Comparison of pneumococcal vaccination response in children with sickle cell disease: HbSS and HbSC.

INTRODUCTION: Sickle cell disease (SCD) children are at increased risk of invasive pneumococcal disease and rely on penicillin prophylaxis and vaccination for infection prevention. Post-vaccination antibody levels in SCD may wane overtime. HbSC are believed to have better immunological response than HbSS. OBJECTIVE: To compare antibody response to 23-valent pneumococcal polysaccharide vaccine (PPSV-23) between HbSS and HbSC. METHODS: Patients with HbSS (n=33) and HbSC (n=11), aged 7-18 years, were prospectively recruited. Luminex pneumococcal antibody levels were measured for 23-serotypes, after two PPSV-23 doses. RESULTS: Absolute median titer for 20 of the 23 serotypes was higher in HbSC than HbSS and significantly higher for serotypes 22 (3.9 vs. 1.6mcg/ml; p=0.039) and 43 (2.9 vs. 0.8mcg/ml; p=0.007). HbSC mounted a better immune anti-pneumococcal response compared to HbSS (≥1.3mcg/ml) for 18 of 23 serotypes, albeit not significant for any of the serotypes. More HbSC (64%) than HbSS (42%) were good vaccine responders (p=0.303). Two of 21 (10%) good vaccine responders and nine of 23 (39%) poor vaccine responders SCD participants subsequently developed acute chest syndrome or pneumonia (p=0.036). None of the HbSC patients developed ACS after receiving PPSV-23. HbSS poor vaccine responders were at increased future recurrence risk for ACS (p=0.003), pneumonia (p=0.036) or both (p=0.011), compared to good vaccine responders. CONCLUSION: HbSC possess better pneumococcal vaccine response than HbSS. Poor vaccine response is concerning for future acute pulmonary events. Current vaccination strategy for SCD sub-types are lacking, therefore further study to evaluate utility of vaccine boosters is necessary.

Comparison of pneumococcal vaccination response in children with sickle cell disease: HbSS and HbSC

Introduction: Sickle cell disease (SCD) children are at increased risk of invasive pneumococcal disease and rely on penicillin prophylaxis and vaccination for infection prevention. Post-vaccination antibody levels in SCD may wane overtime. HbSC are believed to have better immunological response than HbSS. Objective: To compare antibody response to 23-valent pneumococcal polysaccharide vaccine (PPSV-23) between HbSS and HbSC. Methods: Patients with HbSS (n = 33) and HbSC (n = 11), aged 7-18 years, were prospectively recruited. Luminex pneumococcal antibody levels were measured for 23-serotypes, after two PPSV-23 doses. Results: Absolute median titer for 20 of the 23 serotypes was higher in HbSC than HbSS and significantly higher for serotypes 22 (3.9 vs. 1.6mcg/ml; p=0.039) and 43 (2.9 vs. 0.8mcg/ml; p = 0.007). HbSC mounted a better immune anti-pneumococcal response compared to HbSS (≥ 1.3 mcg/ml) for 18 of 23 serotypes, albeit not significant for any of the serotypes. More HbSC (64%) than HbSS (42%) were good vaccine responders (p = 0.303). Two of 21 (10%) good vaccine responders and nine of 23 (39%) poor vaccine responders SCD participants subsequently developed acute chest syndrome or pneumonia (p = 0.036). None of the HbSC patients developed ACS after receiving PPSV-23. HbSS poor vaccine responders were at increased future recurrence risk for ACS (p = 0.003), pneumonia (p = 0.036) or both (p = 0.011), compared to good vaccine responders. Conclusion: HbSC possess better pneumococcal vaccine response than HbSS. Poor vaccine response is concerning for future acute pulmonary events. Current vaccination strategy for SCD sub-types are lacking, therefore further study to evaluate utility of vaccine boosters is necessary

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Haemolymph pressure regulation in Porcellio laevis Latr. (Porcellionidae, Isopoda).

Hydrostatic pressure in the haemocoele in Porcellio laevis adults ranges between 3.69 to 12.92 mm Hg (50 to 175 mm H2O). Mechanism involved in haemolymph pressure regulation includes characteristic contractions of intersegmental body musculature. The effects of temperature, humidity, decapitation, destruction of thoracic ganglion, and the injection of insect Ringer and eserine into the haemocoele on intersegmental muscular contractions were studied. The significance of these findings is discussed.

