Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis in Los Angeles County

Data on Epstein–Barr virus‐related hemophagocytic lymphohistiocytosis (EBV‐HLH) in adults in the United States remain very limited. A cluster of four cases of EBV‐HLH was observed in a 4‐month period at a tertiary center in Los Angeles County (LA County) and the clinical and molecular characteristics identified in these cases are being described. EBV typing, immunophenotypic and molecular genetic studies were performed. Diagnostic criteria that may be used to identify EBV as a cause of HLH in adults are also being suggested. Finally, the crude incidence rate for HLH in LA County was determined and was compared to the worldwide crude incidence rate for HLH. The cases each occurred in young male adult residents of California and were associated with evidence of EBV reactivation and ferritin levels of >20,000 µg/L. A higher rate of cases of EBV‐HLH in 2010 was found at UCLA Medical Center than for 2007–2009 (4.9/10,000 hospital discharges vs. 0.14/10,000 hospital discharges, respectively; P = 0.0017). The cases were associated with EBV type 1, and the insertion of the codon CTC (leucine) was found in numerous of the EBNA‐2 gene sequences. The annual incidence of secondary, non‐familial HLH was estimated to be 0.9 cases per million persons >15 years of age in LA County. Although EBV‐HLH is a rare disease, the incidence in adults in Western countries may be underestimated. J. Med. Virol. 84:777–785, 2012. © 2012 Wiley Periodicals, Inc.     

Geographic and temporal patterns of recurrent intentional injury in south-central Los Angeles.

To better understand geographic and temporal patterns of recurrent intentional injury, 285 consecutive trauma patients were evaluated prospectively. Fifteen were excluded because of immediate death or severe brain injury. The remaining 270 patients were interviewed. Of these, 59 (22%) had been treated in a hospital for a total of 75 previous episodes of intentional trauma (mean: 1.3 episodes/patient). In 66 of the 75 episodes, the patient recalled where treatment had been received (88%). Twenty-eight (42%) of the 66 episodes had been treated at King/Drew Medical Center (KDMC), 36 (55%) had been treated at a hospital within a 3-mile radius of KDMC, 48 (73%) within an 8-mile radius, and 63 (95%) within a 10-mile radius. Sixty-five percent of the episodes occurred 5 years or less prior to the current injury (range: 11 days to 30 years; mean: 4.9 years). Patients currently admitted for intentional injury were more likely to have had intentional injury previously than those with unintentional injury (27% versus 12%). Based on these findings, we conclude that intentional trauma patients in our community remain in a defined geographic region and that there is a definable high-risk period for recurrent intentional injury. These conclusions should enhance the development of a framework on which future violence prevention programs can be designed.     

Results of an asthma education program delivered via telemedicine in rural schools

Background

Asthma morbidity is high in low-income children living in rural US regions, yet few interventions have been designed to decrease the asthma burden in rural populations.

Attitudes and behaviors of African-American and Mexican-American women delivering newborns in inner-city Los Angeles.

To study some of the factors relating to the care of mothers and newborns in an inner-city hospital, three sources of information were reviewed: an obstetric database including information on prenatal care and perinatal mortality, a database of all admissions to the hospital neonatal intensive care unit over the past 5 years, and a detailed questionnaire concerning attitudes and behaviors of recently delivered women. While analyses from these hospital-based data are not conclusive, the results add evidence for the following propositions: 1) Optimal prenatal care is infrequently obtained by mothers delivering at inner-city hospitals. Lack of prenatal care is clearly associated with increased perinatal mortality. While the need for prenatal care is appreciated by 98% of the mothers in this sample, the most frequent reasons why prenatal care is not obtained earlier or more frequently involve knowledge about and access to prenatal care. 2) Inner-city mothers, in general, manifest attitudes and behaviors that promote the welfare of their pregnancies and newborns. These attitudes and behaviors are in stark contrast to those that are frequently attributed to inner-city women by the media. 3) Acute perinatal medical and nursing care are perceived by many postpartum women as suboptimal, particularly in terms of the lack of respect shown to patients by nurses and doctors. 4) Improved acute obstetric and neonatal care improves perinatal morbidity and mortality of infants delivered at inner-city hospitals.     

Prevalence of delta agent among Chinese in Taiwan and Los Angeles

The prevalence of delta agent among 120 Chinese patients with HBsAg-positive chronic active and hepatocellular carcinoma from Taiwan and Los Angeles were studied by serological assay for antibody to delta antigen and immunoperoxidase staining for delta antigen in the liver biopsies. Of 120 patients, only four with chronic active hepatitis and one with hepatocellular carcinoma from Taiwan had antibody to delta antigen in their sera, while none was detected in the patients from Los Angeles. Indirect immunoperoxidase staining for delta antigen in the liver tissue from three of the patients with circulating anti-delta was positive. Thus, the overall prevalence of delta infection was 5.8% among the 86 patients from Taiwan, and 0% in the 34 Chinese patients from Los Angeles.     

Identification of preschool children with asthma from low-income families in Los Angeles, CA.

BACKGROUND: Few studies have addressed asthma screening in the preschool age group. Early asthma recognition and intervention in preschool children may reduce costs related to unscheduled medical care and missed school and work. OBJECTIVE: To facilitate an early recognition and referral process for asthma in a preschool education program in Los Angeles, CA. METHODS: We administered a 7-question survey to parents and guardians of children aged 12 months to 6 years in the prekindergarten program of a large school district in Southern California. English and Spanish survey questions addressed health care use, school absenteeism, and asthma symptoms. Postsurvey reports to parents recommended clinical evaluation of children who had probable asthma. RESULTS: Of the 609 surveys returned from 8 centers (> or = 80% survey return rate), 12% were positive for probable asthma and only 5.4% of these cases had been previously diagnosed. Of the 12% found to have a high probability of asthma, 3 independent factors were associated with a lower likelihood of prior asthma diagnosis: Hispanic descent; Spanish speaking; and medicine use 2 or more times per week for symptoms such as cough, chest tightness, trouble breathing, or wheezing. Symptoms at play, during the day, and at night were noted in 35% to 44% of the preschoolers. Cough was the most frequently reported symptom (71.9%, n = 424). CONCLUSIONS: A school-based screening process in an early education program can help identify preschool children with a high probability of asthma and offer a basis for early recognition and intervention.     

