237. A Case-Control Study Investigating Household, Community, and Clinical Risk Factors Associated with Multisystem Inflammatory Syndrome in Children (MIS-C) after SARS-CoV-2 Infection

Background

Risk factors for MIS-C, a rare but serious hyperinflammatory syndrome associated with SARS-CoV-2 infection, remain unclear. We evaluated household, clinical, and environmental risk factors potentially associated with MIS-C.

Methods

This investigation included MIS-C cases hospitalized in 14 US pediatric hospitals in 2021. Outpatient controls were frequency-matched to case-patients by age group and site and had a positive SARS-CoV-2 viral test within 3 months of the admission of their matched MIS-C case (Figure 1). We conducted telephone surveys with caregivers and evaluated potential risk factors using mixed effects multivariable logistic regression, including site as a random effect. We queried regarding exposures within the month before hospitalization for MIS-C cases or the month after a positive COVID-19 test for controls. Figure.Patient enrollment timeline.

Enrollment scheme for MIS-C case-patients and SARS-CoV-2-positive outpatient controls. MIS-C case-patients were identified through hospital electronic medical records, while two outpatient controls per case were identified through registries of outpatient SARS-CoV-2 testing logs at facilities affiliated with that medical center. Caregivers of outpatient controls were interviewed at least four weeks after their positive test to ensure they did not develop MIS-C after their infection.

Results

We compared 275 MIS-C case-patients with 494 outpatient SARS-CoV-2-positive controls. Race, ethnicity and social vulnerability indices were similar. MIS-C was more likely among persons who resided in households with >1 resident per room (aOR=1.6, 95% CI: 1.1–2.2), attended a large (≥10 people) event with little to no mask-wearing (aOR=2.2, 95% CI: 1.4–3.5), used public transportation (aOR=1.6, 95% CI: 1.2–2.1), attended school >2 days per week with little to no mask wearing (aOR=2.1, 95% CI: 1.0–4.4), or had a household member test positive for COVID-19 (aOR=2.1, 95% CI: 1.3–3.3). MIS-C was less likely among children with comorbidities (aOR=0.5, 95% CI: 0.3–0.9) and in those who had >1 positive SARS-CoV-2 test at least 1 month apart (aOR=0.4, 95% CI: 0.2–0.6). MIS-C was not associated with a medical history of recurrent infections or family history of underlying rheumatologic disease.

Conclusion

Household crowding, limited masking at large indoor events or schools and use of public transportation were associated with increased likelihood of developing MIS-C after SARS-CoV-2 infection. In contrast, decreased likelihood of MIS-C was associated with having >1 SARS-CoV-2 positive test separated by at least a month. Our data suggest that additional studies are needed to determine if viral load, and/or recurrent infections in the month prior to MIS-C contribute to MIS-C risk. Medical and family history were not associated with MIS-C in our analysis.

Disclosures

Natasha B. Halasa, MD, Quidel: Grant/Research Support|Quidel: equipment donation|Sanofi: Grant/Research Support|Sanofi: HAI testing and vaccine donation Mark Hall, MD, Abbvie: Service on a Data Safety Monitoring Board|Kiadis: Licensing income unrelated to the current submission Mary A. Staat, MD, MPH, Centers for Disease Control and Prevention: Grant/Research Support|Cepheid: Grant/Research Support|National Institute of Health: Grant/Research Support|Uptodate: Royalties Pia S. Pannaraj, MD, MPH, AstraZeneca: Grant/Research Support|Pfizer: Grant/Research Support|Sanofi-Pasteur: Advisor/Consultant|Seqirus: Advisor/Consultant Charlotte V. Hobbs, MD, Biofire (Biomerieux): Advisor/Consultant.

Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020-February 2021

BACKGROUND

Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi.

METHODS

Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population.

RESULTS

Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.

CONCLUSIONS

From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.

Evaluation of inner teat morphology by using high-resolution ultrasound: Changes due to milking and establishment of measurement traits of the distal teat canal

The teat canal is important in the defense against invading pathogens, but its functional features can be impeded by the milking process. The objective of our study was to compare teat morphology before and after a standard milking procedure using high-resolution ultrasonography. Tissue changes were determined by measuring inner traits of teat morphology: teat width, teat end width, teat cistern width, diameter of the lower and upper teat wall, teat canal length, and teat canal diameter. Additionally, 3 traits describing the distal teat canal and its external orifice were established: diameter of the distal teat canal orifice, distal teat canal perimeter, and distal teat canal surface. In the first trial, we verified the repeatability of scanning over time with a mixed model. During the second trial, significant changes after milking were observed for all measured traits of teat morphology except teat end width. The traits from the distal teat canal and its orifice were remarkably changed by milking: distal teat canal orifice, +28.9%; distal teat canal perimeter, +25.0%; and distal teat canal surface, +41.5%. Comparing multiparous versus primiparous cows, higher values of teat width, teat end width, and teat canal length were observed in the older animals. Testing the effect of milk yield on teat dimensions, cows with milk yields >11.0 kg/afternoon milking were found to have larger teat widths, teat end widths, and cistern widths before attachment of the cluster. Furthermore, we observed associations of inner teat morphology toward bacterial counts in the appropriate milk. Regarding this udder health-related parameter especially, the newly established traits showed a connection. Teats in which milk showed bacterial growth had larger distal teat canal perimeters and distal teat canal surfaces. High-resolution ultrasonographic scanning of dairy teats allowed a detailed visualization of the inner morphology. The applied procedure can therefore serve as a useful tool for comparison and evaluation of different milking techniques by analyzing the resulting changes of the morphological traits. The thorough description of teat tissue can also be applied for drawing conclusions on the status of the teat canal's physical and mechanical defense function.

