[Nursing stories. The difficult choice].
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Attitude to Death↗
Biomedical subjects
M Jakobsen
Publications and source records attributed to M Jakobsen.
Significance of yeasts and moulds occurring in maize dough fermentation for 'kenkey' production.
Yeasts and moulds associated with the fermentation of maize dough during the processing of the West African traditional food 'kenkey' were investigated. A mixed flora comprising Candida, Saccharomyces, Trichosporon, Kluyveromyces and Debaryomyces species were isolated from raw maize, during steeping and early phases of fermentation. After 24-48 h of fermentation, Candida krusei and Saccharomyces cerevisiae dominated reaching counts exceeding 10(6) cfu/g. This succession of yeast populations and the significant multiplication of C. krusei and S. cerevisiae were observed in all cases for both the fermentation and the production sites investigated. Penicillium, Aspergillus and Fusarium species, including potential mycotoxin producers, were isolated from raw maize. Initial high counts of 10(5) cfu/g for moulds were reduced to less than 10(2)cfu/g within 24 h of fermentation. High levels of aflatoxins were observed in raw maize, and they were not affected during the fermentations.
Aflatoxins↗
Trials of Edmonston-Zagreb measles vaccine in Guinea-Bissau: serological responses following vaccination with Edmonston-Zagreb strain at 4-8 months versus vaccination with Schwarz strain at 9-12 months of age.
In two trials of measles vaccination in Guinea-Bissau, children were randomized to receive either the Edmonston-Zagreb (EZ) virus at age 4-8 months or, as a control group, a standard dose (5000 p.f.u.) of the Schwarz (SW) virus at 9-12 months. In the first trial a medium dose of EZ virus (40,000 p.f.u.) was used and in the later trial a high dose (150,000 p.f.u.). Pre- and postvaccination blood samples were analysed with a haemagglutination inhibition (HAI) test and an enzyme-linked immunosorbent assay (ELISA). For the ELISA the blood samples were collected on filter paper. Of 362 prevaccination specimens, 18 and 55%, respectively, were positive in the ELISA and HAI tests. At 18-20 months, the children who had received the EZ vaccine had a seropositivity of 91% by the ELISA method and one of 89% by the HAI method. The equivalent values for the SW group of children were 100 and 96% respectively. Antibody levels in the EZ group, as measured by either method, were significantly lower than the levels in the SW group. The serological results of the present study suggest that lowering the age at measles vaccination to below 9 months is feasible. However, further studies are needed to determine which virus strain, dosage and age at vaccination will prove to be optimal in countries where severe measles is common before the age of 9 months.
Antibodies, Viral↗
Long-term survival in trial of medium-titre Edmonston-Zagreb measles vaccine in Guinea-Bissau: five-year follow-up.
A trial of protective efficacy which compared medium-titre Edmonston-Zagreb (EZ) measles vaccine (10(4.6) p.f.u.) from the age of 4 months with the standard Schwarz (SW) measles vaccine given from the age of 9 months was started in an urban community in Guinea-Bissau in 1985. Because trials of high-titre measles vaccine have found increased mortality among female recipients, we examined whether EZ medium-titre vaccine was associated with any long-term impact on mortality, suppression of T-cells, or growth. The mortality rate ratio over 5 years of follow-up was 1.12 for EZ children compared with children in the standard group (P = 0.63). Seventy-five percent of the children still residing in the area at 5 years of age took part in an immunological and anthropometric examination. There was no difference in T-cell subsets between the two groups. There was no difference in mid-upper-arm circumference, but EZ children were significantly shorter than the children in the standard group. In conclusion, medium-titre EZ was not associated with reduced survival or persistent immunosuppression.
Age Factors↗
Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age.
