Isolation of mRNA and genomic DNA from epithelial cells in human milk and amplification by PCR

Studies on the regulation of human milk protein genes and suitable cell culture systems have been limited due to restricted availability of tissue samples from lactating women. Although mammary gland tissue has been available from mammary reduction surgery, studies on tissue-specific expression of milk protein genes require samples obtained during specific stages of expression in the tissue, i.e., lactation. We have therefore developed a technique to isolate mRNA and genomic DNA directly from epithelial cells isolated from human milk and used PCR methodology to specifically amplify the cDNA and genomic DNA for human beta-casein. When comparing fresh human milk with milk that has been stored for five hours at 37 degrees C or frozen and thawed, we found that the amount of mRNA isolated was considerably higher from fresh milk. However, in spite of this, we could still isolate intact mRNA from frozen milk. The described methodology should be useful in studies on milk protein gene expression during lactation and studies on variants of milk protein genes.

A family of surface-exposed proteins of 20 kilodaltons in the genus Borrelia

Relapsing fever and Lyme disease spirochetes of the genus Borrelia display at their surfaces abundant lipoproteins: Vmp proteins in Borrelia hermsii and Osp proteins in Borrelia burgdorferi. Vmp and Osp proteins largely determine serotype specificity, and neutralizing antibodies of infected or immunized animals are directed at them. For the present study, we examined B. hermsii serotype 33, which is unique among strain HS1 serotypes in the low frequency of switches to other serotypes during infections and in vitro cultivation. Failing to clone the complete vmp33 gene, we accomplished its further characterization by (i) determining three partial amino acid sequences, (ii) designing oligonucleotide primers based on these amino acid sequences, (iii) cloning and sequencing the central portion of vmp33, and (iv) using outwardly directed primers and the inverse PCR to clone the 5' and 3' ends of the gene and flanking regions. The transcriptional start site was identified by primer extension analysis. Vmp33 was a polypeptide of 211 amino acids; the three partial amino acid sequences were identified in the open reading frame. Vmp33 was found to be more similar to other 20-kDa Vmp proteins of B. hermsii and to OspC proteins of B. burgdorferi than it was to 35- to 39-kDa Vmp proteins of the same strain. Moreover, OspC proteins were more similar to Vmp33 than they were to OspA, -B, or -D proteins of B. burgdorferi. These sequence similarities were consistent with Western blot (immunoblot) findings of cross-reactions between Vmp33 and OspC with anti-Vmp33 and anti-OspC sera. The promoter for the expressed vmp33 gene was found to be different from the expression site for other active vmp genes characterized to date. These results indicate that Vmp33 and other small Vmp's belong with OspC to a genus-wide family of 20-kDa proteins and that expression of these proteins may be coordinated with expression of other Vmp and Osp proteins in Borrelia spp.

PACS-RIS interconnection: results of a feasibility study

In a study on behalf of the Swedish National Board of Development we have attempted to figure out what a complete information system for the small and medium sized radiology department should contain. Some of the results will be presented in this article. One of the main questions was whether a natural interface between what usually is referred to as PACS (picture archiving and communications system) and RIS (radiology information system) exists. Our answer to that question is, simply, no. We mean that an information system that handles all information on the radiology department has to be designed as one system and not be divided into a PACS and an RIS.

Application of vaginal misoprostol before cervical dilatation to facilitate first-trimester pregnancy interruption

OBJECTIVE

To study the capacity of vaginal misoprostol to soften the cervix and facilitate cervical dilatation in women undergoing first-trimester pregnancy interruption.

METHODS

We performed a double-blind, placebo-controlled study in 100 women opting for voluntary pregnancy interruption. The subjects were randomly allocated to two treatment groups, receiving either 200 micrograms misoprostol or placebo in the posterior vaginal fornix 6 hours before cervical dilatation. We noted the number of women with vaginal bleeding, with chorionic tissue in the vagina, or with no resistance to a Hegar 8 dilator, and recorded the total time in minutes for pregnancy interruption.

RESULTS

Vaginal bleeding from the cervix occurred in 70% of the misoprostol group and in 8% of the placebo group (odds ratio 26.83; 95% confidence interval [CI] 9.73-74.00). Almost one-fourth (22%) of the misoprostol-treated women had chorionic tissue in the vagina, compared to one woman (2%) in the placebo group (odds ratio 13.82; 95% CI 2.59-73.61). Cervical dilatation was achieved in 74 and 10% of the misoprostol- and placebo-treated women, respectively (odds ratio 25.62; 95% CI 9.61-68.28). The time required for pregnancy interruption was significantly shorter with misoprostol (P < .004).

CONCLUSION

Misoprostol is significantly more effective in facilitating cervical dilatation than is placebo. The average intervention time for pregnancy interruption was reduced by 35%.

