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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Data on infant and child mortality obtained in 8 studies previously undertaken in various regions of Thailand were reviewed in order to obtain a more accurate assessment of mortality rates and causes of death for infants and preschool children than can be obtained by analyzing birth and death registrations. Studies reviewed included 6 retrospective population and sample surveys conducted between 1969-1979 in marginal areas of Bangkok, rural areas near Bangkok, 6 provinces in the Meklong River Basin, and 9 villages in Ubon Province and a prospective and follow-up study of perinatal and infant deaths in the district of Bang Pa-In. In the retrospective studies women of reproductive age wre interviewed about their pregnancy histories. A summary of the findings of these studies indicated that the infant death rates in rural areas around Bangkok and in the central and northeastern regions of the country were 2-3 times higher than in the metropolitan areas of bangkok. The approxiamte infant mortality rate was 20/1000 live births for Bangkok, 42/1000 live births in the rural areas near Bangkok, and 61-65/1000 live births in the central and northeastern regions. Neonatal deaths accounted for 2/3 of the infant deaths and 2/3-3/4 of the neonatal deaths were early neonatal deaths. Infromation on the cause of death was obtained in some of the surveys and in the prospective study. This information is presented in tabular form. Many of the causes of early and late neonatal deaths, such as tetanus, diarrhea, sepsis, and bleeding are preventable or at least reducible. The prevalence of protein energy malnutrition ranged from 42-34% in the studied areas. The information derived from the analysis should be useful in developing health care programs.
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PMID:Infant and preschool-child mortality rates. 660 95

Results of an epidemiologic study of breastfeeding conducted among socioeconomically less favored classes in suburban areas of 8 Latin American countries and Portugal in 1981-82 are presented. Approximately 500 families at each area completed 271-item questionnaires designed to collect data on breastfeeding practices under similar socioeconomic conditions. The results correlated the time of beginning breastfeeding, the ingestion of colostrum, and the duration of breastfeeding with infant mortality and morbidity in 4 time periods: early neonatal (0-7 days), late neonatal (8-28 days), 1-6 months, and 7-12 months. Of 7569 children studied, 52.9% were male and 47.1% female. 61.2% were Caucasian and 38.8% were not. 7.8% had never breastfed, 14.0% received breast milk for less than 1 month, 10.7% for 1 month, 13.1% for 2 months, 13.0% for 3 months, and 7.4%, 5.3%, and 6.4% respectively for 4, 5, and 6 months. 17.0% were breastfed through 7-12 months. 5703 children (85.5%( received colostrum while 941 (14.2%) did not. Of the 6851 breastfed children, 25.4% were 1st fed within 6 hours of birth, 24.9% between 7-12 hours, 27.2% between 13-24 hours, 8.9% between 25-48 hours, 9.8% between the end of the 2nd and the 4th day, 1.6% between the 5th and 7th days, and 1.8% on the 8th day or later. 89% of the mothers belonged to the lower middle or poor social classes, 27.2% were unmarried, and 41% were illiterate or had incomplete primary school education. A significant difference was found in the neonatal period between the children receiving colostrum and those not receiving it in general morbidity, hospitalization, diarrhea and dehydration. No significant differences were found at 1-6 months or 7-12 months except that the group receiving colostrum had a significantly reduced incidence of upper respiratory infections. No significant differences were found regarding the time elapsed until the beginning of breastfeeding and its correlation with hospitalization and morbidity. 114 of the 7564 children studied had died at less than 1 year before the study. 46 were exclusively breastfed, 32 had received mixed feeding, 11 had received cow's milk or powdered milk, and no information was available on 25. 21 died of upper respiratory infections, 22 of lower respiratory infections, 54 of diarrhea, 23 of dehydration, 6 of septicemia, 13 of congenital malformations, 5 of meningitis, 2 of neonatal tetanus, and 28 of other causes.
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PMID:Breast-feeding and infant morbidity and mortality in developing countries. 664 58

