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. However, the risk appeared to be limited to ghee made in the home from cow's milk. The tool used to cut the umbilical cord was again refuted to be a risk factor; application of topical antibiotics conferred significant protection. Multivariate analysis of the matched data showed that delivery by persons with academic training (physicians, nurses, and lady health visitors) was also protective. Mothers with a past history of NNT babies were shown to have a significantly increased risk, and accounted for more than one-third of all cases in the present study. The findings suggest possible ways to augment the effectiveness of NNT elimination programmes.

PIP: A hospital-based case-control study was conducted to further examine the risk factors for neonatal tetanus (NNT) in the Northwest Frontier Province of Pakistan. 3 control infants were concurrently evaluated for each of 102 consecutively diagnosed NNT cases hospitalized for over an 8-week period. Application for clarified butter (ghee) during the 1st few days of life was seen as a significant risk factor, confirming the previously reported finding of the authors. However, the risk appeared to be limited to ghee made in the home from cow's milk. The tool used to cut the umbilical cord was again refuted to be a risk factor; application of topical antibiotics conferred significant protection. Multivariate analysis of the matched data showed that delivery by persons with academic training (physicians, nurses, and lady health visitors) was also protective. Mothers who had a past history of NNT babies were shown to have a significantly increased risk and accounted for more than 1/3 of all cases in the present study. The findings suggest possible ways to augment the effectiveness of NNT elimination programs. (author's)

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. New prevention opportunities deriving from the finding should be pursued aggressively while efforts to develop effective delivery systems to immunise mothers against tetanus continue, a task made difficult by sociocultural factors.

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%).

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. At least 90% of incorporated, nondialyzable [14C] is situated in the gamma-carboxyl group of gamma-carboxyglutamic acid residues.

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. The amino acid compositions of the elastins purified by different methods were compared for purity and for the detection of possible damage to cross-linking compounds. Cross-linking profiles were obtained by column chromatography either after reduction with 3[H]NaBH4 or after reaction with 14[C]NaCN and NH3. The 3[H]NaBH4 method, under carefully controlled conditions, proved not to be quantitatively reproducible. The reaction of elastin with 14[C]NaCN and NH3 appeared preferable due to its reproducibility; this procedure required one type of hydrolysis for the analysis of all the cross-linking compounds. Examination of the cross-linking profiles of the elastins from various tissue regions revealed differences in the type, distribution, and quality of cross-links.