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A symposium held 3-5 May 1990 commemorated the anniversary of the "Network" by presentations on the health aspects of reproduction in Africa. Prof. Sambra Diarra of the Ivory Coast presented a paper on "Health of Reproduction in Africa, Bi-Dimensional Problems: Biomedical and Social." He stressed the need to emphasize both maternal (MM) and infant mortality (IM) in Africa, where MM rates are 640/100,000 and IMR are 130/1000, because they remain so high. Prof. Fadel Diadhiou of Senegal followed with a paper on "Operations Research on Women's Reproductive Health in Africa." The major themes were that problems in reproductive health have resulted because of the fragmentation between the ecosystem and development and the lack of research is due to the isolation of institutions that lack human and material resources. The 3rd presentation by Prof. Mouhamadou Fall of Senegal on "The Health of Children and the Perspectives for Senegal," focused on the increasing infant and child mortality rates in Senegal (238/1000 in 1981) due to the combination of factors caused by the mother-child syndrome. These are: 1) congenital malformations caused by incest, young or advanced age of mothers; 2) diseases of the mother that cause fetal mortality: diabetes, arterial hypertension, eclampsia; 3) lack of breastfeeding and illiteracy of mothers; 4) public health diseases such as measles, malaria, diarrhea; 5) streptococcic infections and their complications such as anemia and tuberculosis. The last presentation made by Prof. Eusebe Alihonou from Benin on the "Perspectives and Priorities of Reproductive Health in Africa," concluded that the research priorities in Africa should be on health systems that lower utilization rates of services and resources and on epidemiological studies that identify health problems and analyze the risk factors. The Symposium concluded that the research priorities should be: maternal morbidity and mortality; adolescents and reproduction and the morbidity and mortality of infants and children.
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PMID:[Network of researchers on the health aspects of reproduction]. 1234 30

Reversible posterior leukoencephalopathy syndrome is an increasingly recognized disorder with typical radiologic findings of bilateral gray- and white-matter abnormalities in the posterior regions of the cerebral hemispheres. The majority of patients with reversible posterior leukoencephalopathy syndrome are adults, and it is rare in children. Previously reported associations of reversible posterior leukoencephalopathy syndrome include hypertension, vasculitis, nephrotic syndrome, severe hypercalcemia, hemolytic uremic syndrome, eclampsia, renal failure, and use of immunosuppressive drugs. Adie's pupil is described as the presence of a large unilateral or bilateral tonic pupil related to virus infections or trauma. In this article, we describe a case of reversible posterior leukoencephalopathy and Adie's pupil association that occurred after measles vaccination. To our knowledge, this association has not been reported.
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PMID:Reversible posterior leukoencephalopathy and Adie's pupil after measles vaccination. 1694 40

This study assessed the quality of primary care in Pelotas, Rio Grande do Sul, Brazil, through preventable hospitalization rates (1995-2004). Preventable hospitalizations were defined as those related to the following diseases: diabetes mellitus, congestive heart failure, hypertension, chronic obstructive pulmonary disease, and vaccine-preventable diseases (polio, diphtheria, tetanus, whooping cough, and measles). Men and women from 20 to 59 years of age were included in the study. The proportion of preventable causes among hospital admissions was higher for women than for men. From 1995 to 2004 there was a decrease in preventable hospitalization rates. Even after direct standardization, analysis showed that admission rates in Pelotas were lower than for the State of Rio Grande do Sul as a whole. Preventable hospitalization costs decreased in parallel with the drop in hospital admission rates. The decrease in hospitalizations is consistent with improvement in primary health care. However, the findings may result from the system's financial model. Reimbursement for hospital procedures is low, which could induce the hospitals to curtail admissions.
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PMID:[Quality of primary care as measured by preventable hospitalizations in the South of Brazil]. 1867 Jun 93

A 58-year-old man was admitted to our hospital with fever, vomiting and disturbance of consciousness after common cold-like symptoms for 2 days. Physical examination showed high fever, moderate hypertension and tachycardia. There were no superficial lymph nodes swelling nor skin rashes. Cerebrospinal fluid (CSF) examination revealed increased protein level (467 mg/dl) and pleocytosis (508 cells/mm3), but no glucose was detected. CSF smear test detected the pneumococcus. Intravenous cefotaxime was administered along with intravenous immunoglobulins and steroid pulse therapy. However, DIC developed, so FOY therapy was started. With these treatments, level of consciousness gradually improved and he became able to eat. At 11th days after the onset, the patient suddenly developed left facial palsy and paresis of the left arm. Head T2-weighted magnetic resonance imaging demonstrated tumor-like hyperintensity signal lesions (28 x 16.6 mm) with ring enhancements in the right frontal lobe. Acute disseminated encephalomyelitis (ADEM) was diagnosed based on MRI and CSF findings, and then additional corticosteroid pulse therapy was administered twice. Herpes simplex virus and herpes zoster virus DNA in the CSF were undetectable by PCR. After 6 days of treatment with corticosteroid pulse therapy, left facial palsy and paresis of the left arm gradually improved and MRI showed the disappearance of tumor-like hyperintense signals. Although ADEM usually develops as a complication after viral infection such as measles, rubella, mumps and herpes zoster, this case suggests that ADEM complication should be considered even after pneumococcal meningoencephalitis.
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PMID:[A case of acute disseminated encephalomyelitis (ADEM) following treatment for pneumococcal meningoencephalitis]. 1934 73