OBJECTIVE: To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age. DESIGN: Children vaccinated in 1980-3 at 4-5, 6-8, and 9-11 months of age were followed to migration, death, or the age of 5 years. SETTING: One urban district and nine villages in two rural areas of Guinea-Bissau. SUBJECT: 307 children vaccinated at 4-8 months and 256 at 9-11 months. MAIN OUTCOME MEASURES: Mortality from 9 months to 5 years of age for children immunised at 4-5, 6-8, and 9-11 months. RESULTS: Mortality was significantly lower in children vaccinated at 6-8 months than at 9-11 months (mortality ratio = 0.63, (95% confidence interval 0.41 to 0.97), p = 0.047). As vaccination was provided in semiannual or annual campaigns it is unlikely that age at vaccination reflected a selection bias. The trend was the same in all three study areas. Improved survival after early immunisation was not related to better protection against measles infection. With a Cox multivariate regression model to adjust for age, sex, season at risk, season at birth, measles infection, and region, children vaccinated at 4-8 months had a mortality ratio of 0.61 (0.40 to 0.92, p = 0.020) compared with children vaccinated at 9-11 months. Reimmunised children tended to have lower mortality than children who received only one vaccine (0.59 (0.28 to 1.27, p = 0.176)). CONCLUSION: Standard measles vaccination before 9 months is not associated with higher childhood mortality than is the currently recommended strategy of immunising from 9 months, and it may reduce mortality. This has implications for measles immunisation strategy in developing countries.
Age Factors↗
Microbiological and aromatic characteristics of fermented maize doughs for kenkey production in Ghana.
A very uniform microflora was demonstrated in 15 samples of fermented maize dough from different larger commercial production sites. At the advanced stage of fermentation, more than 96% of the bacteria present were morphologically and biochemically uniform, obligatively heterofermentative lactobacilli occurring in concentrations about 10(9) cfu/g. Yeast occurred in levels of about 10(6) cfu/g, dominated by Candida and Saccharomyces spp. Studies on microbial successions indicated a selection towards a micropopulation dominated by lactic acid bacteria. The Gram-negative bacteria, catalase-positive Gram-positive bacteria and moulds underwent three to four decimal reductions during the early phase of the process. The aroma components detected were dominated by lactic acid, acetic, butyric and propionic acids. Volatile aroma components demonstrated by gas chromatography and mass spectrometry were characteristic for lactic acid bacteria with acetoin and related products as typical examples.
Bacteria↗
Flow cytometric detection of wild yeast in lager breweries.
A flow cytometric method for detection of wild yeast infections in breweries is reported. It is based on selective enrichment in Malt extract Yeast extract Glucose Peptone broth (MYGP) at 37 degrees C and in MYGP with 200 ppm CuSO4 at 25 degrees C, staining with a fluorochrome precursor and flow cytometry. In experiments with several types of wild yeast isolated from breweries and two different strains of lager yeast it has been possible to detect one wild yeast per 10(6) culture yeast after 48-72 h of incubation and, in some cases, after 24 h.
Beer↗
Long-term survival after Edmonston-Zagreb measles vaccination in Guinea-Bissau: increased female mortality rate.
In an urban area of Guinea-Bissau, 384 children were enrolled in a randomized trial comparing morbidity and mortality rates after receiving high-titer Edmonston-Zagreb (EZ) measles vaccine administered from 4 months of age, with a control group receiving inactivated poliomyelitis vaccine at 4 months of age and the standard Schwarz vaccine from 9 months of age. Children were followed to the age of at least 3 years. The mortality ratio of the EZ vaccinees compared with control subjects was 1.79 (range, 1.06 to 3.02; p = 0.027) if children were excluded at the time of migration; if deaths after migration were included, the mortality ratio was 1.53 (range, 0.94 to 2.49; p = 0.087). Girls in the EZ group had significantly higher mortality rates than girls in the control group (mortality ratio = 1.95; range, 1.07 to 3.56; p = 0.027); there was no difference for the boys (mortality ratio = 0.98; range, 0.41 to 2.30). Adjustment for background factors in a Cox regression model did not modify these estimates. Furthermore, female recipients of EZ vaccine had more days with diarrhea (relative risk = 1.35; range, 1.17 to 1.56; p = 0.00003) and were more likely than control subjects to visit a health center in the month after vaccination (relative risk = 1.86; range, 1.05 to 3.31; p = 0.027); those who consulted were more likely to die subsequently (mortality ratio = 2.31; range, 0.99 to 5.41; p = 0.054). These observations were unplanned and require confirmation in larger studies.
