Q fever endocarditis associated with extensive serological cross-reactivity.
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Adult↗
Biomedical subjects
L Baden
Publications and source records attributed to L Baden.
Clinical problem-solving. Chest pain with a surprising course.
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Aged↗
Identification of sporadic mutations in the helix initiation motif of keratin 6 in two pachyonychia congenita patients: further evidence for a mutational hot spot.
Pachyonychia congenita (PC) is a rare, autosomal dominant, ectodermal dysplasia characterized most distinctly by the presence of symmetric nail hypertrophy. In the Jadassohn-Lewandowsky form, or PC-1, additional cutaneous manifestations may include palmoplantar hyperkeratosis, hyperhidrosis, follicular keratoses, and oral leukokeratosis. Mutations have previously been identified in the 1A helix initiation motif of either keratin 6 or keratin 16 in patients with PC-1. In the current study, we have identified 2 sporadic, heterozygous mutations in the 1A helix region of the K6 isoform (K6a). The first mutation identified was a 3 base pair deletion (K6adelta N171). The second mutation was a C-to-A transversion resulting in an amino acid substitution (K6a N171K). These data, in combination with previous reports, provide further evidence that this location is a mutational hot spot.
Amino Acid Sequence↗
Maternal immunization with Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine in The Gambia.
OBJECTIVE: To evaluate maternal responses to Haemophilus influenzae type b (Hib) polysaccharide-tetanus protein conjugate (polyribosylribitol phosphate-tetanus or PRP-T) given to pregnant Gambian women, the transplacental transfer of antibody, and the effect of maternal immunization on infant responses to the vaccine. DESIGN: An open, randomized immunogenicity study. SETTING: A busy urban health center in The Gambia. STUDY PARTICIPANTS: A total of 451 pregnant women enrolled during the third trimester of pregnancy. INTERVENTION: Study participants were randomized to three groups. In one group, mothers were given PRP-T during the third trimester and their infants were given PRP-T at 2, 3, and 4 months of age. In the second group, mothers received PRP-T and infants were given inactivated poliovirus vaccine. In the third group, mothers received meningococcal A and C vaccine, and their infants received PRP-T. MAIN OUTCOME MEASURES: Anti-PRP antibody measurements of maternal cord, and infant blood. RESULTS: Vaccinated women had a marked increase in total anti-PRP antibody (geometric mean titer 9.0 micrograms/mL), which was greatest in women in their first or second pregnancy. Previous tetanus vaccination during the same pregnancy and high concentrations of antitetanus antibody were associated with lower anti-PRP responses. In infants of PRP-T recipients, cord blood anti-PRP IgG concentrations were 61% of simultaneous maternal concentrations. In vaccinated infants of vaccinated mothers, geometric mean anti-PRP antibody concentrations at birth, 2 months of age, and 5 months of age were 1.92, 0.35 and 2.84 micrograms/mL, respectively, while in vaccinated infants of unvaccinated mothers, the corresponding concentrations were 0.29, 0.12, and 3.91 micrograms/mL. At 2 months of age, 60% of infants of vaccinated mothers and 26% of infants of unvaccinated mothers had anti-PRP antibody concentrations considered to be protective (>0.15 micrograms/mL). CONCLUSIONS: In areas where much invasive Hib disease occurs in infants younger than 6 months, maternal immunization may help to reduce the risk of Hib disease in infants too young for immunization.
Antibodies, Bacterial↗
Enterovirus 71 infections and neurologic disease--United States, 1977-1991.
Since first described in 1974, enterovirus 71 infections have been associated with severe neurologic disease, and widespread infection was suspected in 1987. To investigate enterovirus 71 activity further, data were reviewed for isolations reported nationally during 1977-1991, virology laboratories were contacted regarding isolations during 1985-1989, and medical records were reviewed for respective patients, 1985-1989. From 1977 to 1991, 193 culture-confirmed enterovirus 71 infections were identified: > or = 1 isolate each year. In 1987, 45 persons in 17 states were infected compared with a maximum of 22 persons in 1-8 states in the other years. Of these 45, 27 (60%) had the following: paralysis (6), Guillain-Barré syndrome (1), meningitis (18), or encephalitis (2). Enterovirus 71 has been endemic in the United States since at least 1977, was identified more frequently in 1987 than in other years, and continues to be an occasional cause of severe neurologic disease.
Adolescent↗
Delivery of primary care in hospital and community settings in Australia.
This study examined the interface between emergency departments and community general practice in terms of their delivery of primary care services. Through the collection of casemix and treatment data, and interviews with patients, information was gathered relating to the extent of primary care delivery in emergency departments, problems managed and treatments provided in the two settings and patients' characteristics and reasons for choosing to seek primary care in the emergency department. The results indicate a high proportion of primary care delivery is in emergency departments, and that there is a need for delivery in this setting to continue. The results are discussed in terms of such quality assurance issues as monitoring primary care in emergency departments and addressing patient needs.
Ambulatory Care↗
Neonatal lupus erythematosus and maternal lupus erythematosus mimicking HELLP syndrome.
A 4-month-old boy had a faint, confluent, macular erythema involving the forehead, nose, and philtrum, and matlike telangiectases over the forehead and eyelids. The clinical features, course, and laboratory studies were characteristic of neonatal lupus erythematosus. He was otherwise healthy and the product of a preterm twin pregnancy complicated by the development of maternal HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome. The patient had elevated Ro(SSA) and La(SSB) antibody titers, and studies performed on maternal blood disclosed positive antinuclear antibodies and elevated Ro and La antibody titers.
