Willingness to be vaccinated against shigella and other forms of dysentery: a comparison of three regions in Asia

We conducted a cross sectional survey of 3163 women and men in six Asian countries to examine willingness for children and adults to be vaccinated against shigellosis and other forms of dysentery. The six sites were clustered into three regions for ease of comparison. The regions are: Northeast Asia (China), Southeast Asia (Thailand, Vietnam, and Indonesia) and South Asia (Bangladesh and Pakistan). We used multiple logistic regression to identify region-specific models for vaccination willingness for both adults and children. A vaccine to protect against dysentery, if available would be very much in demand throughout the three Asian regions for children. For adults, the responses indicate that vaccine uptake by adults will vary. A large proportion of respondents in all regions, specifically in China, do not perceive themselves at risk yet still consider a shigellosis vaccine desirable.     

Platelet transfusion refractoriness associated with two rare platelet- specific alloantibodies (anti-Baka and anti-PlA2) and multiple HLA antibodies

A 65-year-old patient with pancytopenia resulting from osteomyelosclerosis became refractory to platelet transfusions during long-time transfusion support. He developed two rare, platelet-specific antibodies (anti-PlA2 and -Baka) disguised by strong, multispecific HLA antibodies. The specificity of the platelet-specific antibodies was detected by a newly designed enzyme-linked immunosorbent assay using glycoprotein-specific monoclonal antibodies for immobilization of platelet antigens.     

Suppression of ventricular arrhythmia by acebutolol

To study the efficacy of acebutolol in suppressing ventricular arrhythmia, 20 consecutive patients with more than 10 premature ventricular contractions (PVCs) per hour (averaged over 24 hours) were studied. Arrhythmias were not precipitated either by remediable clinical conditions or acute myocardial infarction. Digitalis and antiarrhythmic drugs were discontinued at least 5 days prior to entry into the trial. Besides routine clinical, laboratory, and ECG examinations, all patients also underwent serial 24-h Holter monitoring every 10 days and echocardiographic examinations before and 20 days after treatment. The total duration of the trial was 30 days. The dosage of acebutolol was 400 mg/d during the first 10 days and was increased to 600 mg/d in the next 10 days as necessary, provided also that no significant side effects occurred. The drug was withdrawn for the last 10 days in order to establish drug withdrawal effects. Drug efficacy was assessed quantitatively by calculating the number of PVCs per day, and qualitatively by using the Lown grading system. There were 3 dropouts. Of the 17 patients who completed the trial, 10 (59%) showed a reduction of PVCs of at least 65%, and in 9 (53%) this occurred on a dosage of 400 mg/d. Elimination of grade 4A or 4B arrhythmia was observed in 6 (67%) of 9 patients. Although most patients were normotensive before entry into trial, none developed a drop in systolic blood pressure to 100 mmHg or less. The heart rate decreased slightly but significant bradycardia was not noted. Acebutolol did not adversely affect left ventricular function as assessed echocardiographically. We conclude that acebutolol is safe and effective for the treatment of PVCs And in most patients may be administered in a dosage of 200 mg twice daily.     

Esophageal atresia--a rabbit model to study anastomotic healing and the use of tissue adhesive fibrin sealant

The problem of bringing together two relatively widely separated, small, and fragile ends of a sick newborn baby's atretic esophagus remains a formidable surgical task, wherein the incidence of anastomotic leakage ranges from 10% to 27%. Recently, a multicomponent tissue adhesive fibrin sealant (Tisseel) has been licensed in Canada and declared useful for sealing gastrointestinal (GI) tract anastomoses. To study whether Tisseel might decrease the leakage rate of esophageal anastomoses in neonatal esophageal atresia and perhaps limit stricture formation, a rabbit model of esophageal atresia was developed. Twenty New Zealand white rabbits weighing 2.8 to 3.7 kg underwent thoracotomy and resection of a segment of esophagus with end-to-end, interrupted silk-sutured anastomosis under tension, to mimic the conditions found in newborn esophageal atresia. Four died immediately following operation. Ten rabbits had their anastomosis sealed with Tisseel, six control animals did not. All animals consumed variable amounts of water and food, starting 24 hours after surgery. Survival averaged 10.5 days (range, 5 to 20 days). Eight animals (five experimental, three control) were evaluated by means of barium esophagograms 1 week postoperatively, and all except one control animal demonstrated radiologic evidence of anastomotic leakage. Autopsy specimens revealed gross leakage in nine animals (seven experimental, two control). However, histology revealed leakage and periesophageal abscess formation in all experimental animals and in four control animals. The remaining two controls revealed only some degree of esophageal stenosis. This experiment showed no demonstrable benefit from the use of a fibrin sealant in preventing esophageal anastomotic leakage, such as that which occurs in repaired esophageal atresia.     

