Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion

Serum IgA and IgG functional antibodies and their subclasses to Streptococcus pneumoniae capsular antigen found in two aged‐matched cohorts of children with and without otitis media with effusion The relationship between acute otitis media and otitis media with effusion (OME) is uncertain and the aetiology of OME is multifactorial. Otitis media with effusion may be an inflammatory condition; both bacteria and viral infections could play a part in this inflammation. The four bacteria Streptococcus pneumoniae, Haemophilus influenza, Staphylococcus aureus and Branhamella catarrhalis cause 60% of the infections whereas S. pneumoniae accounts for up to 35%. IgA provides the dominant surface response to polysaccharide and lipopolysaccharide antigens, of which IgA₂ is the main subclass. Once the mucosa has been breached, most protection is provided by IgG. IgG₂ acts mainly against bacterial capsular antigens. This study looked at two groups of 50 children with and without OME who were aged between 3 and 10 years. The aims were to determine if, firstly, the levels of the serum immunoglobulins were different in the two groups, secondly whether these children made the appropriate antibody response to the capsular antigen to S. pneumoniae (PCP), and finally if there was a delay in the maturity of the IgA response. The total IgG, IgA and all subclass levels were measured using radial immunodiffusion. Levels of functional IgA and IgG were measured using ELISAs (25 patients in each group). The results were analysed with non‐parametric tests. The immunoglobulin levels were within the normal levels for both groups. There were very good correlations between the IgG total anti‐PCP and the IgG₂ anti‐PCP (R > 0.9, p = 0.001). There was a good correlation between the levels of both IgG total and IgG₂ anti‐PCP against IgA total anti‐PCP in both groups (R > 0.85, p > 0.01). This confirms a normal antibody response between both groups of patients. The ages of the controls and patients (50 samples) were correlated with increasing titres of circulating functional antibodies (P = 0.001). This is highly suggestive of a normal age‐related response. In conclusion, the findings were contradictory to our original hypothesis that there is a subtle difference in surface protection between children with and without OME. We believe that a previous history of recurrent acute otitis media is unrelated to the development of OME after 3 years of age.     

Brief review: Anesthetic implications of long QT syndrome in pregnancy

PURPOSE: To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. SOURCE: Relevant articles were obtained from a MEDLINE search spanning the years 1980-2006 and a PubMed search spanning the years 1949-2006. Bibliographies of retrieved articles were searched for additional articles. PRINCIPAL FINDINGS: The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias. CONCLUSION: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.     

Mental patients' attraction to the hospital: Correlates of living preference

Mental patients often show attraction to the hospital as a living alternative. In this study, 187 aftercare patients of an urban state hospital were examined for correlates of hospital attraction. Several variables, including background characteristics, psychosocial problems, psychiatric symptoms, substance abuse, and medication noncompliance, characterized the approximately 25% of the sample who showed hospital attraction. A logistic regression model for hospital attraction indicated that past hospital tenure, problems obtaining regular meals, positive symptoms of psychosis, and severe drug abuse contributed separately to the variance. The authors discuss the implications of these findings for treatment and public policy.This research was supported in part by National Institute of Mental Health Level II Research Scientist Development Award 1-KO2-MH-00839-01.     

A cost-effectiveness comparison of supported employment and rehabilitative day treatment

Recent research suggests that, for some people with severe mental illness, supported employment could improve vocational outcomes for little additional expense. This study describes the costs and client outcomes in one mental health center that converted two rehabilitative day treatment programs to supported employment. Converting from day treatment to supported employment improved vocational outcomes significantly without increasing costs. Although total costs for community treatment were lower in both sites after implementing supported employment, differences appeared to be due to decreasing unit costs over the study period. Results illustrate the importance of testing the effects of cost estimation methods on findings.This study was supported by West Central Services, the New Hampshire Division of Mental Health and Developmental Services, and NIMH grant K02-MH-00839. The authors are grateful to Jesse Turner and Phil Wyzik for facilitating the research.     

