Trial of an attenuated bovine rotavirus vaccine (RIT 4237) in Gambian infants

A randomised, controlled trial of bovine rotavirus vaccine was undertaken in Gambian infants. Three doses were administered, from the age of ten weeks, concurrently with oral or killed polio vaccine. Prevaccination rotavirus neutralising antibody levels were high. 84/185 infants (45%) showed an increase in neutralising antibody titre after receiving rotavirus vaccine, compared with 20/91 (22%) unvaccinated infants. Clinical rotavirus infection was detected in 24/78 (31%) children in the rotavirus/oral polio group, 34/83 (41%) children in the placebo/oral polio group, and 23/92 (25%) children in the rotavirus/killed polio group, giving an overall vaccine efficacy of 33% (95% CI 4-53%). RIT 4237 did not appear to reduce the severity of clinical infections. Most cases (92%) were caused by rotaviruses with short RNA electropherotypes. Serological responses to rotavirus vaccination appeared unaffected by the concurrent administration of oral polio vaccine. Lower types 1 and 3 polio antibody levels were found in children who received oral polio and rotavirus vaccines but the differences were not statistically significant.

Deaths in infancy and early childhood in a well-vaccinated, rural, West African population

A survey of deaths in children under the age of 7 years was made over a 1-year period in a rural area of The Gambia with few facilities for curative medicine but with a good record of infant immunizations. One hundred and eighty-four deaths were investigated. Only 12% of deaths occurred in a hospital or health centre but an attempt was made to establish a cause of death by interviewing the family of each dead child and by examining any health records that were available. The infant mortality rate was 142 per 1000 live births and the child mortality rate (death in children aged 1-4 years) 43 per 1000 per year. Acute respiratory infections, malaria and chronic diarrhoea with marasmus were the most frequent causes of death after the 1st month of life. Few children died of diseases that could have been prevented by routine immunizations. An effective immunization programme has probably had some effect on deaths in infancy and early childhood but it will be necessary to find ways of preventing deaths from malaria, acute respiratory infections and chronic diarrhoea/marasmus at the primary health care level if infant and childhood mortality are to be reduced further in rural areas of The Gambia.

Mortality and morbidity from malaria among children in a rural area of The Gambia, West Africa

Mortality and morbidity from malaria were measured among 3000 children under the age of 7 years in a rural area of The Gambia, West Africa. Using a post-mortem questionnaire technique, malaria was identified as the probable cause of 4% of infant deaths and of 25% of deaths in children aged 1 to 4 years. The malaria mortality rate was 6.3 per 1000 per year in infants and 10.7 per 1000 per year in children aged 1 to 4 years. Morbidity surveys suggested that children under the age of 7 years experienced about one clinical episode of malaria per year. Calculation of attributable fractions showed that malaria may be responsible for about 40% of episodes of fever in children. Although the overall level of parasitaemia showed little seasonal variation, the clinical impact of malaria was highly seasonal; all malaria deaths and a high proportion of febrile episodes were recorded during a limited period at the end of the rainy season.

Amino acid sequence of the sex steroid binding protein of human blood plasma

The amino acid sequence of the sex steroid binding protein (SBP) from human plasma has been determined. The SBP subunit consists of a 373-residue polypeptide chain containing two disulfide bonds and three oligosaccharide chains. The sequence was solved primarily by analysis of peptides derived by cleavage at either lysyl or methionyl residues. In our preparations, approximately half of the protein molecules have the amino-terminal sequence Arg-Pro-Val-Leu-Pro; the other half lack Arg-Pro and begin with the valine. Preparations of Hammond et al. [Hammond, G. L., Robinson, P. A., Sugino, H., Ward, D. N., & Finne, J. (1986) J. Steroid Biochem. 24, 815] have an additional leucine at the amino terminus, making a total of 373 residues in the chain. Oligosaccharide chains are placed at Thr-7 and at Asn residues 351 and 367. The two disulfide bonds connect Cys-164 to Cys-188 and Cys-333 to Cys-361. The reported heterogeneity of preparations of the molecule may result in part from the amino-terminal microheterogeneity, in part from variations in the oligosaccharide moieties, and possibly in part from rearrangements involving cyclic imide formation in two Asn-Gly sequences. Certain hydrophobic segments are suggested as possible components of the steroid-binding sites. The protein shows no homology either with the cDNA-derived sequences of the estrogen and glucocorticoid receptors found by others to be homologous with each other or with any other protein sequence in the 1986 data base.