Platelet alloantigen frequencies in Caucasians: a serological study

Summary. Alloimmunization against platelet antigens is related to neonatal alloimmune thrombocytopenia and post-transfusion purpura. Moreover, platelet-specific alloantibodies, in addition to HLA-specific antibodies, play a role in the state of refractoriness to platelet transfusions. Most platelet-specific alloantigens have been assigned to platelet glycoproteins IIb/IIIa, Ib/IX and Ia/IIa. Data on antigen frequencies were first reported for Caucasians, but since then platelet glycoprotein polymorphisms have been reported for other populations, e.g. the Yuk alloantigens in Japanese. As information on the distribution of the recently described alloantigens is incomplete in Caucasians, this study was undertaken to provide reliable data on the PI^A, Ko, Bak, Yuk and Br (HPA 1–5) alloantigens, of the 'low-frequency' Sr^a and Va^a antigens and of the Nak^a isoantigen. In contrast to the frequencies determined in Oriental populations, all 964 individuals tested in this study were Yuk^a-negative and all persons tested ( n = 382) had Nak^a-isoantigen-positive platelets. A comparison of typing results shows that the recently described Sib^a-alloantigen is identical with the Ko^a antigen.     

Rapid detection of HPA-1 alloantibodies by platelet antigens immobilized onto microbeads

BACKGROUND: Neonatal alloimmune thrombocytopenia (NAIT) is one of the most common bleeding disorders in neonates. It occurs when alloantibodies from an immunized mother react with paternally inherited alloantigens, mostly human platelet antigen 1a (HPA-1a), on the fetal platelets (PLTs). Currently, monoclonal antibody-immobilized PLT antigen (MAIPA) assay represents the standard technique for the serologic diagnosis of NAIT. MAIPA is time-consuming, however, and limited by the availability of monoclonal antibodies (MoAbs). Here, a gel antigen-specific assay (GASA) was developed, which allows rapid detection of HPA-1 alloantibodies without the use of MoAbs. STUDY DESIGN AND METHODS: Glycoprotein (GP) IIb/IIIa was purified by affinity chromatography from outdated PLT concentrates derived from HPA-1aa or HPA-1bb donors. Purified GPs were biotinylated, immobilized onto streptavidin beads, and used for the analysis of HPA-1a alloantibodies by a microtyping system. HPA-1a serum samples derived from mothers with NAIT (n = 36) and from posttransfusion purpura patients (n = 2) as well as HPA-1b (n = 4), HPA-5b (n = 2), HPA-3a (n = 4), and HLA Class I (n = 2) alloantiserum samples from multitransfused patients were investigated in GASA and MAIPA assays. RESULTS: GASA was able to detect all HPA-1a and -1b alloantibodies recognized by MAIPA. Cross-reactivity with other PLT-reactive alloantibodies was not observed. Interestingly, 3 of 36 serum samples, which showed only moderate reactivity in MAIPA, reacted strongly in GASA. CONCLUSION: GASA has proved to be a rapid method for the detection of HPA-1a alloantibodies and maybe useful for PLT antibody screening, especially in initial assessment of suspected NAIT cases.     

Should medical students learn to develop a personal formulary?

Objective

This study was performed to determine whether students who are trained in developing a personal formulary become more competent in rational prescribing than students who have only learned to use existing formularies.

Methods

This was a multicentre, randomised, controlled study conducted in eight universities in India, Indonesia, the Netherlands, the Russian Federation, Slovakia, South Africa, Spain and Yemen. Five hundred and eighty-three medical students were randomised into three groups: the personal formulary group (PF; 94), the existing formulary group (EF; 98) and the control group (C; 191). The PF group was taught how to develop and use a personal formulary, whereas e the EF group was taught how to review and use an existing formulary. The C group received no additional training and participated only in the tests. Student’s prescribing skills were measured by scoring their treatment plans for written patient cases.

Results

The mean PF group score increased by 23% compared with 19% for the EF group (p?p?Conclusion Training in development and use of a personal formulary was particularly effective in universities with a classic curriculum and with traditional pharmacology teaching. In universities with a general problem-based curriculum, pharmacotherapy teaching can be based on either existing or personal formularies.