Effects of temperature, and dietary magnesium and nickel levels on magnesium and nickel concentrations during the moult-cycle in Oniscus asellus (Porcellionidae, Isopoda, Crustacea).

Mean magnesium concentrations in intermoult Oniscus asellus, caged at 20 degrees C for 10 days, ranged from 1,059.15 +/- 51.9 ppm on diets containing 10 ppm nickel, to 6,827.6 +/- 314.1 ppm on a mixture of 500 ppm magnesium + 10 ppm nickel. Mean nickel concentrations ranged from 89.4 +/- 4.3 ppm on diets containing 500 ppm magnesium, to 314.0 +/- 14.8 ppm on a mixture of 500 ppm magnesium + 10 ppm nickel. At 30 degrees C, magnesium tissue concentrations ranged from 4,149.8 +/- 153.5 ppm on diets with 10 ppm nickel to 12,602.6 +/- 529.3 ppm on 500 ppm magnesium. Nickel concentrations at 30 degrees C varied from 156.8 +/- 6.7 in isopods in the control to 490.5 +/- 23.5 ppm on those on 500 ppm magnesium + 10 ppm nickel. Magnesium in intermoult isopods was mainly stored in other tissues, including the exoskeleton, and nickel in the hepatopancreas. Differences in both magnesium and nickel concentrations between males and females were not significant. Magnesium and nickel concentrations in postmoult isopods, on the average, amounted to 367.6 +/- 16.5 ppm and 18.7 +/- 0.7 ppm, respectively, at 20 degrees C, and 369.9 +/- 16.3 ppm and 30.9 +/- 1.3 ppm, respectively, at 30 degrees C. Differences between males and females, and between various treatments were not significant at P greater than 0.01. It is suggested that both hepatopancreas and other tissues, including the exoskeleton, are used as sinks to get rid of excessive tissue magnesium and nickel during the moult-cycle.

The physical characteristics of the haemolymph in Porcellio spinicornis say (Porcellionidae, Isopoda).

Absolute haemolymph volume in Porcellio spinicornis, as determined by the 14C-dilution and the haemolymph sodium estimation techniques, ranged, on the average, from 8.1 microliter in the 6th growth--stage to 15.06 microliter in the 9th growth--stage. The mean haemolymph volume per cent for all growth--stages (6th-9th) amounted to 33.78. The haemolymph pH varied from 6.42 to 6.54, osmotic pressure from 221 to 256 mM NaCl equivalents and the specific gravity from 1.031 to 1.052.

Over-the-counter sympathomimetics: a risk factor for cardiac arrhythmias in pregnancy.

More than 170 over-the-counter (OTC) preparations contain a sympathomimetic agent as the active ingredient. Nonprescription medicines are consumed commonly in our society. Phenylpropanolamine, an alpha-adrenergic agonist as well as a popular decongestant, is consumed at a massive volume of 5 billion doses annually. Over-the-counter sympathomimetics have been reported to cause hypertension and arrhythmias. Despite the ability to cause these potentially serious adverse effects and the high-volume consumption of these agents, the medical literature until recently has been scant in reporting adverse events. We report symptomatic ventricular arrhythmia and presyncope in a 36-year-old pregnant woman who consumed relatively high doses of two OTC cold remedies simultaneously. Increased physician awareness of the potential side effects associated with OTC sympathomimetics as well as improved level of patient education are needed. Finally, we support the calls for more prominent warning labels on some selected OTC preparations, including OTC sympathomimetics.

The effect of magnetic field intensities on the oxygen consumption in Porcellio laevis latre (Oniscoidea, Isopoda).

The effects of the 5 gauss, 50 gauss and 500 gauss magnetic fields on the oxygen consumption in Porcellio laevis adults, at soil pH 3.8 and 7.0, were investigated in a series of laboratory experiments. The oxygen consumption was the highest at 5 gauss and pH 3.8, and lowest at 500 gauss and pH 7.0. Highest isopod mortality was recorded under all magnetic fields at pH 3.8, and lowest at pH 7.0. The significance of these findings is discussed.

Adaptation of enzymes to temperature: myofibrillar adenosine triphosphatase from two terrestrial isopod species.

A comparison of the temperature profiles of the myofibrillar ATPase in Porcellio spinicornis and Metoponorthus pruinosus showed that Porcellio enzyme had a maximum activity between pH 6.8-7.2 at 9 degrees C, and that from Metoponorthus between pH 7.0-7.4 at 45 degrees C. The energy of activation for Porcellio enzyme was estimated to be 2.964 kcal/mol and that for Metoponorthus enzyme 9.91 X 10(-1) kcal/mol. The significance of these findings in relation to the natural habitats of these two species is discussed.

