Investigation of Toxoplasma gondii in semen, testicle and epididymis tissues of primo-infected cats (Felis catus)

This study aimed to investigate the presence of Toxoplasma gondii in semen, testicle and epididymis tissues of cats experimentally infected by this coccidium. A total of 12 male felines without a definite breed that were of reproductive age and serologically negative for T. gondii were selected and distributed to the following three experimental groups: GI, inoculated with 600 tissue cysts of the P strain of T. gondii (isolate III); GII, inoculated with 2×10⁵ tachyzoites of the RH strain (isolate I); and GIII, not inoculated (control group). Prior to inoculation (day -7 and 0) and on post inoculation days (PIDs) 7, 14, 21, 28, 42, 56, and 70, all felines were subjected to assessments of anti-T. gondii IgG by indirect immunofluorescence (IIF) and assessments of parasitemia. Collection of semen (electroejaculation) was performed on the specified dates, followed by nested PCR and bioassays in mice to detect T. gondii. On PID 70, all 12 felines were orchiectomized, and the presence of the parasite in the testicles and epididymides was evaluated by nested PCR, murine bioassay, and histopathological and immunohistochemical analyses. All felines inoculated with T. gondii (GI and GII) seroconverted to the toxoplasmic infection after PID 14; on PID 7, seroconversion of three felines (P4, RH2 and RH4) could observed, and all exhibited detectable titers by PID 64. The GII felines exhibited greater serological titers compared with GI felines. The maximum serological titer (IgG) was observed in feline RH3 (titer 1024), while in other experimental felines, a maximum titer of 256 was detected. Parasitemic peaks were diagnosed in all felines of groups I and II from PIDs 7-42. A total of five parasitemic peaks were diagnosed in GI and nine in GII. In none of the experimental time points was the presence of T. gondii diagnosed in seminal samples collected from the felines or in the testicle or epididymis tissues collected from these animals. Thus, sexual transmission in domestic cats does not appear to be a major route of T. gondii infection, possibly demonstrating the tendency of this protozoan to develop a response directed to the formation and excretion of oocysts in the feces of these definite hosts, which act as its main route of perpetuation in the environment.

Effects of fluazuron (2.5 mg/kg) and a combination of fluazuron (3.0 mg/kg) + abamectin (0.5 mg/kg) on the reproductive parameters of a field population of Rhipicephalus (Boophilus) microplus on experimentally infested cattle

The current study assessed the deleterious effects of two formulations of fluazuron (2.5 mg/kg fluazuron and a combination of 3.0 mg/kg fluazuron + 0.5 mg/kg abamectin) on the reproductive parameters of engorged Rhipicephalus (Boophilus) microplus females that naturally detached from experimentally infested cattle in two experiments. Based on the obtained results, it can be concluded that fluazuron (2.5 mg/kg) showed deleterious effects only on the hatchability percentage in the period of 2-7 post-treatment days of this ectoparasite's engorged females. On the other hand, the fluazuron (3.0 mg/kg) + abamectin (0.5 mg/kg) combination presented harmful effects over reproductive parameters of this tick species. Further studies should be performed with a known tick population (reference susceptible strain) to determine the effect of these formulations on the reproductive parameters and to elucidate if this field population is fluazuron resistant.

Short-term and long-term antibody response by mice after immunization against Neisseria meningitidis B or diphtheria toxoid

Serogroup B Neisseria meningitidis (MenB) is a major cause of invasive disease in early childhood worldwide. The only MenB vaccine available in Brazil was produced in Cuba and has shown unsatisfactory efficacy when used to immunize millions of children in Brazil. In the present study, we compared the specific functional antibody responses evoked by the Cuban MenB vaccine with a standard vaccine against diphtheria (DTP: diphtheria, tetanus, pertussis) after primary immunization and boosting of mice. The peak of bactericidal and opsonic antibody titers to MenB and of neutralizing antibodies to diphtheria toxoid (DT) was reached after triple immunization with the MenB vaccine or DTP vaccine, respectively. However, 4 months after immunization, protective DT antibody levels were present in all DTP-vaccinated mice but in only 20% of the mice immunized against MenB. After 6 months of primary immunization, about 70% of animals still had protective neutralizing DT antibodies, but none had significant bactericidal antibodies to MenB. The booster doses of DTP or MenB vaccines produced a significant antibody recall response, suggesting that both vaccines were able to generate and maintain memory B cells during the period studied (6 months post-triple immunization). Therefore, due to the short duration of serological memory induced by the MenB vaccine (VA-MENGOC-BC® vaccine), its use should be restricted to outbreaks of meningococcal disease.

Nasal eosinophilia: an indicator of eosinophilic inflammation in asthma

BACKGROUND

It is noteworthy that there is a clear clinical, epidemiological and pathophysiological association between upper and lower airway inflammation in rhinitis and asthma.

OBJECTIVE

The aim of this study was to compare the eosinophil counts in induced sputum and nasal lavage fluids in asthma, checking their association and the accuracy of nasal eosinophilia as a predictor of sputum eosinophilia by a cross-sectional study.

METHODS

The clinical evaluation, asthma control questionnaire (ACQ), pre- and post-bronchodilator spirometry, nasal and sputum sample was performed. The nasal eosinophilia was analysed by a receiver operating curve and logistic regression model.

RESULTS

In 140 adults, the post-bronchodilator forced expiratory volume in 1 s (FEV(1)) did not differ between patients with or without sputum eosinophilia (0.18). After adjusted for upper airway symptoms, age, ACQ score and post-bronchodilator FEV(1), sputum eosinophilia was associated with 52 times increase in odds of nasal eosinophilia, whereas each 1% increase in bronchodilator response was associated with 7% increase in odds of nasal eosinophilia.

