Sudden and unexpected deaths after the administration of hexavalent vaccines (diphtheria,tetanus, pertussis,poliomyelitis, hepatitis B,<Emphasis Type="Italic"> Haemophilius influenzae</Emphasis> type b): is there a signal?

Deaths in temporal association with vaccination of hexavalent vaccines have been recently reported. The objective of this paper is to assess whether these temporal associations can be attributed to chance. Standardised mortality ratios (SMR) for deaths within 1 to 28 days after administration of either of the two hexavalent vaccines in the 1st and 2nd year of life were determined using the respective annual rates for sudden unexpected deaths (SUDs) from the national vital statistics. The distribution of SUD cases and the vaccination uptake by month were estimated from surveys and sales figures for the individual vaccines. Sensitivity analyses were performed to account for limitations in the data sources. For one of the vaccines, Vaccine B, all SMRs were well below one. For the other, Vaccine A, SMRs exceeded one insignificantly on the 1st day after vaccination in the 1st year of life. In the 2nd year of life, however, the SMRs for SUD cases within 1 day of vaccination with vaccine A were 31.3 (95% CI 3.8–113.1; two cases observed; 0.06 cases expected) and 23.5 (95% CI 4.8–68,6) for within 2 days after vaccination (three cases observed; 0.13 cases expected). Extensive sensitivity analyses could not attribute these findings to limitations of the data sources. Conclusion: These findings based on spontaneous reporting do not prove a causal relationship between vaccination and sudden unexpected deaths. However, they constitute a signal for one of the two hexavalent vaccines which should prompt intensified surveillance for unexpected deaths after vaccination.In this paper the two vaccines have been labelled Vaccine A and Vaccine B. The brand names are not conveyed since the European licensing agency has not recommended regulatory action against either vaccine.     

Prevalence of hepatitis-C virus RNA in serum and throat washings of children with chronic hepatitis

Serum samples from 46 children with chronic and probably transfusion acquired hepatitis were tested for the presence of hepatitis C virus (HCV) RNA by a “nested” polymerase chain reaction (PCR) assay, to judge a possible risk of HCV transmission from these patients. In 73% of the samples, viral RNA was detected, indicating a high virus prevalence in this patient group. High titers of HCV-RNA were observed in some sera as shown by the detection of virus in some samples even at dilutions of 10^?3. Comparison of simultaneously obtained PCR results and ALT values revealed no significant correlation between virus presence in serum and higher ALT levels. It was, however, shown that unusually high ALT values may reflect a high titer of viral RNA in serum. To investigate the prevalence of viral RNA in saliva, which could be a vehicle of virus transmission, 35 throat washing samples from the HCV-infected children were screened by PCR. Using three different sample preparation procedures, 20% of the throat washings were found to be positive for HCV-RNA. This indicates a prevalence of virus in this fluid lower than that reported previously. © 1994 Wiley-Liss, Inc.     

Intestinal worm burden and serum cholesterol or lipid concentration in a Shipibo population (Peru)

Paired samples of stool and serum of 32 members of the Shipibo tribe resident in the rain forest of the Peruvian lowlands were tested for worm egg count and serum lipid parameters, respectively. 90% of the stool samples tested were found to contain eggs or larvae of several worm species, most commonly 3 or 4 different species. Serum lipid levels were found to be relatively low, most probably due to a low proportion of dietary fat ranging from 16-31%. Statistical analysis showed a significant inverse correlation between worm egg excretion and HDL levels which was true for hookworm, strongyloides and trichuris, but not for ascaris. The mechanisms underlying the observed association between intestinal worm load and HDL reduction are not completely understood and may include reduced HDL synthesis in the gut wall due to inflammatory and/or toxic irritation.     

Demonstration of an interpolation method for determining approximate maximum and minimum points as a prerequisite for EEG analysis in the time domain using computers with limited memory capacity

The EEG analysis in the time domain provides several advantages compared to the power spectra analysis, based on a FFT. There is the possibility to differentiate frequency, amplitude and other elementary characteristics of the wave form. This technique of EEG analysis is based on the definition of distinct characteristics of the wave form. Problems for calculating the frequency distribution arise--according to Harner, 1977--due to the fact, that the digitalization rate has to be very fast to reach an adequate resolution. On the other hand a high digitalization rate of 5 ms or below produces problems concerning the limited memory capacity of laboratory computers, especially if more than one derivation should be analysed simultaneously, to make further topological analyses possible. Three procedures of EEG analysis to calculate frequency distributions are shown, two of them are based on an interpolation technique to calculate adjusted minima-maxima. The results of these procedures using two different digitalization rates, were compared and discussed to respect similarity of resulting frequency distributions.     

Phorbol-12,13-dibutyrate improves the quality of cytogenetic preparation in lymphoid malignancies

In cytogenetic preparation of lymphoid malignancies we investigated the quantitative and qualitative impact of phorbol-12,-13-dibutyrate (P) and of this tumor promoter in combination with the calcium ionophore A23187 (PA). Using parallel cultures of unstimulated and stimulated preparations, the effect was examined in 13 patients with malignant lymphomas and six patients with acute lymphoblastic leukemias (ALL). Focusing on high-quality analyzable metaphases, the best results were found in seven of 13 cases with lymphomas and five of six patients with ALL in the cultures supplemented with phorbol-12,13-dibutyrate. The yield of metaphases of good quality regarding length, spreading, and banding of chromosomes was regularly better in F-stimulated 24-hour culture (p < 0.05), followed by 48-hour cultures stimulated with P alone. Addition of the calcium-ionophore was of no further benefit. The yield of the unstimulated direct harvest was rather poor in nearly all patients investigated. Because no mutagenic effect of P was observed, the use of this mitogen may offer interesting perspectives in cytogenetic analysis of lymphoid malignancies and perhaps also in other tumors with low mitotic indexes.     

