophiliac

Thrombosis in hemophilia is very rare and is usually associated with the administration of prothrombin complex concentrates. We describe a severe hemophiliac with P. carinii pneumonia who had clinical and laboratory evidence of acute myocardial infarction and disseminated intravascular coagulation, and at autopsy, nonbacterial thrombotic endocarditis as well. We suggest that prothrombin complex concentrates should be used cautiously in the setting of acute infection, and perhaps be given with appropriate doses of anticoagulants such as heparin.

Asthma: a provincial study

To identify factors contributing to increased mortality and morbidity we prospectively evaluated 200 consecutive adult (greater than 17 years) asthmatic presentations (105 patients) referred to Gisborne Hospital over a 28 month period between 1985 and 1987 using a modified protocol adapted from previous national studies. In the moderate asthmatic group (113 presentations, 56%), 6% failed to use beta agonists prior to admission and 43% were not on regular steroid inhaler therapy. No patient had a crisis plan although 45 (22.5%) had received oral steroid therapy before admission. Poor drug compliance was twice as common in the Maori. Fifty-eight percent of patients were on regular long term oral theophylline whereas 48 (43%) patients with moderate and severe asthma were not on corticosteroid inhalers. We conclude that patient education and more liberal use of steroid inhalers have the greatest potential for improving morbidity and mortality.

Treatment of hairy cell leukaemia with recombinant alpha interferon

Eleven patients with progressive hairy cell leukaemia (three nonsplenectomised) were treated with recombinant alpha-2 interferon (Intron-A or Roferon-A) subcutaneously three times per week at a dosage of 3 x 10(6) units. Ten patients completed at least ten weeks of therapy and could be evaluated; one patient died of haemorrhage from severe thrombocytopenia after only three weeks treatment. Nine of the ten patients responded and all of these are regarded as good partial remissions (normalisation of all blood parameters but still discernible hairy cells in the marrow). Responding patients have all been followed for a median of two years and in one case 3 1/2 years since commencement of therapy. The patients are all transfusion independent and free of infection. We conclude that alpha-2 interferon therapy for progressive hairy cell leukaemia is effective therapy in both splenectomised and nonsplenectomised patients.

The relationship of the periodontal status to fluoride levels of alveolar bone and tooth roots

The periodontal status and fluoride levels of alveolar bone and tooth roots were compared for subjects from a high (2.5 ppm F) and a low (less than 0.05 ppm F) fluoride area. The plaque index, gingival index, probing depth and loss of attachment were measured to determine the periodontal status. The fluoride levels were determined by the use of the fluoride ion-selective electrode. Both communities had high plaque and gingival indices. However, the mean pocket probing depths in both communities were less than 2.5 mm. No statistically significant differences could be found in the periodontal status between the 2 areas. The fluoride levels in bone and root were higher for subjects from the high fluoride area. No statistically significant difference could be demonstrated between the fluoride levels in alveolar bone and tooth roots for each area. It was found that the fluoride levels in bone and roots increased with increasing age, but to a lesser degree for subjects from the low fluoride area.

The relationship of the position of crown margins to gingival health

A survey was conducted of 423 crown margins that were divided into 355 subgingival margins and 68 supragingival margins. The plaque index, gingival bleeding, and recession surrounding the artificial crown were recorded and compared to the unprepared contralateral tooth. Gingival tissues tended to bleed 2.42 times more frequently with subgingival margins and have a 2.65 times higher chance of gingival recession. Crowns with supragingival margins did not differ significantly compared with the contralateral tooth, but crowns with subgingival margins had greater bleeding and recession compared with the contralateral tooth. It is recommended that supragingival margins become standard clinical procedures when feasible. A further analysis will be instituted to determine whether different crown materials affect the gingivae.

Purification and partial chemical characterization of a glycoprotein with antifertility activity from human seminal plasma

The preparation of a highly purified antifertility factor from human seminal plasma is described, and some of its biochemical properties have been determined. Purification was achieved by ultracentrifugation of particle-free human seminal plasma, followed by chromatography of the precipitate using carboxymethyl cellulose, concanavalin A, and Sepharose 6B columns. An occasional contaminant was further removed by preparative isoelectric focusing. During the purification procedures, the activity of the fractions was monitored by mixing them with capacitated mouse spermatozoa for 20 min before adding an aliquot to intact mouse oocytes, and determining fertilization after 24 h. The I50 (amount causing a 50% reduction in fertilization as compared to the control) of the final purified factor was 45 micrograms protein. Purity was established by standard and sodium dodecyl sulfate disc gel electrophoresis, isoelectric focusing, high-pressure liquid chromatography, and sedimentation analysis. These methods, as well as Sepharose gel filtration, were also used for the molecular weight estimations; good agreement was obtained between the various techniques. The factor appears to be a glycoprotein with a molecular weight of about 200,000. It consists of two subunits with molecular weights of about 125,000 and 72,000 and s-20,w of 6.2 s and 4.3 s. The factor contains relatively high amounts of aspartic acid and glutamic acid residues as well as leucine and serine, but only small amounts of tryptophan and no methionine was detected. The carbohydrate fraction is particularly rich in galactose and N-acetylgalactosamine but also contains mannose and N-acetylglucosamine and small amounts of fucose and sialic acid.