Longitudinal study of cyclosporine and lipids in patients undergoing bone marrow transplantation

The metabolic effects of intravenous cyclosporine on lipids and lipoproteins were studied in 29 allogeneic bone marrow recipients compared with 13 autologous bone marrow patients not requiring cyclosporine therapy. Patients were monitored continuously from 5 days prior to 27 days following transplantation; cyclosporine treatment was initiated 4 days before transplantation. Fasting lipid and lipoprotein levels were measured in serial blood samples throughout the study period. Nutritional supplementation, conditioning regimens and concomitant medications were not significantly different between groups. Furthermore, no significant differences in age, weight, lipid, or lipoprotein levels were found at baseline between the patient groups. Cholesterol, triglyceride, low-density lipoprotein cholesterol, and very low-density lipoprotein cholesterol levels remained unchanged in autologous patients. As compared with baseline values, plasma total cholesterol increased by an average of 26 percent in allogeneic transplantation patients receiving cyclosporine. Similarly, the ratio of low-density lipoprotein to high-density lipoprotein cholesterol was fourfold greater in those patients treated with cyclosporine compared to the autologous group. We conclude that cyclosporine appears to elevate cholesterol levels. Neither acute graft vs host disease nor changes in hepatic function could explain the differences in plasma cholesterol levels between groups.     

Occult gunshot injury of the temporal bone.

Increasing firearms violence has produced much public disquiet in recent months and Liverpool has seen a particularly well publicized spate of shootings. This is a case report of an initially occult intracranial injury which illustrates the unpredictable nature of missile trauma and the importance of computerised tomography in all cases of gunshot injury to the head.     

Eighteen-month Coronal Caries Incidence in North Carolina Older Adults

In this longitudinal study of a random sample of North Carolinians over the age of 65 and living in their homes, 325 blacks and 280 whites were examined and interviewed 18 months after baseline examinations. Coronal caries incidence was greater among whites than blacks. The increment due to teeth becoming root fragments were similar for both races; however, there were more newly crowned teeth among whites. Newly crowned surfaces were not used as part of the caries increment in logistic regression models to investigate potential risk predictors. For blacks, caries development over the 18-month period was associated with a higher lactobacillus score and more coronal caries at baseline, more previously filled coronal surfaces, and lack of active membership in clubs or other groups. For whites, having no self-reported tooth sensitivity, having a lower socioeconomic index score, taking antihistamine medications at baseline, and having the perception of more problems after the age of 40 than before were all associated with the development of coronal caries.     

Evoked potentials and EEG in multiple sclerosis

Thirteen patients with clinically definite multiple sclerosis (MS) were studied with electroencephalogram (EEG), magnetic resonance imaging (MRI), evoked potentials and cerebrospinal fluid (CSF) analysis. We attempted to correlate the findings with physical disability as defined by Kurtzke score and presence of dementia or seizures. More severe plaque disease on MRI and increased physical disability correlated significantly with abnormality on brain-stem auditory evoked potentials (BAEPs) while visual evoked potential (VEP) abnormality correlated only with MRI findings. No such correlation was found with the EEG. The close relationship between BAEP and MRI abnormalities probably reflects frequent involvement of brain-stem corticospinal pathways.     

Metabolism of cysteine and cysteinesulfinate in rat and cat hepatocytes

The metabolism of cysteine and cysteinesulfinate was studied in freshly isolated hepatocytes from fed rats and cats. In incubations of rat hepatocytes with cysteinesulfinate, the rate of hypotaurine plus taurine production was approximately the same as the rate of conversion of the 1-carbon of cysteinesulfinate to CO2. In contrast, no significant production of hypotaurine plus taurine occurred in incubations of cat hepatocytes with cysteinesulfinate. These data are consistent with the species difference in the activity of hepatic cysteinesulfinate decarboxylase, which converts cysteinesulfinate to hypotaurine. In incubations of either rat or cat hepatocytes with cysteine, no hypotaurine plus taurine production was detected. However, the 1-carbon of cysteine was converted to CO2 and the production of urea plus ammonia nitrogen was significantly increased over the rates observed in incubations of cells without substrate. Our results suggest that most cysteine oxidation by hepatocytes occurs by pathways that do not involve formation of cysteinesulfinate.