Pharmacokinetics of intravenous lithium chloride and assessment of agreement between two methods of lithium concentration measurement in the horse

BACKGROUND

Pharmacokinetics of lithium chloride (LiCl) administered as a bolus, once i.v. have not been determined in horses. There is no point-of-care test to measure lithium (Li⁺ ) concentrations in horses in order to monitor therapeutic levels and avoid toxicity.

OBJECTIVES

To determine the pharmacokinetics of LiCl in healthy adult horses and to compare agreement between two methods of plasma Li⁺ concentration measurement: spectrophotometric enzymatic assay (SEA) and inductively coupled plasma mass spectrometry (ICP-MS).

STUDY DESIGN

Nonrandomised, single exposure with repeated measures over time.

METHODS

Lithium chloride was administered (0.15 mmol/kg bwt) as an i.v. bolus to eight healthy adult horses. Blood samples were collected pre-administration and at multiple times until 48 h post-administration. Samples were analysed by two methods (SEA and ICP-MS) to determine plasma Li⁺ concentrations. Pharmacokinetics were determined based on the reference ICP-MS data.

RESULTS

Adverse side effects were not observed. The SEA showed linearity, R² = 0.9752; intraday coefficient of variation, 2.5%; and recovery, 96.3%. Both noncompartmental and compartmental analyses (traditional two-stage and nonlinear mixed-effects [NLME] modelling) were performed. Geometric mean values of noncompartmental parameters were plasma Li⁺ concentration at time zero, 2.19 mmol/L; terminal elimination half-life, 25.68 h; area under the plasma concentration-time curve from time zero to the limit of quantification, 550 mmol/L min; clearance, 0.273 mL/min/kg; mean residence time, 31.22 h; and volume of distribution at steady state, 511 mL/kg. Results of the traditional two-stage analysis showed good agreement with the NLME modelling approach. Bland-Altman analyses demonstrated poor agreement between the SEA and ICP-MS methods (95% limits of agreement = 0.14 ± 0.13 mmol/L).

MAIN LIMITATIONS

Clinical effects of LiCl have not been investigated.

CONCLUSIONS

The LiCl i.v. bolus displayed pharmacokinetics similar to those reported in other species. The SEA displayed acceptable precision but did not agree well with the reference method (ICP-MS). The Summary is available in Spanish - see Supporting Information.

Central venous thrombosis and perioperative vascular access in adult intestinal transplantation

BACKGROUND

Venous access is crucial in intestinal transplantation, but a thrombosed venous system may prevent the use of central veins of the upper body. The incidence of venous thrombosis and the necessity to perform alternative vascular access (AVA) in intestinal transplant recipients have not been fully investigated.

METHODS

Records of adult patients who underwent intestinal transplantation between January 1, 2001, and December 31, 2009, were reviewed. Contrast venography was performed as pre-transplantation screening. Vascular accesses at the transplantation were categorized as I (percutaneous line via the upper body veins), II (percutaneous line via the lower body veins), and III (vascular accesses secured surgically, with interventional radiology, or using non-venous sites). Categories II and III were defined as AVA. Risk factors for central venous thrombosis and those for requiring AVA were analysed, respectively.

RESULTS

Among 173 patients, central venous obstruction or stenosis (<50% of normal diameter) was found in 82% (141 patients). AVA was required in 4.6% (eight patients: four in each category II and III). Large-bore infusion lines were placed via the femoral arteries in all category III patients without complications. Existing inferior vena cava filter and hypercoagulable states were identified as the risk factors for the use of AVA, but not for central venous thrombosis. Outcomes of patients who underwent AVA were similar to those of patients without AVA.

CONCLUSIONS

The majority of adult patients undergoing intestinal transplantation had at least one central venous stenosis or obstruction. The recipient outcomes were comparable when either standard vascular access or AVA was used for transplantation.

Observation of ferromagnetic resonance in SrRuO3 by the time-resolved magneto-optical Kerr effect

We report the observation of ferromagnetic resonance (FMR) in SrRuO3 using the time-resolved magneto-optical Kerr effect. The FMR oscillations in the time-domain appear in response to a sudden, optically induced change in the direction of easy-axis anisotropy. The high FMR frequency, 250 GHz, and large Gilbert damping parameter, alpha approximately 1, are consistent with strong spin-orbit coupling. We find that the parameters associated with the magnetization dynamics, including alpha, have a nonmonotonic temperature dependence, suggestive of a link to the anomalous Hall effect.