Clinical engineering services at the VA Medical Center, Los Angeles

A large, modern Medical Center requires clinical engineering services to account for all medical equipment utilized in the treatment of the short-visit clinic patient, as well as the critically ill, who require extensive hospital, surgical or medical health care. The clinics act as multiphasic screening systems, providing simple treatment and referral for more extensive medical treatment. The hospital provides the necessary medical systems to accommodate the extensive daily patient flow. Few of the clinics can provide the facilities or machines to handle the expense of newer diagnostic and therapy requirements. Manpower and funding for maintenance today is concentrated in the fast-growing Radiology, Radiation Therapy/Nuclear Medicine, and Laboratory areas of the Medical Center. These departments require service specialists, and large amounts of dedicated funding to balance and insure reasonable maintenance of the newer, high-technology equipment. Growth of such technology in the hospital must be matched by the growth of service professionals in biomedical engineering departments.     

Changes in knowledge, attitudes and behavior of women participating in a community outreach education program on breast cancer screening.

A community-based intervention project on Long Island was supported by the National Cancer Institute to increase the use of mammography and breast physical examination among older women. During a 1-year period 526 women aged 50 and older attended educational sessions presented by the project staff conducted in the community in a variety of settings. Sixty-eight percent (355) of the women who participated provided identifying data and completed pre- and post-session surveys while 40% (210) also completed a mail survey 6-12 months later. Screening behavior improved subsequent to the intervention, at follow-up 61% had taken some related action. More than half of the 109 women who had a mammogram after attending the session indicated that the presentation influenced them to do so. The use of a game created a positive atmosphere for conveying information about a sensitive subject and encouraged discussion among women who had a variety of experiences with screening.     

Reed Neurological Research Center, UCLA School of Medicine, Los Angeles, California.

Various clinical, virological, immunological, and morphological aspects of velogenic Newcastle disease were defined in chickens inoculated by natural routes with the Missouri-(H) Len 1950 strain. The disease initially appeared as a severe pneumonitis from which most birds recovered. Several days later, many of these birds developed severe encephalitic signs, largely referable to inflammatory changes in the cerebellum. During the pneumonic stage, virus was easily isolated in relatively high titers from the brains of all chickens, and viral products were easily detected in Purkinje neurons. However, when the encephalitis developed, virus was isolated irregularly and in low titers from brains, and morphological evidence for the presence of viral products could not longer be obtained. The encephalitic disease is discussed in relation to encephalitic syndromes induced by other neurotrophic viruses.     

Ecology of mosquitoes and St. Louis encephalitis virus in the Los Angeles Basin of California, 1987-1990.

St. Louis encephalitis (SLE) virus has become established in the Los Angeles Basin of California, where it most likely is maintained by horizontal transmission among Culex tarsalis Coquillet and passerine birds in park-riparian habitat. Viral transmission also was detected at low levels in residential habitat by the infrequent seroconversion of sentinel chickens. SLE virus activity was documented in all months except March and April. Cx. tarsalis was incriminated as the primary vector, based on elevated field infection rates (0.17 infected females per 1,000 tested), population abundance concomitant in time and space with increased SLE virus activity, vector competence, and vectorial capacity. Culex stigmatosoma Dyar also may be important in the horizontal maintenance of SLE virus because this species was an efficient laboratory vector, fed frequently on passeriform birds, and had field infection rates (0.15 females per 1,000) comparable with Cx. tarsalis. However, difficulty in trapping adult females precluded the assessment of Cx. stigmatosoma because abundance may have been underestimated and comparatively few females were tested for virus. Although Cx. quinquefasciatus Say was the most abundant species in residential habitats (greater than 85% of total catch at CO2 traps) where it occasionally fed on humans (0.6% of total tested), this species was considered to be of secondary importance because field infection rates were low (0.03 females per 1,000) and few females became infected and transmitted SLE virus in laboratory vector competence experiments. Although Culex erythrothorax Dyar fed on humans in marsh habitat (5% of total tested), this species infrequently fed on birds (12%) and was refractory to SLE virus infection in vector competence experiments; therefore, it was not considered a vector of SLE virus. Future SLE virus surveillance and mosquito control programs should be directed toward Cx. tarsalis populations.     

A program to enhance k-12 science education in ten rural New York school districts.

The Rural Partnership for Science Education, designed by educators and scientists in 1991 with funding from the National Institutes of Health, works in two rural New York State counties with students and their teachers from kindergarten through grade 12 to improve pre-college science education. The Partnership is an alliance among ten rural New York school districts and several New York State institutions (e.g., a regional academic medical center; the New York Academy of Sciences; and others), and has activities that involve around 4,800 students and 240 teachers each year. The authors describe the program's activities (e.g., summer workshops for teachers; science exploration camps for elementary and middle-school students; enrichment activities for high school students). A certified science education specialist directs classroom demonstrations throughout the academic year to support teachers' efforts to integrate hands-on activities into the science curriculum. A variety of evaluations over the years provides strong evidence of the program's effectiveness in promoting students' and teachers' interest in science. The long-term goal of the Partnership is to inspire more rural students to work hard, learn science, and enter the medical professions.