Haemolymph characteristics of a copper-tolerant decapod Orconectes virilis (Hagen) (Astacidae, Crustacea).

The mean haemolymph volume in a copper-tolerant, intermoult (C2-C4) adult (more than a year old) Orconectes virilis, as determined by [14C-carboxylic] inulin dilution method, ranged from 61.17 microliters in females (mean wet body weight = 4.34 g; mean carapace length = 4.43 cm) to 61.79 microliters in males (mean wet weight = 5.73 g; mean carapace length = 4.49 cm). The mean haemolymph volume per cent varied from 14.5 (in females) to 31.1 (in males). Haemolymph from males had an average pH of 7.35, osmotic pressure of 414.1 mmol/kg H2O, and a specific gravity of 1.0603, while that from females averaged a pH of 7.48, osmotic pressure of 433.6 mmol/kg H2O and a specific gravity of 1.0469. Mean total haemocyte counts ranged from 3,434/mm3 (1,000/mm3 halinocytes, 1,125/mm3 hemi-granulocytes and 1,309/mm3 granulocytes) in males to 4,905/mm3 (1,525/mm3 halinocytes. 1,490/mm3 hemi-granulocytes and 1,890/mm3 granulocytes) in females.

The challenges of cardiac pacing: an illustrative case.

The history of transvenous pacing encompasses the past five decades. Multiple lead complications have been described, including problems related to central venous access, venous thrombosis, extravascular bleeding, lead and pacemaker pocket infections, lead fractures, lead dislodgment, lead perforation, diaphragmatic pacing, and chronic lead threshold changes. Potential solutions to these problems have included: improvements in lead composition and tip technology, multiple pacemaker lead and generator insertions, alternative lead sites, pacemaker lead extenders, extraction of infected leads, multiprogrammable pacemaker generators, high output generators, antibiotics and anticoagulants, and venous reconstruction. This case illustrates complications and solutions over a 20-year period. The indications for temporary transfemoral and permanent iliac vein transvenous pacing are reviewed, including a new indication for the iliac venous approach.

Electrocardiographic changes with right-sided pneumothorax.

Pneumothorax is a well-known complication of central line placement in the intensive care unit. Other causes include spontaneous pneumothorax, trauma, and infection. Most frequently, dyspnea or respiratory decompensation raises suspicion for pneumothorax, especially after central line placement. The diagnosis is confirmed by physical examination and chest radiography. We present five cases of right-sided pneumothorax in which electrocardiographic findings resolved with reexpansion of the lung. A new finding is reported in two cases.

A comparative study in Porcellio laevis (Lat.) and Armadillidium vulgare (Lat.): response to temperature, photoperiod and oxygen concentration.

Relationship of body weight, imposed fasting, temperature, light intensity, and oxygen concentration to oxygen consumption in Porcellio laevis and Armadillidium vulgare has been investigated in a series of laboratory experiments. It was observed that (1) the metabolic response in the two species to temperature change was a uniform increase of oxygen consumption with increasing temperature from 15 degrees C to 60 degrees C. Beyond 30 degrees C, the oxygen consumption in each species fell, and the thermal death point was reached at about 40 degrees C. (2) The response to decreasing oxygen concentrations was a corresponding decrease in oxygen consumption. Armadillidium vulgare was a partial regulator while Porcellio laevis was able to conform its internal state to the changing oxygen levels. (3) In each species there was a decrease in metabolic rate with increasing body weight. (4) On the basis of their general activity level and oxygen consumption rate, Porcellio appeared to be a nocturnal species, while Armadillidium had a day active metabolism.

The effect of magnesium and manganese uptake and accumulation on oxygen consumption and ammonia excretion in Porcellio spinicornis Say (Porcellionidae, Isopoda).