An old concept--passively immunizing a fetus by actively immunizing (vaccinating) its mother--is reevaluated in light of 50 years of data. The history and data reviewed here suggest that this concept is one whose time has come for active modern research and clinical use. In Third World countries, this concept already has provided significant reduction in morbidity and mortality from neonatal infections such as tetanus. Some other neonatal and infant infections--heretofore life-threatening--may now have a practical method for prevention. These include group B beta-streptococcal sepsis and Hemophilus influenzae meningitis.
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PMID:Neonatal passive immunization by maternal vaccination. 669 Oct 6

This prospective study evaluated host resistance in a surgical population who walked into the hospital for elective surgery. Patients were stratified into Hospital Reactive (HR, n = 19) if they reacted to two or more of five recall skin test antigens and Walk-in Anergic (WA, n = 26) if they did not react to the antigens. The WA patients were slightly older (74.4 +/- 1.8 years, +/- SEM versus 66.7 +/- 2.7 p less than 0.05). Diagnosis in the HR and WA group were: tumors 13/19 versus 21/26, diverticulitis 3/19 versus 0/19, and miscellaneous 3/19 versus 5/26. Twenty-five laboratory normal controls (LN) were also studied. There were no significant differences in the following parameters between the HR and WA groups: stage of disease; hemoglobin; circulating leukocyte count; polymorphonuclear cell counts; total lymphocyte counts (both groups lower than LN, p less than 0.05), monocyte counts (both higher than LN, p less than 0.05); per cent E-rosettes and lymphocyte blastogenesis to mitogens (phytohemagglutinin, concanavalin-A) and antigens (purified protein derivative and tetanus); phagocytosis of preopsonised Staphylococcus aureus 502A, at 5, 10, and 20 minutes; alpha, beta, and gamma globulins; C3, and total hemolytic complement (CH50) levels; C-reactive protein; and ANA and DNA levels. The HR group demonstrated an increase in the rate of killing of Staphylococcus 502A at 10, 20, 40, and 80 minutes compared to the LN group but the WA group did not show this augmentation (p less than 0.001). The serum albumins were: LN = 4.46, HR = 3.98, WA = 3.43 g/dl (p less than 0.05). Degree and duration of surgery was the same in the HR and WA groups. There were no major sepsis episodes (bacteremia or proven intracavitary abscess) in the HR patients versus 25% in the WA patients (p less than 0.05). There was one death (6%, pulmonary embolus) in the HR group and 8 (40%) in the WA group (p less than 0.05). Antibiotic prophylaxis was equal but the WA patients received therapeutic antibiotics more frequently (65% versus 11% p less than 0.05). Of all the host immunocompetence tests measured in this study, the delayed type hypersensitivity skin test response and the serum albumin were variables abnormal between the survivors and those who died.
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PMID:The walk-in anergic patient. How best to assess the risk of sepsis following elective surgery. 671 20

Bactericidal antibodies directed against surface loops of class 1 outer membrane proteins play a crucial role in protection against meningitis and sepsis caused by Neisseria meningitidis. So far, all efforts to obtain protective antibodies against these apparently conformational epitopes by using linear peptide analogs have been in vain. In this study, conjugates of head-to-tail cyclic peptides encompassing the predicted top of a protective surface loop were used for immunization. A series of 18 cyclic peptides with a ring size ranging from 7 to 17 residues, conjugated to tetanus toxoid, was investigated. Antipeptide and anti-whole-cell immunoglobulin G (IgG) titers elicited by the conjugates were determined. Conjugates of three peptides, containing 14, 15, and 17 amino acid residues (peptides 7, 12, and 13, respectively), induced an anti-whole-cell titer when Quillaja saponin A was used as the adjuvant. When alum was used as the adjuvant, the conjugate of peptide 12 did not elicit an anti-whole-cell response. From the Quillaja saponin A group, some of the sera obtained with conjugates of peptides 7 and 12 and all sera obtained with the peptide 13 conjugate were bactericidal in vitro. None of the sera evoked with alum as the adjuvant showed bactericidal activity. Nonbactericidal sera contained IgG1 primarily, whereas bactericidal sera showed significant titers of IgG2a and IgG2b. Class 1 protein-derived synthetic cyclic peptides which are capable of eliciting bactericidal antibodies, such as peptide 13 derived from meningococcal strain H44/76, represent potential candidates for a (semi)synthetic vaccine against meningococcal disease.
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PMID:Conjugates of synthetic cyclic peptides elicit bactericidal antibodies against a conformational epitope on a class 1 outer membrane protein of Neisseria meningitidis. 754 83

