Neonatal tetanus associated with topical umbilical ghee: covert role of cow dung.

Background: Previous studies in Pakistan have shown that ghee (clarified butter) is commonly applied to umbilical wounds of neonates, and have documented that such applications are a risk factor for neonatal tetanus (NNT). In-use contamination of ghee with Clostridium tetani has been demonstrated, but mechanisms underlying the risk of ghee have been incompletely evaluated epidemiologically.

Methods: Detailed information on ghee usage, including fuels used to heat it, was obtained from cases of NNT (n = 229) and their matched controls (n = 687) from a population-based study of NNT in Punjab Province, Pakistan.

Circumcision and neonatal tetanus: disclosure of risk and its reduction by topical antibiotics.

Background: Previous case-control studies have paradoxically suggested that circumcisions protect against neonatal tetanus (NNT), but these observations have not been adjusted for differences in the length of survival of cases and controls.

Methods: Boy cases (n = 133) and their sex-matched controls (n = 399) were extracted from a population-based study of NNT undertaken in Punjab Province, Pakistan. In the resulting file, circumcisions were censored such that analysis was restricted to only those that occurred before onset in cases or before age of onset in the matched case for controls.

Protective effects of topical antimicrobials against neonatal tetanus.

Background: Case-control studies previously conducted in Pakistan suggested that topical antimicrobials might provide protection against neonatal tetanus (NNT) when applied to the umbilical cord wound during the first several days of life. The present case-control study, the largest such study yet reported, was undertaken in Punjab Province, Pakistan and afforded further opportunities to evaluate such effects.

Methods: A population-based, matched, case-control study was undertaken to assess topical antimicrobials and other factors related to NNT risk in rural parts of Punjab Province.

Bundling, a newly identified risk factor for neonatal tetanus: implications for global control.

Background: Bundling, which consists of wrapping an infant for prolonged periods in a sheepskin cover after dried cow dung is applied, is a common and apparently unique practice limited to the rural, mountainous regions of Northern Pakistan. The practice is initiated at various ages during the neonatal period. Its potential contribution to neonatal tetanus (NNT) had not been evaluated.

Epidemic cholera in Latin America, 1991-1993: implications of case definitions used for public health surveillance.

This report presents the various cholera case definitions used by the affected countries of Latin America, shows the numbers of cholera cases and deaths attributable to cholera (as reported by Latin American countries to PAHO through 1993), and describes some regional trends in cholera incidence. The information about how cholera cases were defined was obtained from an October 1993 PAHO questionnaire. In all, 948429 cholera cases were reported to PAHO by affected Latin American countries from January 1991 through December 1993, the highest annual incidences being registered in Peru (1991 and 1992) and Guatemala (1993).

Further observations on ghee as a risk factor for neonatal tetanus.

Background: Previous case-control studies of neonatal tetanus (NNT) in the North West Frontier Province of Pakistan indicated that clarified butter (ghee) applied to the umbilical wound of newborns was a significant risk factor for NNT. However, the mechanisms underlying the risk remained undisclosed.

Methods: A hospital-based case-control study was undertaken to evaluate further ghee and other factors possibly associated with risk of NNT.

A reassessment of risk factors for neonatal tetanus.

A hospital-based case-control study was conducted to further examine the risk factors for neonatal tetanus (NNT) in the North-west Frontier Province of Pakistan. Three control infants were concurrently evaluated for each of 102 consecutively diagnosed NNT cases hospitalized over an 8-week period. Application of clarified butter (ghee) during the first few days of life was shown to be a significant risk factor, confirming our previously reported finding.

Ghee applications to the umbilical cord: a risk factor for neonatal tetanus.

A case-control study was done to elucidate risk factors for neonatal tetanus (NNT) in rural Pakistan; three controls were selected for each of the 69 cases. Factors commonly believed to be associated with NNT, such as the tool used to cut the umbilical cord and the method of preparing the tool, were not confirmed as risk factors. However, applying ghee to the wound stump was.

Clinical efficacy of a new, enhanced-potency, inactivated poliovirus vaccine.

The 1986-87 outbreak of paralytic poliomyelitis in Senegal, with 676 reported cases, provided an opportunity to evaluate the efficacy of an enhanced-potency inactivated poliovirus vaccine (N-IPV) in the Kolda region, where this vaccine has been used since 1980. 89 cases, confirmed to have poliomyelitis with residual paralysis, were enrolled in a case-control study, up to 5 matched controls being obtained for each case. The clinical efficacy for one dose of N-IPV was 36% (95% confidence interval 0%, 67%) and for two doses was 89% (95% CI 62%, 97%).

[External intestinal fistulae. Clinical treatment. Surgical treatment].

There are 105 cases shown, all of them as a consequence of surgical operations or external traumatisms or surgery in the duodenum, jejunum, ileum and colon. These 105 cases were divided into two major groups: 1) simple and 2) multiple. 76 of the first group and 29 of the second group were treated.

Vitamin K-dependent gamma-carboxyglutamic acid formation by mouse renal adenocarcinoma cells (RAG).

Previous studies have identified gamma-carboxyglutamic acid as a constituent of one or more protein(s) synthesized by rat and chicken kidney microsomes in vitro in a vitamin K-dependent post-translational reaction [1]. Incubation of microsomes from a mouse kidney cell line (RAG) with [14C]NaHCO3 results in formation of protein-bound [14C]gamma-carboxylglutamic acid. Incorporation is stimulated threefold by addition of the active vitamin K compound 2-methyl, 3-farnesyl, 1,4-naphthoquinone.

Isolation, purification, and cross-linking profiles of elastin from lung and aorta.

Elastin from anatomically defined regions of young calf lung and dog aorta was isolated and purified by a procedure which sequentially removed lipids, collagen, structural glycoproteins, and the microfibrillar proteins without apparent damage to the cross-linking residues, which have been shown to be sensitive to autoclaving and hot alkali treatment. One of the methods described was effective in obtaining pure elastin from lung parenchyma. Visceral pleura was found to be the richest source (25% dry weight) of elastin in the lung tissues examined.

Functional renal failure (FRF) in cirrhosis of the liver and liver carcinoma.

The term ‘functional renal failure’ has been used to describe the renal failure developing in advanced cirrhosis in which tubular function and structure remain intact. It may develop spontaneously, in which case prognosis is poor, but may be secondary to gastro-intestinal haemorrhage or excessive use of diuretics, in which case correction of the precipitating factor leads to improvement in renal function. It is suggested that the renal failure is due to a reduction in effective circulating plasma volume.