Biomedical subjects
I Lind
Publications and source records attributed to I Lind.
STDS in women attending family planning clinics: a case study in Addis Ababa.
For cultural reasons modern contraception has been slow to gain acceptance in Ethiopia. Knowledge about contraception and abortion is still limited in many family and community settings in which it is socially disapproved. By 1990 only 4% of Ethiopian females aged 15-49 used contraception. Little is known of sexually transmitted disease (STD) prevalence in family planning (FP) attenders in Africa in general and Ethiopia in particular, even though attenders of family planning clinics (FPCs) are appropriate target groups for epidemiological studies and control programmes. A study of 2111 women of whom 542 (25.7%) attended FPCs in Addis Ababa showed utilisation rates to be highest in women who were: Tigre (33%) or Amhara (31%), aged 20-34 years (30%), age 16 or older at first marriage/coitus (28%:38% in those first married after 25 years); who had a monthly family income of 10 Ethiopian Birr (EB) or more (33%:36% for those with income 100-500 EB), three or more children (37%), more than five lifetime husbands/sexual partners (39%); or were bargirls (73%) or prostitutes (43%). The seroprevalence rates for all STDs, higher in FPC attenders compared with other women, were syphilis (TPHA) 39%, Neisseria gonorrhoeae 66%, genital chlamydia 64%, HSV-2 41%, HBV 40% and Haemophilus ducreyi 20%. Only 4% of FPC attenders had no serological evidence of STD: 64% were seropositive for 3 or more different STD. Clinical evidence of pelvic inflammatory disease (PID) was also more common in the FPC attenders (54%), 37% having evidence of salpingitis. The FPC provides a favourable setting for screening women likely to have high seroprevalence of STD, who for lack of symptoms will not attend either an STD clinic nor a hospital for routine check up. We recommend that measures be taken to adequately screen, treat and educate FPC attenders, their partners, and as appropriate and when possible their clients, in an attempt to control STDs and ultimately HIV in the community. Social, economic and cultural factors in the occurrence of STDs, prostitution, family planning and modern contraception coverage in Ethiopia are identified and deficiencies of current programmes briefly discussed with the objective of targeting services more effectively.
Antimicrobial resistance in Neisseria gonorrhoeae.
The changing patterns of antimicrobial resistance in Neisseria gonorrhoeae have been reviewed regularly since the introduction of antimicrobial therapy in the 1930s. At present, ceftriaxone, fluoroquinolones, and spectinomycin have remained efficient as single-dose treatment of gonorrhea worldwide. To ensure that limited resources can be used in the best possible way, continuous surveillance of gonococcal resistance to antimicrobials is needed.
Measurement of antibodies against meningococcal capsular polysaccharides B and C in enzyme-linked immunosorbent assays: towards an improved surveillance of meningococcal disease.
In order to improve the surveillance of serogroup B and C meningococcal diseases, enzyme-linked immunosorbent assays (ELISAs) specific for anti-B immunoglobulin M (IgM) and anti-C IgM and IgG antibodies were developed. The tests were evaluated by using paired sera from 122 patients with and 101 patients without laboratory evidence of meningococcal disease. Fifty-three of 67 patients (79%) with culture-confirmed serogroup B disease had an anti-B IgM antibody response; anti-B IgM levels waned rapidly in children < or = 4 years of age. Twenty-four of 25 patients (96%) with culture-confirmed serogroup C disease had an anti-C IgM and/or IgG antibody response (IgM, 92%; IgG, 68%). In patients without evidence of meningococcal disease, 19% of children < or = 4 years of age and 69% of those > 4 years of age had intermediate anti-B IgM titers. In contrast, only 1 and 5% of these patients had intermediate titers of anti-C IgM and anti-C IgG, respectively. The ELISAs were shown to be powerful tools for discriminating between serogroup B and C diseases in 96 to 100% of culture-confirmed cases. For 90% of patients with culture-negative meningococcal disease, a serogroup-specific diagnosis could be established by examination of paired sera in the ELISAs. As serogroup B and C meningococci account for practically all cases of meningococcal disease in industrialized countries, the availability of these tests may improve surveillance and prevention.
