Showing papers by "Saint Francis University published in 1999"

Prevalence and mother-to-infant transmission of hepatitis viruses B, C, and E in Southern Tanzania.

Abstract: Hepatitis B and C markers were tested in 980 pregnant women, in the infants born to infected mothers, and in a random sample of 42 and 50, respectively, children born to uninfected mothers in Tanzania. Sixty-two women (6.3%) were positive for HBsAg and 15 (24%) were HBeAg-seropositive. Anti-HCV was detected in 49 women (5%), 15 (31%) of whom had detectable viremia. HCV RNA serum levels were low and only genotype 4 was identified. Sixty-six women (6.7%) were positive for anti-HIV, six of whom were coinfected with HBV and one with HCV. Anti-HEV was negative in the 180 women tested. At 8 months of age, HBsAg was detected in 8% and 2% of children born to HBV-infected and noninfected mothers, respectively (P = 0.2). Corresponding figures at 18 months of age were 31% and 21% (P = 0.3). When tested at 2 months of age, HCV RNA was not detected in any of the 43 children born to anti-HCV-positive mothers nor in any of 50 children born to anti-HCV-negative mothers. At 18 months, only one child, born to an anti-HCV-positive mother, had detectable HCV RNA. None of the infants born to women with HIV coinfection were infected with hepatitis viruses. This study suggests that exposure to HEV does not occur in southern Tanzania. The prevalence of current HBV infection in pregnant women from rural Tanzania is lower than in other sub-Saharan areas. In early childhood, HBV infection appears to occur by horizontal rather than maternofilial mechanisms of transmission. The prevalence of HCV infection is similar to that in other African countries. The results of this study show for the first time in Africa that mother-to-infant transmission does not play a significant role in the acquisition of HCV infection.

Causes and complications associated with swallowing disorders in traumatic brain injury.

Abstract: A major complication commonly seen in persons with severe brain injury is swallowing dysfunction. The neuropathology leading to impaired swallowing is discussed. In addition, Other risk factors associated with dysfunctional swallowing, such as tracheostomy and the need for prolonged ventilatory support, are discussed. Within the intensive care environment, the consequences of impaired swallowing leading to aspiration-a major cause of pneumonia-are discussed.

Evaluation of the SPf66 vaccine for malaria control when delivered through the EPI scheme in Tanzania.

Abstract: Summarybackground Malaria control programmes need to protect young children, who bear the brunt of malaria disease and death in Africa. The development of a vaccine is a priority if improved and sustained malaria control is to be achieved. The best use of a vaccine in Africa will be achieved if it can be delivered through the expanded programme of immunization (EPI). We conducted a trial designed to evaluate the efficacy of SPf66 vaccine for malaria control when delivered through the EPI scheme in Tanzania. methods The study was a two-arm, double blind, individually randomized placebo controlled trial involving 1207 infants. The primary objective of the trial was to estimate the efficacy of three doses of SPf66 given at 1, 2 and 7 months of age in preventing clinical episodes of malaria. These were documented through a health facility-based passive case detection system. results Among 1207 randomized children, overall compliance for third dose was 91%. SPf66 was safe, immunogenic and did not interfere with the humoral immune responses to EPI vaccines. There were 294 children among SPf66 recipients and 288 among placebo recipients with at least one malaria episode, yielding a vaccine efficacy estimate of 2% (95% CI: −16, 16; P = 0.84). conclusion This has been the first trial of a malaria vaccine among very young infants. It provides information on the safety of peptide vaccines administered at this early age as well as their capacity to induce immune responses without negatively interacting with EPI vaccines. Given the modest protection previously documented in older age groups and the lack of efficacy in younger infants, this vaccine in its current alum-based formulation does not appear to have a role in malaria control in sub-Saharan Africa. The lack of efficacy found in this trial also raises concerns about potential difficulties of inducing protective immune responses against malaria through immunization in infants.

Factors affecting oral feeding with severe traumatic brain injury.