Cause of Death↗
Transcranial Doppler recordings in raised intracranial pressure.
The pulsatility index (PI) registered by the transcranial doppler (TCD) was examined in relation to arterial pCO2 (paCO2) and epidural pressure (ICP). In 10 normal subjects PI was studied during variations in paCO2. In 10 neurosurgical patients with head injuries concomitant measurements of PI and ICP were obtained. The results showed a negative exponential correlation between PI and paCO2. PI changes with 3.2% pr mmHg paCO2. A positive exponential correlation between PI and ICP was observed. PI changed with 2.4% pr mmHg ICP. In the subgroup of patients with raised ICP (15 mmHg <) paCO2 was found not to influence the PI-reflection of the ICP, probably because paCO2-changes affected PI as well as ICP. The results suggest that the noninvasive bedside TCD-registration may be a useful marker of the ICP and probably replace the former invasive methods of measuring ICP.
Adolescent↗
Role of initial brain ischemia in subarachnoid hemorrhage following aneurysm rupture. A pathophysiological survey.
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Aneurysm, Ruptured↗
Cerebral blood flow and metabolism following subarachnoid haemorrhage: effect of subarachnoid blood.
The amount of effused blood following a subarachnoid haemorrhage (SAH) was estimated in 48 patients by cerebral computerized tomographic scanning. The cerebral oxygen consumption (CMRO2) was calculated as arteriovenous difference for oxygen multiplied by mean cerebral blood flow measured by the 133-Xe inhalation technique. A significant negative correlation was observed between CMRO2 and amount of subarachnoid blood, with additional reduction in CMRO2 in case of ventricular bleeding. Cerebral blood flow on admission, opposed to CMRO2, showed no correlation to amount of blood on CT scan. A correlation was observed for blood flow measured at day 5 and further on, indicating a restored coupling between flow and metabolism. The clinical (Hunt) grade on admission and the outcome correlated to the amount of blood. These observations suggest that the acute reduction in CMRO2 following a SAH is mainly determined by the amount of blood escaping during the aneurysm rupture, and that the cerebral blood flow level a few days after SAH mainly is determined by the initial reduction in oxygen uptake.
Blood Flow Velocity↗
Relation between angiographic cerebral vasospasm and regional CBF in patients with SAH.
The relation between angiographically determined cerebral vasospasm following a subarachnoid hemorrhage and regional cerebral blood flow (CBF) was studied in 63 investigations of 45 patients. The CBF was measured using the intra-arterial 133-Xe clearance technique within one hour of angiography. A positive correlation between regional CBF and diameter of major supplying vessel was observed. However, in the 13 cases with focal vasospasm the reduction in CBF was global and not restricted to the area of the spastic vessel. The cerebral oxygen extraction was reduced but independent of the degree of vasospasm, speaking against vasospasm as the cause for the reduction in CBF. The observed association between reduction in CBF and vasospasms could be caused by a common factor responsible for development of both. Thus, it is proposed that the amount of blood escaping at time of aneurysm rupture determines 1) the amount of reduction in cerebral oxygen uptake and thereby the reduction in CBF and 2) the degree of vasospasm. If so a correlation, yet not causal, between reduction in CBF and degree of vasospasm, will be observed.
Cerebral Angiography↗
Spasm index in subarachnoid haemorrhage: consequences of vasospasm upon cerebral blood flow and oxygen extraction.
A spasm index, defined as transcranial Doppler detected flow velocity in the middle cerebral artery divided by regional cortical cerebral blood flow (CBF), was used on 24 patients with subarachnoid haemorrhage (SAH). The aim was to estimate degree and time course of vasospasm, even in cases with great day-to-day variation in CBF, and correlate to CBF and oxygen extraction. All patients showed increase in spasm indices with peak index in the second or third week. The index seemed stable in spite of day-to-day fluctuations in CBF. Severe vasospasm were associated with poor clinical condition, reduced CBF (less than 30) and high AVDO2. The same picture could be seen with minor degree of vasospasm, probably, in some cases, due to high intracranial pressure. The results suggest that the spasm index is useful in monitoring patients with subarachnoid haemorrhage, and that severe vasospasm has a negative influence on clinical condition, CBF and oxygen extraction.