An estimated 8 million infants and 2 million children and adults may die from tetanus during the 1990s despite efforts by the World Health Organization (WHO) to eliminate it by 1995. Vaccination to prevent postabortal and maternal tetanus has been neglected. The immunization of preschool children and of pregnant women has omitted adolescent girls, who are therefore at risk. Data collected on 1101 cases of maternal tetanus in developing countries between 1958 and 1990 indicated that 27% were attributed to postabortal and 67% to postpartum sepsis. In southeastern Nigeria where abortion rates are high, a high proportion of girls were also seronegative for tetanus antibodies. Many unvaccinated pregnant women cite the lack of money for obtaining vaccination when obtaining prenatal services. The WHO is promoting vaccination of women of reproductive age by screening their tetanus toxoid status, but adolescents are poorly covered because they are not regular attenders. Expressly targeting girls would be feasible, as it would require 5 injections providing protection for life. Even 4 injections may protect for 20 years if delivered at the end of primary school. Thus a school health service delivering tetanus vaccination may improve the vaccination of adolescent girls. This could be combined with distribution of vitamin A and antihelminthics whereby the response to the vaccine could be improved significantly. In addition, it has also been suggested that a late dose of an acellular pertussis vaccine and a second dose of measles vaccine given in adolescence would reduce the pool of susceptible girls, just as girls have been targeted for rubella vaccination. Implementation of tetanus vaccination would require local schools vaccination days, immunization cards, high potency primary vaccination, and tetanus boosters free of charge with a system to monitor antibody responses.
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PMID:Protecting adolescent girls against tetanus. 754 4

Vibrio vulnificus causes septicemia and wound infections in immunocompromised humans. The capsular polysaccharide of Vibrio vulnificus (VvPS) is critical for virulence. We synthesized conjugate vaccines of carbotype 1 VvPS under conditions and in formulations suitable for human use. Purified VvPS was conjugated to tetanus toxoid (TT) or to inactivated V. vulnificus cytolysin or elastase by two different schemes. All conjugates elicited elevated anticapsular immunoglobulin G (IgG) and IgM and antiprotein IgG responses in mice compared with saline placebo. The conjugates prepared through caboxyl activation of VvPS (VvPS-TTa, VvPS-cytolysin, and VvPS-elastase) were more immunogenic than the one prepared through hydroxyl activation (VvPS-TTb). The protective efficacy of conjugated and unconjugated formulations of VvPS and that of protein carriers were evaluated in a mouse septicemia model. Eighty percent of mice actively immunized with VvPS-TTa vaccine survived challenge with carbotype 1 V. vulnificus, while VvPS-cytolysin and VvPS-elastase conjugates conferred 44 and 40% protection, respectively. Control mice immunized with VvPS, cytolysin, or elastase alone, or saline only, showed 70 to 100% mortality. VvPS-TTa vaccine is nontoxic, immunogenic, and protective in mice.
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PMID:Capsular polysaccharide-protein conjugate vaccines of carbotype 1 Vibrio vulnificus: construction, immunogenicity, and protective efficacy in a murine model. 762 11