A bactericidal antibody to Borrelia burgdorferi is directed against a variable region of the OspB protein

Borrelia burgdorferi, an agent of Lyme disease, is killed by some monoclonal antibodies in the absence of complement or phagocytes. In the present study, the bactericidal action of monoclonal antibodies against B. burgdorferi and B. hermsii, a cause of relapsing fever, was further characterized. H6831, an antibody recognizing the OspB proteins of some B. burgdorferi strains, and H4825, an antibody specific for one serotype of B. hermsii, were purified, and Fab fragments of the antibodies were prepared. In time-kill studies, more than 99.9% of strain B31 B. burgdorferi cells were killed after 30 min of exposure to H6831 Fab fragments. The MBC of the Fab fragments was 10 micrograms/ml. Electron microscopy revealed that the bactericidal Fab fragments produced numerous blebs and cell lysis of the borrelias for which they were specific. To identify the epitope for H6831, the OspB sequences of H6831-susceptible and -resistant strains and mutants were determined. The deduced OspB proteins of all H6831-resistant strains and mutants differed from the strain B31 OspB at residue 253. Murine antisera raised against a 21-mer synthetic peptide representing the region around residue 253 were specific for strain B31 by Western blot (immunoblot) and growth inhibition assays. Furthermore, the antipeptide serum inhibited the binding of H6831 to whole borrelias. These findings indicated that the linear component of the bactericidal antibody's epitope was located at or near residue 253.

Structure of the human beta-casein encoding gene

The entire human beta-casein-encoding gene, Bca, was cloned and sequenced. The gene consists of eight exons ranging from 21 to 531 nucleotides (nt) in length and extending over 10,466 nt. Exon-2 contains the translational start, the entire signal sequence and the codons for the two first amino acids of the mature protein. This corresponds to the organization found in other species. The translational stop is localized to exon-7. Exon/intron boundaries are in accordance with the AG/GT rule and conform to suggested consensus sequences. Splice junctions are located between coding triplets. In all other species analyzed, Bca has been found to consist of nine exons; however, within intron-2 of the human gene, a sequence omitted from human mRNA, but corresponding to exon-3 of other known Bca genes, was revealed.

Identification of a highly cross-reactive outer surface protein B epitope among diverse geographic isolates of Borrelia spp. causing Lyme disease

The outer surface lipoprotein B (OspB) of Borrelia burgdorferi is a major component of the borrelial protein profile and has been shown to be highly immunogenic in experimentally immunized and infected mammals. However, the ospB loci of different strains show considerable heterology at the nucleic acid sequence level, and the progeny of a clonal strain of B. burgdorferi exhibited OspB polymorphisms with respect to apparent molecular weights and reactivities with monoclonal antibodies. These data suggest that OspB is not a good candidate for vaccination or diagnostic purposes. The present study describes a monoclonal antibody, designated 84C, directed against a very highly conserved domain of the OspB lipoprotein. Western immunoblot analysis with 84C demonstrated reactivity in 84.2% of human, tick, and other vertebrate isolate strains examined from widely diverse geographic regions, including strains of B. burgdorferi sensu stricto and two closely related species, B. garinii and B. afzelii. The 84C-binding region was delimited to a highly conserved 11-amino-acid region in the carboxyl terminus of OspB as demonstrated by (i) DNA sequence analysis of wild-type and 84C-resistant mutant ospB alleles and (ii) deletion mutagenesis of a recombinant ospB gene in Escherichia coli. Finally, the 84C epitope was demonstrated to be exposed on the borrelial surface in situ as (i) the monoclonal antibody 84C was able to agglutinate borrelias in culture and (ii) 84C-resistant escape variants were isolated. These data suggest that the potential value of OspB as a vaccine candidate or diagnostic tool be examined more closely, in the context of the 84C-reactive domain.

An incident case-referent study of stillbirths at Harare Maternity Hospital: socio-economic and obstetric risk factors

This incident case-referent study was conducted at Harare Maternity Hospital in 1989-1990 on 104 consecutive cases of stillbirth with unknown aetiology and 96 age- and parity-matched referents. Information was collected by interviewing the women following a standardized form and by review of antenatal cards. None of the women refused to participate. The most significant obstetric risk factors were prevalence of earlier stillbirths (odds ratio, OR = 6.1) and miscarriages (OR = 4.8). Low height and body mass index also increased the risk of having a stillborn baby significantly as well as a history of flue-like illness during pregnancy (OR = 4.6). The latter may have stimulated the women to book early causing the unexpectedly high OR for early booking among these cases. The pattern for the socio-economic risk factors was not easy to interpret. The most striking finding was the U-shaped relationship between socio-economic status and stillbirths with a higher risk among those with low and high status.