Identification of a microsatellite on chromosome 7B showing a strong linkage with yellow pigment in durum wheat (Triticum turgidum L. var. durum)

The objective of this study is to identify QTLs linked to yellow pigment content in durum wheat. A durum-dicoccoides genetic linkage map was constructed using 124 microsatellites, 149 amplified fragment length polymorphism (AFLPs), and six seed storage proteins (SSP) in a population of 114 recombinant inbred lines (F8). The population has been obtained from a cross between a durum cultivar Omrabi5 and Triticum dicoccoides600545 and backcrossed to Omrabi5. The map consists of 14-durum chromosomes plus an unknown group; and shows a good synteny to the previously published wheat maps. Yellow pigment was measured in the population in three different locations during 3 seasons. Analysis of QTLs was based on simple and simplified composite interval mapping (SIM and sCIM). Three QTLs for yellow pigment were detected on the chromosomal group 7 (7AL and 7BL telomeres) explaining 62% of the total variation. On 7BL, a major microsatellite (Xgwm344) explained by itself 53%, whereas on 7AL, the other two QTLs have contributed 13 and 6%. All determined QTLs showed a strong genetic effect and a weak QTL x E effect. The QTLs effect was consistent across all environments and showed a large effect. Consequently, promising QTLs will be used in the marker assisted breeding program to enhance the selection efficiency for yellow pigment.

Cancer prevention in the dental practice: oral cancer screening and tobacco cessation advice

OBJECTIVES

In this paper we describe the proportion of US adults who report receiving oral cancer screening and tobacco cessation counseling and assistance from dentists and other health professionals.

METHODS

Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement, a nationally representative sample of 12,035 adults 18 years of age and older, are analyzed.

RESULTS

In 1992, less than 10 percent of adults reported oral cancer screening by a dentist or hygienist within the past three years. White adults (10.1%, 95% CI = 9.3, 10.9) reported an oral cancer screening three times more frequently than black (3.2%, 95% CI = 1.9, 4.5) or Hispanic (3.4%, 95% CI = 2.1, 4.7) adults. About half of adult current smokers had seen a dentist within 12 months, and of those only 24.1 percent (95% CI = 21.7, 26.5) had been advised to quit smoking. Heavy smokers (two or more packs a day) were more likely to have been advised to quit than light (pack or less per day) or occasional smokers. A similar proportion (24.3%, 95% CI = 17.6, 31.0) of white adult men who reported using smokeless tobacco products had been told by a dentist to quit using tobacco.

CONCLUSIONS

Results from this population-based survey indicate that cancer screening and tobacco cessation advice are underutilized in the dental practice. Increased patient awareness and implementation of screening and tobacco cessation interventions could improve oral cancer incidence and mortality and have a public health benefit for other tobacco-related morbidity and mortality as well.

The use of buck and ram extenders and two packaging systems to cryopreserve aoudad (Ammotragus lervia) spermatozoa

Because the aoudad has been hunted to near extinction, cryopreservation of their semen would be useful for DNA conservation and for the possible re-establishment of captive bred animals to their former ranges. This study was conducted to investigate the effectiveness of cryopreserving aoudad spermatozoa. Semen samples from four post-pubertal animals were collected using electro-ejaculation. Microscopic analysis was performed to assess the percentages of progressively and non-progressively motile spermatozoa as well as intact acrosomes in samples prior to freezing and post-thaw. Extended samples (0.2 mL) were frozen using 2 different extenders and packaging systems and stored in LN2 Post-thaw data were arcsine-transformed and analyzed using ANOVA, 2 x 2 factorial. Samples that were processed using the ram/straw method had a significantly higher percentage (P < 0.05) of spermatozoa with intact acrosomes than did any other system. In addition, samples that were processed with the buck/pellet system had significantly greater percentages (P < 0.05) of progressive and non-progressively motile spermatozoa than the samples processed using either extender and packaged in straws. This study illustrates that some aoudad spermatozoa may be cryopreserved using the extender/processing systems developed for the domestic buck and ram.

Validation of self-reported chronic conditions and health services in a managed care population

BACKGROUND

Self-reported data are commonly used to estimate the prevalence of health conditions and the use of preventive health services in the population, but the validity of such data is often questioned.

METHODS

The Behavioral Risk Factor Survey (BRFS) was admin istered by telephone to a stratified, random sample of health maintenanc e organization (HMO) subscribers in Colorado in 1993, and self-reports w ere compared with HMO medical records for 599 adults aged >21. Sensitivity and specificity were calculated for three chronic conditions and use of six preventive services.