CONCLUSION

This study brings further evidence that upper airway diseases are an important component of the asthma syndrome. Furthermore, monitoring of nasal eosinophilia by quantitative cytology may be useful as a surrogate of sputum cytology in as a component of composite measurement for determining airway inflammation.

Does net energy cost of swimming affect time to exhaustion at the individual's maximal oxygen consumption velocity?

AIM

The purpose of the present study was to examine the relationship between time limit at the minimum velocity that elicits the individual's maximal oxygen consumption (TLim-v VO2max) and three swimming economy related parameters: the net energy cost corresponding to v VO2max (Cv VO2max), the slope of the regression line obtained from the energy expenditure (E) and corresponding velocities during an incremental test (C(slope)) and the ratio between the mean E value and the velocity mean value of the incremental test (C(inc)). Complementarily, we analysed the influence of Cv VO2max, C(slope) and C(inc) on TLim-v VO2max by swimming level.

METHODS

Thirty swimmers divided into 10 low-level (LLS) (4 male and 6 female) and 20 highly trained swimmers (HTS) (10 of each gender) performed an incremental test for v VO2max assessment and an all-out TLim-v VO2max test.

RESULTS

TLim-v VO2max, v VO2max, Cv fVO2max, C(slope) and C(inc) averaged, respectively, 313.8+/-63 s, 1.16+/-0.1 m x s(-1), 13.2+/-1.9 J x kg(-1) x m(-1), 28+/-3.2 J x kg(-1) x m(-1) and 10.9+/-1.8 J x kg(-1) x m(-1) in the LLS and 237.3+/-54.6 s, 1.4+/-0.1 m x s(-1), 15.6+/-2.2 J x kg(-1) x m(-1), 36.8+/-4.5 J x kg(-1) x m(-1) and 13+/-2.3 J x kg(-1) x m(-1) in the HTS. TLim-v VO2max was inversely related to C(slope) (r = -0.77, P < 0.001), and to v VO2max (r = -0.35, P = 0.05), although no relationships with the Cv VO2max and the C(inc) were observed.

CONCLUSIONS

The findings of this study confirmed exercise economy as an important factor for swimming performance. The data demonstrated that the swimmers with higher and v VO2max performed shorter time in TLim-v VO2max efforts.

Phenotypic and molecular analyses of yellow fever 17DD vaccine viruses associated with serious adverse events in Brazil

The yellow fever (YF) 17D virus is one of the most successful vaccines developed to data. Its use has been estimated to be over 400 million doses with an excellent record of safety. In the past 3 years, yellow fever vaccination was intensified in Brazil in response to higher risk of urban outbreaks of the disease. Two fatal adverse events temporally associated with YF vaccination were reported. Both cases had features similar to yellow fever disease, including hepatitis and multiorgan failure. Two different lots of YF 17DD virus vaccine were administered to the affected patients and also to hundreds of thousands of other individuals without any other reported serious adverse events. The lots were prepared from the secondary seed, which has been in continuous use since 1984. Nucleotide sequencing revealed minor variations at some nucleotide positions between the secondary seed lot virus and the virus isolates from patients; these differences were not consistent across the isolates, represented differences in the relative amount of each nucleotide in a heterogeneous position, and did not result in amino acid substitutions. Inoculation of rhesus monkeys with the viruses isolated from the two patients by the intracerebral (ic) or intrahepatic (ih) route caused minimal viremia and no clinical signs of infection or alterations in laboratory markers. Central nervous system histological scores of rhesus monkeys inoculated ic were within the expected range, and there were no histopathological lesions in animals inoculated ih. Altogether, these results demonstrated the genetic stability and attenuated phenotype of the viruses that caused fatal illness in the two patients. Therefore, the fatal adverse events experienced by the vaccinees are related to individual, genetically determined host factors that regulate cellular susceptibility to yellow fever virus. Such increased susceptibility, resulting in clinically overt disease expression, appears to be extremely rare.

Epidemic of jungle yellow fever in Brazil, 2000: implications of climatic alterations in disease spread

Seventy-seven human cases of sylvatic yellow fever were reported in Brazil during the period January-June 2000. The first cases were reported 1 week after New Year's day and originated at Chapada dos Veadeiros, a tourist canyon site in Goiás state, near Brasília, the Brazilian capital. The laboratory procedures used for diagnoses included serology with an IgM capture assay and plaque reduction neutralization test, virus isolation in suckling mice and C6/36 cells, and immunohistochemistry. All cases were diagnosed by at least two different laboratory procedures, with the exception of the first three fatal cases, which were diagnosed on the basis of clinical and epidemiological information. The cases were reported in eight Brazilian states as follows: Goiás with 64.9% (50 cases); Amazonas (1); Bahia (10); Distrito Federal (1); Mato Grosso (4); Minas Gerais (2); Pará (1); São Paulo (2); and Tocantins (6). Patient ages were within the following ranges: 13-74 years old (mean 34.3), 64 (84.4%) were male, especially agricultural workers (n = 30), but tourists (n = 11), carpenters (n = 4), fishermen (n = 4), students (n = 3), truck drivers (n = 3), and other people (n = 22) were also sickened. The case fatality rate was 50.6% (39/77). In Bahia state, a serologic survey that was carried out has suggested a symptomatic/asymptomatic coefficient of 1:4. Field studies developed in Distrito Federal, Goiás, and São Paulo states showed that Haemagogus janthinomys was the mosquito species associated with the transmission. A single strain was also obtained from Aedes scapularis in Bahia. Epizootic occurrence (monkey mortality) was observed in 49 municipalities mainly in Goiás state, where 40 municipalities made reports, 21 of which also diagnosed human cases. Data obtained by the National Institute of Meteorology in Brazil showed an increase in temperature and rain in December 1999 and the first 3 months of 2000 in Goiás and surrounding states, which perhaps has contributed to the intense and widespread transmission of the yellow fever virus. The relatively small number of cases probably reflects the extensive use of yellow fever 17D-vaccine during the last 3 years, in which about 45 million doses were used. During the last months of 1999, 16 and 11 yellow fever cases were reported in Tocantins and Goiás states, respectively. It is noteworthy that the last reported autochthonous cases of sylvatic yellow fever in São Paulo and Bahia, both states outside the endemic/enzootic area, had occurred in 1953 and 1948, respectively.

