Control of cerebrospinal meningitis epidemics with sulfadimidine and penicillin; report on an experiment in mass chemoprophylaxis in the Sudan

Four villages in Kordofan Province of the Sudan were selected by the authors to determine the effectiveness of mass prophylactic treatment with sulfa drugs and penicillin in controlling cerebrospinal meningitis epidemics in rural areas with highly primitive living conditions. Sulfadimidine was given orally in two of the villages, and procaine penicillin G in oil with 2% aluminium monostearate (PAM) was given intramuscularly in the other two. The population of the villages was classified by age and by sex and given the following prophylactic doses: in Kaldung village, where 93% of the population was treated, 4 g of sulfadimidine were given to persons over 15 years of age, 2.5 g to those between 15 and 5, and 1.5 g to those under 5; in Korongo Abdulla, the same age-groups received 2.0 g, 1.0 g, and 0.5 g, respectively, and 34% of the population was treated; in El Machicha and Miri Bara villages, PAM was given to 38% and 90% of the respective populations in the dosage of 150,000 units to those over 15 years of age, 100,000 units to those between 15 and 5, and 75,000 to those under 5.     

Qualitative changes in dental plaque formation related to removable partial dentures

A study was performed on the microbial composition of dental plaque developing on fifteen abutment teeth in nine partially edentulous subjects. Bacteria were counted in samples of plaque which had formed on vestibular surfaces, and on proximal surfaces facing edentulous spaces, during a period when dentures were not worn, and then for a period when dentures were being worn. It was found that the presence of removable partial dentures favoured a proliferation of spiral organisms.     

Standardizing the assessment of diarrhea in clinical trials: results of an interobserver agreement study

Interobserver agreement was determined between nurses and parents using a standard method of assessing diarrheal stools. The study population consisted of patients less than three years of age hospitalized at The Hospital for Sick Children, Toronto, Canada. Stool samples were independently categorized by observer pairs within minutes of being obtained from children with and without diarrhea as: watery—liquid, no solid elements; loose—liquid with solid elements; pasty—like a paste; formed—normal solid. Watery and loose stools were regarded as abnormal and indicative of diarrhea. Teaching sessions were conducted for nursing shifts, while parents were instructed prior to each observation. In the nurses' agreement study, each stool specimen was examined by the nurse providing care to the patient from whom the stool was obtained and a nurse not looking after the patient. Parents' assessments were also compared with nurses' assessments. Finally, parents' assessments were compared with each other. In the first group, agreement beyond chance for presence or absence of diarrhea measured by kappa was 0.78 (95% confidence intervals (CI) 0.55–1.0). The observed agreement on 148 pairs of observations between parents and nurses was 75% (kappa = 0.5; 95% CI 0.36–0.64). Between-parent agreement on 30 other paired observations was 77% (kappa = 0.54; 95% CI 0.24–0.84). Teaching parents about the four categories is a potentially useful adjunct for assessment of diarrheal stools in children.     

The effects of indomethacin on in vitro peripheral blood mononuclear cell reactivity in human schistosomiasis

The peripheral blood mononuclear cell (PBMN) proliferative responses of cells from patients with schistosomiasis were studied in the presence and absence of indomethacin in the culture medium. PBMN cultures were exposed to antigenic extracts of either adult S. mansoni worms (SWAP) or cercariae (CAP), and assayed for the incorporation of tritiated thymidine. More than 70% of the 48 patients studied with SWAP and the 40 patients studied with CAP, were not substantially effected by the addition of indomethacin to the cultures. The remainder (less than 30%) was augmented more than 50% by indomethacin and comprise a group which gave initially low responses to these antigenic preparations. Further analysis indicated that in some schistosomal patients the effect of an adherent suppressor cell population may, in part, be based on a prostaglandin-mediated, indomethacin-sensitive suppressive mechanism. However, the majority of patients, most of whom display adherent suppressor cells, are unaffected by indomethacin. Apparently, other adherent cell suppressor mechanisms are responsible for the regulation observed.     

Pancreas divisum: thin-section CT

Twelve patients with known pancreas divisum underwent thin-section computed tomography (CT) to determine the capability of CT to depict this pancreatic anomaly. Focal pancreatic enlargement was present in five patients. Two distinct pancreatic moieties separated by a fat cleft were noted in three patients; a fourth patient had focal atrophy in the distribution of the dorsal pancreas. The two pancreatic moieties were identified at the same craniocaudal level in all four of these patients. The dorsal duct was depicted in all 12 patients, while the short ventral duct was seen in only five of the 12 patients. Failure of the ventral and dorsal pancreatic ducts to fuse was identified in all five patients in whom both ducts were seen. CT may not enable specific diagnosis of pancreas divisum in the majority of patients. If, however, distinct pancreatic moieties or unfused ductal systems are evident, the diagnosis may be confidently suggested.