RESULTS

Sensitivity was highest for hypertension (83%), moderate for diabetes (73%), and lowest for hypercholesterolemia (59%); specificity was >80% for all three conditions. Sensitivity ranged from 86% to 99% for influenza immunization, clinical breast examination, blood cholesterol screening, mammography, Pap test, and blood pressure screening; specificity was <75% for all preventive services.

CONCLUSIONS

Self-reports are reasonably accurate for certain chronic conditions and for routine screening exams and can provide a useful estimate for broad measures of population prevalence.

Concordance between results of optic disc tomography and high-pass resolution perimetry in glaucoma

PURPOSE

To evaluate concordance between results obtained with the Heidelberg Retina Tomograph (HRT) (Heidelberg Engineering GmbH, Heidelberg, Germany) and those obtained with the high-pass resolution perimeter (HRP) in glaucoma diagnosis.

METHODS

A total of 217 patients from the glaucoma services at St. Erik Eye Hospital, Stockholm, Sweden (n = 107) and Sahlgrenska University Hospital, Göteborg, Sweden (n = 110) were included in the study. All patients were examined because of known or suspected glaucoma in at least one eye. The conventional indices presented by the instruments were used, i.e., glaucoma index from the HRT (negative values = abnormal, positive = normal) and combined deviation (upper normal limit 2.1 dB) from the HRP.

RESULTS

The concordance regarding the classification of normal or glaucomatous by the two instruments was 71% (153/217 eyes). The HRT indicated glaucoma but HRP findings were normal in 47 patients, and the reverse occurred in 17 patients. There was a significant difference in optic disc area between patients with abnormal HRT findings and normal HRP findings and in patients with normal HRT findings and abnormal HRP findings. The concordance could not be improved by adjusting for disc size. The correlation between combined deviation on HRP and the HRT glaucoma index was r = -0.53.

CONCLUSION

A significant correlation was found between the combined index given by HRP and the HRT glaucoma index in 217 patients examined for known or suspected glaucoma. Discordant findings were observed in 64 patients; in 22 this discordance was explained by the influence of disc size. No other reasons for differences in examination results could be detected.

Working with glaucoma patients - prospects for "shared care"

PURPOSE

To investigate the prospects for "shared care" by evaluating to what extent ophthalmic nurses are involved in ophthalmic care decision tasks in the management of glaucoma patients, how well prepared the nurses feel they are for these tasks and their level of satisfaction in those tasks they actually are performing.

METHODS

A questionnaire was sent to the ophthalmic nurses at 13 eye clinics in Sweden. The clinics were selected to represent different parts of Sweden as well as university clinics and smaller rural clinics.

RESULTS

A difference was found between clinics regarding the number of tasks independently performed by the ophthalmic nurses and a significant correlation was found between level of participation and satisfaction (p=0.008). The nurses felt prepared for (61/62) and satisfied (58/62) when performing the glaucoma management tasks, and a high and very significant correlation (r=0.96, p= 0.0001) was found between the mean preparedness and satisfaction scores for each of the 14 tasks.

CONCLUSIONS

The findings in the study show that the ophthalmic nurses feel prepared for their tasks and regard their involvement in glaucoma care as subjectively satisfactory. These observations support the idea of "shared care" in glaucoma management.

A robust method for determining DNA binding constants using capillary zone electrophoresis

Capillary zone electrophoresis (CZE or CE) with on-line UV detection was utilized to measure the binding constants between purified calf thymus DNA and a library of designed tetrapeptides which had been constructed using unnatural amino acids with thiazole ring side chains. Mixtures containing a constant amount of a tetrapeptide, the neutral marker (mesityl oxide), and varying concentrations of DNA were prepared and equilibrated at 8 degreesC for 12 h. CE was then utilized to separate unbound tetrapeptides from the DNA-peptide complex. The UV absorbance of the peak representing unbound tetrapeptide decreased incrementally as a result of increasing the concentration of DNA in the equilibrium mixture. The absorbance of the peak corresponding to the unbound tetrapeptide was obtained directly from the electropherogram and used in the calculation of the DNA-peptide binding constants. The binding constant for each tetrapeptide to calf thymus DNA was obtained from the negative slope of a Scatchard plot and a comparison of the binding constants for different peptides showed that the tetrapeptides in the library have DNA-binding affinities ranging from 10(2) to 10(6) M-1.

Cerebrospinal fluid hydrothorax caused by transdiaphragmatic migration of a ventriculoperitoneal catheter through the foramen of Bochdalek

Cerebrospinal fluid hydrothorax is a very rare complication following ventriculoperitoneal shunting. The authors report a case of a 3-year-old girl who developed cerebrospinal fluid hydrothorax (caused by migration of the intra-abdominal catheter through the right vertebrocostal trigone of Bochdalek, the one most unlikely to be congenitally patent) and respiratory distress. The patient was successfully treated with thoracocentesis and shunt revision.

Cervical cancer incidence and screening: status report on women in the United States

PURPOSE

Population-based estimates of cervical cancer incidence and screening are described.

