Effectiveness of parental cocooning as a vaccination strategy to prevent pertussis infection in infants: A case-control study

BackgroundDuring a pertussis epidemic in 2009, the Department of Health, Victoria, Australia, implemented a cocoon program offering parents of new babies a funded-dose of pertussis-containing vaccine. We assessed vaccine effectiveness (VE) of the program in reducing pertussis infection in infants.MethodsUsing a matched case-control design, infants aged <12 months that were notified with pertussis between 1 January 2010 and 31 December 2011, and born during the time that the cocoon program was in place, were identified. Controls were matched by area of residence and date of birth. Telephone interviews we conducted to ascertain parents’ vaccination status, and if vaccinated, timing of vaccination receipt relative to the birth of their baby. Odds ratios (ORs) were calculated for the association between vaccination and pertussis infection, with VE calculated as (1 – OR) × 100%.ResultsThe study recruited 215 cases and 240 controls (response rates 67% and 25% of eligible participants, respectively). Vaccination of both parents after delivery of the infant and ≥28 days prior to illness onset reduced pertussis infection by 77% (Vaccine Effectiveness [VE] = 77% (confidence interval [95% CI], 18–93%). After adjusting for maternal education, presence of a sibling within the household, and the infants’ primary course vaccination status, the adjusted VE was 64% (95% CI, −58–92%).ConclusionsAlthough not reaching statistical significance, our results demonstrated that cocoon immunisation – where both parents are vaccinated in the post-partum period – may offer some protection again infant pertussis infection. Cocoon immunisation could be considered in circumstances where antenatal vaccination of the mother has not occurred.     

Prospective study of definite caterpillar exposures.

Exposure to caterpillars results in a variety of clinical effects depending on the species involved. The aim of this study was to describe the clinical effects from caterpillar exposures within Australia. Cases were recruited prospectively from calls to a poison information centre. Subjects were included if they had a definite exposure and they had collected the caterpillar or cocoon. The caterpillars were identified to genus and species level where possible. There were 36 included cases: two were contact exposures to caterpillar contents, one was an ingestion of a caterpillar and the remaining 33 patients had definite reactions from caterpillar or cocoon exposure. There were five families of caterpillars identified in the study: Arctiidae, Limacodidae, Anthelidae, Lymantriidae and Sphingidae, many of which occur worldwide. Clinical effects ranged from severe pain to an urticarial response depending on the species involved. There were no adverse effects following ingestion in this study. Treatment consisted primarily of removal of the caterpillar or cocoon. Other treatment measures consisted of symptomatic treatment such as ice packs and antihistamines. This is the first prospective study of caterpillar exposures within Australia and demonstrates that exposures can result in a variety of reactions depending on the family and species involved.     

Vermiconversion of wastewater sludge from textile mill mixed with anaerobically digested biogas plant slurry employing Eisenia foetida

Vermicomposting is commonly used for the management of organic wastes. We have investigated the potential of an epigeic earthworm, Eisenia foetida, to transform solid textile mill sludge (STMS) spiked with anaerobically digested biogas plant slurry (BPS) into vermicompost to evaluate the feasibility of vermicomposting in industries for waste management. The growth and reproduction of E. foetida was monitored in a range of different feed mixtures for 15 weeks in laboratory under controlled experimental conditions. E. foetida did not survive in fresh STMS. But worms grew and reproduced in STMS spiked with BPS feed mixtures. A greater percentage of STMS in feed mixture affected biomass gain and cocoon production by earthworms. The maximum growth was recorded in 100% BPS. The net weight gain by E. foetida in 100% BPS was two-four-fold higher than STMS-containing feed mixtures. After 15 weeks, maximum cocoons (78) were counted in 100% BPS and minimum (26) in 60% BPS+40% STMS feed. Vermicomposting resulted in pH shift toward acidic, significant reduction in C:N ratio, and increase in nitrogen, phosphorus, and potassium contents. Microbial activity measured as dehydrogenase activity increased with time up to day 75 but decreased on day 90, indicating the exhaustion of feed and decrease in microbial activity. These experiments demonstrate that vermicomposting can be an alternate technology for the recycling and environmentally safe disposal/management of textile mill sludge using an epigeic earthworm, E. foetida, if mixed with anaerobically digested BPS in appropriate ratios.     

Empirical maximum lifespan of earthworms is twice that of mice

We considered a Gompertzian model for the population dynamics of Eisenia andrei case-cohorts in artificial OECD soil under strictly controlled conditions. The earthworm culture was kept between 18 and 22°C at a constant pH of 5.0. In all, 77 lumbricids were carefully followed for almost 9 years, until the oldest died. The Eisenia median longevity is 4.25 years and the oldest specimen was 8.73 years. Eisenia cocoons were hand-sorted every 3 weeks, washed in distilled water, placed in Petri dishes, and counted. Regular removal did not reduce breeding. Each fertile cocoon contained on average two or three embryos. The failure rates (mortality and infertility percentages) are smooth power functions where the rate at time (n + 1) captured most of the phenomenology of the previous rate at time n, as expected by the considered law, but not at both the beginning and the end of this long-term laboratory study.     