Obstetric implications of rhesus antigen distribution in Mozambican and Swedish women

AB0 and Rhesus phenotypes were analyzed in 199 Mozambican women and the gene frequencies were calculated. The frequencies of the K and Fya antigens were also investigated. The findings were interpreted against the background of the corresponding phenotype distribution of a Swedish population. D- and Du-positive women amounted to 97.0%, which is significantly more than in Sweden (p < 0.001). Among AB0 groups it was found that blood group 0 is significantly more predominant in Mozambican than in Swedish women (p < 0.001). The reverse is true for blood group A (p < 0.001). Blood group B has a similar prevalence in Mozambican and Swedish women. The obstetric implication of the low prevalence of D-negative women is that the Rhesus alloimmunization problem may be of a much smaller magnitude than would be expected.

Value of symphysiotomy in obstructed labour management and follow-up of 31 cases

Experience of 32 cases of symphysiotomy carried out in Mozambique and in Botswana is reviewed. Of all cases only 1 was lost to follow-up. The observation period varied from 7 days to 6 months. Among 31 cases examined at discharge or on return from check-up few complications occurred. Vaginal laceration occurred in 3 cases, haematuria in 1 case and wound infection in 1 case. In 2 cases there was significant postoperative pain causing gait problems, but in no case were there significant problems with pain at discharge or at follow-up. It is concluded that the intervention is seldom complicated by severe sequelae, provided strict adherence to given indications is respected. In rural areas in the third world symphysiotomy is a life-saving and simple surgical intervention, which should be regarded as an adjunct measure in some cases with a moderately contracted pelvic outlet incompatible with normal vaginal delivery.

Audit of uterine rupture in Maputo: a tool for assessment of obstetric care

Records of 96 women who had rupture of the uterus in labor were audited to find circumstances significantly associated with pregnancy outcome. The prevalence was 1 rupture in 424 deliveries. In 74 cases (77.1%) uterine rupture occurred after hospitalization, the remaining 22 cases being emergency transfers with rupture secondary to a delivery attempt elsewhere. History of a previous cesarean section was present in 46%, whereas 54% of the women had an unscarred uterus. Maternal mortality was 7.3% whilst perinatal mortality was 62.9%. Adverse outcome for the mother was associated with ruptures occurring in unscarred uteri (p < 0.02) and outside the Maternity (p < 0.01); this latter condition also contributed to higher fetal mortality (p < 0.002). The findings confirm that delay in reaching medical care is an aggravating factor in the evolution of uterine rupture in developing countries and suggest the need for better medical attention and timely diagnosis in laboring women with unscarred uterus.

Risk factors in puerperal endometritis-myometritis. An incident case-referent study

Postpartum endometritis-myometritis (PPEM) was identified in 51 women after vaginal delivery, who were compared with 51 healthy referent parturients, matched for age, parity and days postpartum. Socio-economic background data, past and current obstetric history and clinical data from recent delivery were analyzed. Endocervical and intracavitary cultures and blood cultures were performed and serological analyses of syphilis and HIV antibodies were carried out. No socio-economic factor studied discriminated significantly between cases and referents. Previous stillbirth (OR 9.44) and previous low-birthweight delivery (OR 3.90) occurred significantly more often among cases. In recently past pregnancy preterm delivery (OR 10.07), low birthweight (OR 16.55) and serious neonatal morbidity (OR 14.27) were significantly more common among cases. Cases and referents differed also significantly in body mass index < 22.5 (OR 3.41), left mid-upper-arm circumference < 25 cm (OR 2.66), haemoglobin < 100 g/l (OR 3.12) and high-risk classification in antenatal care (OR 11.95). Bacterial intracavitary cultures tended to be positive and have anaerobes more frequently in cases than in referents. It is concluded that women with PPEM in the setting studied belong to a group at risk also regarding adverse fetal outcome, both in recently past and in previous pregnancies.

Prevalence of syphilis infection in Mozambican women with second trimester miscarriage and women attending antenatal care in second trimester

OBJECTIVES

To elucidate whether recent syphilis infection is significantly more prevalent among women with mid-trimester miscarriage than among antenatal care attenders in midtrimester pregnancy.

DESIGN

Two categories of pregnant women were compared regarding serological signs of syphilis. Rapid Plasma Reagin (RPR) analyses were done in Mozambique and Veneral Disease Research Laboratory (VDRL) tests in Sweden. In case of RPR and/or VDRL positivity, Treponema pallidum haemagglutination (TPHA) and Captia Syphilis-M were performed.

SETTING

A suburban antenatal care clinic and the emergency ward at the Department of Obstetrics and Gynecology at the Central Hospital in Maputo, Mozambique, were studied June-August 1991.

SUBJECTS

Randomly selected women seeking antenatal care in midtrimester pregnancy (N = 202) were compared with 114 women consecutively entering with clinical signs of midtrimester miscarriage.