[Pityriasis versicolor in infants under one year of age. A report of 92 cases]

BACKGROUND

Pityriasis versicolor is a common world wide mycosis caused by Malassezia spp. and by Malassezia furfur sensu lato. It is uncommon in children and almost always with atypical clinical manifestations. It has been reported as exceptional in children under one year of age.

OBJECTIVES

To determine the clinical and epidemiological data of pityriasis versicolor in infants under one year of age.

METHODOLOGY

This is a restrospective and transversal study of pityriasis versicolor in the pediatric population studied during one year at the Instituto Dermatologico y Cirugia de Piel in Dominican Republic. Everyone with a Malassezia spp. positive scotch tape test with methylene blue were included.

RESULTS

Among 5160 cases of pityriasis versicolor where 797 were children, we found 92 (11%) cases under one year of age. The clinical manifestations were atypical and the most commonly affected zone was the face (81%) and thorax (16%). Less frequently the neck (8.6%) and upper and lower limbs (5%) were affected.

CONCLUSIONS

Pityriasis versicolor in children under one year of age is not exceptional in humid and hot climates. The hypochromic lesions are the main clinical manifestation and the most affected site is the face. Diagnosis is easy and cheap with a positive Malassezia spp. scotch tape test with methylene blue.

Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases

BACKGROUND

The yellow fever vaccine is regarded as one of the safest attenuated virus vaccines, with few side-effects or adverse events. We report the occurrence of two fatal cases of haemorrhagic fever associated with yellow fever 17DD substrain vaccine in Brazil.

METHODS

We obtained epidemiological, serological, virological, pathological, immunocytochemical, and molecular biological data on the two cases to determine the cause of the illnesses.

FINDINGS

The first case, in a 5-year-old white girl, was characterised by sudden onset of fever accompanied by headache, malaise, and vomiting 3 days after receiving yellow fever and measles-mumps-rubella vaccines. Afterwards she decompensated with icterus and haemorrhagic signs and died after a 5-day illness. The second patient-a 22-year-old black woman-developed a sore throat and fever accompanied by headache, myalgia, nausea, and vomiting 4 days after yellow fever vaccination. She then developed icterus, renal failure, and haemorrhagic diathesis, and died after 6 days of illness. Yellow fever virus was recovered in suckling mice and C6/36 cells from blood in both cases, as well as from fragments of liver, spleen, skin, and heart from the first case and from these and other viscera fragments in case 2. RNA of yellow fever virus was identical to that previously described for 17D genomic sequences. IgM ELISA tests for yellow fever virus were negative in case 1 and positive in case 2; similar tests for dengue, hantaviruses, arenaviruses, Leptospira, and hepatitis viruses A-D were negative. Tissue injuries from both patients were typical of wild-type yellow fever.

INTERPRETATION

These serious and hitherto unknown complications of yellow fever vaccination are extremely rare, but the safety of yellow fever 17DD vaccine needs to be reviewed. Host factors, probably idiosyncratic reactions, might have had a substantial contributed to the unexpected outcome.

Psychological response to prenatal genetic counseling and amniocentesis

The purpose of the present study was to characterize the psychological status (attitudes toward selective abortion, perceived risk, comprehension, patient satisfaction, coping, and state anxiety) of pregnant women at increased risk for fetal genetic anomalies who were referred for prenatal genetic counseling and amniocentesis; to determine which of these factors would predict amniocentesis use; and to identify patient outcomes associated with counseling and testing. Participants were 129 women aged 18 years and older who had one or more fetal genetic risk factors. All were recruited from an urban women's health clinic. The results revealed elevated perceptions of risk and moderate state anxiety despite adequate comprehension of, and patient satisfaction with, the process and content of genetic counseling. Approximately 78% agreed to testing; those who consented were more likely to hold favorable attitudes toward abortion than those who refused. Post-counseling, women experienced decrease in their perceived risk of having a baby born with a birth defect although perceived risk estimates remained higher than actual risks. Anxiety was clinically elevated and highest at the pre-counseling stage, though it dissipated to normal levels over time. Previous experience with prenatal diagnostic testing, increased perceived risk of a birth anomaly, and favorable attitudes toward abortion were independently associated with increased pre-counseling anxiety. Women who were more anxious pre-counseling remained more anxious post-counseling. Coping (high versus low monitoring) was unrelated to anxiety. These findings suggest that women who participate in prenatal counseling and testing may be subject to experience distress and unrealistic perceptions of their risk and may benefit from interventions designed to lessen these states.

[Pityriasis versicolor in Santo Domingo, Dominican Republic. In vivo morphological data of Malasezzia spp. in 100 cases]

BACKGROUND

Pityriasis versicolor is caused by Malassezia spp. It is a common world wide mycosis. Seven species are known of the Malassezia genus, and are identified in vitro by their morphological characteristics, biochemical tests and by molecular biology.

OBJECTIVES

to determine clinical and epidemiological data of pityriasis versicolor as well as morphological aspects of Malassezia in vivo.

METHODOLOGY

we performed a direct examination of the scales and classified the microscopic mycological elements as oval and orbicular spores, short and long hyphae.

RESULTS

pityriasis versicolor mainly affected the thorax. Orbiculare yeasts and short hyphae frequently present. We could corroborate the wide morphological range of Malassezia spp.