DESCRIPTION OF STUDY

Data from the Surveillance Epidemiology and End Results and from the 1992 National Health Interview Survey Cancer Control Supplement were used to examine differences in disease rates, stage at diagnosis, and screening practices among population groups.

RESULTS

The overall age-adjusted incidence rate for invasive cervical cancer was 8.5 per 100,000 women in 1988-1992. Rates for black women were 66% higher than those for white women. At the youngest ages, rates were similar for both races--about 2.0 per 100,000. At older ages, rates diverged, increasing to 17.2 for white women ages 60 to 64 and 47.0 for black women aged 85 and older. Most cervical cancers were diagnosed at the localized stage, and older women and minority women were more likely to be diagnosed with advanced stage disease. Almost 25% of women reported they had not had a Papanicolaou smear test within the past 3 years. Among women younger than 45, whites were more likely than blacks not to have been screened. Among black women, there were regional differences in the use of Papanicolaou test, with those who lived in the South most likely not to be screened.

CLINICAL IMPLICATIONS

Although rates for some groups appear to be converging, disparities still exist. Targeted approaches to screening, follow-up, and treatment are necessary to ensure that trends in cervical cancer incidence continue to improve.

Cancer statistics for African Americans, 1996

Although cancer remains a major public health burden for African Americans, progress is being achieved. For both genders, stomach cancer mortality and mortality related to Hodgkin's disease showed large decreases over the past 30 years. Among African-American females, large decreases in cancer mortality occurred for nonmelanoma skin cancers, rectal cancers, and cervical and other uterine cancers. Tobacco use continues to decline among African Americans and, at present, is significantly lower among African-American youths than among their white counterparts. Despite these successes, additional work remains. Increased patient education regarding self-examinations and improved access to cancer screening are necessary to reduce the high percentage of cancers diagnosed at late stages among African Americans. Improved screening ultimately would increase survival and decrease cancer mortality. Some research has suggested that the increased morbidity and mortality in African Americans are related to poverty, lower education, and inadequate access to care as opposed to inherent racial characteristics. A recent study of black-white differences according to stage at diagnosis of breast cancer confirms some of these factors but also suggests that multiple factors may explain these differences, including mammograms, having a breast examination by a physician, and a history of patient delay. Such observations point to the importance of enacting broad social policies and establishing support mechanisms to diminish the impact of cancer in the African-American community.

Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps?

Using data from the National Health Interview Survey Cancer Control Supplements, we examined the trends in mammogram and Pap smear test screening between 1987 and 1992 and the demographic characteristics associated with the use of those screening tests in 1992. In 1992, 67% of women 40 years of age and older reported ever having had a mammogram compared with 36% in 1987. A mammogram within the past year was reported by 29% of women in 1992, an increase from 14% in 1987. Among women 18 and older, 91% had ever had a Pap smear test in 1992, and 43% had one within the past year, an increase from 89% and 38%, respectively, in 1987. These changes represented significant increases in the use of both mammograms and Pap smear tests between 1987 and 1992 (P < .05). Race was not significantly associated with underutilization of mammograms, but income showed a significant relationship, with a declining likelihood of mammogram use as income decreased (odds ratio [OR] = 0.4, 95% confidence interval [CI] = 0.3, 0.6 for the income less than poverty level). Pap smear tests were less likely to be reported by older women ( > or = 65), widows, and never-married women, African-American women were more likely than Caucasian women to have had a Pap smear test, and women of other races were the least likely of any race/ethnic group to have ever had one (OR = 0.2, 95% CI = 0.1, 0.4). Women with less than 12 years of education had about a 40% decreased risk of having had a recent mammogram or Pap smear test. Women without a usual source of medical care also underutilized both screening procedures. Significant gains in the use of mammograms were found for all groups between 1987 and 1992. However, for the Pap smear test, some groups reported no differences during the five-year period. Although race and ethnic differences in the rates of screening use have been reduced somewhat, socioeconomically disadvantaged women and those with poor access to health care are still important target populations for increasing screening, particularly mammograms.

Antibody fragment separations by capillary zone electrophoresis

This study investigated methods of improving the separation and identification of an IgA antibody, McPC603, and its pepsin fragments. The problem presented by purification of antibody fragments (Fabs) and the antibody light chain required accurate and informative analysis of highly hydrophobic proteins, which can polymerize and fold to form secondary structures. Capillary zone electrophoresis (CZE) permits the separation of peptides and small proteins by a method which is orthogonal to the traditional method of reversed-phase HPLC. To facilitate planned studies of the antibody's biological activity, our buffer composition was kept as simple as possible. During CZE analysis, if the buffer pH is below the isoelectric point of the protein, or the protein is large (with a heterogeneous distribution of surface charges), it can irreversibly blind to the capillary wall unless the capillary is coated. We found that C1-coatings in RP-capillaries at pH 9.5 adequately prevented the antibody fragments from binding to the wall. However, the coating did not remain stable at such high pH, so different conditions were sought. We achieved adequate separations in several buffers at nearly physiological pH, in a bare silica capillary which had been coated once with a soluble cationic polymer coating (Micro-Coat applied during column conditioning). Antibody electropherograms changed depending on the type of inorganic buffer salt used in a separation. Phosphate binds to the antigen-binding site of the IgA with low affinity, and interesting effects were observed in separations using phosphate buffer. These effects will de discussed.