Abstract: Safe and adequate nutrition, vital to the recovery from a traumatic brain injury, can be severely compromised by the presence of dysphagia. This study identified injury severity and swallowing factors that were associated with impaired oral intake in patients with severe brain injury. An admitting G

The metabolic response to acute traumatic brain injury and implications for nutritional support.

Abstract: An overview of the metabolic response to acute traumatic brain injury is presented. The consequences of hypermetabolism, hypercatabolism, and an altered immune function are discussed. Once a person with acute traumatic brain injury develops this hyperdynamic state, the resultant excessive protein breakdown ensues. This can lead to malnutrition. The feeding methods used to prevent malnutrition are discussed, along with the proper alimentation to provide to diminish the hyperdynamic state and improve immune function.

Triiodothyronine induces collagenase-3 and gelatinase B expression in murine osteoblasts.

Abstract: Triiodothyronine (T3) increases bone resorption, but its effects on matrix metalloprotease (MMP) expression in bone are unknown. We tested the effects of T3 on collagenase-3 and gelatinase A and B expression in MC3T3 osteoblastic cells. T3 at 1 nM to 1 microM for 24-72 h increased collagenase-3 and gelatinase B mRNA levels, but it did not increase gelatinase A transcripts. In addition, T3 increased immunoreactive collagenase and gelatinase activity. Cycloheximide prevented the stimulatory effect of T3 on collagenase-3 but not on gelatinase B transcripts. Indomethacin did not prevent the effect of T3 on either MMP. T3 did not alter the decay of collagenase-3 or gelatinase B mRNA in transcriptionally arrested MC3T3 cells, and it increased the rate of collagenase-3 and gelatinase B gene transcription. Although T3 enhanced the expression of the tissue inhibitor of metalloproteinase-1 in MC3T3 cells, it increased collagen degradation in cultured intact rat calvariae. In conclusion, T3 increases collagenase-3 and gelatinase B synthesis in osteoblasts by transcriptional mechanisms. This effect may contribute to the actions of T3 on bone matrix remodeling.

A Comparison of the Mogen and Gomco Clamps in Combination With Dorsal Penile Nerve Block in Minimizing the Pain of Neonatal Circumcision

Abstract: Objectives. 1) To compare the Mogen and Gomco clamps with regard to pain experienced during neonatal circumcision, and 2) to assess neonatal circumcision pain with and without dorsal penile nerve block (DPNB). Design/Methods. A randomized, controlled, nonblinded clinical trial; 48 healthy, full-term infants were randomized into one of the following four groups: Gomco vs Mogen with (+) or without (−) DPNB. DPNB+ infants were injected with 0.8 mL of 1% lidocaine before circumcision. DPNB− infants received no placebo injection. Heart rate, respiratory rate, and oxygen saturation (Sao 2 ) during the procedure were monitored and data transferred to computer files by using the Datalab software system. Crying was recorded on videotape. Pre- and postcircumcision saliva samples for cortisol analysis were collected. Heart rate, respiratory rate, Sao 2 , cortisol changes, and duration of crying were evaluated statistically with two-way analyses of variance and t tests. Results. The type of clamp but not the use of anesthesia was significantly associated with the length of the procedure (mean Mogen time, 81 seconds; mean Gomco time, 209 seconds) and percentage of respiratory rate change. The use of anesthesia but not the type of clamp was significantly associated with percentage of crying time and percentage of Sao 2 change during the procedure. Heart rate changes and total crying time were significantly associated with both the type of clamp and the use of anesthesia. Neither clamp type nor anesthesia status was significantly associated with salivary cortisol changes, although the mean increase for the DPNB− group was approximately twice that for the DPNB+ group. Fifty-six percent of infants circumcised with the Mogen clamp and DPNB did not cry at all during the procedure. Conclusions. DPNB is effective in reducing neonatal circumcision pain with either the Mogen or the Gomco clamp. For a given anesthesia condition, the Mogen clamp is associated with a less painful procedure than the Gomco. The Mogen clamp with DPNB causes the least discomfort during neonatal circumcision.