CONCLUSIONS

The morphological study of Malassezia spp. in vivo is not sufficient to determine the distribution of the various species.

Yellow fever in Pará State, Amazon region of Brazil, 1998-1999: entomologic and epidemiologic findings

Yellow fever (YF) is frequently associated with high severity and death rates in the Amazon region of Brazil. During the rainy seasons of 1998 and 1999, 23 (eight deaths) and 34 (eight deaths) human cases of YF were reported, respectively, in different geographic areas of Pará State; most cases were on Marajó Island. Patients were 1 to 46 years of age. Epidemiologic and ecological studies were conducted in Afuá and Breves on Marajó Island; captured insects yielded isolates of 4 and 11 YF strains, respectively, from Haemagogus janthinomys pooled mosquitoes. The cases on Marajó Island in 1999 resulted from lack of vaccination near the focus of the disease and intense migration, which brought many nonimmune people to areas where infected vectors were present. We hypothesize that YF virus remains in an area after an outbreak by vertical transmission among Haemagogus mosquitoes.

Pressure ulcers. Analysis of guidelines for treatment and management

Although prevention is the most important step in pressure ulcer care, clinicians should be familiar with the best methods for treating and managing these lesions, because proper care and subsequent vigilance can prevent worsening of the wound. In 1994, the U.S. Department of Health and Human Services published clinical practice guidelines to help standardize and improve ulcer care. Six key areas of ulcer management were addressed. The section on ulcer care--which includes discussions of debridement, wound cleansing, dressings, and adjunctive therapies--is examined here.

Dengue epidemic in Belém, Pará, Brazil, 1996-97

We describe clinical and epidemiologic findings during the first epidemic of dengue fever in Belém, Pará State, Brazil, in 1996-97. Of 40,237 serum samples, 17,440 (43%) were positive for dengue by virus isolation or serologic testing. No hemorrhagic cases or deaths were reported. Mycobacterium tuberculosis

Ilheus virus (Flaviviridae, Flavivirus) is closely related to Japanese encephalitis virus complex

The Ilheus (ILH) virus has long been known to belong to group B of the arboviruses. Previous attempts to relate it to existing serogroups within the Flavivirus genus using conventional serological techniques such as hemagglutination inhibition, neutralization and complement fixation tests have been inconclusive. We have first used denaturing gel electrophoresis to estimate the molecular weight of immunoprecipitated radiolabeled viral proteins and the cross-reactivity among ILH proteins and hyperimmune sera to several flaviviruses only from the mosquito-borne encephalitis virus serogroups. The estimated molecular weight for the three proteins was in the same order of magnitude, as previously established, for mosquito-borne flaviviruses. Cross-immunoprecipitation tests showed that NS3 protein is the most cross-reactive. Partial nucleotide sequence analyses of the NS3 gene, corresponding to an area linking the helicase and the RNA triphosphatase domains, revealed that ILH virus is very closely related to the Japanese encephalitis virus complex confirming earlier serological data.

Folate status response to controlled folate intake in pregnant women

A metabolic study (84-d) was conducted to investigate the folate status response of pregnant subjects (n = 12) during their second trimester and nonpregnant controls (n = 12) to folate intakes approximating the current (400 microg/d) and former (800 microg/d) recommended dietary allowance (RDA). The overall goal of the study was to provide metabolic data to assist in the interpretation of the current RDA for folate. Subjects were fed a controlled diet containing 120 +/- 15 microg/d (mean +/- SD) folate and either 330 or 730 microg/d synthetic folic acid. Outcome variables between and within supplementation groups were compared at steady state. Serum folate was higher (P </= 0.05) in pregnant women consuming 850 compared with 450 microg/d (44.6 +/- 13.4, 26.3 +/- 11.3 nmol/L, respectively, mean +/- SD). No differences (P > 0.05) were detected in serum folate between pregnant and nonpregnant women within the same supplementation group. Urinary 5-methyl-tetrahydrofolate excretion was greater (P </= 0.05) in pregnant women consuming 850 compared with 450 microg/d (198.0 +/- 100.4, 9.5 +/- 3.2 nmol/d, respectively). No differences (P > 0.05) in 5-methyl-tetrahydrofolate excretion were detected between pregnant and nonpregnant women within supplementation groups. Differences (P </= 0.05) were not detected in red cell folate between pregnant women consuming either 450 or 850 microg/d (1452.5 +/- 251.8, 1733.5 +/- 208.5 nmol/L, respectively) or between pregnant and nonpregnant women consuming 450 microg/d. Our data suggest that 450 microg/d (dietary folate + synthetic folic acid) is sufficient to maintain folate status in pregnant women. This level of intake equates to approximately 600 microg/d dietary equivalents, assuming 50 and 75% availability of dietary folate and synthetic folic acid consumed with meals, respectively.

Colonic transit times and the effect of lactulose or lactitol in hospitalized patients

OBJECTIVE

To investigate whether a small dose (10 g per day) of a laxative (liquid lactulose, crystallized lactulose, or crystallized lactitol) can prevent the slow colonic transit associated with the physical inactivity of hospitalization.

DESIGN

Patients were randomly allocated to one of four groups: control, liquid lactulose, crystallized lactulose or crystallized lactitol, and the average of mean colonic transit times in these groups was compared.

SETTING

Gastroenterologic Unit, Hospital dos Covoes, Coimbra, Portugal.

PATIENTS

Patients with normal bowel movements, admitted to hospital for the investigation of conditions not associated with constipation or diarrhoea, were allocated to one of the four treatment groups and had their mean colonic transit times studied after hospitalization using radiopaque markers and abdominal radiographs. Each study group had 18 patients. During the study, each patient was given a normal diet and no drugs except the relevant laxative.