The effect of psychotropic medication on seizure duration during bilateral electroconvulsive therapy: a retrospective study

A five-year retrospective study investigating the effects of psychotropic medication on first seizure length was undertaken on 109 patients who received 131 courses of electroconvulsive therapy (ECT). Bilateral ECT was administered under methohexitone anaesthesia. Induction of a seizure was successful in 105 patients. Stepwise linear regression analysis showed that except for selective serotonin reuptake inhibitors (SSRIs) seizure length was not affected by psychotropic medication, SSRIs were associated with prolonged seizure length (p=0.0012). Less than one-third of the subjects had drugs with anticonvulsant properties omitted before treatment. Drugs with anticonvulsant properties did not shorten seizure length. Though this study suggests that SSRIs may prolong fit length, further clarification of the predictors for seizure duration is required.

Recognition and management of anxiety and depression in elderly patients

OBJECTIVE

To describe important aspects of the recognition and management of anxiety and depression in elderly patients.

DESIGN

We reviewed pertinent recent articles in the medical literature and compiled guidelines for diagnosing and treating anxiety and depression in the geriatric population.

RESULTS

Depression and anxiety are common in the elderly population. The development of depression in elderly subjects is associated with a higher risk of death from suicide than for any other age-group. Recognition of depression in elderly patients is often hampered by an inability or reluctance on the part of these patients to report depressive symptoms. In addition, anxiety and depression are often attributed to organic illness in this age-group. Pharmacotherapy is effective; however, older patients are probably more likely than young patients to experience adverse effects. Using medications at lower doses, choosing drugs with shorter half-lives, and avoiding drugs with potent anticholinergic side effects are often advisable.

CONCLUSION

Anxiety and depression are common conditions among the elderly population. Correct recognition, attention to underlying precipitating factors, and compassionate, supportive care can vastly improve the quality of the lives of these patients.

Nursing faculty practice: challenges for the future

Just as artists need to create their own art, so nursing instructors need to practise nursing. However, traditional educational settings and clinical placements limit the capacity of nursing instructors to practice nursing directly with clients. The creation of a nursing faculty practice model in Canada, whereby teaching roles and responsibilities are combined with clinical practice, is discussed within the context of a community college environment. A nurse-managed health centre is suggested as an innovative practice arena which is more in line with the changes in the health care system.

[Canine tuberculosis and its importance in public health]

The present paper describes tuberculosis in a family whose dog also presented the disease. The importance of animal epidemiological investigation in cases of tuberculosis in man is discussed.

Nicotinamide and carbogen: relationship between pO2 and radiosensitivity in three tumour lines

The effects of carbogen breathing, nicotinamide injection and their combination on tumour radiosensitivity were correlated with changes in tumour O2 tension to determine the relationship between radiosensitivity and measured pO2. The radiosensitivity (in vivo-in vitro colony assay) and O2 tension (computerized pO2 histograph KIMOC 6650) of two human xenografted tumours (HRT18 and Na11+) and one murine tumour (EMT6) were measured under similar experimental conditions. A single dose of radiation was delivered (8 Gy for HRT18 and Na11+, 12 Gy for EMT6). Carbogen breathing, nicotinamide injection, and their combination all significantly increased radiosensitivity in the three cell lines (p < 0.05); the most efficient treatment was carbogen plus nicotinamide. The radiosensitization was optimum for EMT6 and Na11+. Mean and median pO2 increased with all three treatments, except for carbogen breathing in EMT6. Carbogen breathing had little effect on the proportion of low pO2 values, but induced pO2 values > 30 mmHg in all three tumour lines. Nicotinamide decreased the proportion of low pO2 values. This effect is larger with the combination carbogen plus nicotinamide. Almost all pO2 values < 2.5 mmHg were eliminated for HRT18 and EMT6. The relationship between radiosensitization and pO2 was significant when pO2 was expressed as the percentage of values below 7, 8, 9 and 10 mmHg for the three lines.

Management of breast cancer in the elderly

The management of breast cancer in elderly women was analysed by a retrospective study of 150 women over 70 years old referred to our department between 1984 and 1988. 80 were T1-T2, 33 were T3 and 34 were T4. 107 were N0 and 43 were N1-N2. 16 women (11%) were in poor health, preventing conventional treatment. Treatment choice varied with age: 60% of the women aged 70-79 (group 1) and 23% of the oldest women (group 2) were treated conventionally. The use of surgery decreased with age and surgical procedures were conventional in only 85% of the group 1 women and in 56% of the group 2 women. Definitive radiation therapy was used more frequently in the oldest women, as was primary hormone therapy. Quality of follow-up also varied with age. Five-year survival rates were still high in both groups while relapses were frequent. Breast cancer was consequently a frequent cause of death. The increase in the proportion of elderly people with breast cancers over the next few years will require validated guidelines. Specific protocols and specific rules of management must be drawn up.