Reduced concentrations of glutamine (GLN) in plasma and skeletal muscle, defective host defense systems, and a diminished expression of the HLA-DR antigen on monocytes are important diagnostic parameters for late post-injury sepsis. In this in vitro study, we investigated whether blood monocyte-derived macrophage antigen expression and function from healthy donors is influenced by GLN. Lowering the GLN concentration in culture medium from 2 mmol/L to 200 mumol/L reduced the expression of HLA-DR by 40% (P < .001) on monocyte-derived macrophages, and decreased tetanus toxoid-induced antigen presentation. In addition, low GLN levels downregulated the expression of intercellular adhesion molecule-1 (ICAM-1/CD54), Fc receptor for IgG (Fc gamma RI/CD64), and complement receptors type 3 (CR3; CD11b/CD18) and type 4 (CR4; CD11c/CD18). A correlation was found between the phagocytosis of IgG-sensitized ox erythrocytes or opsonized Escherichia coli and the decreased expression of Fc gamma RI and CR3. Monocyte expression of CD14, CD71, and Fc gamma RIII/CD16 and capacity to phagocytose latex beads were not affected by altering the level of GLN. Depletion of GLN was associated with a significant reduction in cellular adenosine triphosphate (ATP), which may have influenced cell surface marker expression and phagocytosis. It remains to be seen whether these in vitro findings are of clinical significance in the treatment of sepsis.
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PMID:Influence of glutamine on the phenotype and function of human monocytes. 763 65

Antibody levels to the protein antigen tetanus toxoid (TTx) and the carbohydrate antigens pneumococcal capsular polysaccharides (PCP) were studied by enzyme immunoassay in 14 patients with acute lymphocytic leukemia (ALL) and 32 patients with acute non lymphocytic leukemia (ANLL) before and three weeks after initiation of chemotherapy. The antibody levels to TTx were significantly lower in ALL patients than in controls. This was associated with elevated levels of sCD8 (soluble CD8) in the serum of 12 out of the 14 ALL patients. Patients with ANLL had normal antibody levels before chemotherapy. After chemotherapy ANLL patients with septic complications had a reduced increase of antibody titers to TTx than patients without sepsis. The average antibody titers to PCP decreased in patients with sepsis, while they increased slightly in patients without sepsis. We conclude that in contrast to ANLL patients ALL patients have preexisting decreased antibody levels to thymus dependent protein antigens, while antibody levels to thymus independent carbohydrate antigens are normal in both types of leukemias.
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PMID:Impaired antibody levels to tetanus toxoid and pneumococcal polysaccharides in acute leukemias. 769 35

In February 1992 in Nigeria, pediatricians and community health workers interviewed parents living in 1263 households in the rural tropical rainforest community of Nko in Ugep Local Government Area of Cross River State to determine the pattern of infant and child mortality in a typical rural community and to examine family and social patterns which may influence child mortality. There were no records of birth and death in Nko. They identified 471 pediatric deaths (=or 15 year olds) that occurred during 1991. Children between 1 and 5 years old comprised the largest group of pediatric deaths (43.3%) followed by those older than 5 years (33.3%), 1-12 month old infants (18.1%), and newborns (5.1%). The leading causes of neonatal death were septicemia (37.5%), tetanus (20.8%), and birth asphyxia (20.8%). The leading causes of infant death included malaria (46.5%), protein energy malnutrition (PEM) (10.5%), pneumonia (10.5%), and diarrhea (10.5%). Among preschoolers (1-5 year olds), the major causes of death were malaria (35.8%), PEM (18.1%), and diarrhea (13.7%). Pneumonia (16.6%), malaria (15.3%), and tuberculosis (13.4%) were the chief causes of death among school-aged children. Among all 471 pediatric deaths, malaria was the leading cause of death. Pediatric deaths peaked in the months of March and August, periods of high malaria transmission during the transitional period from dry to wet season and from wet to dry season. Only 5% of the deceased children had adequate immunization coverage. 52.9% of the children were not treated in health facilities, as the nearest health facility was in the town of Ugep, 15 km away from Nko. Insufficient waste disposal, lack of potable water, and streams polluted with human wastes contribute to the diarrhea deaths. An open toilet system, bushes littered with domestic wastes, and no water drainage system are breeding grounds for mosquitoes. Overcrowding in the homes foster the spread of infections. Protein-poor root crops predominate, leading to PEM.
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PMID:Community-based surveillance of paediatric deaths in Cross River State, Nigeria. 785 18


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