新生儿破伤风护理的新体会

目的 探讨新生儿破伤风护理的新方法,提高临床治愈率,降低患儿病死率。方法 对26例患儿采用止痉镇静药控制痉挛,早期胃管鼻饲喂养,提供营养支持,脐部彻底清创后暴露,保持呼吸道通畅。结果 26例患儿中,1例放弃治疗,4例因呼吸衰竭死亡,21例治愈出院,治愈率80.8%。结论 有效、合理地控制痉挛及早期胃肠内营养支持、脐部彻底清创后暴露、及时采取有效的降温等护理措施,大大提高了新生儿破伤风的治愈率。     

深圳松岗孕产妇死亡和新生儿破伤风发病调查

目的 分析深圳市松岗街道孕产妇死亡率和新生儿破伤风发病率情况,为松岗街道进一步做好妇幼保健工作提供参考.方法 用回顾性和PPS方法调查,分析1999～2006年松岗街道孕产妇死亡率、新生儿破伤风发病率和流动人口住院分娩率情况.结果 8年中,共有孕产妇16 248人,其中流动孕产妇占74.07%;孕产妇死亡率逐年下降（P＜0.05）;新生儿破伤风发病率逐年下降（P＜0.05）;流动人口孕产妇住院分娩占总分娩比例逐年上升（P＜0.05）.结论 1999～2006年松岗街道的孕产妇死亡率和新生儿破伤风发病率逐年下降,地下接生是导致孕产妇死亡和新生儿破伤风的主要因素,仍需加大对流动孕产妇健康教育力度和黑诊所的监管力度,坚决执行贫困孕产妇救助计划.     

In-Vivo Immune Responses of Breast- and Bottle-fed Infants to Tetanus Toxoid Antigen and to Normal Gut Flora

The effects of breast and bottle-feeding on serum immunoglobulin levels and specific antibody responses have been examined in 30 infants on five occasions from 6 days until 9 months of age. No significant differences were found on any sample occasion between the two feeding groups in total immunoglobulin levels of G, M and A classes or in class-specific antibody responses to tetanus toxoid vaccine. This suggests that the capacity of the two groups to make serum antibodies develops similarly. Concentrations of antibodies to commensal Escherichia coli 'O'lipopolysaccharide antigens, however, were significantly greater in the bottle-fed group, and it is suggested that this difference is due to an increase in the exposure of the systemic immune system to these gut antigens in the bottle-fed infants. There are several possible explanations for this increased exposure and the resulting effects on the infants'immune system. These experiments also illustrate a possible role of breast milk in stimulating the immune system.     

Loading of Tetanus Toxoid to Biodegradable Nanoparticles from Branched Poly(Sulfobutyl-Polyvinyl Alcohol)-g-(Lactide-Co-Glycolide) Nanoparticles by Protein Adsorption: A Mechanistic Study

Purpose. Mucosal delivery of vaccine-loaded nanoparticles (NP) is an attractive proposition from an immunologic perspective. Although numerous NP preparation methods are known, sufficient antigen loading of NP remains a challenge. The aim of this study was to evaluate adsorptive loading of NP with a negatively charged surface structure using tetanus toxoid (TT) as a model vaccine. Methods. Blank NP, consisting of poly(sulfobutyl-polyvinyl alcohol)-g-(lactide-co-glycolide), as well as poly(lactide-co-glycolide) NP were prepared by a solvent displacement technique. The use of polymers with different degrees of substitution resulted in NP with different negative surfaces charges. Adsorption of TT to NP was performed varying to NP surface properties, protein equilibrium concentration, and loading conditions. Results. The protein adsorption was controlled by NP surface properties, and maximum TT adsorption occurred at highly negatively charged NP surfaces. Results from isothermal titration calorimetry and -potential measurement suggest an adsorption process governed by electrostatic interactions. The adsorption followed the Langmuir isotherm in the concentration ranges studied. TT withstood this gentle loading procedure in a nonaggregated, enzyme-linked immunoabsorbant assay-active form. Conclusions. The results demonstrate that negatively charged NP consisting of poly(sulfobutyl-polyvinyl alcohol)-g-(lactide-co-glycolide) are suitable for adsorptive loading with TT and may have potential for mucosal vaccination.     

Loss of hilar somatostatin neurons following tetanus toxin-induced seizures

A loss of inhibitory interneurons has been reported in the hippocampus following seizure activity in various animal models of epilepsy and in human epileptic tissue. The question of whether particular populations of inhibitory neurons are similarly affected by the chronic block of inhibition tha tresults after tetanus toxin injections directly into the brain has not previously been addressed. In the present study a unilateral intrahippocampal injection of tetanus toxin into the ventral hippocampus was used to produce a chronic epileptic syndrome characterised by brief seizures that recurred intermittently for 6–8 weeks. The results reveal, for the first time, the morphological changes in somatostatin interneurons following tetanus toxin-induced seizures in the rat. A bilateral short-term increase in immunoreactivity of somatostatin neurons is present 1 week after injection. This is accompanied by an increased intensity of somatostatin-immunoreactive axon terminals in the outer molecular layer of the dentate gyrus, which is more marked on the contralateral side. A chronic and significant loss of somatostatin-immunoreactive neurons was noted in the hilus of the dentate gyrus 2 months later. The significance of the chronic loss of the hilar somatostatin neurons in the control of excitatory activity in the dentate gyrus and whether the acute morphological changes are due to a direct action of the toxin on release mechanisms or as a result of seizure activity are discussed.     

