Enzyme immunoassay for diagnosis of gonorrhea.

An enzyme immunoassay (EIA; Gonozyme [Abbott Laboratories]) for gonococcal antigen was assessed for the rapid diagnosis of gonorrhea. Patients attending two sexually transmitted disease clinics were tested by EIA and culture on Thayer-Martin medium. EIA was highly effective in detecting gonococcal infection among symptomatic men, with 70 of 75 (93.3%) culture-positive men having positive tests and no false-positive reactions. The performance of the test was not as good in detecting cervical gonorrhea; the best result obtained was a sensitivity of 87% (33 of 38) for EIA compared with culture. EIA false-positives occurred at a relatively low rate for women, with the test having a specificity of ca. 97%. The test clearly is capable of detecting gonococcal antigen in cervical and urethral specimens, but its role in routine diagnosis is not clear. Its performance seems equal to that of the Gram stain for men, but it seems to be less sensitive than culture for cervical gonorrhea--a drawback in high-risk populations. The low false-positive rate could be an important issue in screening low-prevalence populations.     

Congenital clubfoot in Europe: A population‐based study

We aimed to assess prevalence, birth outcome, associated anomalies and prenatal diagnosis of congenital clubfoot in Europe using data from the EUROCAT network, and to validate the recording of congenital clubfoot as a major congenital anomaly by EUROCAT registries. Cases of congenital clubfoot were included from 18 EUROCAT registries covering more than 4.8 million births in 1995–2011. Cases without chromosomal anomalies born during 2005–2009, were randomly selected for validation using a questionnaire on diagnostic details and treatment. There was 5,458 congenital clubfoot cases of which 5,056 (93%) were liveborn infants. Total prevalence of congenital clubfoot was 1.13 per 1,000 births (95% CI 1.10–1.16). Prevalence of congenital clubfoot without chromosomal anomaly was 1.08 per 1,000 births (95% CI 1.05–1.11) and prevalence of isolated congenital clubfoot was 0.92 per 1,000 births (95% CI 0.90–0.95), both with decreasing trends over time and large variations in prevalence by registry. The majority of cases were isolated congenital clubfoot (82%) and 11% had associated major congenital anomalies. Prenatal detection rate of isolated congenital clubfoot was 22% and increased over time. Among 301 validated congenital clubfoot cases, diagnosis was confirmed for 286 (95%). In conclusion, this large population‐based study found a decreasing trend of congenital clubfoot in Europe after 1999–2002, an increasing prenatal detection rate, and a high standard of coding of congenital clubfoot in EUROCAT.     

Glycosylation is not required for the fusion activity of the G protein of vesicular stomatitis virus in insect cells

The gene encoding the complete glycoprotein of vesicular stomatitis virus (VSV, Indiana serotype G protein) with potential asparagine-linked glycans at amino acid residues 179 and 338 was inserted into a baculovirus transfer vector pAcYM1, derived from the nuclear polyhedrosis virus of Autographa californica (AcNPV). The gene was placed under the control of the AcNPV polyhedrin promotor and expressed by the derived recombinant viruses to high levels in Spodoptera frugiperda cell lines. The principal product was the glycosylated version of the G protein, although some alternative (including probable degradation) forms of the protein were also observed. Similar recombinant viruses were prepared with deletion of one, the other, or both glycosylation sites of the VSV G protein. All forms expressed VSV G protein derivatives and mediated cell fusion and the production of syncytia at low pH. The fusogenic properties of the VSV G protein expressed on the surface of insect cells was prevented using anti-VSV sera, or by elevating the pH above 6.2. A reduction of the pH to 5.5, or 5.0, accelerated the rate of syncytia formation.     

Biology of Hyalomma impeltatum (Acari: Ixodidae) under laboratory conditions

Completion of the life cycle of Hyalomma impeltatum Schulze & Schlottke required an average of 108 d at 26 +/- 1 degree C, 92-96% RH, and 12:12 (L:D) photoperiod. Weights of unfed larvae, nymphs, and females were 0.02, 0.16, and 15.4 mg, respectively, and increased 23-, 164-, and 55-fold, respectively, as a result of feeding on guinea pigs. Larvae and adults exhibited host-seeking behavior less than 1 d after hatching and molt, respectively; nymphs exhibited host-seeking behavior 2.9 d after molt. The mean (+/- SE) feeding period as larvae was 5.9 (+/- 2.23) d, nymphs 6.7 (+/- 1.10) d, and females 8.0 (+/- 0.19) d. Larvae molted 12.4 (+/- 0.26) d and nymphs molted 28.9 (+/- 0.22) d after engorgement. A sex ratio of 1.26:1 female/male was determined from emerged adults. Females began oviposition 8.9 (+/- 0.22) d after engorgement and produced 10,680 (+/- 300) eggs per female. Egg hatch was 84% (+/- 2.68) after an incubation period of 32.8 (+/- 0.19) d. Females converted 55% of engorged weight into eggs and produced 12,475 (+/- 188) eggs/g of engorged body weight. A freshly laid egg on the first day of oviposition weighted 47.7 (+/- 0.65) micrograms. An inverse relationship between egg weight and rate of egg production was observed.     