Family history, age, and risk of fatal breast cancer

A family history of breast cancer potentially identifies women at high risk for whom mammography may be especially valuable. The authors examined the association of fatal breast cancer and family history in a large, prospective study of US adults. After 6 years of follow-up, 880 cases of fatal breast cancer were observed in a cohort of 604,412 women who were cancer free at interview in 1982. Cox proportional hazards modeling found that a family history of breast cancer in a mother or sister was significantly related to fatal breast cancer risk (rate ratio = 1.59, 95% confidence interval (CI) 1.29-1.95). The association was greatly modified by age; the rate ratio was 4.91 (95% CI 1.39-17.3) in women aged < 40 years at enrollment compared with 1.28 (95% CI 0.78-2.11) in women aged > or = 70 years. Among young (aged < 50 years) women, the risk associated with a positive family history was greatest if the relative was also young at the time of diagnosis (rate ratio = 5.22, 95% CI 3.00-9.11). These associations were not altered in multivariate analyses controlling for known breast cancer risk factors. In the authors' data, family history is strongly predictive of early fatal breast cancer, particularly when the disease is diagnosed before age 50 in the relative. Women with a family history of early breast cancer should receive special instructions regarding mammography and early detection.

Demographic predictors of mammography and Pap smear screening in US women

OBJECTIVES

Proven screening technologies exist for both breast and cervical cancer, but they are underused by many women. We sought to evaluate the effect of demographic characteristics on the underuse of mammography and Pap smear screening.

METHODS

We analyzed responses from 12,252 women who participated in the 1987 National Health Interview Survey Cancer Control Supplement. Demographic profiles were produced to target severely underserved groups of women.

RESULTS

Low income was a strong predictor of mammography underuse, as was Hispanic ethnicity and other race, low educational attainment, age greater than 65, and residence in a rural area. A strong predictor of never having had a Pap smear was never having been married; however, the importance of this characteristic is difficult to interpret in the absence of data on sexual activity. Hispanic women and women of other races of all ages and all income levels underused Pap smear screening, as did older women, particularly older Black women.

CONCLUSIONS

The tendency of women to underuse screening technologies varies greatly across levels of basic demographic characteristics. The importance of these characteristics differs for mammography screening versus Pap smear screening.

Ten-year review of otitis media pathogens

Data collected from 1980 to 1989 by investigators at the Pittsburgh Otitis Media Research Center were examined to detect changes over time in the prevalence of bacteria isolated from middle ear effusions in patients with otitis media. The organisms isolated most commonly from the 7396 effusions cultured at the center were Streptococcus pneumoniae and Haemophilus influenzae. S. pneumoniae predominated in the subgroup of patients with acute otitis media, whereas H. influenzae was isolated most frequently from patients with otitis media with effusion. The most notable changes to occur during the 10-year period were a statistically significant increase in the prevalence of S. pneumoniae in patients with acute otitis media and a progressive rise in the percentage of beta-lactamase-producing strains of H. influenzae and Moraxella (Branhamella) catarrhalis. The latter finding suggests the need for therapeutic alternatives to amoxicillin, which is not active against beta-lactamase-producing organisms, when these organisms are suspected or cultured from the middle ear.

[Effect of cetylpyridinium chloride on formation and metabolism of human dental plaque]

In this work, the Cepacol (cetylpyridinium chlorid) diluted 1:2, when used for mouthwashes three time a day decreased the "in situ" formation of human dental plaque, however it didn't decreased neither the plaque fermentation, nor the IEP synthesis by the plaque. When the Cepacol was used for treating the "in vitro" dental plaque in both 1:10 and 1:20 dilutions, decreased the fermentation and the IEP synthesis of the "in vitro" plaque.

In-vivo comparison of four absorbable sutures: Vicryl, Dexon Plus, Maxon and PDS

Absorbable sutures are initially equal or superior to nonabsorbable sutures in terms of tensile strength but are absorbed at variable rates by the action of hydrolysis. This study demonstrated that the in-vivo half-life tensile strength of the braided absorbable sutures polyglycolic acid (Dexon Plus) and polyglactin 910 (Vicryl) is 2 weeks, whereas those of the monofilament absorbable sutures polyglyconate (Maxon) and polydioxanone (PDS) are 3 and 6 weeks respectively. The addition of a single hitch or six knots reduced the in-vitro tensile strength by 30% to 35%. Polyglyconate (Maxon) suture demonstrated the best in-vitro knot security.

