The Fc Binding Regions in Protein A are not Responsible for the Polyclonal B Cell Activating Property of Protein A

To test whether the polyclonal B cell activating property of protein A is due to its ability to bind to the Fc part of immunoglobulins, experiments were carried out with purified monomeric or dimeric Fc-binding fragments of protein A. Neither monomeric nor dimeric fragments induced polyclonal antibody synthesis in vitro, whereas intact protein A was a strong activator. It is concluded that the Fc binding part of protein A is not responsible for activation of polyclonal antibody synthesis.     

Early preventive attachment-oriented psychotherapeutic intervention program with parents of a very low birthweight premature infant: Results of attachment and neurological development

The birth of a very small preterm infant ( 1500 grams) can be a traumatizing experience for many parents. A developmental risk model is presented that is the background to an early attachment-oriented preventive psychotherapeutic intervention. This comprehensive parent-centered intervention program is composed of supportive group psychotherapy, attachment-oriented focal individual psychotherapy, a home visit and video-based sensitivity training. The intervention aims at improving parental coping, the process of attachment and parent-infant interaction. In a prospective longitudinal design mothers were randomly assigned to a control (N = 44) and an intervention group (N = 43) after preterm delivery. Results show that the percentage of secure (control vs. intervention group: 77.8% vs. 59.4%) and insecure (control vs. intervention group: 8.3% vs. 31.3% avoidant, 13.9% vs. 9.4% ambivalent) attachment quality in high-risk preterm infants is comparable to results from studies with term infants. There was no significant statistical difference in terms of quality of attachment of the preterm infants between the control group and the intervention group. However, only in the control group, impaired neurological development corresponded significantly with an insecure quality of attachment, but not in the intervention group, although there were significantly more neurologically impaired infants in the intervention group. This result is discussed as an effect of the intervention program.     

Adverse effects of perioperative paracetamol,NSAIDs, glucocorticoids,gabapentinoids and their combinations: a topical review

Post‐operative pain affects millions of patients worldwide and the post‐operative period has high rates of morbidity and mortality. Some of this morbidity may be related to analgesics. The aim of this review was to provide an update of current knowledge of adverse events (AE) associated with the most common perioperative non‐opioid analgesics: paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs), glucocorticoids (GCCs), gabapentinoids and their combinations. The review is based on data from systematic reviews with meta‐analyses of analgesic efficacy and/or adverse effects of perioperative non‐opioid analgesics, and randomised trials and cohort/retrospective studies. Generally, data on AE are sparse and related to the immediate post‐operative period. For paracetamol, the incidence of AEs appears trivial. Data are inconclusive regarding an association of NSAIDs with mortality, cardiovascular events, surgical bleeding and renal impairment. Anastomotic leakage may be associated with NSAID usage. No firm evidence exists for an association of NSAIDs with impaired bone healing. Single‐dose GCCs were not significantly related to increased infection rates or delayed wound healing. Gabapentinoid treatment was associated with increased sedation, dizziness and visual disturbances, but the clinical relevance needs clarification. Importantly, data on AEs of combinations of the above analgesics are sparse and inconclusive. Despite the potential adverse events associated with the most commonly applied non‐opioid analgesics, including their combinations, reporting of such events is sparse and confined to the immediate perioperative period. Knowledge of benefit and harm related to multimodal pain treatment is deficient and needs clarification in large trials with prolonged observation.     

Post‐operative analgesic effects of paracetamol,NSAIDs, glucocorticoids,gabapentinoids and their combinations: a topical review

In contemporary post‐operative pain management, patients are most often treated with combinations of non‐opioid analgesics, to enhance pain relief and to reduce opioid requirements and opioid‐related adverse effects. A diversity of combinations is currently employed in clinical practice, and no well‐documented ‘gold standards’ exist. The aim of the present topical, narrative review is to provide an update of the evidence for post‐operative analgesic efficacy with the most commonly used, systemic non‐opioid drugs, paracetamol, non‐steroidal anti‐inflammatory drugs (NSAIDs)/COX‐2 antagonists, glucocorticoids, gabapentinoids, and combinations of these. The review is based on data from previous systematic reviews with meta‐analyses, investigating effects of non‐opioid analgesics on pain, opioid‐requirements, and opioid‐related adverse effects. Paracetamol, NSAIDs, COX‐2 antagonists, and gabapentin reduced 24 h post‐operative morphine requirements with 6.3 (95% confidence interval: 3.7 to 9.0) mg, 10.2 (8.7, 11.7) mg, 10.9 (9.1, 12.8) mg, and ≥ 13 mg, respectively, when administered as monotherapy. The opioid‐sparing effect of glucocorticoids was less convincing, 2.33 (0.26, 4.39) mg morphine/24 h. Trials of pregabalin > 300 mg/day indicated a morphine‐sparing effect of 13.4 (4, 22.8) mg morphine/24 h. Notably, though, the available evidence for additive or synergistic effects of most combination regimens was sparse or lacking. Paracetamol, NSAIDs, selective COX‐2 antagonists, and gabapentin all seem to have well‐documented, clinically relevant analgesic properties. The analgesic effects of glucocorticoids and pregabalin await further clarification. Combination regimens are sparsely documented and should be further investigated in future studies.     