A study of the antigenicity and immunogenicity of a new hepatitis B vaccine using a panel of monoclonal antibodies

The successful prevention of infection with hepatitis B virus (HBV) has been achieved by vaccination with purified hepatitis B surface antigen (HBsAg). The ability of a novel synthetic HBV envelope antigen vaccine (Hep B-3, Hepagene ™; Medeva), which contains part of the pre-S1 and the complete pre-S2 regions and the whole of the S region and was produced in a mammalian cell line, to induce antibodies required for a protective immune response is of importance. In this study, the use of a panel of monoclonal antibodies known to bind to epitopes within the common “a” determinant has demonstrated that the epitopes present on this new vaccine are comparable to those found with plasma-derived HBsAg. In addition, the epitope specificity of the antibodies induced by this vaccine was examined and shown to accord well with previous results obtained using both a plasma-derived vaccine and a recombinant vaccine prepared in yeast. J. Med. Virol. 54:1–6, 1998. © 1998 Wiley-Liss, Inc.     

Detecting pre-ovulatory luteinizing hormone surges in urine

The study objectives were to determine (i) if pre-ovulatory luteinizing hormone (LH) surges, undetected in urine by two immunoradiometric assays (IRMA), were detectable by an ultrasensitive immunofluorometric assay (IFMA) and (ii) the influence of creatinine adjustment on the detection and timing of the urinary LH surges. Daily urine specimens were contributed by healthy 25-36 year old volunteers during 14 ovulatory menstrual cycles for an epidemiological study conducted in 1983-1985. Specimens were selected as having been previously assayed by two IRMA without consistently detecting LH surges. These urine specimens were remeasured using an IFMA and adjusted for creatinine concentration. IFMA measurements revealed unambiguous LH surges in all cycles. Adjusting IRMA urinary LH values for creatinine concentrations revealed previously undetected LH surges in four of eight cycles. Creatinine adjustment also altered the timing of IRMA and IFMA LH surges by 1-5 days. These results demonstrate an IFMA that detects pre- ovulatory LH surges in unpreserved, frozen urine from cycles where such surges were previously undetectable. Further, creatinine adjustment can markedly affect detection and timing of the onset and peak of the urinary LH surge. While our analysis suggests that this adjustment improves the validity of the LH measure, this requires further investigation.      

High maternal vitamin E intake by diet or supplements is associated with congenital heart defects in the offspring

Objective  To study associations between maternal dietary and supplement intake of antioxidants vitamin E, retinol and congenital heart defects (CHDs).
Design  Case–control study.
Setting  Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Population  Participants were 276 case mothers of a child with CHD and 324 control mothers with their children.
Methods  Food frequency questionnaires covering the intake of the previous 4 weeks were filled out at 16 months after the index pregnancy. Data were compared between cases and controls using the Mann–Whitney U test. Risk estimates for the association between CHD and dietary intake of vitamin E and retinol were estimated in a multivariable logistic regression model.
Main outcome measures  Medians (5–95th percentile) and odds ratios with 95% CI.
Results  Dietary vitamin E intake was higher in case mothers than in controls, 13.3 (8.1–20.4) and 12.6 (8.5–19.8) mg/day ( P = 0.05). CHD risk increased with rising dietary vitamin E intakes ( P -trend = 0.01). Periconception use of vitamin E supplements in addition to a high dietary vitamin E intake above 14.9 mg/day up to nine-fold increased CHD risk. Retinol intakes were not significantly different between the groups and not associated with CHD risk.
Conclusions  High maternal vitamin E by diet and supplements is associated with an increased risk of CHD offspring.     

Down's syndrome and acute lymphoblastic leukaemia: clinical features and response to treatment

AIMS—To examine the clinical and biological features of acute lymphoblastic leukaemia in children with Down''s syndrome (DS), to compare their survival with other children, and to determine if entry to trials and survival has improved.METHODS—Examination of presenting features and response to treatment in patients treated in two consecutive national trials, MRC UKALL X and XI.RESULTS—The proportion of children with DS was significantly higher in UKALL XI (1.9%) than UKALL X (0.9%). Children with DS tended to be under 10 years and to have the common ALL subtype. Cytogenetic analysis showed that favourable features, such as high hyperdiploidy and t(12;21) were less frequent but also that there was a lack of translocations associated with a poor prognosis. Children with DS showed no increase in risk of relapse at any site but their survival and event free survival were inferior to other children. These results were caused by an increased number of infective deaths during remission (11% compared to 2%). At five years overall survival was 73% in DS children compared with 82% in other children; event free survival was 53% compared to 63% in non-DS children.CONCLUSIONS—Entry of children with DS to national trials has increased and survival has improved. However they remain at risk of relapse and also of treatment related mortality. These findings emphasise the need for both intensive chemotherapy and optimal supportive care.     

Decreasing nosocomial urinary tract infection in a large academic community hospital

Urinary Tract Infection (UTI) is the second most prevalent complication at Lehigh Valley Hospital and Health Network, occurring in 3% of all patients admitted over a 12-month period and contributing to a significant increase in costs. Utilizing data from CareScience's Care Management System, an online decision support tool, in conjunction with hospital laboratory data, and without manual chart review, approximately 20% of all UTIs diagnosed were found to be potentially nosocomial, and were often treated with an expensive broad-spectrum antibiotic. A multidisciplinary hospital committee developed interventions to study and address these findings. The National Nosocomial Infection Surveillance program was initiated on selected units of the hospital; strict catheter placement guidelines and a postoperative urinary retention protocol were developed to minimize catheter use and dwell time, a cost-benefit analysis was conducted, antibiotic use for UTIs was evaluated, and system-wide education was conducted for physicians, residents, and nurses.