RESULTS

The average of the mean colonic transit times in each of the four groups were: 52.16 h [95% confidence interval (CI) 39.42-64.84] for controls; 22.45 h (95% CI 13.84-31.06) in the liquid lactulose group; 24.05 (95% CI 12.13-35.97) in the crystallized lactulose group; and 35.95 (95% CI 23.82-48.08) in the crystallized lactitol group. The differences were statistically significant for the two lactulose groups. The study of the mean colonic regional transit times showed that these differences related to transit in the right colon.

CONCLUSIONS

A small dose of lactulose (either liquid or crystallized) was effective in preventing slow colonic transit and constipation in hospitalized patients without causing unwanted symptoms. The slow transit affected mainly the right colon, and it was in this region that the laxative had effect.

Chlamydial infection in the Amazon region of Brazil

The prevalence of antibodies to Chlamydia was determined in 9 population groups with different risk levels for sexually transmitted diseases in Belém, Pará state, Brazil. 583 serum samples were examined by the indirect immunofluorescence test. The prevalence rates varied from 33.3% in patients attending a sexually transmitted disease clinic to 97.1% in Parakana Indians. One or more pathogens were found in 55 of 86 patients presenting a clinical picture of urethritis; C. trachomatis was isolated from 11% (6/55) of these cases by inoculation to McCoy cell cultures, accounting for 30% (6/20) of the cases of non-gonococcal urethritis. C. trachomatis was isolated from one of 28 female patients (3.6%) attending gynaecology and obstetrics outpatient clinics. The positive patients had no symptom or complaint that would have suggested the diagnosis.

Heterogeneity in envelope protein sequence and N-linked glycosylation among yellow fever virus vaccine strains

We have compared the deduced envelope (E) protein sequences of two biologically well-characterized yellow fever (YF) virus vaccine strains. The 17DD strain has been produced in Brazil for more than 50 years and used to successfully vaccinate millions of people worldwide. The 17D-213 is a candidate vaccine strain produced in tissue culture which has previously passed the monkey neurovirulence assay for testing human YF vaccines. Nucleotide sequence analysis of polymerase chain reaction-amplified cDNA revealed a number of mutations which were strain- and substrain-specific. A major difference of 17DD and 17D-213 as compared to 17D-204 and Asibi was the existence of a potential N-linked glycosylation site located at amino acid residues 153 and 151 of 17DD and 17D-213, respectively. These acceptor sites are apparently utilized for the addition of high-mannose carbohydrate chains as shown by endoglycosidase analyses of immunoprecipitated E proteins. Glycosylated E protein is also used to assemble YF vaccine virions. This work and eventual complete nucleotide sequence analysis of both vaccine strains should help to define possible changes involved in YF virus attenuation and allow their biological importance to be determined using a recently developed system for generating YF virus from cDNA. In addition, these data provide an estimate on the extent of genetic variability among YF 17D seeds and vaccines.

Treatment of human taeniasis in the Philippines: a review

Studies relating to the treatment of human taeniasis in the Philippines using Atabrine, bithionol, and mebendazole are reviewed. Cure rates of 93.7% for Atabrine, 85%-100% for bithionol, and 84.62% for mebendazole are reported. Aside from these studies, recent experience in the treatment of Taenia saginata infections at the Department of Parasitology, College of Public Health, is also reported. Twenty patients referred to the department were treated, 3 with bithionol, 17 with praziquantel. Of the 17 patients treated with praziquantel, the study reported cure rates of 47-88.24%.

Ultrasonographic diagnosis of congenital anomalies in twins

To determine whether serial ultrasonographic examinations with basic anatomic surveys provide an adequate screen for congenital abnormalities that are more common in twins, we compared the results of prenatal sonograms and neonatal examinations for 314 twins (157 pairs) delivered during a recent 42-month period. An anomaly was defined as major if it potentially required surgical repair or precluded normal life expectancy; otherwise it was defined as minor. Thirty-three twins (9.5%) had 40 anomalies; 28 (9%) were major and 12 (4%) were minor. Prenatal ultrasonography with cardiac screening limited to the four-chamber view provided detection of 39% of all major anomalies, 55% of noncardiac major anomalies but none of the cardiac lesions, and 69% of the major anomalies for which routine prenatal management should be altered. No false-positive diagnoses incorrectly altered management. We conclude that serial prenatal ultrasonographic examinations are useful in detecting noncardiac anomalies for which twins are at increased risk, but the four-chamber view is not an adequate screen for the cardiac malformations of twins.

The "crowding effect" phenomenon in Ascaris lumbricoides

Ascaris lumbricoides worm populations were studied from 150 Filipino children (0-14 years) dewormed with pyrantel pamoate (Combantrin) or oxantel-pyrantel pamoate (Quantrel). Populations were classified according to intensity of infection: very light, light, moderate or heavy. A total of 2072 adult worms were sexed (939 males and 1133 females) and weighed. Descriptive statistics on the weights obtained from each sex were derived and one-way ANOVA was performed to compare the mean weights among the 4 intensity classes. Linear regression analysis (individual worm weight versus total worm burden) was also employed to equalize the possible influence of host factors. Statistical analysis revealed that mean weights of both sexes were significantly different and decreased as worm burden increased. This strongly suggests that the "crowding effect" phenomenon may also apply to Ascaris lumbricoides, and not only to tapeworms, as reported in the literature.

Predictive value of Apgar scores for developmental outcome in premature infants

For more than two decades, Apgar scores have been used to predict developmental outcome in newborns. However, most studies have used full-term babies for their data base, and the predictive value of Apgar scores for low birthweight infants has remained unclear. This study was designed to provide a data base for premature infants, demonstrating to what degree Apgar scores predict developmental outcome. We tested Apgar scores alone and in combination with two other easily quantified variables, birthweight and gestational age, as predictors of risk for 256 infants weighing less than 1800 gm at birth. Although significant correlations existed between Apgar scores and Bayley Mental and Psychomotor Developmental Indices, multiple regression analyses demonstrated that these relationships were not significant independent of birthweight and gestational age. That is, after controlling for birthweight and gestational age, Apgar scores did not predict morbidity in low birthweight infants and should not be used to provide a developmental prognosis.

