The laryngeal mask for failed intubation at caesarean section.
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Biomedical subjects
Publications and source records attributed to J Storey.
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A genetically engineered subunit vaccine against FeLV infection was developed. The protective immunogen in the vaccine was a purified recombinant protein containing the entire amino acid sequence of FeLV subgroup A gp70 envelope protein. The optimal adjuvant was determined to be a highly purified saponin, QS-21, derived from Quillaja saponaria Molina. A vaccine formulation containing the recombinant protein, QS-21, and aluminum hydroxide was tested in specific-pathogen-free kittens and was shown to induce neutralizing antibodies as well as appreciable antibody responses to native gp70 by enzyme immunoassay and protein (western) immunoblot analysis and of whole virus preparations.
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The detection of haptoglobins in Anopheles gambiae s.l. has been used to obtain an estimate of the incidence of multiple feeding for the village of Barmawa, Garki District, Kano State, Nigeria. The results indicated that the incidence of multiple feeding was approximately 10% but problems were encountered by the high incidence of ahaptoglobinaemia in the population. In four villages in Garki District the incidence of ahaptoglobinaemia varied between 65 and 76% while in young children and personnel under constant malaria chemoprophylaxis it was less than 30%. A strong correlation between ahaptoglobinaemia and malaria infections was seen. The results show evidence of selection of hosts by mosquitoes at Barmawa although this does not necessarily imply a preference per se. The results provide evidence of movement of blood-fed mosquitoes, between houses and from houses to resting sites.
The prevalence of different haemoglobins and their interaction with malaria have been studied in Garki, Kano State, Nigeria. Sickle cell trait was present in 24% of newborn and 29% of those aged over five years. Hb.AC was present in 0.7%. Frequency of both haemoglobin variants was greater in Hausa than Fulani. Sickle cell anaemia was almost invariably fatal in early childhood. The distribution curve of percentage of Hb.S in sickle cell trait subjects was normal, and did not demonstrate any high frequency of a gene for alpha-thalassaemia. The presence of beta-thalassaemia minor could not be tested, but Hb.S/beta-thalassaemia was not detected. Hb.S gene frequency appears to have been maintained by a fitness in heterozygotes of 21% over normal homozygotes; increased fertility and high mutation rate did not make any apparent contribution. Hb.AS subjects had on average lower frequency and considerably lower densities of Plasmodium falciparum trophozoites than Hb.AA from the age of 30 to 59 weeks; density was less in sickle cell trait up to age three years in the dry season only. It is suggested that the survival advantage and hence the prevalence of sickle cell trait may be greatest in some hyperendemic areas and less where malaria transmission is extremely high or when it is high and unvaried.
Subjects with sickle cell disease were identified in (i) a whole population sample (2742) Garki District, Kano State, Nigeria, and in (ii) the 534 infants born into the population during five years. Eleven (2.1%) newborn had Hb.SS, as was expected from gene frequency (0.146). Prevalence was maintained in the first year of life, but fell to 0.4% at one to four years and to 0.05% (one person) over the age of nine years. Antimalarial intervention for two transmission seasons was followed by an apparent but not significant decrease in Hb.SS mortality. There was one male aged about 40 years who had Hb.SC (the expected number was three). Hb.SS children were compared to normal subjects at the same age, the same village and the same survey; they had significantly less than the expected Plasmodium malariae infection (P less than 0.01) and lower than median P. falciparum densities while below five years (P less than 0.05). Over one year of age, they tended to have below average indirect fluorescent antibody (IFA) (P less than 0.01), indirect haemagglutinating antibody (IHA) (P less than 0.01) titres and number of precipitin rings (not significant) against P. falciparum antigen, and IFA against P malariae (P less than 0.01). They had above average IgM (P less than 0.05), but their IgG concentrations did not differ from normal. We conclude that (i) sickling is sufficient to protect against P. malariae in Hb.SS but not Hb.AS; (ii) sickling prevents intense P. falciparum infection in Hb.SS, as in Hb.AS; (iii) in Hb.SS, there is less antigenic stimulus and hence less antibody against P. falciparum (like Hb.AS) and P. malariae (unlike Hb.AS); (iv) although less intense, malaria is frequently fatal in Hb.SS, especially in age-group one to four years (unlike Hb.AS); (v) IgM levels are high in Hb.SS in response to frequent infections other than malaria (unlike Hb.AS).
Haemoglobin (Hb) AC electrophoretic pattern was found in 0.7% of the population at Garki, Kano State, northern Nigeria, an area where malaria is hyperendemic. Twenty-one Hb.AC subjects at all ages did not differ from the rest of the population in their frequency or density of Plasmodium falciparum, P. malaria or P. ovale infections, nor in their IgM concentrations and titres of specific antimalarial antibodies. However, IgG levels in Hb.AC subjects were frequently above the average of the reference population (P less than 0.05), especially during a period of protection against malaria (P less than 0.01). These observations suggest that the Hb.C gene may be maintained in certain environments by an enhanced ability to produce IgG antibodies against an antigen or antigens other than malaria, and that its geographical relationship to malaria may be a coincidence. This hypothesis needs to be tested where Hb.C is seen at high frequency, in northern Ghana and Upper Volta or Gwoza (Nigeria).