Mean concentrations of Mg and Mn in whole intermoult 7th growth-stage Porcellio spinicornis are positively correlated with dietary levels up to and including 1,000 ppm of these two trace metals. Lower tissue concentrations in isopods on 1,500 ppm diets are related to either a low food intake or a higher rate of metal excretion. Mean Mg concentration in whole isopods at the end of 7 days ranged from 27 388.26 +/- 598.56 micrograms/g dry tissue in the control to 69 122.08 +/- 31 682.98 micrograms/g dry tissue in the 1,000 ppm dietary group; in the 1,500 ppm dietary group, it amounted to 25 630.26 +/- 13 102.12 micrograms/g dry tissue. Mean Mn concentration varied from 85.53 +/- 11.23 micrograms/g dry tissue in the control to 229.05 +/- 32.33 micrograms/g dry tissue in 1,000 ppm dietary group; in the 1,500 ppm dietary group, it amounted to 199.57 +/- 18.99 micrograms/g dry tissue. Differences between the two sexes were significant at 5% level. Oxygen consumption was negatively and ammonia excretion was positively related to the dietary metal concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

A laboratory study of the copper and nickel uptake and regulation in a copper-tolerant decapod, Cambarus bartoni (Fabricius) (Decapoda, Crustacea).

Tissue copper concentration in whole Cambarus bartoni, exposed for four weeks to 0.125, 0.25 and 0.5 mg Cu/litre and 0.2, 0.4 and 0.8 mg Ni/litre in the laboratory at 18 degrees C, showed a linear relationship with exposure time at 0.25 and 0.5 mg Cu/litre; the regression slope at 0.5 mg Cu/litre (r2 = 0.218; 0.001 less than P less than or equal to 0.05) was approximately two times higher than that at 0.25 mg Cu/litre (r2 = 0.148; 0.025 less than P less than or equal to 0.05). Regression analysis of nickel concentrations in whole crayfish as a function of exposure time showed a third degree polynomial relationship at 0.4 (y = 49.989 + 14.77x - 15.395x2 + 3.194x3) and 0.8 (y = 52.053 + 37.05x - 28.933x2 + 5.133x3) mg Ni/litre, as well as in the control (y = 49.126 + 27.253x - 23.468x2 + 4.168x3) (y = Ni concentration; x = exposure time in weeks), suggesting the occurrence of a Ni flux every 4 weeks.

Magnesium and manganese uptake, accumulation and regulation by a terrestrial isopod, Porcellio spinicornis Say (Porcellionidae, isopoda, Crustacea).

Highest Mg concentration in whole intermoult, 7th growth-stage Porcellio spinicornis, exposed for 7 days to various Mg [367.39 ppb (carrot powder-control), 217.6 ppb (apple powder-control), 100, 150, 500, and 1000 ppm Mg, as well as two mixtures containing 500 ppm Mn + 150 ppm Mg and 500 ppm Mg + 500 ppm Mn)], and Mn concentrations [97.9 ppb (carrot powder-control), 2.0 ppb (apple powder-control), 100, 150, 500 and 1000 ppm)], was observed in males feeding on 500 ppm Mn + 150 ppm Mg, and lowest in females on 500 ppm dietary Mg. Highest tissue Mn concentration, on the other hand, was observed in males exposed to 1000 ppm dietary Mn, and lowest in females on 500 ppm Mg. Approximately 42% of the total tissue Mg was present in hepatopancreas and the remaining in other body tissues, including exoskeleton. In contrast, 78.55% Mn was stored in hepatopancreas and 21.4% in remaining body tissues. Differences between hepatopancreatic Mg levels were not significant between the two sexes, but differences in Mn levels between males and females were significant at P less than 0.01.(ABSTRACT TRUNCATED AT 250 WORDS)

The energy budget of Porcellio spinicornis Say (Porcellionidae, Isopoda) under laboratory conditions.

The rate of energy flow in Porcellio spinicornis was investigated in a select group of a laboratory population. The consumption, assimilation and production were calculated to be 1 233, 1 002 and 304 cal/year, respectively, in the male, and 1 261, 1 198 and 429 cal/year, respectively, in the female. Ignoring loss due to mortality, and applying the population density of 2 295 m2 in the laboratory colony, the isopod population should consume 2 861.8 kcal m-2 year-1, resulting in an assimilation of 2 524.5 kcal m-2 year-1 and a total productivity of 841.1 kcal m-2 year-1.

Subtotal colectomy in a patient with collagenous colitis associated with colonic carcinoma and systemic lupus erythematosus.

A case of colonic carcinoma is described in a 60-yr-old woman with the typical clinical and histopathologic features of collagenous colitis and systemic lupus erythematosus, who is doing well 24 months after undergoing a subtotal colectomy with Brooke ileostomy. Collagenous colitis has only rarely been previously reported in association with colonic carcinoma (n = 1 case) or systemic lupus erythematosus (n = 1 case). In addition, this case is the second report of symptomatic collagenous colitis refractory to medical therapy, treated successfully with surgery.