Maternal weight gain: effect on infant birth weight among overweight and average-weight low-income women

A study was performed to compare the influence of pregnancy weight gain on infant birth weight and outcome among two groups of indigent women from the rural South: those who were highly overweight before pregnancy (greater than or equal to 135%) and those who were of average weight (90% to 120% of standard weight for height). The groups had comparable numbers of black and white subjects. Pregnancy weight gain affected birth weight in the average-weight group but did not significantly affect birth weight in the highly overweight group. Infant outcomes for both groups were similar. These findings suggest that consideration should be given to not requiring a minimum weight gain for women whose degree of overweight equals or exceeds 135% of standard body weight for height.

Evaluation of ultrasound diagnosis of fetal anomalies in women with pregestational diabetes: University of Florida experience

Fetal congenital anomalies have become the major cause of perinatal morbidity and mortality in pregnancies complicated by insulin-dependent diabetes. We evaluated the use of level II ultrasound in predicting congenital anomalies, to determine if the management of pregnant women with insulin-dependent diabetes would be altered by these findings. We examined 43 insulin-dependent diabetic pregnancies. In this group, 10 newborns (23%) were diagnosed either at birth or later to have an abnormality. Of these, four (9%) were diagnosed by ultrasound. Of the seven cases that were undiagnosed, three women did not undergo the level II examination, two women had lesions undetectable by ultrasound, and in two women cardiac abnormalities were missed. Of the four congenital anomalies that were prenatally diagnosed, the findings influenced the management in three cases. The level II ultrasound used as a screening test had a 67% sensitivity and a 100% specificity, with a positive predictive value of 100% and a negative predictive value of 91%. We conclude that high-resolution ultrasound may be used as a screening tool for congenital anomalies in the insulin-dependent diabetic pregnancy. This study also suggests that the use of fetal echocardiography with evaluation of aortic and pulmonary outflow tracts, the arch of the aorta, and ventricular size may be helpful in the diagnosis of fetal cardiac anomalies in the pregnant woman with insulin-dependent diabetes.

Continuous-wave Doppler ultrasound and decreased amniotic fluid volume in pregnant women with intact or ruptured membranes

The cause(s) of decreased amniotic fluid in the absence of fetal anomalies and intrauterine growth retardation is not clear. A prospective study was performed to evaluate umbilical and uterine artery Doppler velocimetric results in pregnancies complicated by decreased amniotic fluid. Three medically high-risk groups were studied: women with (1) normal fluid and intact membranes, (2) decreased fluid and intact membranes, and (3) decreased fluid and ruptured membranes. The decreased fluid/intact membranes group had a significantly increased incidence of abnormal uterine artery waveforms (diastolic notching or absence of end-diastolic velocity); however, uterine systolic/diastolic ratios were not significantly different. The umbilical systolic/diastolic ratios were marginally higher in the intact membranes/decreased fluid group when compared with the ruptured membranes group. This study suggests that problems with maternal blood supply to the placenta may be related to decreased amniotic fluid when membranes are intact.

Prospective pricing model for neonatologists and obstetricians in tertiary care centers

According to the new federal diagnosis-related group (DRG) system, hospitals are reimbursed fixed sums based on discharge diagnoses, rather than variable sums that depend on specific goods and services consumed and number of days hospitalized. The government is now exploring DRGs as a potential mechanism for reimbursing physicians. In Florida, two DRG-type reimbursement systems were developed for neonatal and obstetrical hospitalizations in tertiary care settings, as departures from the federal DRG system. Called neonatal care groups (NCGs) and obstetrical care groups (OBCGs), both classification systems predicted hospital charges in these settings more accurately than did federal DRGs. The feasibility of a prospective pricing system for neonatologists and obstetricians based on NCGs and OBCGs was investigated. The data showed that neonatologists' charges had a high correlation with hospital charges (r = .90) and that increasing levels of intensity of care as defined by the NCGs were reflected by consistent increases in reimbursement to neonatologists. If the NCG system were to be applied, neonatologists would receive compensation equivalent to that which they currently earn according to the fee-for-service system. In contrast, obstetricians' charges bore almost no relationship to hospital charges. However, modest differences in obstetrician's charges did emerge as a reflection of number of complications, which are incorporated into the OBCG categories; this suggests that a reimbursement system based on hospital OBCG categories might be applied to obstetricians.

Rh sensitization after third-trimester fetal death

Three primigravidas developed Rh sensitization after unexplained third-trimester fetal death. One patient manifested sensitization after the diagnosis of fetal death had been made but before delivery occurred. The other two demonstrated anti-D antibodies early in the next pregnancy, despite having received postpartum Rh immunoglobulin. Unsensitized Rh-negative women with unexplained third-trimester fetal death should be screened routinely for fetomaternal hemorrhage when fetal death is discovered, so that adequate prophylaxis against Rh sensitization can be given.

A unique 7p/12q chromosomal abnormality associated with recurrent abortion and hypofibrinogenemia

Recurrent first trimester abortions led to evaluation of a 25-year-old woman. Studies revealed she had hypofibrinogenemia (68 mg/dL) without evidence of dysfibrinogenemia or increased fibrinogen turnover. She was also found to have a unique 46,XX, t(7;12) (p 15.2;q24.31) karyotype. Hypofibrinogenemia and identical chromosomal abnormalities were found in other members of her kindred. Southern blots of genomic DNA from the patient, her mother, and her daughter hybridized to human fibrinogen probes showed alpha, beta, and gamma fibrinogen genes to be present and without structural alterations when compared to normal controls. We conclude that the chromosomal abnormality and the hypofibrinogenemia are related but in an unclear manner. Because fibrinogen infusion in the proposita was associated with successful gestation, we also concluded that the chromosomal abnormality itself was not responsible for the repeated abortions but that fibrinogen concentration may be critical in securing implantation.