A meat cutter who experienced wheezing when working in the area where price labels were heated, was challenged with the inhalation of the emission of heated price labels and nebulized phthalic anhydride. Only exposure to the emissions from the heated price labels evoked a response. The spectrum of emissions from heated price labels, analyzed by gas chromatography and mass spectrometry, was found to include phthalic anhydride, 2,5-di-tert-amyl quinone and dicyclohexylphthalate.
Two infant populations, the one exposed to intense malaria transmission and the other protected, were followed and compared by six serological tests. The IgG and IgM levels increased with age and were systematically, though only slightly, lower in the protected children. The results of three Plasmodium falciparum tests (precipitin, indirect fluorescent antibody (IFA) and indirect haemagglutination and one P. malariae test (IFA) were high at birth and decreased rapidly afterwards in both populations. In the unprotected population, this decrease was followed by an increase, closely associated with the parasitological findings, while in the protected population the decrease continued to very low levels.
A longitudinal seroimmunological investigation of malaria was performed as part of the WHO research project conducted in the northern part of Nigeria from 1970 to 1975. The project included a preintervention phase, an intervention phase with application of malaria control measures (spraying of residual insecticide and mass drug administration), and a postintervention phase. Serological observations were made on the total population of eight villages consisting of approximately 3000 persons. Six immunological parameters were studied, namely, the serum levels of IgG and IgM, the number of bands of precipitation for Plasmodium falciparum in the double diffusion (Ouchterlony) test, the titres of antibodies for P. falciparum and P. malariae in the indirect fluorescent antibody (IFA) test, and the titres of agglutinating antibodies for P. falciparum by the indirect (passive) haemagglutination (IHA) test. The serological results were used to evaluate the impact on the humoral immune response of different levels of parasitaemia resulting, in the unprotected population, from natural factors such as seasons and ageing and in the protected population, from human intervention through the application of control measures and their interruption. The linkage by computer processing of the longitudinal data allowed analysis of the relationship between the results of a serological test in the same person at different surveys, and analysis of correlation between serological results and the concurrent parasitological findings. The correlation between parasitaemia and the results of the different serological tests at the same survey in the same person were also examined and analysed in terms of sensitivity and specificity of the tests.
Six patients with secondary syphilis and one control subject were observed over a period of up to 8 hr following the administration of either penicillin or erythromycin. Serial clinical observations were made and blood samples obtained for complement and serological analysis. The patients showed Jarisch-Herxheimer reactions (JHR) of varying intensity which were found to be preceded by and to parallel in degree certain changes in complement and syphilitic antibody titres. Falls in total haemolytic complement, in C4, C3, C6 and C7 and a marked drop in C1INH were observed. There was no change in total GBG/GGG or evidence of conversion of GBG to GGG. Associated falls occurred in the titres of the QFTA and the QTPHA antibodies but not of the QVDRL or QTPI antibodies. C3 conversion was found in the two patients that suffered severe reactions. Immune complexes were not detected and it is suggested that complement activation occurred in the extra-vascular body compartment. The significance of these changes in relation to other plasma enzyme systems and to the development of the full clinical picture of the JHR is discussed.
A method is described of estimating the malaria incidence rate ĥ and the recovery rate r from longitudinal data. The method is based on the assumption that the phenomenon of patent parasitaemia can be represented by a reversible two-state catalytic model; it is applicable to all problems that can be represented by such a model.The method was applied to data on falciparum malaria from the West African savanna and the findings suggested that immunity increases the rate of recovery from patent parasitaemia by a factor of up to 10, and also reduces the number of episodes of patent parasitaemia resulting from one inoculation. Under the effect of propoxur, ĥ varies with the estimated man-biting rate of the vector while r increases, possibly owing to reduced super-infection.
A comparative trial was carried out in northern Nigeria of the ability of the drug combinations chloroquine-pyrimethamine and sulfalene-pyrimethamine to clear the peripheral blood stream of asexual forms of P. falciparum within 7 days. The reappearance of asexual P. falciparum forms within the 70-day follow-up period and the occurrence of vomiting during the 2-3 hours following administration of the drugs were also recorded. The purpose of the trial was to choose the more suitable of the two drug combinations for repeated mass administration in the intervention phase of a collaborative field research project in the epidemiology and control of malaria in the African savannah. No differences were observed between the two drug combinations from a parasitological point of view. However, the sulfalene-pyrimethamine combination was found easier to administer and occasioned fewer records of vomiting. It was therefore recommended for use in the project.
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