Nucleated red blood cells in infants of mothers with asthma

OBJECTIVE: The purpose of this study was to evaluate whether the absolute nucleated red blood cell and lymphocyte count is elevated in term, appropriate-for-gestational-age infants born to women with asthma. STUDY DESIGN: We compared absolute nucleated red blood cell counts taken during the first 12 hours of life in two groups of term, vaginally delivered, appropriate-for-gestational-age infants; one group was born to mothers with active asthma during pregnancy (n = 28 infants), and the other group was born to control mothers (n = 29 infants). Asthma severity was classified according to the National Asthma Education and Prevention Program. We excluded infants of women with diabetes mellitus, hypertension, alcohol, and tobacco or drug abuse and infants with fetal heart rate abnormalities, hemolysis, blood loss, or chromosomal anomalies. RESULTS: There were no differences between groups in birth weight, gestational age, maternal age, gravidity, parity, maternal analgesia during labor, 1- and 5-minute Apgar scores, and infant sex. The hematocrit level, red blood cell count, absolute nucleated red blood cell count, and corrected leukocyte and lymphocyte counts were significantly higher in the asthma group than in the control group. The platelet count was not significantly different between groups. The absolute nucleated red blood cell count correlated significantly with the asthma severity score (r (2) = 28%, P <.001). Backward stepwise multiple regression that included Apgar scores and gestational age showed a significant correlation of absolute nucleated red blood cell count with the presence of asthma and its severity (P <.001). CONCLUSION: At birth, term appropriate-for-gestational-age infants born to mothers with asthma have increased circulating absolute nucleated red blood cell and lymphocyte counts compared with control infants.     

Epiphyseal involvement of simple bone cysts

Epiphyseal involvement of a simple bone cyst (SBC) is uncommon. Eight patients are reported in whom an SBC was found to cross the growth plate, involving the epiphysis in seven patients and the apophysis in one. All patients had more than two pathologic fractures. In seven patients growth disturbance was found. Functional impairment did not develop in any patient. Radiographically, all lesions presented a characteristic involvement of the epiphysis and metaphysis in various proportions. Only one of four cysts treated with methylprednisolone acetate injections showed incomplete healing; the others failed to respond. After percutaneous grafting of autologous bone marrow, three of seven cysts healed and the others attained incomplete healing. Epiphyseal involvement of SBC should be considered a more aggressive form of an active lesion.     

Nano- and microparticles as adjuvants in vaccine design: success and failure is related to host natural antibodies

Bovine serum albumin (BSA) and the surface A-layer protein (AP) of an atypical strain of fish bacterial pathogen Aeromonas salmonicida were covalently linked with polymeric nano- and microparticles, and antigenicity of the resulted conjugates was compared in mice and goldfish. Distinct albeit different levels of natural BSA and AP antibodies were present in both animal species. Significant stimulation of the anti-AP antibody response in mice strikingly contrasted to unresponsiveness or even suppression in fish. The results negatively correlate with the levels of respective natural antibodies in the host and are discussed in context of problems related to fish vaccination. The work reinforces the instructive role of natural antibodies in adaptive immune response.     

Sunitinib in patients with metastatic renal cell carcinoma

Context  Current treatment options for metastatic renal cell carcinoma (RCC) are limited and there is a need to identify novel and effective therapies. Sunitinib malate is an oral multitargeted tyrosine kinase inhibitor, which has shown activity in an initial study of cytokine-refractory metastatic RCC patients. Objective  To confirm the antitumor efficacy of sunitinib as second-line treatment in patients with metastatic clear-cell RCC, the predominant cell type of this malignancy. Design, Setting, and Patients  Open-label, single-arm, multicenter clinical trial. Patients were enrolled between February and November 2004, with follow-up continuing until disease progression, unacceptable toxicity, or withdrawal of consent. The reported data apply through August 2005. Patients (N = 106) had metastatic clear-cell RCC, which had progressed despite previous cytokine therapy. Intervention  Repeated 6-week cycles of sunitinib, 50 mg per day given orally for 4 consecutive weeks followed by 2 weeks off per treatment cycle. Main Outcome Measures  Assessment of clinical response, degree of tumor regression on imaging studies using the Response Evaluation Criteria in Solid Tumors (RECIST) guidelines. Primary end point was overall objective response rate (complete plus partial). Secondary end points were progression-free survival and safety. Response was evaluated by independent third-party core imaging laboratory and by treating physicians (investigator assessment). Results  All 106 patients received sunitinib and were included in the intent-to-treat population for safety analyses. Of these, 105 patients were evaluable for efficacy analyses. The objective response rate according to an independent third-party assessment resulted in 36 patients with partial response (34%; 95% confidence interval, 25%-44%), and a median progression-free survival of 8.3 months (95% confidence interval, 7.8-14.5 months). The most common adverse events experienced by patients were fatigue in 30 (28%) and diarrhea 21 (20%). Neutropenia, elevation of lipase, and anemia were the most common laboratory abnormalities observed in 45 (42%), 30 (28%), and 27 (26%) patients, respectively. Conclusion  The results of this trial demonstrate the efficacy and manageable adverse-event profile of sunitinib as a single agent in second-line therapy for patients with cytokine-refractory metastatic clear-cell RCC. Trial Registration  clinicaltrials.gov Identifier: NCT00077974      