Blood Flow Velocity↗
Cerebral blood flow and metabolism following subarachnoid haemorrhage: cerebral oxygen uptake and global blood flow during the acute period in patients with SAH.
Forty-eight patients with subarachnoid haemorrhage were studied with repeated rCBF and CMRO2 measurements. Cortical rCBF was measured using xenon-inhalation technique. CMRO2 was calculated as AVDO2 x CBF. When first studied the 29 conscious patients showed relative hyperaemia with CBF at 50 ml and reduced CMRO2 at 2.17 ml. In the following week CBF decreased to 41. CMRO2 remained reduced and constant. The 19 unconscious patients showed initially pronounced reduction in CMRO2 to 1.26, followed by gradual increase to 1.73 in 4-5 days. Simultaneously CBF increased from 18 ml to slightly above 30 ml. In the conscious patients the early reduction in CMRO2 and the concomitant luxury perfusion may be explained by global ischaemia because of very high ICP at the time of the haemorrhage. The reduced CBF in the unconscious group could be due to increased ICP, as ventricular drainage increased CBF to levels of relative hyperaemia as demonstrated in one case. As no decrease in CMRO2 was seen during the first 2 weeks, it is suggested that ischaemia at the time of aneurysm rupture is the most important single factor in reduction of global CMRO2.
Adult↗
Problems in cerebral blood flow calculation using xenon-133 in patients with pulmonary diseases.
We used the end-tidal concentration of xenon-133 (air curve) to estimate the profile of its arterial concentration in calculating cerebral blood flow. We examined the effects of pulmonary disease and artificial ventilation on the air curve and the calculated cerebral blood flow. We studied the relation between arterial and end-tidal xenon activities in 19 subjects, of whom 15 had pulmonary dysfunction. The t 1/2 of the declining phases of the arterial and air curves were used to express their shapes. The mean +/- SD reference t 1/2 from 15 normal volunteers was 26.8 +/- 8.4 seconds. The mean +/- SD t 1/2 s of the air and arterial curves from the 15 patients with pulmonary dysfunction were 10.4 +/- 2.9 and 33.8 +/- 10.9 seconds. The degree of pulmonary dysfunction (expressed as the pulmonary shunt percentage) correlated with distortion of the air curve. Substituting the arterial for the air curve, mean calculated cerebral blood flow (as the initial slope index) increased from 40 to 61 for the 12 patients with chronic obstructive pulmonary disease. The degree of underestimation of cerebral blood flow using the air curve correlated with the pulmonary shunt percentage. Our work confirms the problems of estimating cerebral blood flow in subjects with pulmonary dysfunction.
Adult↗
Retrograde catheterization of the right internal jugular vein for serial measurements of cerebral venous oxygen content.
Serial measurements of CBF and metabolism require multiple cerebral venous blood samples. Retrograde catheterization of the right internal jugular vein is easily performed at a point 2.5-3 cm lateral to, and 2 cm above, the medial end of the right clavicula. Complications are few and minor. In 1/80 (1.25%) cases the carotid artery was punctured during cannulation. Insertion of the catheter for 16-18 cm reduces contamination with extra-cerebral blood to a minimum.
Catheterization, Central Venous↗
Trial of high-dose Edmonston-Zagreb measles vaccine in Guinea-Bissau: protective efficacy.
In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.
Age Factors↗
Filament hygrometer for water activity measurement: interlaboratory evaluation.
A method is presented for measuring water activity (aw) of foods with a filament hygrometer. An interlaboratory evaluation carried out for the Nordic Committee on Food Analysis demonstrated that measurements can be made with a repeatability and reproducibility of 0.005 and 0.010 aw, respectively. The critical parameters of aw measurements are defined and discussed in relation to the accuracy and reproducibility required. The need for strictly standardized procedures for maintenance of the equipment, sample treatment, calibration, and measuring is emphasized.
Food Analysis↗