Fibroblast growth factor-2 induces hepatocyte growth factor/scatter factor expression in osteoblasts.

Abstract: Hepatocyte growth factor/scatter factor (HGF/SF) is a multifunctional growth factor with a major role in tissue morphogenesis and repair. It stimulates the proliferation of cells of the osteoblast and osteoclast lineages. Mitogenic factors playing a role in fracture repair may act by regulating HGF/SF expression or activity in bone-forming cells. We investigated the effect of fibroblast growth factor-2 (FGF-2) on the expression of HGF/SF and its receptor, encoded by c-met, in the MC3T3-E1 osteoblastic cell line. MC3T3-E1 cells expressed low levels of HGF/SF messenger RNA (mRNA), which were markedly increased by FGF-2 in a dose- and time-dependent manner. FGF-2 also induced HGF/SF polypeptide synthesis. The stimulation of HGF/SF mRNA expression by FGF-2 was blocked by cycloheximide, a protein synthesis inhibitor, but not by DNA or prostaglandin synthesis inhibitors. FGF-2 increased the rate of HGF/SF gene transcription by approximately 2-fold, as determined by nuclear run-on assays, and did not modify the ...

Cortisol enhances the expression of mac25/insulin-like growth factor-binding protein-related protein-1 in cultured osteoblasts.

Abstract: Glucocorticoids inhibit the synthesis of insulin-like growth factor I (IGF-I) and regulate the expression of IGF-binding proteins (IGFBPs) in osteoblast cultures. IGFBP-related protein-1 (IGFBP-rP1), the product of the mac25 gene, binds IGF-I, IGF-II, and insulin, and we postulated that glucocorticoids regulate IGFBP-rP1 synthesis in osteoblasts. We tested the expression of mac25/IGFBP-rP1 in cultures of osteoblast-enriched cells from 22-day-old fetal rat calvariae (Ob cells). Cortisol treatment at 10 nM to 1 microM for 24-48 h caused a time- and dose-dependent increase in mac25/IGFBP-rP1 messenger RNA (mRNA) levels in Ob cells. Cycloheximide at 3.6 microM did not alter mac25/IGFBP-rP1 transcripts in control or cortisol-treated cells. Cortisol did not modify the decay of mac25/IGFBP-rP1 mRNA in transcriptionally arrested Ob cells and increased the rate of IGFBP-rP1 transcription as determined by nuclear run-on assays. Retinoic acid also increased mac25/IGFBP-rP1 mRNA levels, but 17beta-estradiol, testosterone, 5alpha-dihydrotestosterone, progesterone, and 1,25-dihydroxyvitamin D3 did not. In conclusion, cortisol stimulates mac25/IGFBP-rP1 expression in Ob cells by transcriptional mechanisms. As IGFBP-rP1 binds and possibly modifies the effects of IGFs and insulin, its increased expression could be relevant to the inhibitory actions of cortisol in bone.

Cross-Cultural Perspectives on the Common Cold: Data from Five Populations

Abstract: This paper focuses on conceptualizations of the common cold among Latin Americans, as compared with middle-class Americans. Four geographically dispersed groups of Latin Americans were chosen for study: Guatemalans in Guatemala; Mexicans in Guadalajara, Mexico; persons of Mexican descent in Edinburg, Texas (on the Texas-Mexican border); and Puerto Ricans in Hartford, Connecticut. In addition, a comparison group of middle-income Americans living in Tampa, Florida, was also studied to see the extent to which folk concepts were seen in what is considered to be a "mainstream" population. The data suggest a great deal of both intra- and intercultural agreement as to causes, symptoms, and treatments of the common cold. The cold seems to be viewed as very much in the realm of a biomedical illness, with the exception of ascribing the hot/cold system of causality to the common cold, among all five populations. Finally, the cold is clearly differentiated from "the flu," which seems to exist as an illness only among...