RESULTS

Among antenatal care attenders, 37/202 (18.3%), and among women with midtrimester miscarriage, 37/114 (32.5%), had syphilis confirmed with the Treponema pallidum haemagglutination test (p < 0.01). Significant titres of IgM antibodies tended to be more prevalent among women with miscarriage (7.0%) than among women attending antenatal care (4.5%), though the difference only approached statistical significance.

CONCLUSION

The findings suggest a potential association between syphilis seropositivity and midtrimester miscarriage. Present findings justify more extensive studies to establish whether or not recent syphilis infection is a risk factor for midtrimester miscarriage.

Expression of human milk beta-casein in Escherichia coli: comparison of recombinant protein with native isoforms

Studies on physiological function and on structure-function relationships of human milk beta-casein have been limited. In this study, we have introduced the human beta-casein cDNA into vectors designed for expression in Escherichia coli. The inducible T7-based expression system resulted in high-level expression of recombinant beta-casein. The recombinant beta-casein, localized intracellularly in E. coli, was purified to homogeneity and compared with purified native beta-casein, in particular with respect to phosphorylation. The E. coli-produced beta-casein was found to comigrate with the full-length, nonphosphorylated native human beta-casein isoform on SDS-PAGE. An N-terminal peptide containing all tentative phosphorylation sites was isolated from the recombinant protein and analyzed by mass spectrometry. The molecular mass as well as the migration of this peptide on reversed-phase chromatography confirmed that it was unphosphorylated.

Obstetric characteristics in parturient women with newborns dying during the first 24 hours of life in Maputo

A case-control study of parturient women with newborns dying during the first 24 hours of life was undertaken at the Maputo Central Hospital. A total of 36 such parturients were recruited on a consecutive basis. For each case woman two referent women randomly selected among parturients with newborns surviving the first 24 hours of life were recruited. Parturients suffering neonatal loss had, in relation to their referents, a similar number of previous pregnancies but significantly fewer surviving children, lower average gestational length, lower average fundal height at birth, longer duration of membrane rupture, fewer normal, cephalic vaginal deliveries, and much lower birthweight. Parturient women suffering from early neonatal loss in this setting represent a more vulnerable segment of the population than their referents. Their newborns suffer from a shorter gestational length and from a more prolonged duration of membrane rupture than newborns from referents.

Coxsackie B virus infections in women with miscarriage

To study the possible role of Coxsackie B virus serotypes 1-5 (CBV 1-5) as an etiological factor in miscarriage, 97 women with miscarriage were tested for the presence of CBV-IgM by radioimmunoassays (RIAs) and compared with 113 control women undergoing voluntary interruption of pregnancy in the same gestational week. Of the 80 women with miscarriage before the 13th week of gestation, 34 (42%) had CBV-IgM, whereas 18 of 100 (18%) corresponding control women had these antibodies, a statistically significant difference (P < 0.001). There was no significant difference in CBV-IgM frequency between the women with miscarriage from the 13th through the 27th week and their controls. IgM against CBV 2 predominated, followed by IgM against CBV 5, CBV 4, CBV 3, and CBV 1. Two strains of CBV 5 were used in the RIAs, one (M147) isolated from a woman with miscarriage included in the study and one (V136) isolated in 1971 from a patient with meningitis. When the former strain was used, 13 women with miscarriage and seven control women had IgM, but with use of V136 only two women in each group were IgM positive. CBV 5 was isolated from the placental tissue from more women with miscarriage (6 of 28; 21%), than control women (2 of 21; 10%), but the difference was not statistically significant. No other viruses, except cytomegalovirus from a woman with miscarriage, were isolated.

A Lyme borreliosis cycle in seabirds and Ixodes uriae ticks

The Lyme disease spirochaete, Borrelia burgdorferi s.l., is the only Borrelia known to infect both mammals and birds. The main vertebrate reservoirs of B. burgdorferi are thought to be various small and intermediate size mammals, but the importance of birds as a reservoir has not been thoroughly explored. In the Northern and Southern Hemispheres the seabird tick, Ixodes uriae, is prevalent and closely associated with many species of colony-nesting marine birds. Here we report the presence of spirochaetes, demonstrated by immunofluorescent assay, by polymerase chain reaction and in culture, in I. uriae infesting razorbills on an island in the Baltic Sea. This island is free from mammals. The protein profile of the spirochaetes and the sequences of their flagellin and ospA genes are identical to those of the Lyme disease spirochaete, Borrelia burgdorferi s.l., previously isolated from I. ricinus on a nearby island. In biopsies from the foot web of razorbills, B. burgdorferi-specific DNA was detected after amplification by polymerase chain reaction. Our results suggest that birds play an important part in the maintenance of B. burgdorferi and that mammals may not be a prerequisite for its life cycle.

