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To focus attention on the problem of infant mortality in Lebanon, data were compiled on infant mortality from 1978 to 1986 at the American University of Beirut Medical Center. Causes of death are analyzed for 602 males and 398 females. 54.9% deaths occurred at 1 month of age and 77.4% died within the 1st year. Autopsies were performed on .7%. 37.7% of all neonatal deaths were due to neonatal diseases such as hyaline membrane disease, asphyxia neonatorum, immaturity, necrotizing enterocolitis, hemorrhage, hemolysis, meconium aspiration, and kernicterus. Better prenatal care would reduce this group, or the administration of corticosteroids to the mother 24-48 hours prior to delivery, as well as rapid resuscitation at birth and prevention of the 5 curses: hypoxemia, hypoglycemia, hypothermia, hypotension, and acidosis. Although unavailable in Lebanon, administration of surfactants through an endotracheal tube would also help. Infections constitute 25.1% of deaths; many are preventable through adequate public health measures and strict personal hygiene, i.e., diseases such as sepsis, pneumonia, meningitis, gastroenteritis, hepatitis, encephalitis, and 1-2 cases of the following: diphtheria, measles, peritonitis, tetanus, tuberculosis, cytomegalis inclusion, herpes, parathyphoid, pertussis, poliomyelitis, and shigellosis. Congenital diseases were 21.6%. In utero diagnosis could prevent some diseases and in utero treatment is possible for hydrocephalus and hydronephrosis. Screening programs postnatally could lead to treatment. 5.9% were malignancies such as leukemia, lymphoma, brain tumors, histocytosis, Wilm's tumor, Ewing sarcoma, and Hodgkin's disease. Early diagnosis is critical if mortality is to be reduced in this group, but medical advances are still needed. 2.9% are miscellaneous diseases such as poisoning, rheumatic diseases, marasmus, Reye's syndrome, nephrosis, rickets, and epilepsy. Most of these diseases are preventable, except for rheumatic inflammation of the heart. Recommended necessary steps to reduce infant mortality are: prenatal care, diagnosis and screening, intrauterine surgery; resuscitation and intensive care centers with modern equipment and trained personnel; national vaccination and screening programs; adequate public health measures and hygiene; parental education; and well-equipped hospitals to serve all regardless of income level.
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PMID:Pediatric mortality: an avoidable tragedy. 251 28

Salmonellae have demonstrated an extraordinary capacity to adapt to a wide range of ecologic niches and to the peculiarities of modern society, such as the mass production of food products. The vast majority of infections in the United States are caused by serotypes not specifically adapted to human or animal hosts, whereas the most frequent isolate in developing countries is S. typhi, which is highly adapted to human hosts. The number of isolates reported in the United States has been increasing steadily since 1975, largely a result of outbreaks associated with the mass production of food products, particularly poultry, which is frequently contaminated. Salmonella infection occurs when ingested organisms bypass gastric defenses, multiply within the intestinal lumen, penetrate the intestinal mucosa, and multiply within macrophages of the reticuloendothelial system. They may then disseminate via the systemic circulation. Several virulence factors have been identified. The wide range of pathologic and clinical manifestations are subdivided into four syndromes, each requiring a distinct diagnostic and therapeutic approach: (1) gastroenteritis, (2) enteric fever, (3) bacteremia with or without metastatic disease, and (4) asymptomatic carriage. Although any serotype can cause any of these syndromes, certain serotypes are associated with specific presentations. Serious complications of bacteremic infection include infections of the aorta, endocardium, bone, and meninges. Salmonella infection is particularly severe in patients who have AIDS, leukemia, lymphoma, immunodeficiency of other causes, inflammatory bowel disease, schistosomiasis, and macrophage dysfunction. Diagnosis is based on culture of the organism from appropriate sites. Several serologic tests have been developed that warrant further evaluation. Chloramphenicol, ampicillin, amoxicillin, and trimethoprimsulfamethoxazole have clearly established efficacy. Experience with third generation cephalosporins and quinolones is preliminary and fragmentary, but results suggest that they may prove to be efficacious in certain clinical circumstances. Antibiotic resistance has become a major problem in certain geographic areas. The three vaccines for S. typhi that are currently in use internationally provide only moderate protection for short periods of time.
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PMID:The spectrum of Salmonella infection. 307 16