Bed-nets (mosquito-nets) and morbidity from malaria

A study was undertaken in the Farafenni area of The Gambia to determine the relation between morbidity from malaria in children and the use of bed-nets (mosquito-nets). From comparisons of parasite and spleen rates in bed-net users and in non-users it seemed that bed-nets had a strong protective effect. However, the prevalence of malaria in the study population was also influenced by ethnic group and place of residence, and the association of bed-net use with these two confounding factors accounted for some of the differences observed between bed-net users and non-users. Nevertheless, a significant inverse correlation between splenomegaly and the use of bed-nets remained. This suggests that bed-nets give Gambian children some protection against malaria and that the use of bed-nets, either untreated or treated with an insecticide such as permethrin, should be investigated further as a means of malaria control in Africa.

Molecular organization of the sex steroid-binding protein (SBP) of human plasma

Several years ago this laboratory presented evidence that SBP is a dimer composed of two subunits having similar molecular weights. The question of whether or not these subunits are identical and therefore products of a single gene remained unanswered. We now report that the two polypeptide chains are identical and that SBP is a homodimer. The experimental approach was to reduce and [14C]alkylate cystine residues in human SBP, digest the product with trypsin or cyanogen bromide and determine the number of unique amino acid sequences around each [14C]carboxymethylcysteine residue. Only four unique sequences were found when all the radioactive peptides were analyzed. Since there are eight half-cystine residues per dimer, the results support a homodimeric structure.

Partner support and the use of coping techniques in labour

This study examined the relationship between partner support, use of pain control techniques and epidural anaesthesia in 80 primiparous women. It was found that the use of psychological 'pain control' techniques did not reduce the intensity of labour pain, nor did their use enable women to do without an epidural anaesthesic. However, the use of techniques did correlate with reduced frequency of anaesthesia when women were consistently supported and encouraged throughout labour, and when the labour was relatively short.

Human vascular smooth muscle responses mediated by alpha 2 mechanisms in vivo and in vitro

The effects of compounds with alpha 2-agonist and alpha 2-antagonist properties on human forearm blood flow and on isolated human arterial segments have been studied. The findings from these studies in vivo and in vitro did not provide evidence in support of the hypothesis that postsynaptic alpha 2-receptors mediate smooth muscle contraction in the tissues under investigation. The constriction of the forearm vascular bed in response to low intra-arterial doses of idazoxan (RX 781094), an alpha 2-antagonist, provides evidence for a physiological role for a presynaptic alpha 2 autoregulatory mechanism. The variability of the forearm vascular responses to higher doses of idazoxan highlights the pitfalls that may have misled previous authors in their interpretation of the results of similar studies. A U-shaped dose-response curve to compounds with mixed alpha 2- and alpha 1-antagonist properties may be constructed, which emphasizes the importance of the dose-dependent selectivity of these antagonists at alpha 2- and alpha 1-receptors. The effect of idazoxan on the responses of arterial segments in vitro to exogenous catecholamines was dependent on the integrity of the endothelium, and provides evidence that alpha 2-receptors may mediate release of the endothelium-derived relaxing factor.

Course-related depressive syndromes in schizophrenia

The authors evaluated 20 patients, diagnosed by Research Diagnostic Criteria after 1 week of hospitalization as having schizophrenia, weekly throughout their hospitalization. Four patients developed syndromes of depression after resolution of their psychoses: three manifesting a "minor" and one a "major" postpsychotic depressive syndrome. Four other patients went on to develop syndromes equivalent to major depression at a time when they were still actively psychotic, and their cross-sectional diagnoses were therefore changed to schizoaffective disorder, depressed type. The authors discuss the implications of these findings for diagnosis.

Medroxyprogesterone acetate and homozygous sickle-cell disease

The haematological and clinical effects of medroxyprogesterone acetate in homozygous sickle-cell (SS) disease were assessed in a 2-year controlled crossover trial completed by 23 patients. Haematological indices remained steady during the placebo phase, but during the medroxyprogesterone-acetate phase fetal haemoglobin, total haemoglobin, red-cell mass, and red-cell survival rose significantly, and reticulocytes, irreversibly-sickled-cell counts, and total bilirubin fell significantly. Painful crises were significantly less frequent during the medroxyprogesterone-acetate than the placebo phase. These results are compatible with an inhibition of in-vivo sickling in patients with SS disease during medroxyprogesterone-acetate treatment. The mechanisms of such an effect require further study.

Third-party consent to medical procedures

The issue of consent to medical procedures is a particularly complex one when the patient is incapable of giving valid consent (because of age, mental disability, or physical state). A medical practitioner who proceeds with treatment without valid consent may be liable to legal action or disciplinary proceedings. Third-party consent can be given by parents legally appointed guardians. Consent is not required if emergency treatment is necessary to preserve the life of the patient. It is extremely doubtful whether valid third-party consent can be given for procedures which are not essential for the preservation of life or health.