Hepatitis B: a case for prenatal screening of all patients

Evaluation of a mass screening program to detect hepatitis B surface antigen in the obstetric population of Shands Hospital, University of Florida in Gainesville, from January 1, 1983, through December 31, 1985, was undertaken. Prevalence of hepatitis B surface antigen seropositivity was 0.54%. Review of medical records revealed that 67% of patients with positive hepatitis B surface antigen screens had no risk factors identifiable by routine prenatal history. Although all patients were screened on admission to the hospital, the results of the immunoassay were not available in time for staff to institute isolation procedures for the laboring mother or unwashed neonate. In 82% of the cases, treatment of neonates occurred later than 12 hours after delivery (the current Centers for Disease Control recommendation). It is recommended that prenatal screening of all patients with a hepatitis B surface antigen immunoassay be done by 34 weeks' gestation where the patient population is of predominantly low socioeconomic status to ensure appropriate isolation and timely neonatal immunoprophylaxis.

The relationship of Apgar scores, gestational age, and birthweight to survival of low-birthweight infants

While Apgar scores provide a valid prediction of mortality in term infants (primarily reflecting asphyxia), intervening variables in premature newborns complicate interpretation. Physiologic states normal to preterm infants (such as, decreased muscle tone) can depress scores but may not influence survival significantly. Therefore the relationship between Apgar scores and survival in term and preterm infants differs. Because of the paucity of studies on preterm infants, we tested Apgar scores, as well as birthweight and gestational age, as outcome predictors in 748 low-birthweight infants (500-1800 gm). Our purpose was to assess the relationship between 1- and 5-minute Apgar scores and survival, and to evaluate all combinations of the four variables as outcome predictors. Univariate analysis showed a significant relationship between each of the four variables and survival; however, no single variable accounted for more than 32% of the variance in outcome, thus no single factor could be invoked as the major determinant of survival. Logistic regression analyses demonstrated the interrelationships of the four variables to survival. While both Apgar scores were related to survival, independent of the effects of birthweight and gestational age, they were slightly less predictive than either of these variables alone. However, when 1- and 5-minute Apgar scores were combined with gestational age, the predictive value was slightly better than any of the four variables alone or in other possible combinations.

Prospective pricing system by diagnosis-related groups: comparison of federal diagnosis-related groups with high-risk obstetric care groups

Of 468 diagnosis-related groups identified by the federal government for Medicaid reimbursement, 15 are related to obstetric hospital care. Each diagnosis-related group is considered a distinct group in which cases are homogeneous with respect to resource consumption. Because the diagnosis-related group system is based primarily on data from community and secondary care hospitals, it does not differentiate sufficiently among high-risk obstetric patients seen at tertiary care institutions, such as Florida's Regional Perinatal Intensive Care Centers. We developed an alternative scheme for diagnosis-related groups, called obstetric care groups, using the federal diagnosis-related groups as the model from which to depart. Data collected for 4192 women during a 2 1/2-year period indicate that obstetric care groups provide more homogeneous groups than diagnosis-related groups for our population of high-risk patients. The obstetric care groups differentiate between no complications, one complication, and two or more complications, while the diagnosis-related groups differentiate only between no complications and one or more complications. Also, complications for obstetric care groups are based on only 19 diagnoses that contribute significantly to resource consumption, while the list of possible complications exceeds 200 for diagnosis-related groups. Although the obstetric care group classification system is simpler than that for diagnosis-related groups, it results in a more accurate reimbursement of hospitalization charges for high-risk obstetric care.

Sonographic detection of fetal urinary-tract anomalies

The diagnosis of urinary-tract anomalies in the fetus can frequently be made with antenatal ultrasound imaging. This report details 19 cases of fetal urinary-tract malformation diagnosed during a 30-month period. Early onset and more complete urinary-tract obstruction, oligohydramnios, renal dysplasia, and pulmonary hypoplasia occur frequently in cases where urinary-tract anomalies were detected in utero. The frequent association of other major structural anomalies, severe renal damage, and irreversible pulmonary hypoplasia make imperative an intensive evaluation of the fetus before considering invasive surgical procedures.

Immunocytochemical localization of relaxin in human decidua and placenta

Specimens from 20 human term placentas were stained with 4 different antisera produced against porcine relaxin (Rlx) using the avidin-biotin immunoperoxidase procedure. Cells of the parietal decidua adherent to the fetal membranes, cells of the chorionic cytotrophoblast, as well as cells of the placental basal plate consistently stained with all 4 anti-Rlx sera. Occasionally, Rlx was detected in epithelial cells lining the amniotic membrane. The syncytiotrophoblast stained for Rlx in 2 specimens only. This response was seen only in syncytiotrophoblast that lined villi in close proximity to the basal plate. Syncytiotrophoblast of the chorionic villi either did not stain at all or gave very weak positive immunostaining with the anti-Rlx sera in all specimens. No difference was noted in staining patterns among placentas delivered by elective cesarean section or vaginal delivery.

Intrauterine positional deformations masquerading as multiple congenital malformations

A 1,340-g male neonate was delivered by emergency cesarean section at 28 weeks' gestation following failed therapy with isoxsuprine hydrochloride and fetal distress. Transverse-lie presentation with the posterior side of the thorax wedged into the maternal pelvis and the head flexed firmly against the anterior side of the thorax led to a severe deformation sequence initially interpreted as multiple congenital malformations. This case illustrates the difficulty in distinguishing between pure deformations and malformations with and without subsequent deformations. It also emphasizes the clinician's need for a definitive diagnosis to guide the management of suspected malformations that are potentially lethal or portend a poor neurodevelopmental outcome.