There are many similarities in the Vibrionaceae that cause human illness in the United States (see Table 1). Vibrios are characteristically indigenous to marine, estuarine, and brackish environments. They are distributed mainly in Gulf of Mexico coastal water, and these organisms "bloom" when the water is warm. Outbreaks of disease in humans frequently occur in summer, coinciding with multiplication of vibrios in warm water. Sporadic cases and small outbreaks of cholera continue to occur in persons living on or near the Gulf of Mexico, but infection in most persons is unrecognized. In fact, more serious and frequent illnesses result from V. vulnificus wound infections and from gastroenteritis caused by vibrios other than V. cholerae 01. Underlying hepatic or neoplastic disease (especially leukemia) apparently increases the likelihood and severity of illnesses caused by V. vulnificus and Aeromonas. Some Vibrionaceae produce clinical illness by means of enterotoxins identical or similar to cholera toxin. For many others, hemolysins, cytotoxins, and other exotoxins are necessary to produce disease; the importance of these virulence factors often is not known or the importance of these virulence factors often is not known or is of doubtful significance. Also, purported pathogenicity as demonstrated by animal models, such as fluid accumulation in ligated ileal loops, is quite nonspecific and needs to be interpreted cautiously. For Plesiomonas, a mode of pathogenesis has not been discovered. Eating raw shellfish (frequently raw oysters) has been linked epidemiologically to enteric infections with most of these bacteria; foreign travel and exposure to seawater are other frequently observed epidemiologic associations with infection. Foreign travel, particularly to the Yucatan Peninsula of Mexico, has been strongly associated with the acquisition of non-01 V. cholerae and Plesiomonas organisms. Most Vibrionaceae in the United States are susceptible in vitro--and illnesses from them are responsive--to tetracycline, trimethoprim-sulfamethoxazole, and other common antimicrobial agents. However, as for other bacteria that cause diarrhea, the main treatment for uncomplicated disease is the judicious replacement of fluids and electrolytes lost in diarrhea. A loose network of surveilance for these organisms comprises hospital and public health laboratories in Gulf coastal states that plate diarrheal stools on TCBS agar. As recognized pathogens are more assiduously screened for, and as newly identified vibrios are definitely included or excluded as enteric pathogens, the clinical importance of these members of the Vibrionaceae family should become clearer.
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PMID:Vibrios and Aeromonas. 307 21

I.C.R.F. 159, a new antitumour agent, has been assessed in six patients with acute leukaemia and three with lymphosarcoma. In all but two there was a considerable fall in circulating primitive cells, and in one there was bone-marrow evidence of a partial remission. Severe toxic effects were seen in only one case; they consisted of alopecia and gastroenteritis. It is suggested that I.C.R.F. 159 is worth further examination in all forms of acute leukaemia and lymphosarcoma.
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PMID:Preliminary clinical assessment of I.C.R.F. 159 in acute leukaemia and lymphosarcoma. 525 96

The state of child health in Singapore from 1914 to the present is discussed. In 1914 there were 225 reported cases of tetanus neonatorum out of 7420 births and 340 deaths from gastroenteritis with an infant mortality rate (IMR) of 292.9/1000 live births. In 1936 the IMR was 167.74 and in 1962 it was still high at 31.2. Causes of death included tetanus neonatorum, gastroenteritis, tuberculosis, and poliomyelitis. Diphtheria immunization had lowered the rate of mortality from this disease. The 1st priority in improving infant health after 1962 was lowering the IMR, especially by treating the newborn. The 2nd priority was infections. Oral Sabin was introduced against polio and programs for tetanus, whooping cough, and measles vaccinations were begun as well; compulsory diphtheria innoculation began in 1963. Malnutrition was identified as a cause in high childhood morbidity and mortality, relating to a decrease in breastfeeding to only 29% with only about 4% continuing after 3 months; this also caused diarrhea and gastroenteritis. A Breast Feeding Mothers Group was established to help mothers and to support a breast milk bank. In addition the birthrate was very high, 2.8% with very young and elderly mothers giving birth in large numbers and constituting poor obstetric risks. In 1966 the government established a national family planning program. This program, together with nutrition education, improved housing and promotion of breastfeeding has raised the nutrition level. By 1976 the IMR had fallen to 11.8 and the neonatal mortality rate (NMR) was 8.4, both of which were lower than rates in the US, UK, Australia, and New Zealand. In 1981 the IMR fell to 10.8 and the NMR to 7.7. Although deaths from infections and diseases have dropped, those from congenital anomalies and malignancies such as leukemia have not changed. Health education has had an effect on lowering mortality rates from accidents. Rates of death from dengue hemorrhagic fever have been lowered but not abolished by mosquito surveillance, as is the case with other viral infections such as measles. With bacterial infections the latest problem is the existence of antibiotic-resistant strains. Further efforts must emphasize health rather than the reduction of mortality and mental and emotional morbidity must receive more attention as well.
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PMID:Child health in Singapore--past, present and future. 713 9

Vibrio parahemolyticus is a halophilic marine vibrio commonly associated with outbreaks of acute gastroenteritis which also sometimes causes serious wound infection. It is an uncommon cause of septicemia. A few reports suggest that patients with chronic liver disease and leukemia are more susceptible. A case of liver cirrhosis with septicemia caused by this organism is discussed. The patient's condition rapidly deteriorated, and he died 12 hours after admission.
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PMID:Septicemia caused by Vibrio parahemolyticus: a case report. 829 34