Usefulness of the DNA-fingerprinting pattern and the multilocus enzyme electrophoresis profile in the assessment of outbreaks of meningococcal disease.
The objective of the study was to assess whether genotypic characterization by means of DNA-fingerprinting pattern (DFP) and multilocus enzyme electrophoresis (MEE) profile as compared to phenotypic characterization would improve the differentiation of Neisseria meningitidis strains associated with outbreaks from strains associated with sporadic cases of meningococcal disease. In addition, the differentiation of serogroup C carrier strains from those associated with an outbreak of serogroup C meningococcal disease was investigated. A total of 118 N. meningitidis strains were available for the study: 59 from patients involved in outbreaks of meningococcal disease (2 serogroup B and 2 serogroup C), 37 patients considered to be sporadic cases and 22 serogroup C carrier strains. Among the 59 strains from patients involved in outbreaks the 4 strains isolated from the patient registered as the first in each outbreak were designated the index strains. Among the remaining 55 outbreak strains 52 were either DFP-identical or DFP-indistinguishable when compared with the one relevant out of the 4 index strains. This was only the case for 17 of the 37 strains isolated from sporadic cases caused by the same serogroup of meningococci during the outbreak periods, and 5 of the 22 meningococcal strains isolated from healthy carriers. Among the 56 (52 + 4) DFP-identical or DFP-indistinguishable outbreak strains 5 different electrophoretic types were identified by MEE. Among 59 assumed outbreak strains a total of 4 were identified as genotypically distinct. Among the 37 mainly DFP-indistinguishable or DFP-different strains from sporadic cases 17 different ETs were identified, and among the 22 mainly DFP-different carrier strains 13 different ETs were identified. Two strains among those selected from sporadic cases were identical to the outbreak strain. None of the local serogroup C carrier strains isolated during the outbreak of serogroup C disease were identical to the outbreak strain. Both DNA-fingerprinting and MEE improved the differentiation of meningococci when compared with phenotypic characterization. The results indicate that tracing a virulent strain within a open group of contacts is irrelevant.
Gonorrhoea.
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[Outbreak of serogroup C meningococcal disease among teenagers in Randers--preventive measures and examination of the meningococcal carrier conditions].
An outbreak involving 20 cases of serogroup C meningococcal disease, predominantly among teenagers, occurred over a seven-month period in the Randers area of Denmark. The cases were caused by a serogroup C:2a:P1.2 sulphonamide-resistant strain. The available evidence was against the transmission being related to particular schools. The outbreak was experienced as three clusters. At two schools involved in the first and the third cluster of the outbreak, 351 students were examined regarding pharyngeal carriage of meningococci, 282 of whom were tested again 17 weeks later; 308 students attending two similar schools in a nearby area were examined once. The majority of strains isolated from group C carriers in the high-risk area were serologically indistinguishable from the outbreak strain (13/14 = 95%), but less often sulphonamide-resistant (5/13 = 38%). In both areas, the overall carrier rate (30%), the overall group C rate (3%) and, the carrier rate for the outbreak strain (1%) were the same. The attack rate for the outbreak strain differed significantly: 1/40 in the high-risk area versus 1/2.500 in the normal risk area. No conditions that might explain this difference were revealed. Immediately after recognition of the first and the third cluster, 780 and 13,300 students, respectively, were vaccinated with meningococcal polysaccharide vaccine A+C. It was concluded that the definition of target groups for vaccination should be liberal, because the "at risk" population may be difficult to recognize at the onset of an outbreak.
Neisseria gonorrhoeae IgA1 proteases share epitopes recognized by neutralizing antibodies.