Clinical utility of the relationship between fetal femur length and biparietal diameter

The relationship between fetal femur length and biparietal diameter on ultrasound examination was evaluated in a large, unselected obstetric population of 12-40 weeks' gestational age. The derived ratio of fetal femur length to biparietal diameter was evaluated retrospectively as a tool for examining the technical reliability of fetal measurements obtained and as a screening mechanism for detecting asymmetric fetal development. The ratio of femur length to biparietal diameter is of value as an aid to the detection of fetal developmental anomalies and should be a routine parameter considered in the performance of an obstetric ultrasound examination.

Fetal pulmonary maturity in isoimmunized pregnancies

That the lecithin/sphingomyelin (L/S) ratio correlates very closely with fetal gestational age in the uncomplicated pregnancy is well accepted. The presence of fetal or maternal disease has been found to accelerate or retard the development of fetal lung maturity in certain pregnancies. Although only a very small number of isoimmunized pregnancies has been evaluated in the obstetric literature, there is general acceptance that most isoimmunized pregnancies have delayed pulmonary maturation. Our observation has been that, in mild to moderately severe isoimmunized pregnancies, fetal lung maturation is not delayed. This study was designed to compare fetal pulmonary maturation in pregnancies affected by isoimmunization to that in a control group of unaffected but sensitized pregnancies. The results of this study suggest that pulmonary maturation in the mild to moderately affected pregnancy as measured by the L/S ratio is neither delayed nor accelerated but unchanged when comparison is made to the control group.

Hydramnios: ultrasound diagnosis and its impact on perinatal management and pregnancy outcome

Ultrasonographic technique allows for noninvasive quantification of amniotic fluid volume in pregnancy. A series of 12 pregnancies with ultrasonographically confirmed hydramnios is presented in detail. Following the diagnosis of hydramnios an intensive system-by-system evaluation of the fetal structures was performed. Developmental defects known to be associated with the production of hydramnios were detected in 83% of these pregnancies. Anomalies detected included abdominal wall defects, abnormalities of the central nervous system, pleural effusions, obstructions of the fetal gastrointestinal tract, and others. The early definition of hydramnios and the subsequent discovery of anomalies associated with increased amniotic fluid volume may lead to alteration in prenatal care, in intrapartum management, and in postdelivery resuscitative measures in these complicated pregnancies. In this series, despite early diagnosis of hydramnios and associated fetal developmental anomalies, complications of the pregnancies directly resultant from hydramnios resulted in a high perinatal mortality rate.

Changes in placental ultrasonic appearance. II. Pathologic significance of Grade III placental changes

Changes in placental texture and structure on ultrasonic examination have been suggested as correlating to advancing fetal pulmonary maturity. The association of preterm appearance of Grade III changes in the placenta in the complicated pregnancy suggests that these changes are associated with a decrease in placental function and premature senescence of the placenta. Placentas were routinely graded on all obstetric examinations performed during a 1-year period of time. Those pregnancies in which Grade III changes in the placenta prior to term were reviewed. A high incidence (78%) of perinatal problems were found in association with preterm appearance of Grade III changes. Perinatal complications included maternal hypertensive disorders, intrauterine growth retardation, abruptio placentae, and fetal distress in labor. The high incidence of these disorders in preterm pregnancies with Grade III changes in the placenta suggests that the sonographic changes found reflect placental dysfunction or senescence rather than normal maturational development. The appearance of Grade III changes in the placenta in the preterm pregnancy is suggested as a predictive indicator of potential perinatal problems in late pregnancy.

Changes in placental ultrasonic appearance. I. Incidence of Grade III changes in the placenta in correlation to fetal pulmonary maturity

Placental grading has been proposed as a substitute for amniotic fluid analysis for predicting fetal pulmonary maturity. The efficacy of placental grading was prospectively evaluated by grading the placenta at the time of 174 amniocentesis procedures done for determination of fetal pulmonary maturity. Grade III changes in the placenta were a rare finding that occurred in only 7% of the examinations performed. Placental grading proved to be insensitive in that it predicted pulmonary maturity in only 5% of pregnancies in which amniotic fluid analysis predicted a mature fetus. In addition, placental grading falsely predicted fetal pulmonary maturity in 42% of patients in whom Grade III placental changes were found. These findings suggest that the determination of Grade III changes in the placenta occurs too rarely to be of use in predicting fetal pulmonary maturity in the uncomplicated pregnancy. Incorrect prediction of pulmonary maturity by placental grading in the complicated pregnancy makes this test of little value in the management of high-risk pregnancy.

Ultrasonic measurement of femur length as a predictor of fetal gestational age

Ultrasonic determination of fetal femur length is useful as a parameter in the determination of fetal gestational age. One hundred thirty measurements were made in pregnancies at 14 to 36 weeks' gestation. The measurements were plotted against gestational age, and we found that a strong correlation exists between fetal femur length and fetal gestational age, with 95% confidence limits of plus or minus seven days. This ultrasound parameter of fetal age assessment should be added to the other methods available for accurate dating of pregnancy.

Cyclic variation in the adherence of group B streptococci to human vaginal epithelial cells

Studies conducted on three normally menstruating women demonstrated a distinct cyclic variation in adherence of group B streptococcus type III to vaginal epithelial cells. This cyclic variation consisted of a gradual rise in adherence during the first half of the menstrual cycle, reaching a maximum on day 14, followed by a sharp decline to low levels of adherence that persisted through the second half of the cycle. These changes in adherence correlated directly with the variation in the pyknotic index of the vaginal epithelial cells, suggesting that hormonal factors played a role in adherence of group B streptococci to vaginal epithelium.