Leukemia inhibitory factor and oncostatin M stimulate collagenase-3 expression in osteoblasts

Abstract: Leukemia inhibitory factor (LIF) and oncostatin M (OSM) have multiple effects on skeletal remodeling. Although these cytokines modestly regulate collagen synthesis in osteoblasts, their effects on collagenase expression and collagen degradation are not known. We tested whether LIF and OSM regulate the expression of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) in osteoblast-enriched cells isolated from fetal rat calvariae. LIF and OSM increased collagenase-3 (MMP-13) mRNA and immunoreactive protein levels in a time- and dose-dependent manner. LIF and OSM enhanced the rate of transcription of the collagenase gene and stabilized collagenase mRNA in transcriptionally arrested cells. LIF and OSM failed to regulate the expression of gelatinase A (MMP-2) and B (MMP-9). LIF and OSM modestly stimulated the expression of TIMP-1 but did not alter the expression of TIMP-2 and -3. In conclusion, LIF and OSM stimulate collagenase-3 and TIMP-1 expression in osteoblasts, and these effects may be involved in mediating the bone remodeling actions of these cytokines.

Proximal biceps tendon rupture: primarily an injury of middle age.

Abstract: A 51-year-old man suffered a rupture of the long-head tendon of the left biceps and a small rotator cuff tear while rock climbing. The typical signs and symptoms of a ruptured long-head biceps tendon include anterior shoulder pain, tenderness in the bicipital groove, and unusual bulging of the injured biceps. The history and physical exam are generally sufficient to make the diagnosis, but x-rays and MRI may be helpful to rule out related disorders. Because the injury is often associated with rotator cuff tendinitis, a complete shoulder exam is necessary. Conservative treatment will enable most patients to regain normal strength.

Parathyroid hormone increases mac25/insulin-like growth factor-binding protein-related protein-1 expression in cultured osteoblasts.

Abstract: PTH induces the synthesis of insulin-like growth factor I (IGF-I) and regulates the expression of IGF-binding proteins (IGFBP) in osteoblast cultures. IGFBP-related protein-1 (IGFBP-RP-1), the product of the mac25 gene, binds IGF-I, IGF-II, and insulin. We tested the actions of PTH on the expression of mac25/IGFBP-RP-1 in cultures of osteoblast-enriched cells from 22-day-old fetal rat calvariae (Ob cells). PTH at 0.1-10 nM for 6-48 h increased mac25/IGFBP-RP-1 messenger RNA (mRNA) levels in Ob cells, an effect not altered by cycloheximide. PGE2 increased mac25/IGFBP-RP-1 mRNA levels, but indomethacin did not modify basal or PTH-stimulated mac25/IGFBP-RP-1 expression. The decay of mac25/IGFBP-RP-1 mRNA in transcriptionally arrested Ob cells was not modified by PTH, and PTH increased the rate of IGFBP-RP-1 transcription. GH, insulin, bone morphogenetic protein-2, fibroblast growth factor-2, platelet-derived growth factor BB, IGF-I, and IGF-II did not modify mac25/IGFBP-RP-1 expression, whereas transforming growth factor-beta1 was modestly stimulatory. In conclusion, PTH stimulates mac25/IGFBP-RP-1 transcription in osteoblasts, an effect that could be relevant to the actions of PTH in bone.

Familial patent ductus arteriosus and bicuspid aortic valve with hand anomalies: a novel heart-hand syndrome.

Abstract: The association between cardiac and limb defects, particularly those affecting the hand, has been well documented by the delineation of several heart-hand syndromes. Based on observations with a three-generation family with seven affected individuals, we describe a novel heart-hand syndrome comprising patent ductus arteriosus, bicuspid aortic valve, 5th metacarpal hypoplasia, and brachydactyly. The inheritance pattern was consistent with autosomal dominance, although X-linked dominance could not be excluded. Penetrance appeared to be complete, but there was variability of the cardiac and hand phenotypes. Because this new syndrome closely resembled Char syndrome (patent ductus arteriosus, 5th finger middle phalangeal hypoplasia, and minor facial anomalies), multipoint linkage analysis was performed using polymorphic DNA markers spanning the recently identified Char syndrome critical region at chromosomal bands 6p12-p21.1. This analysis formally excluded this 3-cM region, documenting that the two traits are not allelic. In sum, a novel heart-hand syndrome involving left ventricular outflow and aortic arch as well as an ulnar ray derivative has been identified. Because the hand anomalies can be subtle, thorough evaluation is suggested for families inheriting these cardiac defects as a mendelian trait.