Pregnancy interruption by vaginal misoprostol

A total of 132 pregnant women with average gestational age of 14.2 weeks (range 11-22 weeks) undergoing legal abortion volunteered for a trial utilizing vaginal administration of misoprostol. In 106 women a dose of 800 micrograms was utilized, whilst in 26 women 1,200-1,600 micrograms were given. Nonsurgical expulsion of the fetus was successful in 117 cases (88.6%). Four cases had to be excluded for various social reasons. A total of 11 did not achieve fetal expulsion within 56 h after application of misoprostol. These cases (11/132; 8.3%) were considered failures. Previous reports in the literature of toxicity trials on animals reporting no fetotoxic nor teratogenic effects of misoprostol at doses up to 10,000 micrograms/kg body weight seem to be of no validity in the human since we could demonstrate that almost 80% of pregnancies were interrupted at a dose of 10-15 micrograms/kg body weight. The conclusion is that vaginal administration of this prostaglandin analogue, not requiring cool temperature for storage, is remarkably effective in achieving safe interruption of pregnancy without any significant complications.

Materno-fetal transmission of pregnancy malaria: an immunoparasitological study on 202 parturients in Maputo

A total of 202 delivering mothers and their newborns were studied with the intention to follow the materno-fetal transmission of malaria. Malaria infection was encountered in 35 cases (17.3%) in which Plasmodium falciparum predominated in peripheral blood while P. malariae predominated on the placental surface. In cord blood P. falciparum was encountered in 1.5% of the cases. There was slightly more maternal infection in rural (23%) than in suburban areas (19%). Less malaria infection was encountered in primiparas than in multiparas and there was similar antibody response in both mothers and their newborns. Anaemia was encountered in 70% of the mothers and in 93% of the newborns. There was no significant correlation between low birthweight of the newborn and malaria parasitaemia in the mother.

Intrauterine infections and their association with stillbirth and preterm birth in Maputo, Mozambique

Subclinical intrauterine infections during pregnancy in Mozambican women were studied in an attempt to elucidate their potential association with adverse pregnancy outcome, particularly stillbirth and preterm birth. A total of 39 stillbirths and 21 preterm live births were compared with 121 term live births. Extraplacental membranes and amniotic fluid were studied to ascertain the presence or absence of chorioamnionitis and of antibacterial activity in amniotic fluid. It was found that signs of maternal subclinical disease in extraplacental membranes in combination with an absence of antibacterial activity in amniotic fluid was overrepresented in stillbirths and preterm births in relation to term live births. A tentative conclusion is that a lack of antibacterial activity in amniotic fluid and established chorioamnionitis represent a vicious combination with strongly negative significance for the fetal outcome.

HIV-1 and HIV-2 antibodies in pregnant women in the City of Maputo, Mozambique. A comparative study between 1982/1983 and 1990

The seroprevalence of HIV-1 and HIV-2 among pregnant women in Maputo, the capital of Mozambique, was compared between the years 1982/83, 1988 and 1990. None of the 432 serum samples collected in 1982/83 was positive for HIV antibodies whereas in 1988 the HIV-1 and HIV-2 seroprevalence was 0.4% (2/500) and 0.6% (3/500), respectively, and in 1990 0.6% (12/2014) and 0.2% (4/2014), respectively. These results indicate that HIV infection has been introduced recently in Maputo and is spreading at a slow rate among women.

Value of perinatal audit in obstetric care in the developing world: a ten-year experience of the Maputo model

A decade of perinatal audit in the Maputo Central Hospital is reviewed with the objective of addressing the potential value of the audit process in monitoring the different constituents of morbidity and mortality in the perinatal period. The perinatal mortality showed a significant but transient change during the observation period 1982-1991, while intrapartum fetal mortality was significantly reduced from 10.9 to 3.9 per thousand (p < 0.0005). Staff members were sensitized towards immediate and long-term effects of implemented surveillance routines by regular feedback of perinatal data on visible wall charts and by weekly conferences. The advantages of a comprehensive audit approach in perinatal medicine comprising both maternal and fetal/infant aspect are underscored. An ethical commitment to nonconfidential straight-forwardness and open-mindedness in critical discussions regarding mismanagement is emphasized for a successful audit strategy.

IgM-antibodies against T. pallidum detected in sera from mothers of stillborn babies in Mozambique by the solid-phase haemadsorption assay (SPHA)

Serum samples taken at the delivery from 27 syphilitic mothers in Mozambique, 16 with stillborn babies and 11 with healthy babies were tested upon presence of IgM antibodies against T. pallidum by the solid-phase haemadsorption assay (SPHA). Fourteen out of the 16 serum samples from mothers with stillborn babies but only one out of the 11 samples from mothers with healthy babies were found positive by the SPHA test. Clinical signs indicative of syphilis are difficult to find in the Maputo area as there were more than 40,000 annual births and only five obstetricians when the study was carried out. It is believed that the findings may indicate those mothers who were serologically positive with the SPHA test had clinically active syphilis and that syphilis might be the cause or a contributory cause of death in 14 of the stillborn babies. The SPHA test was easy to perform and we recommend its adoption by laboratories with facilities to perform the TPHA test.