Adult↗
The relationship of the U wave to the 10-year incidence of myocardial infarction.
The relationship between the baseline electrocardiogram and 10-year incidence of myocardial infarction was examined in a cohort of 1013 men. The men were participants in the Normative Aging Study, a longitudinal study of aging initiated in 1963 at the Veterans Administration Outpatient Clinic in Boston, Massachusetts. Absence of the U wave among these men yielded a relative risk estimate of myocardial infarction of 2.7 as compared to men with a U wave present (95% confidence interval, 1.4-5.2). This association persisted when standard coronary risk factors (cholesterol, blood pressure, and cigarette smoking) were taken into consideration in a multivariate analysis. The results support the conclusion that an abnormality in the electrocardiogram considered to be of little importance indicates an increased risk of myocardial infarction independent of known coronary risk factors.
Adult↗
The effect of retirement on physical health.
This prospective study compared pre- to post-retirement changes in physical health among male retirees with changes among age peers who continued to work. The 229 retirees and 409 workers aged 55-73 at follow-up were all participants in the Veterans Administration Normative Aging Study. Physical health at baseline and follow-up (three to four years apart) was rated on a four-point scale according to the findings of medical examinations. Although physical health declined generally over time, regression analyses showed no significant difference between eventual retirees and continuing workers on health change, after controlling for age and excluding men who retired due to illness or disability. Among retirees alone, pre- to post-retirement health change was also not significantly associated with several circumstances which purportedly make the retirement transition more stressful, such as mandatory retirement or retirement to a reduced standard of living. The results of this study of physical health, which corroborate those of other studies based on self-reported health measures and mortality data, support the conclusion that the event of retirement does not influence the risk of health deterioration.
Aged↗
Comparison of stratum corneum and hair fibrous proteins.
The Tris-urea-mercaptoethanol (pH 9) soluble fibrous proteins of hair and stratum corneum have been compared in a number of animals. The 2 tissues show different urea (pH 8.3) and SDS polyacrylamide gel electrophoretic patterns and vary in amino acid composition. Cyanogen bromide cleavage was done on human stratum corneum and hair fibrous proteins and found to give different fragments by electrophoresis. Antibodies to stratum corneum protein did not react with hair protein and vice versa. Although the 2 types of fibrous proteins have the same helical structure as shown by x-ray diffraction analysis, their differences in composition may be important for specific interactions with other macromolecules.
Amino Acids↗
A stain for plucked anagen hairs.
Anagen and telogen plucked hairs may be difficult to distinguish based on their microscopic appearance. The root ends of plucked anagen hairs develop a red color when stained with 4-dimethylaminocinnamaldehyde, while those of plucked telogen hairs do not. This is the result of a reaction with citrulline-containing proteins in the internal root sheath. This histochemical stain provides a simple and accurate means of determining the telogen/anagen ratio in plucked hairs.
Aldehydes↗
Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center.
BACKGROUND: Antibiotic misuse is common and costly and may promote antibiotic resistance. We tested the efficacy of a targeted one-on-one educational program ("academic detailing") designed to improve the appropriateness of broad-spectrum antibiotic use. METHODS: A randomized controlled trial was conducted in a large US teaching hospital. During an 18-week study period, 17 general medical, oncology, and cardiology services either received academic detailing or did not. The intervention was prompted by an order for either levofloxacin or ceftazidime that led to a computer-based review of data for that patient. Orders for the 2 target antibiotics deemed unnecessary by a priori criteria were included in the study. The primary outcome examined was the number of days that unnecessary levofloxacin or ceftazidime was administered in intervention and control groups. RESULTS: Before the trial, intervention and control services had similar prescribing patterns for the target antibiotics; the drugs were used for similar indications throughout the study period. During the intervention, there was a reduction of 37% in days of unnecessary levofloxacin or ceftazidime use per 2-week interval on services randomized to the educational intervention vs control services (P< .001). In multivariable analyses controlling for baseline prescribing and study interval, the rate of unnecessary use of the 2 target antibiotics was reduced by 41% on the intervention services compared with controls (95% confidence interval, 44%-78%; P< .001). Length of stay, intensive care unit transfers, readmission rates, and in-hospital death rates were similar in both groups (P> or =.10 for all). CONCLUSION: Targeted one-on-one education is a practical, effective, and safe method for reducing excessive broad-spectrum antibiotic use.
Aged↗
Smoking status and the electrocardiogram: a cross-sectional and longitudinal study.
Previous cross-sectional studies have shown age trends in electrocardiographic wave patterns, including leftward shift in frontal plane axis and decreases in R, S, and T wave amplitudes with age. The effects of smoking on electrocardiographic measurements have also been examined. Findings of several studies vary and include possible smoking-induced changes in T wave amplitude and frontal plane axis measurements. To examine both cross-sectionally and longitudinally the effects of cigarette smoking on electrocardiographic measurements, serial recordings obtained 5 yr apart were taken from 702 healthy male participants of the Normative Aging Study, who were 23-74 yr of age at their first examination. These men were classified as current smokers (at both baseline and follow-up examinations, N = 291), former smokers (men who stopped smoking prior to the baseline examination, N = 203), or never smokers (at any time, N = 208). At baseline, P-R interval duration was shorter in current smokers than in former or never smokers. Longitudinal results indicated that R, S, and T wave amplitudes decreased at greater rates in smokers than in nonsmokers. These findings suggest that changes in the electrocardiogram attributed to aging may be modified by smoking.
Adult↗