The antigenic diversity among IgA1 proteases of 61 Neisseria gonorrhoeae strains isolated during a period of 23 years and on four continents was examined in enzyme neutralization assays employing rabbit antisera raised against selected IgA1 proteases. The antigenic analyses were compared with results of iga gene-region RFLP patterns and enzyme cleavage specificity for substrate IgA1. Type 1 IgA1 proteases were antigenically uniform while six different antigenic types were detected among type 2 enzymes. Extensive cross-reactions of antibodies against the different antigenic types suggested only minor differences in relevant epitopes. Epitopes previously found to be common to all Neisseria meningitidis IgA1 proteases were also shared by all N. gonorrhoeae IgA1 proteases in the collection. Human sera from patients with gonorrhoea showed broadly cross-reactive neutralizing activity at titers comparable to those of sera from immunized rabbits. In conclusion, N. gonorrhoeae IgA1 proteases show a remarkable lack of diversity of epitopes recognized by enzyme-neutralizing antibodies. If future studies confirm that cleavage of IgA1 is an important step in gonococcal infections, Neisseria IgA1 proteases may be attractive vaccine candidates.
Serotypes and subtypes of Neisseria meningitidis: results of an international study comparing sensitivities and specificities of monoclonal antibodies.
An international study supported by the World Health Organization comparing monoclonal antibodies for serotyping and serosubtyping of Neisseria meningitidis strains was performed and the results were assessed in 1992. A collection of 6 serotype-specific (1, 2a, 2b, 4, 14, and 15) and 12 serosubtype-specific (P1.1, P1.2, P1.4, P1.5, P1.6, P1.7, P1.9, P1.10, P1.12, P1.14, P1.15, and P1.16) monoclonal antibodies was provided to 11 participating laboratories throughout the world. Monoclonal antibodies were tested on 85 Neisseria meningitidis strains with known reference results. Whole-cell enzyme-linked immunosorbent assay was used for analysis in 10 of 11 laboratories. The sensitivities and specificities of individual serotype- and subtype-specific monoclonal antibodies were evaluated. Differences in individual laboratories and with individual monoclonal antibodies were assessed. Relatively large differences in sensitivities were achieved in individual laboratories. On the contrary, the specificities remained at high levels in all laboratories. The sensitivities of serotype-specific monoclonal antibodies ranged from 72.0 to 100%. Individual serosubtype-specific monoclonal antibodies showed sensitivities ranging from 64.1 to 98.1%. The most frequent reason for the incorrect results obtained with the monoclonal antibodies were false-negative results. The collaborative study demonstrated that some monoclonal antibodies are not very sensitive. Another study to define the most suitable monoclonal antibodies is planned.
[Relation between cervical conization, microbial colonization and threatening preterm labor].
UNLABELLED: The relationship between prior cervical conization, the cervical microbial colonization and threatening preterm delivery was investigated in 35 women with preterm premature rupture of the membranes (PPROM), 38 women with idiopathic preterm labor and 75 normal pregnant women at 26-34 weeks of gestation. Prior cervical conization occurred with a significantly higher frequency in PPROM patients than in patients with preterm labor (p < 0.01) and normal pregnant women (p < 0.001). The prevalence of lactobacilli was lower in patients with PPROM than in patients with preterm labor (p < 0.05) and control patients (p = 0.05)--and lower in patients with prior cervical conization than in patients without prior conization (p < 0.05). All other microorganisms occurred with the same frequencies in all groups. CONCLUSIONS: Prior conization was associated with PPROM. Women with prior conization and women with PPROM had a reduced prevalence of lactobacilli in the cervix. The "absence" of lactobacilli may indicate changes in the cervical microflora, which could be of importance for PPROM.
Characterization of Neisseria meningitidis isolates and clinical features of meningococcal conjunctivitis in ten patients.
Cases of meningococcal conjunctivitis occurring in Denmark in the period 1982-1991 were reviewed. In a survey of laboratory reports, ten cases were identified. The meningococcal strains were characterized by serological grouping, typing and subtyping, and by antimicrobial susceptibility testing. Five cases were caused by serogroup B meningococci (B:15:P1.16, B:15:P1.6, B:4:P1.15) and five cases by serogroup C meningococci (C:2a:P1.2 (4 strains), C:14:NST). The median age of the patients was 12.5 months (range 7 days to 9 years). Signs of conjunctivitis were predominant; in addition, five of the patients had fever and general malaise. In one patient the same strain was recovered from blood and eye secretions. None of the patients had signs of meningitis. All meningococcal strains isolated from patients with meningococcal conjunctivitis were assumed to be virulent and had the same characteristics as strains causing meningococcal disease in Denmark within the same period.