This cross-sectional study evaluated the immune status of non-vaccinated healthy infants to determine if it is possible to replace both measles vaccine (at 9 months) and measles, mumps and rubella (MMR) vaccine (at 18 months) with a single dose of MMR at 12 months. Serum samples from 566 children in Alexandria, Egypt showed a significant decrease in the seropositive rate to the 3 viral diseases with increasing age, but a significant increase in the seropositive rate among infants who were ranked 1st or 2nd in their family, full-term or born to mothers with no history of hypertension during pregnancy. We recommend administration of the first dose of MMR vaccine between 9 and 12 months of age, and a booster dose of MMR vaccine at 4 years of age.
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PMID:Could the MMR vaccine replace the measles vaccine at one year of age in Egypt? 1946 30

Commonly used dermatologic eponyms and characteristic skin signs are enormously helpful in guiding a diagnosis, even though they may not be pathonemonic. They include, on the nails, Aldrich-Mees' lines (syn.: Mees' lines), Beau's lines, Muehrcke's lines, Terry's nails, and half and half nails, often associated, respectively, with arsenic poisoning, acute stress or systemic illness, severe hypertension, liver disease and uremia, and, around the nails, Braverman's sign, associated with collagen-vascular disease. Elsewhere, one may see the Asboe-Hansen and Nikolsky's signs, indicative of the pemphigus group of diseases, Auspitz's sign, a classic finding in psoriasis, Borsieri's and Pasita's signs, seen in early scarlet fever, the butterfly rash, indicative of systemic lupus erythematosus, and the buffalo hump, seen in Cushing's disease and also in the more common corticosteroid toxicity. Gottron's papules and the heliotrope rash are signs of dermatomyositis. Janeway's lesions and Osler's nodes are seen in bacterial endocarditis. A Dennie-Morgan fold under the eye is seen in association with atopic disease. Koplik's spots are an early sign of rubeola. Fitzpatrick's sign is indicative of a benign lesion (dermatofibroma), whereas Hutchinson's sign is indicative of a malignant one (subungual melanoma). Petechiae are seen in many diseases, including fat embolization, particularly from a large bone fracture following trauma. Palpable purpura is indicative of leukocytoclastic vasculitis, and is an early, critical sign in Rickettsial diseases, including Rocky Mountain Spotted Fever, which must be diagnosed and treated early. Hyperpigmentation of areolae and scars is seen in Addison's disease. Acanthosis nigricans may indicate internal cancer, especially stomach cancer, whereas Bazex's syndrome occurs in synchrony with primary, usually squamous cancer, in the upper aerodigestive tract or metastatic cancer in cervical lymph nodes. Perioral pigmented macules or one or more cutaneous sebaceous neoplasms may be a sign of the Peutz-Jeghers or Muir-Torre syndrome, respectively, both associated also with intestinal polyps that have a malignant potential. Telangiectasiae in the perioral region may be associated with similar lesions internally in Osler-Weber-Rendu disease. Kerr's sign is indicative of spinal cord injury and Darier's sign of mastocytosis. Post proctoscopic periobital purpura (PPPP) is a phenomenon observed in some patients with systemic amyloidosis. Koebner's isomorphic response refers to the tendency of an established dermatosis, such as psoriasis, to arise in (a) site(s) of trauma, whereas Wolf's isotrophic response refers to a new dermatosis, such as tinea, not yet seen in the patient, arising in (a) site(s) of a former but different dermatosis, such as zoster.
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PMID:Cutaneous signs of systemic disease. 2185 27

Vaccination has made an enormous contribution to global health. Two major infections, smallpox and rinderpest, have been eradicated. Global coverage of vaccination against many important infectious diseases of childhood has been enhanced dramatically since the creation of WHO's Expanded Programme of Immunization in 1974 and of the Global Alliance for Vaccination and Immunization in 2000. Polio has almost been eradicated and success in controlling measles makes this infection another potential target for eradication. Despite these successes, approximately 6.6 million children still die each year and about a half of these deaths are caused by infections, including pneumonia and diarrhoea, which could be prevented by vaccination. Enhanced deployment of recently developed pneumococcal conjugate and rotavirus vaccines should, therefore, result in a further decline in childhood mortality. Development of vaccines against more complex infections, such as malaria, tuberculosis and HIV, has been challenging and achievements so far have been modest. Final success against these infections may require combination vaccinations, each component stimulating a different arm of the immune system. In the longer term, vaccines are likely to be used to prevent or modulate the course of some non-infectious diseases. Progress has already been made with therapeutic cancer vaccines and future potential targets include addiction, diabetes, hypertension and Alzheimer's disease.
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PMID:The contribution of vaccination to global health: past, present and future. 2482 19