Field based evidence of enhanced healthcare utilization among persons insured by micro health insurance units in Philippines

Underutilization of healthcare is common among rural and low-income population segments in countries with lower income or inequitable income distribution. Micro health insurance units (MIUs) are created by informal sector groups because people cannot access health insurance or are dissatisfied with the programmes they can access. The policy choice to support MIUs relies on evidence that affiliation with these schemes increases healthcare utilization. This article examines new evidence of the association between affiliation with MIUs and healthcare utilization. We analyzed field data collected in 6 MIUs in the Philippines in 2002 (through a household survey encompassing 890 insured- and 1063 uninsured households). The two cohorts did not differ in demographic parameters, and differed only marginally in income and education levels, both higher amongst the insured. Insured persons reported higher hospitalization rates, higher rates of professionally-attended deliveries, lower rates of delivery at home, a higher frequency of primary-care physician encounters, a higher rate of diagnosed chronic diseases, and better drug compliance among chronically ill. Increased utilization by the insured is not due to adverse selection, judging by two facts: morbidity of the two cohorts, as assessed by a proxy indicator (the reported number of episodes of illness) did not differ; and rates of deliveries were even slightly higher among the uninsured. We conclude that MIUs in the Philippines can alleviate underutilization of heath care.     

Recommended micronutrient supplementation for institutionalized elderly

A committee nominated by the Israel Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily micronutrient supplementation for institutionalized elderly living in institutions supervised by the Ministry of Health. The micronutrient preparatory, tailored for this population, is designed to contain about half the RDA for most of the vitamins and some microelements. Biotin and vitamins C, D and B12 as well as zinc, copper, chromium and molybdenum are suggested at a level higher than half the RDA, whereas fluorine, at a lower level. Major elements (calcium, magnesium and phosphorus) are excluded and should be supplied separately. Vitamin K and iron are also excluded. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation for institutionalized elderly is part of the Ministry of Health s balanced nutrition policy. The committee s recommendations are also applicable to the free-living elderly population.     

A comparative study of the effects of intranasal triamcinolone acetonide aerosol (ITAA) and prednisone on adrenocortical function

A comparison of adrenocortical function before and after treatment with either intranasal triamcinolone acetonide aerosol (ITAA), prednisone, or placebo was done. Sixty-two male subjects with allergic rhinitis were treated for 6 weeks with either ITAA (220 or 440 micrograms/day), oral prednisone (10 mg/day), or placebo in double-blind, parallel-group fashion. Adrenocortical function was assessed by 6-hour cosyntropin stimulation before and at the end of the treatment period. The placebo-treated and two ITAA-treated groups produced no changes in adrenocortical function with treatment, and the ITAA-treated groups were not different from the placebo-treated group with mean +/- SEM changes in stimulated plasma cortisol (micrograms per deciliter) as follows: placebo, -2.68 +/- 1.77; ITAA 220 micrograms, -2.69 +/- 1.18; ITAA 440 micrograms, -2.96 +/- 1.81. The prednisone-treated group had a mean reduction in adrenocortical function (mean +/- SEM change in stimulated plasma cortisol of -19.8 +/- 1.77 micrograms/dl) that was significant (p less than 0.0001) compared with that of the placebo-treated group. The results of this study indicate that 6 weeks of treatment with 220 micrograms/day or 440 micrograms/day of ITAA has no effect on adrenocortical function, but prednisone, at a dosage of 10 mg/day for 6 weeks, produces partial adrenocortical suppression.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.