Erectile dysfunction in men with diabetes mellitus

During a fourteen-month period, 497 men were evaluated for a primary complaint of erectile dysfunction. The initial evaluation consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, a physical examination, and serum testosterone, serum prolactin, and nocturnal penile tumescence studies. When appropriate, additional evaluations, including penile vascular studies, two-hour oral glucose tolerance tests, and psychiatric consultation were obtained. Abnormal glucose metabolism was present in 161 men (32%). Five men (1%) had insulin-dependent diabetes mellitus (IDDM), 80 men (16%) had noninsulin-dependent diabetes mellitus (NIDDM), 55 men (11.1%) had newly diagnosed noninsulin-dependent diabetes mellitus, and 21 men (4.2%) had impaired glucose tolerance tests. One hundred forty-seven of these men (91.3%) had organic pattern impotence, and 14 (8.7%) had psychogenic pattern impotence.

Wheelchair accessibility of public buildings in Utica, New York

This survey reviewed 13 public buildings for accessibility to wheelchair-bound consumers in Utica, New York. Buildings were both private and government supported. The scale used was based on the 1971 specifications of the American National Standards Institute. Buildings surveyed represented those built before and after enactment of the Architectural Barriers Act of 1968 and were subject to various regulations or no regulations concerning accessibility. Results revealed a trend of improved accessibility in both privately and publicly supported facilities, with the most accessible buildings having been built since 1980. No facility was found to be 100% in compliance with standards.

Cost-effective evaluation of impotence

Two hundred consecutive men presenting with a chief complaint of impotence have been evaluated with a protocol involving one or two outpatient visits. The initial evaluation for all patients consisted of a history taken in a conventional manner and supplemented by a patient-completed sexual function questionnaire, physical examination, serum testosterone and prolactin, and two-night nocturnal penile tumescence studies. Following the initial evaluation the patients were placed in one of three categories: (1) organic impotence, (2) functional impotence, (3) ambiguous impotence (mixed functional and organic impotence or organic impotence of undetermined etiology). Patients in the latter group underwent additional testing including penile vascular studies, two-hour oral glucose tolerance test, and psychiatric consultation. With this protocol, patients can be efficiently and effectively evaluated as outpatients with costs ranging from +250 to +450.

Psychometric differentiation of biogenic and psychogenic impotence

In a sequential clinical sample of 64 subjects exclusively diagnosed as either biogenically or functionally impotent, Minnesota Multiphasic Personality Inventory (MMPI) and California Psychological Inventory (CPI) standard scales and the Beutler, et al., MMPI signs were all found to be ineffective in reliably classifying patients into the correct diagnostic groupings. Specific item analysis of the MMPI and CPI did identify a significant number of significantly differentiating individual items. Most of these items were shown to be reliably characterizable as indicating either performance anxiety or somatic complaint. Using these classifications of the items, the performance anxiety items were shown, consistent with theory, to be clearly associated with the functional impotence group. The somatic complaint items were shown to be clearly associated with the biogenic impotence group, presumably reflecting the symptoms of physiopathology, such as diabetes, underlying the biogenic condition.

Recognition and management of depression in the elderly

Depression is probably the most common psychiatric disorder of the elderly. Societal stereotypes and atypical clinical features are contributing factors to inadequate diagnosis and treatment. Somatic complaints without an obvious mood defect and a syndrome of pseudodementia are commonly encountered. Treatment strategies rest firmly on a comprehensive evaluation that considers the biological, psychologic, and social factors involved. Psychotherapy is a valuable tool in some elderly persons. When antidepressant agents are used, it should be recognized that lower than usual dosage may be effective and that the elderly person is particularly sensitive to the autonomic side effects of these chemical agents. Electroconvulsive therapy remains a helpful and sometimes lifesaving resource when other methods have failed.

Erectile impotence--it can be highly treatable

In brief, the treatment of impotence is the treatment of the underlying cause whenever possible. When irreversible organic impotence is found, however, penile prosthesis should be considered. Both hydraulic inflatable and semirigid rod types are available. Morbidity with the procedure is relatively low in experienced hands and patient satisfaction has been reported as quite high. Pharmacogenic impotence may require a change or reduction of medication. Depression usually responds to some combination of antidepressants, psychotherapy, or electroconvulsive therapy, while modern short-term sex therapy has proved effective in reversing many of the anxiety-related cases. Deep-seated, anxiety-based impotence may require extensive psychotherapy, but many cases of recent-onset psychogenic impotence can be managed quite successfully with education, reassurance, and the optional short-term use of testosterone.

Diagnostic evaluation, classification, and treatment of men with sexual dysfunction

During a two-year period, 165 men were evaluated for sexual dysfunction. Most evaluations were conducted on an outpatient basis and required two separate visits. Fifty-one per cent, 47 per cent, and 2 per cent of the patients were found to have functional disorders, organic disorders, and incomplete evaluations, respectively. Treatment recommendations were tailored to each patient using information gathered during the diagnostic evaluation.

Cerumen types in Choctaw Indians

Certinen from 432 Choctaw Indians from Mississippi was classified as sticky or dry. The frequency of the autosomal recessive dry type was intermediate between that for Indians of western North America and that for Mayan groups of southern Mexico.