Transcathater percutaneous device closure of a large PDA closed in a 3 kg infant

Patent ductus arteriosus (PDA) is common congenital heart disease which may require treatment as transcatheter percutaneous device closure (PDA device closure) or surgical ligation in symptomatic full-term patients. Surgical ligation is an invasive procedure and has more complications especially in the neonates. Problems in PDA device closure are difficult vascular access, manipulation of catheters and sheath, residual shunts, residual obstruction of major arteries etc and these complications increase in low birth weight babies, but it is a less invasive procedure and has fewer complications than surgery, so should be tried in low birth weight patients also. We are presenting a case of 3 kg infant with large PDA (8 mm) presented with failure to thrive, lower respiratory tract infection and heart failure. He successfully underwent PDA device closure with 10 × 12 mm Cocoon PDA device. To the best of our knowledge, this is the first case of the use of such a large device in a 3 kg child with good results.     

Catheter closure of atrial septal defects using the Cocoon septal occluder: Preliminary results of a European multicenter study

Despite its simplicity, device closure of atrial septal defects is still associated with rare but potentially lethal complications. In this prospective non-randomized multicenter study we investigated the safety and efficacy of the Cocoon septal occluder (CSO) for closure of atrial septal defects (ASDs) in 92 patients. Median age of the patients was 10.5 years (range 3–61 years) and median weight was 25 kg (range 13–65 kg). The device is an improved new generation double disc design made of Nitinol wire mesh that is coated with platinum using NanoFusion technology. The discs are connected by a waist with diameter ranging from 6 mm to 40 mm with 2 mm increments. All patients completed a 3-month follow-up. Mean ASD diameter was 21 ± 7 mm (range 10–35 mm), while the mean device diameter was 24 ± 8 mm (range 14–40 mm). The CSO was permanently implanted in all 92 patients. Complete echocardiographic closure of the defect immediately after the procedure or at the one month follow-up, was observed in all 92 patients (100%). No device-related complications were observed during the procedure or at short-term follow-up (range 3–12 months). Our preliminary results indicate that CSO is a promising device for transcatheter closure of ASDs. Further studies are required to document its efficacy, safety and long-term results in a larger patient population.     

Internal hernias and their mimics: How would radiologists help?

Purpose

Trying to define the most valuable radiological sign(s) for the diagnosis of internal hernias and their mimics; mainly cocoon syndrome and adhesions.

Review

Nowadays with the increasing number of bariatric surgeries, the number of diagnosed internal hernias has increased significantly. Adhesions and cocoon syndrome are among the differential diagnosis. Although many signs were suggested for the diagnosis of such conditions, yet no single sign is enough to diagnose each of the above.

Method and subjects

This is a retrospective study. In a period of 32 consecutive months, from June 2010 to February 2013 a total of 240 patients were admitted with abdominal pain with signs of remittent or persistent intestinal obstruction. All cases are subjected to multislice CT examination. Several criteria are used to diagnose internal hernia. Informed consents were taken from all patients and organizational ethics committee were informed.

Results

The age of the patients varies between 22 and 63 years with average age of 36 ± 2.3 years. Most of the patients were females with ratio of 2:1. Commonest presentation was abdominal pain present in all cases. The study diagnosed 13 cases/internal hernias, 14/adhesions, two cases/cocoon syndrome, two cases/intussusceptions and one case/malrotation. The most important signs used are Swirl’s sign, localized bowel gathering and segmental bowel dilatation.

Conclusion

A single sign is not enough for the diagnosis of internal hernia, rather the use of more than one sign is essential to narrow the differential diagnosis.

Clinical relevance/application

The prevalence of internal hernia is increasing due to increased rate of operative abdominal intervention. Prompt radiological diagnosis is crucial to avoid unwanted surgery in a non-virgin abdomen.     

腹茧症合并术后早期炎性肠梗阻:1例报告并文献复习

目的:探讨腹茧症合并术后早期炎性肠梗阻的诊断与治疗经验.方法:总结1例腹茧症合并术后早期炎性肠梗阻患者的诊治经验并复习文献.结果:本患者为69岁男性,因阵发性腹痛,肛门停止排气、排便,伴呕吐1 d入院.急诊行剖腹探查术,术中及术后病理证实为腹茧症, 7 d后出现术后早期炎性肠梗阻,经保守治疗痊愈,随访3月正常.结论:腹茧症手术时广泛的粘连分离易导致术后早期炎性肠梗阻,该并发症的治疗应以保守治疗为主;传统的腹茧症手术原则应视情况灵活掌握,不必强求过分的粘连分离,以预防术后早期炎性肠梗阻的发生.