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Biomedical subjects

D Goldblatt

Publications and source records attributed to D Goldblatt.

At least 55 records · Page 3Linked to original sources
PubMed1998

Hospital admissions in children due to pneumococcal pneumonia in England.

Hospital records of 116 children under 5 years of age discharged from 11 hospitals in three regions in England with a diagnosis of lobar (pneumococcal) pneumonia were reviewed to estimate the proportion likely to be attributable to infection with Streptococcus pneumoniae. Of these, 100 (86%) had lobar/focal changes on chest X-ray consistent with pneumococcal infection, although only one (1%) had pneumococcus isolated from blood. However, a further 89 (89%) with a lobar/focal picture were considered to be likely or possibly due to pneumococcal infection on the basis of the white cell count, level of C-reactive protein, isolation of the S. pneumoniae from either sputum or nasopharingeal aspirate and failure to identify another responsible pathogen. Of 135 cases with a discharge diagnosis of bronchopneumonia or pneumonia (organism unspecified), two (1%) had S. pneumoniae isolated from blood and a further 95 (70%) had clinical or laboratory features consistent with pneumococcal infection or S. pneumoniae isolated from either sputum or nasopharyngeal aspirate. With the imminent availability of conjugate pneumococcal vaccines, there is a need for improved diagnostic methods for identifying the pathogens responsible for community-acquired pneumonia in young children.

Age Distribution↗
PubMed1998

Antibody avidity as a surrogate marker of successful priming by Haemophilus influenzae type b conjugate vaccines following infant immunization.

Evaluation of the new generation of conjugate vaccines is hampered by the absence of reliable surrogate markers of immunologic memory. Memory responses are characterized by rapid production of relatively high-avidity antibody; thus, a solid-phase ELISA was adapted for the measurement of anti-Haemophilus influenzae type b (Hib) IgG avidity. In a cohort of infants vaccinated at 2, 3, and 4 months of age with Hib conjugate vaccines, avidity increased in the period following vaccination, while antibody titer fell. After a booster dose at 1 year of age, both antibody titer and avidity increased. In a cohort with anti-Hib IgG <1.0 microg/mL following primary immunization, antibody avidity after booster was low, indicating an absence of priming. Antibody avidity may help distinguish, in persons with low antibody titers, between those who are primed for memory and those who are not.

Antibodies, Bacterial↗
PubMed1998

Recent developments in bacterial conjugate vaccines.

Study of the epidemiology of childhood infection reveals that the brunt of disease for a number of invasive bacterial infections is borne by children under the age of 4 years. Haemophilus influenzae type b (Hib), Neisseria meningitidis and Streptococcus pneumoniae, the three most important causes of childhood meningitis, illustrate this phenomenon, which is caused by the inability of infants and young children to mount antibodies to the carbohydrates that form a capsule surrounding these organisms. Carbohydrates are traditionally viewed as T-independent antigens with a number of unique and important immunological properties that are not encountered when inducing an immune response to proteins. These properties include no overt requirement for the presence of T cells to induce an immune response, dominance of IgM, failure to induce memory following immunisation, an absence of affinity maturation following immunisation, and poor immunogenicity in infants, the elderly and the immunocompromised. These properties of carbohydrates have precluded the use of pure carbohydrate vaccines in those patients most at risk. Conjugate vaccine technology, where a carbohydrate antigen is coupled chemically to a protein carrier, has overcome the limitations of carbohydrates as vaccine antigens by rendering the carbohydrate moiety of such vaccines immunogenic, even in the very young. The dramatic success of the Hib conjugate vaccines, the first conjugates licensed clinically for human use, in reducing the incidence of invasive Hib disease has demonstrated the potential value of such conjugate vaccines. Similar technology is, therefore, being applied to a number of other vaccines in development, including N. meningitidis (groups A and C) and S. pneumoniae vaccines. The large number of pneumococcal carbohydrate serotypes that require inclusion in a vaccine makes this conjugate formulation far more complicated than that for Hib, and it is likely that the dramatic success of the Hib conjugate vaccines will be more difficult to repeat for the pneumococcus.

Animals↗
PubMed1998

Immunisation and the maturation of infant immune responses.

Maturation of the adaptive immune system occurs early in development and by 14 weeks gestation the developing foetus has circulating differentiated T cells and B cells capable of responding to antigen. While the immune system is capable of responding appropriately at birth to protein antigens, its capacity to respond to carbohydrates is limited. A consequence of this is the success of bacteria with carbohydrate capsules in causing invasive paediatric infections. Vaccines containing purified carbohydrates alone are thus limited in their immunogenicity and fail to provide protection for those most at risk. Conjugate vaccine technology, where a carbohydrate antigen is chemically coupled to a protein carrier, has overcome the limitation of carbohydrates as vaccine antigens. The first such vaccine to enjoy widespread use, the Haemophilus influenzae type b conjugate vaccines, have met with enormous success and have almost eradicated invasive Hib disease in those countries where their use in infancy is routine. Conjugate technology is thus being applied to a number of other vaccines in development, including Neisseria meningitidis groups A and C and Streptococcus pneumoniae vaccines.

Bacterial Vaccines↗
PubMed1997

Immunodeficiency syndromes and recurrent infection.

Individuals with increased susceptibility to infection may have an acquired or inherited abnormality of the immune system. In the second of two reviews we aim to outline some of the most important immunodeficiency syndromes that may be associated with a clinical presentation of frequent infection. Awareness of such syndromes may aid pattern recognition and the appropriate investigation of patients with recurrent infection.

Disease Susceptibility↗
PubMed1997

Managed care and the survival of neurology referral centers. A commitment to centers of excellence.

Since the collapse of federal health system reform legislation in 1994, there has been a growing concern with the quality of care provided within managed care systems. Just as physicians practicing under a traditional fee-for-service payment base have financial incentives to do as much as possible for each patient (doing well by doing good), physicians working for managed care plans are sometimes given perverse incentives to do as little as possible. A major quality-related concern among patients and payers (often referred to jointly and ambiguously as consumers of care) is the much larger role assigned to primary care physicians in managed care plans than is usually the case with traditional indemnity insurance.

Aged↗
PubMed1997

Characterisation of an outer membrane protein of Moraxella catarrhalis.

To elucidate potential vaccine antigens, Moraxella catarrhalis outer membrane proteins (OMPs) were studied. We have previously shown an OMP to be a target for human IgG and have now further characterised this OMP which appears to have a molecular mass of 84 kDa and to be distinct from the 81-kDa OMP, CopB. Human transferrin was shown to bind the 84-kDa OMP alone. N-terminal sequencing of this OMP and purified M. catarrhalis transferrin binding protein B (TbpB) revealed homology both with each other and with the TbpB of Haemophilus influenzae and Neisseria meningitidis. Adsorption of human anti-serum with purified TbpB from two M. catarrhalis strains abolished or reduced binding of IgG to the 84-kDa OMP from three M. catarrhalis isolates. IgG binding to CopB was unaffected. It is clear that the 84-kDa OMP is distinct from CopB and is a likely homologue of TbpB.

Adult↗
PubMed1996

N of 1.

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Diabetic Neuropathies↗