Parasuicide in Pakistan: experience at a university hospital

Khan MM, Islam S, Kundi AK. Parasuicide in Pakistan: experience at a university hospital. Scand 1996: 93: 2644267. © Munksgaard 1996. There have been few reports of parasuicide from Pakistan, where the act is considered to be a criminal offence and the Islamic religion strongly disapproves of it. In order to address the problem, a retrospective case report analysis of all index cases of parasuicide presenting over a period of 3.5 years to a university hospital in Karachi, Pakistan, was undertaken. Our results showed that most of the subjects were young adults, with married women representing the single largest group. Self-poisoning with medication was the most common method, and benzodiazepines the most frequently used drug. Interpersonal conflict with the opposite sex was the most common precipitating cause. In Pakistani culture, marriage appears to be a significant source of stress for women. Reports based on official police records do not reflect the true picture of the problem in Pakistan.     

Emergence of low level vancomycin resistance in MRSA

One hundred and twenty methicillin resistant Staphylococcus aureus (MRSA) strains were checked for minimum inhibitory concenteration (MIC) of vancomycin. The results showed that 98 strains (81.7 %) had MIC < 4microg/mL, 18 strains (15 %) had MIC 8 microg/mL, and 4 (03.3%) had MIC 16 microg/mL which being borderline between sensitive (< 4microg/mL) and resistant (>32 microg/mL) values points towards possible emergence of low level vancomycin resistance in the organisms and may explain the reasons of delayed therapeutic success of vancomycin in S. aureus bacteraemia in some situations.     

Karyotype plus NPM1 mutation status defines a group of elderly patients with AML (≥60 years) who benefit from intensive post‐induction consolidation therapy

Although it is generally appreciated that a subset of elderly patients with acute myeloid leukemia (AML) may benefit from intensive consolidation, little is known about variables predicting such benefit. We analyzed 192 consecutive patients with de novo AML aged ≥60 years who were treated with intensive chemotherapy. About 115 patients (60%) achieved complete hematologic remission (CR). Among several parameters, the karyotype was the only independent variable predicting CR (P < 0.05). About 92% (105/115) of the CR‐patients received up to four consolidation cycles of intermediate dose ARA‐C. Median continuous CR (CCR) and disease‐free survival (DFS) were 1.3 and 1.1 years, respectively. CCR, DFS, and survival at 5 years were 23%, 18%, and 15%, respectively. Only karyotype and mutated NPM1 (NPM1mut) were independent predictors of survival. NPM1mut showed a particular prognostic impact in patients with normal (CN) or non‐monosomal (Mkneg) karyotype by Haemato‐Oncology Foundation for Adults in the Netherlands (HOVON)‐criteria, or intermediate karyotype by Southwest Oncology Group (SWOG)‐criteria. The median CCR was 0.94, 1.6, 0.9, and 0.5 years for core‐binding‐factor, CN/Mkneg‐NPM1mut, CN/Mkneg‐NPM1‐wild‐type AML, and AML with monosomal karyotype, respectively, and the 5‐year survival was 25%, 39%, 2%, and 0%, respectively (P < 0.05). Similar results (0.9, 1.5, 0.9, and 0.5 years) were obtained using modified SWOG criteria and NPM1 mutation status (P < 0.05). In summary, elderly patients with CN/Mkneg‐NPM1mut or CBF AML can achieve long term CCR when treated with intensive induction and consolidation therapy whereas most elderly patients with CN/Mkneg‐NPM1wt or Mkpos AML may not benefit from intensive chemotherapy. For these patients either hematopoietic‐stem‐cell‐transplantation or alternative treatments have to be considered. Am. J. Hematol. 91:1239–1245, 2016. © 2016 Wiley Periodicals, Inc.     

Analysis of plasma surfactant protein D levels in lung transplant recipients

In lung transplant recipients (LTRs), severe clinical complications, such as microbial infections of the lung or transplant rejection, may occur. Surfactant protein D (SP‐D) is a C‐type lectin that is mainly produced in alveolar type II cells. Plasma SP‐D levels are usually low, but may increase when the lung–blood barrier is impaired. In this study, we analyzed whether plasma SP‐D concentrations reflect rejection or infection of the lung allograft. An enzyme‐linked immunosorbent assay was used to measure SP‐D levels in plasma samples from 58 LTRs during intervals without pathologic respiratory findings and during episodes of acute cellular rejection (ACR), microbial colonization, and microbial pneumonia. Median plasma SP‐D levels were significantly increased during episodes of microbial pneumonia, but not in the absence of pathologic respiratory findings, during microbial colonization, or during ACR up to grade A2–A3 (P < 0.05). During pneumonia, an increased plasma SP‐D level was detected in 60% of LTRs and this was further associated with a significantly higher risk for the patients to develop stage III bronchiolitis obliterans syndrome (BOS III) or to die within the subsequent 6 months after pneumonia (P = 0.0093). All patients with a plasma SP‐D level of >300 ng/mL during pneumonia developed BOS III and/or died within 6 months of follow‐up (P = 0.001). The determination of SP‐D levels in plasma during pneumonia in LTRs may be of prognostic value and warrants further evaluation.