The aetiology of preterm labour

Summary. Factors associated with spontaneous preterm birth were analysed in 254 primigravidae who gave birth to singleton infants between 28 and 36 completed weeks gestation in Aberdeen City District between 1978 and 1982. In 144 women labour followed premature rupture of the membranes and in 110 the membranes were intact and labour began with contractions. Among those with intact membranes, unmarried women and teenagers were over represented to a significant extent compared with all primigravidae. Among those with premature rupture of the membranes, the distribution of age and marital state was similar to that in all primigravidae, but the birthweight centile distribution showed a significant shift towards light-for-dates babies. It is argued that there may be two distinct categories of pregnancies that end in spontaneous preterm labour.     

Early Feeding Problems in an Affluent Society

ABSTRACT. The aim of this study was to investigate the natural course of later problems and their prevalence in children with early feeding difficulties. Forty-two children with feeding problems without any obvious medical reason during the first year of life were followed up prospectively to the age of two years. Comparisons were made with 42 age- and sex-matched controls. Information was obtained from parental interviews, medical records and assessments of psychomotor development. In 21 (50%) of the children with feeding problems the problems persisted at the age of two years. There were significantly higher frequencies of infections and behavioural problems among the children with early feeding problems than among the controls. No differences in psychomotor development were found. Recurrent infections, behaviour problems and psycho-social problems were significantly correlated with severe persistent feeding problems at the age of two years.     

SERUM LEVELS AND RENAL EXCRETION OF DIGOXIN DURING MAINTENANCE THERAPY IN CHILDREN

ABSTRACT. Iisalo, E. and Dahl, M. (Departments of Pharmacology and Paediatrics, University of Turku, Turku, Finland). Serum Levels and Renal Excretion of Digoxin during Maintenance Therapy in Children. Acta Paediatr Scand, 63: 699, 1974.—To exclude an increased excretion of digoxin as a possible reason for higher dose requirement in children a radioimmunoassay of digoxin in the serum and the 24 hr urine was carried out in 26 children, mainly infants, with congenital heart disease. This procedure was repeated on two consecutive days, in total 64 times during digoxin maintenance therapy.
The daily digoxin dose per kilogram of body weight in these small children was twice as high as that used in adults. The steady state level of serum digoxin corresponded approximately to that of adults. A few fairly high digoxin levels were, however, measured in infants without any signs of digitalis toxicity.
The daily excretion of digoxin in the urine during maintenance therapy was approximately the same in all age groups and on an average 47 per cent of the daily dose. This percentage is somewhat lower than that found in adults. The low renal excretion of digoxin in one newborn caused high serum digoxin levels.
The higher dosage requirement of digoxin per kilogram of body weight in children as compared to adults cannot be explained with differences in the renal excretion of digoxin.     

Total serum IgE levels in Venezuelan schoolchildren

Seventy-eight disease-free children were evaluated by PRIST for total serum IgE in order to establish the normal range for this immunoglobulin and assess its utility, in tropical climates, such as Venezuela, as a diagnostic tool for clinical allergy. Seventy-eight normals were selected from a group of 1053 children, aged 7-12 years from fourteen schools in Caracas. Exclusion from the normal pool was based on nationality, and on historical, clinical, and/or laboratory evidence of atopic and/or infectious diseases, particularly with parasites. In addition to a routine CBC and differential, the following studies were performed: a search for stool ova and parasites; in vitro (RAST) and in vivo (skin prick) testing for specific IgE to Dermatophagoides pteronyssinus, Aspergillusfumigatus, and ragweed. Measurement of antibodies against influenza A and B, adenovirus A₂: and B, cytomegalovirus, parainflucnza 1 and 3, herpes simplex, respiratory syncytial virus, Coxsackie B₁ to B₆, Mycoptasma pneumoniae and Rolavirus was also carried out. Normal serum IgE levels for disease-free children in the age group studied ranged from 1.7-255 u/ml. The highest average level (± 74 u/ml) occurred at the age of 9 years. These values differed significantly from age-matched control groups of known atopic and helminth-infected children. Thus, once common causes for elevated IgE levels are eliminated, determination of total serum IgE can be utilized as a valuable tool in diagnosis of clinical allergy in countries with tropical climates.     

The preparedness of dental professionals to treat persons with disabling conditions in long-term care facility and community settings

A survey was conducted of 300 state long-term care facilities to determine prior training and needs for further instruction of dental staff in the management of patients in this setting. In addition, dental practitioners in two states, Missouri and Washington, were surveyed with respect to their qualifications and availability to treat persons with disabling conditions in the community. A large proportion of dentists who work in long-term care facilities reported a lack of formal preparation for their area of dental practice. Many community dentists who stated a willingness to treat persons with disabling conditions also appeared to be inadequately prepared. Responses to the Missouri and Washington surveys were generally similar; apparent differences with respect to experience may have been caused by variation in survey criteria. Positive effects of training are beginning to carry over into practice. Larger numbers of recent graduates reported training and expressed willingness to treat patients with disabling conditions compared with dentists who have been in practice longer. Dentists with training and extensive experience probably best reflect available dental resources for persons with disabling conditions in the community.