Extrachromosomal elements of spirochetes

The spirochetes include some important pathogenic bacteria, Treponema, Borrelia and Leptospira. The pathogeneses of these spirochetes are very diverse. In an attempt to learn more about the virulence factors among the spirochetes, their genetic organization and capacity have been studied. Structural analysis of the genome in Borrelia has shown that the genome is composed of one linear maxi-chromosome with additional linear minichromosomes as well as several supercoiled circular plasmids. Moreover, the molecular analysis of the terminal ends of one of the linear minichromosomes has revealed that this unique replicon has sequence similarities with poxviruses and particularly the viral agent of African swine fever. The presence of nucleic-acid-containing vesicles and its possible role in mediating DNA transfer between borreliae is an additional, very interesting feature of these organisms. Treponema does not contain any linear DNA, chromosomal or extrachromosomal, however molecular characterization of a 2.6-kb plasmid of Treponema denticola has been performed with the aim of establishing cloning vehicles to study the virulence properties of the genus Treponema.

Antigenic variation and strain heterogeneity in Borrelia spp

Antigenic variation and strain heterogeneity have been demonstrated for the pathogenic Borrelia species, i.e. B. burgdorferi and the relapsing fever borreliae. In relapsing fever, new borrelia serotypes emerge at a high rate spontaneously, a mechanism that is caused by DNA rearrangements on linear plasmid translocating genes coding for variable major proteins from previous silent to expression sites (i.e. from inner sites to telomeric sites of the plasmid). As a result of this variation, the borreliae escape the immune response of the host, thus leading to the relapse phenomenon. In B. burgdorferi, which is the causative agent of the multisystem disorder Lyme borreliosis, there is also a growing body of findings that antigenic variation is involved in pathogenesis of the disease. Phenotypic variation of strains in vitro concerns the size and the amount of surface-associated proteins (OspA, OspB and pC). There are indications that OspA and OspB truncations are due to deletions within the ospAB operon caused by recombination events, and that OspA/OspB-less mutants lack the 49-kb plasmid that bears the ospAB operon. With the increasing number of isolates obtained from various geographic and biological sources, it became apparent that B. burgdorferi is immunologically and genetically more heterogeneous, as previously believed. The major outer surface proteins OspA and OspB (which have been efficient antigens in vaccine studies) are heterogeneous at a genetic level. The same degree of genetic non-identity was observed for the pC protein. Other proteins like flagellin and the highly specific immunodominant p100 range protein show a lower degree of non-identity. Recombinant OspA, pC, p100 range protein and flagellin have been hyperexpressed in E. coli and these proteins are immunologically reactive. This allows further research for development of vaccines and diagnostic tools. B. burgdorferi isolates have been investigated with genotyping (DNA hybridization, PCR and 16S rRNA analysis) as well as serotyping by various authors. Comparison of the different methods has shown good agreement when the same strains have been investigated. No correlation could be found between different phenotypic and genotypic groups with respect to the ability to cause arthritis in SCID mice. A serotyping system based on immunological differences in OspA detected by a panel of monoclonal antibodies has been proposed. Serotyping a large number of B. burgdorferi isolates has shown a striking predominance of the OspA serotype 2 among European isolates from human skin, in contrast to isolates from ticks or CSF.(ABSTRACT TRUNCATED AT 400 WORDS)

Coma in Mozambican gravidas: causes and perinatal outcome

Ninety-one consecutive cases of coma were identified among gravidas at Maputo Central Hospital. The commonest causes were eclampsia (70 cases), cerebral malaria (six cases), and meningitis (five cases). Fetal mortality in eclampsia was 23 per cent and maternal mortality 10 per cent. There was a markedly higher incidence of eclampsia during the colder months.