Combined influence of quartz dust, ozone and NO2 on chemotactic mobility, release of chemotactic factors and other cytokines by macrophages in vitro.
In this study the single as well as combined effects of quartz, ozone and nitrogen dioxide (NO2) on some immunofunctions of bovine alveolar macrophages (BAM) were investigated. After incubation with 10 micrograms/ml of particles the chemotactic response of BAM is increased nonspecifically, whereas after incubation with 100 micrograms/ml of quartz chemotaxis is specifically decreased. In addition, quartz induces tumor necrosis factor alpha (TNF-alpha) and chemokines to be released dependent on the concentration. Ozone by itself is also a very potent inducer of the release of chemokines and TNF-alpha, but in combination with ozone, quartz has not more than an additive effect. NO2 alone suppresses drastically the release of TNF-alpha. The results show that quartz, ozone and NO2 alter some immunofunctions of BAM and that by combining toxic particles such as quartz with these gases, additive but not synergistic effects might be expected.
Effect of preheating on potato texture.
Preheating potatoes at 50 to 80 degrees C has a firming effect on the cooked potato tissue. This effect is particularly pronounced at a preheating temperature of 60 to 70 degrees C followed by cooling. Several theories have been presented in the literature to explain this firming effect: retrogradation of starch, leaching of amylose, stabilization of the middle lamellae and cell walls by the activation of the pectin methylesterase (PME) enzyme, and by the release of calcium from gelatinized starch and the formation of calcium bridges between pectin molecules. Most probably, none of these theories alone can explain the phenomenon and more than one mechanism seems to be involved. Some of these mechanisms seem to be interdependent. As an example, calcium could be considered as a link all the way through release after starch gelatinization to cross-linking pectin substances in the cell wall and the middle lamellae, which has been demethylated by the PME enzyme. More research and "clear cut" experiments are needed in order to elucidate the role of each mechanism, especially which of them is the main contributor to the process of firming. Most probably, the calcium-pectin-PME mechanism plays a secondary role, that is, it only retards the collapse of the tissue structure that would otherwise occur during the final heating without preheating, and it is not the main factor of firmness.
Pharyngeal carriage of Neisseria meningitidis before and after treatment of meningococcal disease.
The aim of the study was to determine whether patients with meningococcal disease carry meningococci in the throat both before and after treatment for the disease. During the 7 months of the study 106 patients with confirmed meningococcal disease were admitted to Danish hospitals, of whom 77 (73%) had a throat swab examined at least once and were included in the study. Sixty-two patients were examined on admission and 52 were examined on discharge; 37 were examined on both occasions. On admission, meningococci were isolated from 18 (49%) of 37 throat specimens examined selectively for pathogenic Neisseria spp. Meningococci were not isolated from any throat specimen taken on discharge from hospital; 47 (90%) of 52 of these specimens had been examined adequately. From an observed carriage rate of 0 out of 47 it can be judged that the carrier rate does not exceed 6.4% (95% confidence limit). From these results we conclude that it is unlikely that patients who have been treated for meningococcal disease according to the regimens used in Denmark can be the source of infection for secondary cases.
Uro-genital microbial colonization and threatening preterm delivery.
OBJECTIVE: To examine whether there is a relationship between the uro-genital microbial colonization and threatening preterm delivery. STUDY DESIGN: The microflora in the urine and endocervix was studied in 43 women with preterm labor, 45 women with preterm premature rupture of the membranes (PPROM) and 80 normal pregnant women at 26-34 weeks of gestation. Amniotic fluid was examined in 20 of the patients with preterm labor. Data were analyzed by Fisher's exact test (two-tailed). RESULTS: The microflora in the urine was not significantly different in patients with preterm labor, PPROM and normal pregnant women. Compared with normal pregnant women, patients with preterm labor had significantly lower prevalences of corynebacteria (p < 0.05) and coagulase-negative staphylococci (p < 0.01) in the cervix, while patients with PPROM had significantly lower prevalences of lactobacilli (p < 0.05) and coagulase-negative staphylococci (p < 0.05) in the cervix. Positive amniotic fluid cultures were detected in three of the 20 patients with preterm labor who underwent transabdominal amniocentesis. Evidence of ascending colonization was found in two of these cases. CONCLUSIONS: The microbial colonization of the urine was not associated with threatening preterm delivery. Reduced prevalences of lactobacilli, corynebacteria and coagulase-negative staphylococci in the cervix were associated with threatening preterm delivery.