Skeletal bone morphogenetic proteins suppress the expression of collagenase-3 by rat osteoblasts.

Abstract: Bone morphogenetic proteins (BMPs) are secreted by skeletal cells, induce the differentiation of mesenchymal cells into cells of the osteoblastic lineage, and increase their differentiated function. BMPs also decrease collagenase-3 expression by the osteoblast. We tested the autocrine role of BMPs on collagenase-3 expression in osteoblast-enriched cells from fetal rat calvariae (Ob cells) by examining the effects of noggin, a specific inhibitor of BMP binding and function. Although collagenase-3 transcript expression declined in untreated Ob cells in culture over a 24-h period, BMP-2, -4, and -6 decreased collagenase-3 messenger RNA levels in cells treated for 2-24 h. The addition of noggin prevented the decrease of collagenase-3 transcripts in control cultures, opposed the inhibitory actions of BMP-2, and increased the levels of the protease in the culture medium. Noggin did not alter the decay of collagenase-3 messenger RNA in transcriptionally arrested cells, and it increased the levels of collagenase-3 heterogeneous nuclear RNA in Ob cells. In conclusion, noggin enhances the synthesis of collagenase-3 in osteoblasts, supporting the notion that BMPs act as autocrine suppressors of collagenase-3 in skeletal cells, an effect that may contribute to the maintenance of the bone matrix.

Molecular evidence of mother-to-infant transmission of hepatitis G virus among women without known risk factors for parenteral infections.

Abstract: Hepatitis G virus (HGV) RNA was detected in 18 of 133 pregnant women from Tanzania without known risk factors for HGV infection and in 7 of 18 children born to HGV RNA-positive mothers. Molecular evidence of mother-to-infant transmission was obtained only for three of seven children. HGV RNA was also detected in 4 of 42 children born to non-HGV-infected women. Thus, mechanisms other than materno-filial may play an important role in HGV transmission during early childhood.

Episodic spontaneous hyperhidrosis hypothermia in human immunodeficiency virus-positive patients.