Heterogeneity of outer membrane proteins in Borrelia burgdorferi: comparison of osp operons of three isolates of different geographic origins

Biochemical and immunochemical studies of the outer membrane proteins of Borrelia burgdorferi have shown that the OspA and OspB proteins from strains of different geographic origins may differ considerably in their reactivities with monoclonal antibodies and in their apparent molecular weights. To further characterize this variation in Osp proteins between strains, the osp operons and deduced translation products from two strains, one from Sweden (ACAI) and one from eastern Russia (Ip90), were studied. Polyacrylamide gel electrophoresis and Western blot (immunoblot) analyses confirmed differences between ACAI, Ip90, and the North American strain B31 in their Osp proteins. The sequences of the ospA and ospB genes of ACAI and Ip90 were compared with that of the previously studied osp operon of B31 (S. Bergström, V. G. Bundoc, and A. G. Barbour, Mol. Microbiol. 3:479-486, 1989). The osp genes of ACAI and Ip90, like the corresponding genes of B31, were found on plasmids with apparent sizes of about 50 kb and are cotranscribed as a single unit. Pairwise comparisons of the nucleotide sequences revealed that the ospA genes of ACAI and Ip90 were 85 and 86% identical, respectively, to the ospA gene of strain B31 and 86% identical to each other. The ospB sequences of these two strains were 79% identical to the ospB gene of B31 and 81% identical to each other. There was significantly greater similarity between the ospA genes of the three different strains than there was between the ospA and ospB genes within each strain. These studies suggest that the duplication of osp genes in B. burgdorferi occurred before the geographical dispersion of strains represented by ACAI, Ip90, and B31.

Vulvar oedema among pregnant Mozambican women

During a 3-year period, a total of 22 pregnant women with vulvar oedema were observed in a high-risk antenatal clinic (ANC) in Maputo. They were compared with 22 unselected normal ANC attenders, matched for age, parity, gestational length and area of living. Reported and observed genital ulcers were more prevalent in the oedema group than in the referent group. Reported and observed vaginal discharge was also significantly more common in the oedema group. Syphilis screening by VDRL was positive in 61.9% of oedema cases while positivity reached 5.0% in referents (p < 0.005). Cases found seropositive on screening were confirmed using Wassermann reaction (WR) in a reference laboratory, in which WR-positive cases underwent FTA-ABS analysis and IgM assay with solid-phase haemadsorption. IgM-positive individuals were significantly more prevalent among WR-positive oedema cases than among WR-positive referents (p < 0.05). It is concluded that among antenatal attenders in Maputo presenting with vulvar oedema, a significant proportion is associated with recent syphilis. Vulvar oedema should be considered as an important marker for seropositive syphilis during pregnancy.

Post-partum contraceptive preference in high-risk parturients in Maputo

A total of 171 consecutive high-risk parturients in Maputo Central Hospital were studied regarding post-partum contraceptive choice in order to plan a new post-natal clinic approach in maternal health care. It was found that contraceptive interest was much less in women with experience of child loss than in women with all children surviving (p less than 0.005). The findings were useful in planning various measures to meet the documented demand for available methods under adverse circumstances of scarce manpower and material resources.

Two cases of neonatal pneumococcal septicemia

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. Two recent cases that occurred within a short period of time are described. They were found to exhibit most clinical characteristics, previously described, of Group B Streptococci (GBS) septicemia with an early onset, but appear to have a graver prognosis.

Seasonal incidence of eclampsia and its relationship to meteorological data in Mozambique

Gestational hypertension is common in Mozambique. In a prospective study lasting 12 months every case of eclampsia in Maputo city was registered. The monthly ratio of eclampsia cases to births was calculated. With the purpose to test the hypothesis of a correlation between meteorological data and eclampsia incidence, monthly averages of temperature, humidity and atmospheric pressure were tabulated. Temperature (p less than 0.005) and atmospheric pressure (p less than 0.001) were significantly associated with the eclampsia/birth ratio. Humidity showed no significant association. We conclude that there is a statistical association between eclampsia incidence and air temperature and atmospheric pressure, respectively.

Role of rhesus alloimmunization in the etiology of late fetal death in Maputo

Grand multiparous parturients with unexplained late fetal death (n = 70) and with surviving newborns (n = 755) were analyzed and compared regarding blood group in general and presence of D and Du antigens in particular. In the stillbirth group, none of the parturients had any signs of disease (syphilis, preeclampsia, placental abruption, severe anemia or fever) that could be associated with the fetal death. It was found that none of the parturients with stillbirth were D- and Du-negative while 28/755 (3.71%) of parturients with liveborn babies were D- and Du-negative. It is concluded that, among grand multiparous parturients with otherwise unexplained late fetal death, the risk of having fetomaternal rhesus incompatibility as stillbirth etiology is insignificant. The advantage of introducing anti-D immunoglobulin for prophylaxis against rhesus alloimmunization would presumably be insignificant.