Periodontal disease in partial denture wearers--a biological index

Studies on the adverse effects of partial dentures on the remaining tissues require both a yardstick of measurement to record the level of oral disease, and the use of controls, preferably within the same patient. A method was devised for pooling the individual values related to the level of periodontal disease on abutment and control teeth in partial dentitions. The difference in these combined values was expressed as the Biological Price. This value provided a useful means of evaluating partial denture designs and patient features, in attempting to assess the major contributing factors responsible for the Biological Price levied by the denture. Whilst wearing an acrylic partial denture at night adds to the price paid by the remaining tissues, the mechanical features of the partial denture, and the overall features of the patient and his remaining dentition appear to be insignificant in determining the Biological Price.

Darkfield microscopy of subgingival plaque of an urban black population with poor oral hygiene

A low socio-economic community residing in Crossroads, Cape Town, consists of people who originated from the Eastern Cape areas of the Ciskei and Transkei. These individuals have had virtually no dental care, with the exception of emergency treatment for pain. A darkfield microscopic study of a random sample of 52 individuals was undertaken to determine the predominant morphological forms in the subgingival plaque of this population. Spirochetes were found to constitute 42.1% and motile rods, 7.7%, of the total darkfield microscopic count. Clinical assessment of the periodontal status of 100 individuals revealed the following mean values; plaque index (PI) = 1.44, gingival index (GI) = 1.31, probing depth (PD) = 2.35 mm and loss of attachment = 0.64 mm. Subgingival calculus deposits were present in 42% of the group and little or no mobility of the teeth was evident. Poor oral hygiene resulted in 90% of the tooth surfaces of the sampled population in Crossroads being covered with plaque, yet these individuals appear to be resistant to periodontitis. The high proportions of spirochetes and motile rods found in the subgingival plaque of this group were not indicative of periodontitis and therefore, fail to confirm the findings of other investigators.

Prevalence of dental caries, patterns of sugar consumption and oral hygiene practices in infancy in S. Africa

Dental caries is one of the most prevalent diseases of man and is the major cause of tooth mortality in the young. Although the precise aetiology of the disease is unknown, scientific evidence incriminates the interaction of three factors, viz. diet, plaque and the tooth. Several studies demonstrate a positive correlation between patterns of sugar consumption and caries experience. In contrast other studies showed no such association. This study investigated the frequency of sugar consumption habits, the mother's knowledge of oral hygiene as well as the oral hygiene methods she applies to her child and the prevalence of dental caries in infants between 1-2 yr of age. A representative sample of 100 mothers and infants from 10 child health clinics were interviewed. The results show that: mothers have a limited knowledge about oral hygiene and oral hygiene practices; infant sugar consumption habits seem to be influenced by the mother's sugar consumption habits; infants are introduced to sucrose containing food and drinks at the time of the eruption of the first tooth; the mean dmft(t) value in this group of infants was 2.37.

Bacteriuria in pregnancy

In a racially mixed community in Gisborne, New Zealand, the prevalence of asymptomatic (covert) bacteriuria of pregnancy was 9.6%. The prevalence in Maori women was 17.1% and in non-Maori women 4.7%. There was a higher prevalence of bacteriuria in the younger women. Escherichia coli was the infecting organism in 58 of the 72 women with bacteriuria. Twenty-five (44%) of the E. coli were resistant to ampicillin and amoxycillin. Fifty-eight (81%) of the women with bacteriuria also had pyuria. In 37 of the 44 women (84%) who received antimicrobial therapy, the infection was cured. Single dose therapy was just as effective as a course of treatment. In 14 of the 28 untreated women, the infection cleared spontaneously. Four of the 28 (14%) patients in the untreated bacteriuric group developed acute pyelonephritis. More patients with bacteriuria had anaemia and a low fetal birth-weight.

Prevalence and severity of periodontitis in a high fluoride area in South Africa

The prevalence of periodontal disease is widespread throughout the world. Its severity varies considerably and the factors responsible for this variation are not known. Although the effect of fluoride on the reduction of dental caries is well established, its effect on chronic inflammatory periodontal disease is obscure. In this investigation, the prevalence and severity of periodontitis in 71 adults residing in a high fluoride area (2-3 ppm) was studied. In spite of large amounts of plaque and the prevalence of severe gingivitis in these individuals, there was little evidence of periodontal destruction (mean probing depth = 2.5 mm; mean loss of attachment = 1.02 mm). The possible reasons for the resistance of this population to = 1.02 mm). The possible reasons for the resistance of this population to periodontitis are discussed.

Experience with the third generation cephalosporins, cefoperazone and cefotaxime: report

The efficacy of the third generation cephalosporins, ceforperazone and cefotaxime, was evaluated in a provincial hospital in a small group of patients with severe infections. In one study, patients with severe sepsis were randomly allocated to a group receiving either cefoperazone or ampicillin (ticarcillin or cloxacillin) and gentamicin. In the other trial, a selected group of ill patients was given cefotaxime. Clinical and laboratory analyses showed that these two drugs are safe, well tolerated and effective in the blind treatment of severe infections.