Abstract: Episodic spontaneous hyperhidrosis hypothermia (ESHH) was described in 1969 in association with agenesis of the corpus callosum (Shapiro’s syndrome) [1, 2]. It has been observed in patients with CNS abnormalities affecting structures involved with thermoregulation [3, 4] and in those without evidence of CNS pathology [5]. Different medications (e.g., clonidine [6] and cyproheptadine [7]) have been used, with varying success, to decrease symptoms. We describe two patients with HIV infection who presented with symptoms and signs suggestive of ESHH. A 48-year-old male with HIV infection, secondary syphilis, and a CD4 cell count of 624/mL presented with complaints of recurrent episodes of profuse sweating that started several weeks earlier. These episodes were occurring about once every other day. He denied any history of head trauma, impotence, or postural syncope. During physical examination, he was sweating profusely, and his temperature was 94.5°F. He had a normal blood pressure and pulse without orthostasis. Despite hypothermia, he felt hot and was not shivering. His medication included doxycycline, itraconazole, zidovudine, and prednisone. His complete blood cell count was normal. Blood, urine, and pharyngeal cultures (routine and for mycobacteria) were negative. A chest radiograph and brain MRI showed no abnormalities. Therapy with oral clonidine (up to 0.2 mg t.i.d.) was started. This treatment resulted in reduction in the severity and frequency of attacks within 4 weeks. He became noncompliant with treatment; soon after, his symptoms intensified, requiring resumption of the medication with subsequent reduction in attacks. A 48-year-old male with HIV infection, HIV dementia, candidal esophagitis, and CD4 cell counts of ,10/mL was seen in the clinic for recurrent episodes of profuse sweating. During physical examination, his vital signs were as follows: temperature, 95.4°F; pulse rate, 87; and blood pressure, 133/88 mm Hg (without orthostasis). He was in no distress and was not shivering but was perspiring profusely. A chest radiograph was unchanged from prior films. His medications included zidovudine, lamivudine, indinavir, acyclovir, trimethoprim-sulfamethoxazole, omeprazole, and prednisone. No electrolyte abnormalities were found, and his complete blood cell count was normal. A recent CT scan of the head showed only lacunar infarcts within the anterior rim of the right internal capsule. Therapy with oral clonidine (up to 0.6 mg daily) was started. Although he was not completely asymptomatic, he reported less frequent and less severe bouts of sweating and chills. These cases appear to be consistent with previously reported cases of ESHH. As in other reports [7], our patients had an absence of shivering despite documented hypothermia. Neither patient had symptoms or signs consistent with dysautonomia, which may be seen with HIV infection. With clonidine treatment, both patients responded with reduction in the frequency of attacks. There has been no consistent finding of definable CNS pathology in ESHH. In Shapiro’s syndrome, the absence of the corpus callosum is not believed to be the etiology of ESHH, as patients who have undergone corpuscallostomy have not been described with ESHH [7]. Some investigators have described ESHH as being a manifestation of “diencephalic epilepsy” and reported responses to antiepileptic medications [8]. The absence of seizure foci (despite frequent electroencephalographic abnormalities) during attacks, however, questions this theory. ESHH in our patients may represent HIV-related neurodegenerative processes involving the thermoregulatory areas. We cannot determine if HIV infection or one of its complicating illnesses was responsible for the development of thermal dysregulation. ESHH may be a manifestation of unidentified structural abnormalities, either congenital or acquired (e.g., from HIV-related neurodegeneration), resulting in episodic dysfunction of central thermoregulatory areas. Our patients described their symptoms as “fever” and sweats, prompting a search for infectious complications of HIV in both of them. Negative studies and the observation that the sweats occurred in the face of hypothermia led to the current diagnostic and therapeutic strategy.

Designing a competency-based nursing practice model in a multicultural setting.

Abstract: Cultural diversity of patients and staff has challenged nurse educators to create new culturally sensitive learning environments and to participate in the design of systems that ensure standards of care for patients and standards of performance for nurses are met. Performance expectations require nurses to render age-specific, culturally congruent nursing care and function as integral members of interdisciplinary, multicultural healthcare teams. In this article the author describes the development of a Competency-based Nursing Practice Model in a multicultural setting and explores the role of the staff development educator throughout the design process.

Safety in infants of SPf66, a synthetic malaria vaccine, delivered alongside the EPI

Abstract: The malaria parasite Plasmodium falciparum causes more morbidity and mortality than any other parasitic disease of man. However malaria control efforts have been frustrated by delays in the development of an effective vaccine. So far only SPf66 a multistage synthetic peptide has shown any evidence of protection in phase III vaccine field trials. Research has shown that SPf66 has an estimated combined efficacy of 23% in reducing the incidence of first attacks of clinical malaria and that further evaluation is warranted. Since most malaria disease and death is concentrated among very young children in sub-Saharan Africa the only realistic way to deliver a vaccine to that age group is through the Expanded Program of Immunization (EPI) which begins its schedule at birth. This paper reports the safety and reactogenicity of SPf66 when delivered alongside the EPI program to infants aged 1 2 and 7 months in southern Tanzania. The study was of randomized double-blind placebo-controlled design. The monitoring of safety and reactogenicity during the trial included detailed clinical and laboratory assessments on 98 infants and the assessment of adverse effects within 1 hour of vaccination for all 1207 children vaccinated. Surveillance systems monitored attendances as outpatients admissions to hospital and fatal events in the community. No serious adverse effects were detected more frequently among SPf66 recipients than among placebo recipients suggesting that this vaccine can be safely administered to very young infants.