This retrospective study aimed to describe the clinical presentations, possible causes, and outcomes of children with idiopathic intracranial hypertension who presented to the authors' clinic. The mean age at onset of symptoms in the authors' cohort of 19 children was 6 years (range: 7 months to 12 years). Most patients (90%) were under 11 years old and (84.2%) symptomatic. The probable cause was identified in 7/19 (37.0%) patients. The most common cause was vitamin D deficiency (26.3%). Other associated probably coincidental comorbidities included sinusitis (5/19, 26.3%), hypophosphatasia (1/19), Pyle disease (1/19), and measles vaccine (1/19). Apart from 2 patients who required lumboperitoneal shunt, the cerebrospinal fluid pressure returned to normal in all patients within a period of 6 weeks to 1 year (average, 5 months). Of those who followed up with the authors' ophthalmologist, 30.7% developed optic atrophy or pallor; 75% of these patients had previous ocular comorbidities.
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PMID:Intracranial Hypertension in Children: Etiologies, Clinical Features, and Outcome. 2576 86

Neonates born to renal transplanted women are exposed in utero to immunosuppressors and to antenatal conditions that may predispose the neonate to a high risk of prematurity and intrauterine growth retardation. These factors might interfere with the transfer of maternal IgG immunity. Total IgG levels and specific antibodies to measles, varicella, tetanus, Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae (serotypes 4,6B,9V,14,18C,19F and 23F) were evaluated on maternal and cord blood samples of 23 sets of renal transplanted women and their newborns and 32 sets of healthy women-newborns at term. Total IgG levels were measured by nephelometry and specific antibodies, by ELISA. Renal transplanted mothers had lower median tetanus antibodies (0.67IU/mL) than controls (1.53IU/mL; p=0.017). Neonates from renal transplanted mothers had lower median tetanus antibodies (0.95IU/mL) than controls (1.97IU/mL, p=0.008). Antibodies to measles, varicella, Hib and the 7 serotypes of S. pneumoniae were similar between groups. Maternal antibodies were associated with an increase in neonatal antibodies for all antigens; gestational age was associated with an increase in Hib neonatal antibodies. Preeclampsia was associated with a decrease in neonatal total IgG and serotype 4 S. pneumoniae antibodies; chronic hypertension was associated with a decrease in neonatal serotype 6B S. pneumoniae antibodies. As neonates from transplanted women may be born with lower tetanus antibodies than controls, efforts should be made to keep maternal vaccines up-to-date. Clinical antenatal care with control of preeclampsia, chronic hypertension and prevention of premature delivery might also contribute to neonatal antibody levels to specific antigens at birth.
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PMID:Maternally acquired IgG immunity in neonates born to renal transplanted women. 2598 39

Background: The FUT2 (fucosyltransferase 2) gene encodes alpha (1,2) fucosyltransferase, which determines blood group secretor status. Being homozygous for the inactive "non-secretor" rs601338(A) allele appears to confer resistance to certain infections (e.g. Norovirus, Rotavirus and Helicobacter pylori) and susceptibility to others (e.g. Haemophilus influenza and Streptococcus pneumonia). Non-secretors also have an increased risk of type 1 diabetes and inflammatory bowel disease. We aimed to determine the association of the FUT2 secretor genotype with infections and chronic conditions in the population-based Avon Longitudinal Study of Parents and Children (ALSPAC). Methods: This study included 7,582 pregnant women from the ALSPAC pregnancy cohort. Personal history of infections (measles, mumps, chicken pox, whooping cough, cold sores, meningitis, genital herpes, gonorrhea and urinary infections) and chronic conditions (kidney disease, hypertension, diabetes, rheumatism, arthritis, psoriasis, hay fever, asthma, eczema and various allergies) were self-reported by standardized questionnaire. FUT2 secretor status was determined from the rs601338 genotype. Results: Overall, 1920 women (25.3%) were homozygous for the FUT2 non-secretor allele (AA). Secretor status was associated with mumps, with 68% of non-secretors experiencing this infection, compared to 48% of secretors (RR, 1.40; 95% CI, 1.34-1.46; p<0.0001). A weaker association was observed for measles infection (76% vs. 72%; RR, 1.05; 95% CI, 1.02-1.09; p=0.0008). Non-secretors also experienced a 39% increased risk of kidney disease (5.4% vs. 3.9%; RR, 1.39; 95% CI, 1.11-1.75; p=0.004). For some conditions, including gonorrhea and arthritis, FUT2 heterozygosity (GA) appeared to confer an intermediate phenotype. There was no strong evidence of association between FUT2 secretor status and other infections or chronic conditions, although statistical power was limited for rare outcomes. Conclusion: Our results identify an association between FUT2 secretor status and kidney disease, and confirm a recently reported association with susceptibility to mumps infection. The clinical implications of these associations warrant further investigation.
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PMID:FUT2 secretor genotype and susceptibility to infections and chronic conditions in the ALSPAC cohort. 3034 75


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