Following the establishment of university departments of pediatrics after World War II, national pediatric associations were formed in several countries (in Korea in 1945 and in Nepal in 1981). In Papua New Guinea, the Papuan Medical College began in 1959, and a university department of pediatrics was established in 1974. The population of Papua New Guinea is growing at a rate of 2.3% a year, and less than 70% of women receive prenatal care. Only 40% of deliveries are done under medical supervision. Most of child health problems are associated with malnutrition, pneumonia, gastroenteritis, malaria, meningitis, and tuberculosis. Nonetheless, the infant mortality rate (IMR) dropped from 134/1000 in 1971 to 72/1000 in 1980, and to 60/1000 in 1991. In Nepal, improved child health is a national priority, because the IMR is 129/1000 live births, the under-five mortality rate is 200/1000 live births, life expectancy is 52 years, and adult literacy rates are 39% for males and 12% for females. Nurses receive graduate pediatric training, and there is a postgraduate Diploma in Child Health. In Thailand, supervision of births increased from 33.7% in 1980 to 64.8% in 1988; the IMR dropped from 54.8/1000 live births in 1980 to 42/1000 in 1988; and malnutrition in under-fives dropped from 35.6% in 1980 to 28.5% in 1988. However, 85% of children live in rural communities, and rapid urbanization has resulted in overcrowding, with infectious and parasitic diseases, and high maternal malnutrition. Industrialization profoundly affected child health indices. In Korea the IMR was only 12.5/1000 in 1987, life expectancy was 67 years for males and 75 years for females. In Japan, the IMR dropped from 124/1000 in 1930 to 5.2/1000 in 1986; and maternal mortality declined from 176/100,000 live births in 1950 to 10.8 in 1989. Life expectancy increased from 59.6 years for males and 63 years for females in 1950 to 75.5 years and 81.3 years in 1988, respectively. In Australia, children's hospitals mostly treat asthma, congenital anomalies, and leukemia. Pediatric postgraduate education programs had been developed by the 1980's in most countries. The 7th Asian Congress of Pediatrics was held in Perth, Australia, in May 1991, focusing on priorities of child health.
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PMID:Paediatrics in the Asia-Pacific region. 848 6

Water-soluble derivatives of camptothecin, and active topoisomerase I inhibitor, have shown a broad spectrum of activity against human tumors. Early clinical trials with the water-soluble sodium salt of camptothecin were hindered by significant cystitis, gastroenteritis, and leukopenia. Furthermore, the sodium salt of camptothecin has been shown to have significantly less activity than the water-insoluble lactone form of the compound. We describe a formulation of lipid-complexed CPT (LC-CPT; particle size range 20.8-208.1 nm) that is very easy to prepare and allows for intravenous administration in vivo in clinically relevant lipid-drug ratios (12.5:1 w/w). The lipid formulation had in vitro antitumor activity similar to that of CPT formulated without lipids and displayed similar cytotoxicity against MDR-1-negative and -positive tumor cells. The biodistribution of CPT was profoundly affected by lipid complexation; free CPT achieved the greatest concentration in the pulmonary parenchyma while LC-CPT achieved the highest concentration in the gastrointestinal tract. LC-CPT had significant antitumor activity in vivo against intraperitoneal L1210 and P338 leukemia and appeared to be more potent then free CPT.
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PMID:Lipid-complexed camptothecin: formulation and initial biodistribution and antitumor activity studies. 861 6

Total body irradiation is being used with increasing frequency for the treatment of lymphopoietic malignancies and in preparation for marrow transplantation. Acute toxicities include reversible gastroenteritis, mucositis, myelosuppression and alopecia. As the success of treatment improves and more patients become long-term survivors, manifestations of delayed and chronic toxicity become evident. These include impairment of growth and development, gonadal failure and sterility, cataract formation and possibly secondary malignancies. The contribution of total body irradition to the development of pneumonitis and pulmonary fibrosis is still poorly understood. Some of these changes are reversible or correctable, whereas others are permanent. Nevertheless, until equally effective but less toxic regimens become available, total body irradiation appears to be the treatment of choice to prepare patients with leukemia for marrow transplantation.
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PMID:Acute and delayed toxicities of total body irradiation. Seattle Marrow Transplant Team. 946 96

Rhodococcus equi is a common cause of pneumonia in animals. Human infection is rare. Increasing number of cases are being reported in immunosuppressed individuals mostly associated with HIV infection, but also in solid organ transplant recipients and leukemia/lymphoma patients. We report on an adult male who developed pneumonia and gastroenteritis 4 mo after receiving a renal transplant. CT scan of the lungs showed a dominant 2.5-cm upper lobe lung mass and smaller bilateral nodules. He underwent a diagnostic bronchoscopy with fine-needle aspiration biopsy of the largest lung nodule. Smears showed histiocytic granulomatous inflammation, foamy macrophages, and acute inflammatory exudate. Scattered foamy macrophages displayed intracellular coccobacilli identifiable on Diff-Quik stain. A few cells with changes suggestive of viral inclusions were identified. Cytomegalovirus (CMV) immunostain was positive in the cell block sections. Lung cultures grew R. equi. To the best of our knowledge, this is the first report of coinfection with R. equi and CMV.
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PMID:Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy. 1116 94


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