[Meningococcal disease 1987-1989. Outbreak of serogroup B:15:P1.16 in the county of Frederiksborg].
Epidemiological features of an outbreak of group B:15:P1.16 meningococcal disease in Frederiksborg County 1987-1989 were investigated. The study comprised 149 cases notified during the outbreak and the two preceding years. One hundred and fifteen were confirmed by the isolation of Neisseria meningitidis. In 1989 the incidence had increased to 14.1 per 100,000 population. Among group B strains, B:15:P1.16. accounted for 80%. The overall mortality rate was 10%. Regarding cases due to group B:15:P1.16 strains, a significant time-space clustering was demonstrated, occurring exclusively within the 10-19 year-old group. The prophylactic measures used included administration of rifampicin to household contacts. During the outbreak the proportion of secondary cases was high (six to fifteen percent). All secondary cases occurred outside the household, indicating that the household had been protected.
Comparative studies on pharyngeal carriage of Neisseria meningitidis during a localized outbreak of serogroup C meningococcal disease.
An outbreak involving 20 cases of serogroup C meningococcal disease, predominantly among teenagers, occurred over a 7-month period in the Randers area of Denmark. The cases were caused by serogroup C:2a:P1.2 sulphonamide-resistant strains. The available evidence was against the transmission being related to particular schools. The outbreak was experienced as 3 clusters. At 2 schools involved in the first and the third cluster of the outbreak, 351 students were examined regarding pharyngeal carriage of meningococci, 282 of whom were tested again 17 weeks later; 308 students attending two similar schools in a nearby area were examined once. The majority of strains isolated from group C carriers in the high-risk area were serologically indistinguishable from the outbreak strain (13/14 = 95%), but less often sulphonamide-resistant (5/13 = 38%). In both areas, the overall rate (30%), the overall group C rate (3%), the carrier rate for the outbreak strain (1%) were the same. The attack rate for the outbreak strain differed significantly: 1/40 in the high-risk area versus 1/2,500 in the normal risk area. No conditions that might explain this difference were revealed. Immediately after recognition of the first and the third cluster, 780 and 13,300 students, respectively, were vaccinated with meningococcal polysaccharide vaccine A+C. It was concluded that the definition of target groups for vaccination should be liberal, because the "at risk" population may be difficult to recognize at the onset of an outbreak.
The relationship between prior cervical conization, cervical microbial colonization and preterm premature rupture of the membranes.
The occurrence of prior cervical conization and the cervical microbial colonization was investigated in 38 women with idiopathic preterm labor, 35 women with preterm premature rupture of the membranes (PPROM) and 75 normal pregnant women at 26-34 weeks of gestation. Data were analyzed by Fisher's exact test (two-tailed). The frequency of prior cervical conization was significantly higher in PPROM patients compared to normal pregnant women (P < 0.001) and to patients in preterm labor (P < 0.01). Lactobacilli occurred with a lower frequency in patients with PPROM compared to patients in preterm labor (P < 0.05) and control patients (P = 0.0543)-and with a lower frequency in patients with prior cervical conization (P < 0.05). All other microorganisms occurred with the same frequencies in all groups. The absence of lactobacilli may indicate changes in the cervical flora, which could increase the risk of PPROM. Prior cervical conization may impair the antimicrobial defense-mechanisms in the cervix, which could facilitate ascending microbial colonization. This may lead to a release of prostaglandins and proteolytic enzymes and subsequently preterm labor and rupture of the membranes.