The influence of drugs on the overflow of noradrenaline and the identification of receptors in guinea-pig atria

1 Salbutamol (1.0 microM) and isoprenaline (1.2 nM) significantly increased the fractional release of tritiated noradrenaline from driven left atria but phentolamine (10 microM) failed to do so. Butoxamine (4.0 microM) blocked the increase in overflow produced by isoprenaline. Isoprenaline (1.2 nM), phentolamine (10.0 microM) and salbutamol (1.0 microM) failed to increase the overflow of tritiated noradrenaline from spontaneously beating atria. 2 Spontaneously beating atria were therefore used to identify the receptors mediating chronotropism and inotropism. 3 There was no clear relationship between inotropism and chronotropism. 4 The inotropic effects of both dobutamine (0.04-4.0 microM) and isoprenaline (0.11-9.0 nM) were inhibited by practolol (4.0 microM) and by butoxamine (4.0 microM). The chronotropic effects were inhibited only by practolol (4.0 microM). 5 Both inotropic and chronotropic effects of noradrenaline (3.0-200 nM) were antagonized by practolol (4.0 microM), but not by butoxamine (4.0 microM). Thus both functions appeared to be mediated by beta 1-adrenoceptors when noradrenaline was the agonist. 6 Inotropic responses to salbutamol (0.45-7.5 microM) were inhibited by both practolol (4.0 microM) and by butoxamine (4.0 microM), but chronotropic responses were antagonized only by butoxamine (4.0 microM), Thus salbutamol acts on both beta 1-and beta 2-adrenoceptors to produce an inotropic response but only on beta 2-adrenoceptors to produce its chronotropic response. 7 It is concluded that both beta 1- and beta 2-adrenoceptors can mediate chronotropism and inotropism in guinea-pig isolated atria. Determination of the postsynaptic effects of drugs should be carried out on spontaneously beating rather than driven atria to obviate modification of the responses by noradrenaline release from sympathetic neurons.

A survey of leptospirosis in febrile patients mainly from hospitals and clinics in Trinidad

Acute and convalescent sera were obtained from 202 febrile patients, most of whom were admitted to or attended hospitals or clinics in northern Trinidad during the 12 months from mid-February 1977 to mid-February 1978. Laboratory tests confirmed that 10 of the patients were suffering from current leptospirosis while another 54 had serological evidence of previous leptospiral infections. Antibodies to strains of the Icterohaemorrhagiae serogroup were most commonly found, followed by those to the Hebdomadis and Autumnalis serogroups. Isolates were obtained from the blood of two and the urine of three of the 10 current cases. Four of these strains were identified as belonging to copenhageni serovar of the Icterohaemorrhagiae serogroup and one to serovar brasiliensis of the Bataviae serogroup. Seven of the patients suffering from leptospirosis were males, all rural dwellers, and all except one under 20 years of age. Two of the three female patients were over 60 years old and were urban dwellers. It was not possible to identify the sources of infection with certainty, although dogs may have been responsible for three of the Icterohaemorrhagiae and one of the Canicola infections. Of the 192 patients who were not currently infected, serological evidence of previous infection was obtained in 31 (40%) males and 23 (21%) females and was most common among farmers and rural workers.

Kinetics and time dependence of the effect of far red light on the photoperiodic induction of flowering in wintex barley

Flowering in the long day plant Hordeum vulgare L. var. Wintex barley was enhanced by the addition of far red light to the main light portion of the photoperiod. Far red energy was provided to produce quantum flux ratios (660/730 nm) and phytochrome photoequilibria (Pfr/total phytochrome) equivalent to those reported both beneath a leaf canopy and outside a canopy at twilight. The photoperiodic requirement for long days can be completely eliminated by the addition of far red light. However, both the effect of extending the photoperiod without far red and the addition of far red to 12-hour photoperiods were suboptimal. Maximal stimulation was achieved only when far red was added to continuous light. The duration of the period of maximal apex elongation rate, as well as the reduction of the time required for floral initiation, were saturated by three inductive cycles. When far red energy was provided intermittently during 3 days of continuous light, the ability to respond varied in a circadian manner. This enhancement of flowering by far red appears to be mediated by the "high irradiance response" of phytochrome.

Control factors in the release of gastrin by direct electrical stimulation of the vagus

The release of gastrin by direct electrical stimulation of the vagus was studied together with the relative effects on the response of antral and duodenal acidification. As expected, gastrin levels increased to three times the normal simulated response following antral neutralization. In contrast, duodenal acidification failed to influence the vagal release of gastrin when the antrum was neutralized although it had a minor effect when the antrum was acidified. Thus the antral pH dominates over duodenal pH as a factor in controlling gastrin release. Surprisingly, atropine in doses which blocked acid release and produced marked cardiac effects failed to inhibit the release of gastrin from the antrum on vagal stimulation. This suggests that, using this model, vagal release of gastrin, if cholinergic, is highly resistant to atropine.