Molecular characterization of Borrelia burgdorferi isolated from Ixodes ricinus in northern Sweden

Ixodes ricinus ticks, harbouring Borrelia burgdorferi, were found in an area in northern Sweden, not thought to be endemic for Lyme borreliosis. This investigation took place at Norrbyskär, an island situated in the Bothnian Gulf, 63 degrees 33'N/19 degrees 52'E. One of 42 nymphal and 8/43 adult I. ricinus ticks collected carried spirochetes as seen by phase contrast microscopy. Pure bacterial cultures were obtained from 2 of the ticks. Western blot analysis using species-specific monoclonal antibodies showed that the isolated spirochetes were B. burgdorferi. The identity of the isolated spirochetes was confirmed by DNA amplification using B. burgdorferi OspA and flagellin gene specific oligonucleotides as well as partial DNA sequencing of the respective OspA and flagellin genes. The 2 isolated spirochaete populations were different as shown by their protein profiles in sodium dodecyl sulphate polyacrylamide gels. Moreover, the demonstration of Lyme borreliosis in a patient from the island of Norrbyskär indicates the need for clinical consideration of this disease in northern Sweden.

External cephalic version and daily post-versional maternal self-assessment of fetal presentation. A prospective study

External cephalic version (ECV) using tocolysis is a widely recognized low-risk intervention in cases of breech presentation, particularly in areas where resources are scarce and the perinatal mortality is high in vaginal breech deliveries. In such a setting, pregnant women were trained to make regular self-assessments of the presenting fetal part after ECV in order to detect spontaneous reversions to breech presentation. It was found that such maternal involvement could significantly improve the final results of ECV.

Neonatal septicemia caused by pneumococci

Pneumococci (Streptococcus pneumoniae) infrequently cause neonatal septicemia. An increased number of cases have been reported in recent years, but no increase in the relative incidence among neonatal infections has been noted. On the basis of two cases of our own and a review of 40 recently published case reports, the clinical characteristics of pneumococcal septicemia are described and the pathogenesis is discussed. The presenting clinical picture in early-onset pneumococcal septicemia is dominated by respiratory distress, frequently accompanied by leukopenia, and is indistinguishable from that seen in septicemia caused by Group B Streptococci (GBS). The onset is preceded by prelabor rupture of the fetal membranes in almost half of the instances. The mortality is 50%, twice the figure given in recent GBS reports.

Perinatal audit of one hundred consecutive vacuum extractions in Maputo

The extraordinary demands on obstetrical services that prevail in many developing countries necessitate critical reviews of existing norms for obstetrical management. Vacuum extractions were studied in this context as a part of the regular perinatal audit carried out at the Maputo Central Hospital, the only hospital in Maputo with emergency surgery catering to the 43,000 annual deliveries. Extractions performed with the fetal head above the ischiatic spines were associated with a high number of complications and an 81% risk of neonatal asphyxia and also with a number of severe neonatal traumas. The risk of intracranial hemorrhage tended to be higher with extractions of fetuses with the head at or above the ischiatic spines, particularly when there was concomitant intrapartum asphyxia. It is concluded that a frequent perinatal audit of selected risk deliveries is a useful monitoring tool for examining prevailing indications for various obstetric interventions.

Parity-related prevalence of rhesus antigens among Mozambican parturients

The potential risk of rhesus alloimmunization and the ensuing risk of fetal death with increasing parity were investigated in two groups of parturients; primiparous and grand multiparous (para > or = 5) women with liveborns. It was hypothesized that significantly fewer women of the latter than of the former group would be rhesus negative, since grand multiparity would be expected to be associated with an increased risk of late fetal death in rhesus-negative parturients. Primiparous (n = 390) and grand multiparous (n = 755) parturients with liveborns were studied in order to identify D- and Du-negative individuals. Sixteen out of 390 primiparas (4.10%) and 28/755 (3.71%) grand multiparas were D and Du negative. The difference did not reach statistical significance. It appears that being a D- and Du-negative grand multiparous parturient, in the absence of anti-D prophylaxis, is not a significant reproductive disadvantage to being primipara in terms of an increased risk of having stillborn babies.

Obstetrical risk factors and pregnancy outcome in rural Mozambique. A prospective study

A study of 373 pregnant women in two rural areas of Mozambique indicates that 38% of pregnant women are classified as having high risk factors according to the antenatal card. A postpartum follow-up of 200 women showed that data were available for 85% of the enrolled women. The 10 women (7%) that had suffered perinatal deaths did not have an overrepresentation of high risk factors according to the card. Neither of the 2 women suffering maternal deaths had had any risk criteria according to the card. More efficient risk criteria will presumably be the outcome of further research for an improved antenatal card.

Cloning and sequencing of human kappa-casein cDNA

A cDNA encoding kappa-casein of human milk was cloned and sequenced. The kappa-casein cDNA was isolated from a lambda gt11 library generated from mRNA prepared from a mammary gland biopsy obtained from a lactating woman. The library was screened with polyclonal rabbit antibodies raised against purified native kappa-casein. The obtained nucleotide sequence contained an ORF sufficient to encode the entire amino acid sequence of a kappa-casein precursor protein consisting of 182 amino acids. This includes a tentative signal peptide of 20 amino acids and a processed protein of 162 amino acids.