Antitoxin's effect on tetanus toxin induced sphincter pupillae paralysis in the rabbit

Summary The effectiveness of antitoxin in preventing tetanus toxin's blockage of acetylcholine release from the cholinergic nerves of the rabbit iris was tested by injecting purified tetanus toxin into the anterior chamber, and by injecting horse antitoxin at various time intervals either into the anterior chamber, intravenously, or into the anterior chamber and intramuscularly.The results indicate that antitoxin is ineffective in preventing the development of sphincter pupillae paralysis once it is induced by tetanus toxin, prior to appearance of the symptoms.The efficacy of antitoxin treatment depends on the administration of an optimal therapeutic dose.Neither the rate of development, nor the rate of recovery from the maximal pupillary paralysis are altered by antitoxin treatment.The severity, the duration, and the time of complete recovery from the paralysis are directly related to the time antitoxin treatment begins.     

Knowledge of general public and health professionals about tetanus immunization

Objective : To study the awareness among general public and health care providers about tetanus immunization in relation to injuries, and their knowledge about tetanus immunization schedules in children, pregnant females and adults.Methods : It was a cross-sectional study done at a perfect health mela and all the government allopathic health agencies in Delhi.Results : The knowledge of tetanus immunization was poor among general public as well as health care providers. A substantial proportion of them indicated tetanus injection after every injury, which was unwarranted. The knowledge of tetanus immunization schedule for adults was poor among all categories of respondents, though it was comparatively better for pregnant females, but only 75% of doctors and 51.1 % of nursing personnel correctly knew the immunization schedule against tetanus in children.Conclusion : There is a need to upgrade the level of knowledge among health care providers so as to ensure that schedules of tetanus are followed properly and unnecessary repeated immunizations are avoided and the same knowledge is passed on to the general public also.     

Reduced-antigen-content-diphtheria-tetanus-acellular-pertussis and inactivated polio vaccine as a booster for adolescents 10 to 14 years of age

High rates of pertussis disease in adolescents suggest that additional boosting against pertussis would be beneficial. A combined acellular-pertussis-containing booster vaccine (dTpa-IPV; Boostrix Polio, n =440) was compared to separately administered dTpa (Boostrix) and inactivated polio virus (IPV; Imovax Polio^®, n =219), and to DTPa-IPV (Infanrix IPV, n =111) vaccine in a partially blind, randomised controlled trial in 10–14 year olds. One month after vaccination, seroprotection/seropositivity rates for all antigens were similar for all groups. Although pertussis and diphtheria antibody geometric mean antibody concentrations were higher after DTPa-IPV, all subjects had protective antibodies against diphtheria, tetanus and polio, and at least 97% had a vaccine response to pertussis antigens. Reactogenicity of dTpa-IPV was comparable to dTpa + IPV, but dTpa-IPV was generally better tolerated than DTPa-IPV. Conclusion:The combined reduced-antigen-content-diphtheria-tetanus-acellular-pertussis and IPV vaccine is immunogenic and well tolerated when administered to adolescents and could be used to improve the control of pertussis disease in this age group.     

Characterization of the tetanus toxin model of refractory focal neocortical epilepsy in the rat

PURPOSE: To characterize in detail a model of focal neocortical epilepsy. METHODS: Chronic focal epilepsy was induced by injecting 25-50 ng of tetanus toxin or vehicle alone (controls) into the motor neocortex of rats. EEG activity was recorded from electrodes implanted at the injection site, along with facial muscle electromyographic (EMG) activity and behavioral monitoring intermittently for up to 5 months in some animals. Drug responsiveness was assessed by using the antiepileptic drugs (AEDs) diazepam (DZP) and phenytoin (PHT) delivered systemically, while 1,2,3,4-tetrahydro-6-nitro-2,3-dioxo-benzo[f]quinoxaline-7-sulfonamide (NBQX), a competitive antagonist at AMPA receptors, was administered directly to the brain to investigate the potential benefits of focal drug delivery. RESULTS: Tetanus toxin induced mild behavioral seizures that persisted indefinitely in all animals. EEG spiking activity, occurring up to 80% of the time, correlated with clinical seizures consisting of interrupted behavioral activity, rhythmic bilateral facial twitching, and periods of abrupt motor arrest. Seizures were refractory to systemic administration of DZP and PHT. However, focal delivery of NBQX to the seizure site reversibly reduced EEG and behavioral seizure activity without detectable side effects. CONCLUSIONS: This study provides a long-term detailed characterisation of the tetanus toxin model. Spontaneous, almost continuous, well-tolerated seizures occur and persist, resembling those seen in neocortical epilepsy, including cortical myoclonus and epilepsia partialis continua. The seizures appear to be similarly resistant to conventional AEDs. The consistency, frequency, and clinical similarity of the seizures to refractory epilepsy in humans make this an ideal model for investigation of both mechanisms of seizure activity and new therapeutic approaches.     

Tetanus immunization in pregnant women. Serum levels of antitetanus antibodies at time of delivery

The objective of this study was to determine the tetanus immunity status of pregnant women at the time of delivery according to tetanus toxoid (TT) vaccination coverage during their most pregnancy. The serum anti-tetanus antibody levels of 493 mothers who had live births at a hospital in Ankara were determined by enzyme-linked immunosorbent assay (ELISA). Protected women were defined as those with serum antibody levels 0.6 IU/ml. Overall, 69.0% of mothers had protective tetanus antibody titers at the time of delivery. The rates of protection for mothers who had received no vaccination, one TT dose, or two TT doses during pregnancy were 46.4, 93.5, and 95.6%, respectively. Vaccinating every pregnant woman with at least one dose of TT would be an affordable and effective way to protect against neonatal tetanus, and would be a step toward eliminating the deaths that continue to occur due to this preventable disease in Turkey.