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Biomedical subjects

P Karma

Publications and source records attributed to P Karma.

At least 19 recordsLinked to original sources
PubMed2001

Efficacy of a pneumococcal conjugate vaccine against acute otitis media.

BACKGROUND: Ear infections are a common cause of illness during the first two years of life. New conjugate vaccines may be able to prevent a substantial portion of cases of acute otitis media caused by Streptococcus pneumoniae. METHODS: We enrolled 1662 infants in a randomized, double-blind efficacy trial of a heptavalent pneumococcal polysaccharide conjugate vaccine in which the carrier protein is the nontoxic diphtheria-toxin analogue CRM197. The children received either the study vaccine or a hepatitis B vaccine as a control at 2, 4, 6, and 12 months of age. The clinical diagnosis of acute otitis media was based on predefined criteria, and the bacteriologic diagnosis was based on a culture of middle-ear fluid obtained by myringotomy. RESULTS: Of the children who were enrolled, 95.1 percent completed the trial. With the pneumococcal vaccine, there were more local reactions than with the hepatitis B vaccine but fewer than with the combined whole-cell diphtheria-tetanus-pertussis and Haemophilus influenzae type b vaccine that was administered simultaneously. There were 2596 episodes of acute otitis media during the follow-up period between 6.5 and 24 months of age. The vaccine reduced the number of episodes of acute otitis media from any cause by 6 percent (95 percent confidence interval, -4 to 16 percent [the negative number indicates a possible increase in the number of episodes]), culture-confirmed pneumococcal episodes by 34 percent (95 percent confidence interval, 21 to 45 percent), and the number of episodes due to the serotypes contained in the vaccine by 57 percent (95 percent confidence interval, 44 to 67 percent). The number of episodes attributed to serotypes that are cross-reactive with those in the vaccine was reduced by 51 percent, whereas the number of episodes due to all other serotypes increased by 33 percent. CONCLUSIONS: The heptavalent pneumococcal polysaccharide-CRM197 conjugate vaccine is safe and efficacious in the prevention of acute otitis media caused by the serotypes included in the vaccine.

Acute Disease↗
PubMed2000

Clinical outcome of acute pneumococcal otitis media and serum antibody responses to pneumococcal pneumolysin and polysaccharides in children.

Serum antibody responses to pneumococcal antigens and their relationship to the clinical outcome were determined in a prospective study of 121 children with acute otitis media (AOM). Pneumococcus positive children with a pneumolysin response more often had a recurrence and middle ear effusion (MEE) after 1 month than did the non-responders (p = 0.005 and p = 0.04, respectively). All the children who responded to pneumolysin also had clinically strong symptoms and signs of AOM. Children who responded to pneumococcal polysaccharides developed otitis media with effusion within a 6-month follow-up period more often than did the non-responders (p = 0.005). The results of this study suggest that children with pneumococcal AOM and an antibody response to the intracellular pneumococcal protein pneumolysin behave clinically differently from children with an antibody response to polysaccharides.

Acute Disease↗
PubMed2000

Factors associated with the development of recurrent acute otitis media--the significance of choosing the right and accurate dependent and independent variables in the multivariate analysis.

The results of univariate and multivariate statistical analysis were compared in identifying predictive factors of the development of recurrent acuta otitis media (RAOM) after an initial episode of acute otitis media (AOM) in 121 children. Univariate correlations between the development of RAOM and potential risk factors were analysed, and variables at p < 0.10 were incorporated into the stepwise multiple logistic regression analysis. The comparisons between the univariate and multivariate analysis in identifying the predictive factors were made and the importance of changing the dependent variables in the multivariate analysis was analysed. It seems that univariate analysis is over-sensitive, but multivariate analysis is over-conservative in finding possible predictors of RAOM. Choosing the right and accurate dependent and independent variables in the multivariate analysis is extremely important, when this method is used.

Acute Disease↗
PubMed1997

Intralesional electrodesiccation of syringomas.

BACKGROUND: Syringomas are common, benign adnexal tumors. In the periorbital area, they pose a cosmetic dilemma for both patients and physicians alike. Many different therapeutic modalities potentially can cause scarring, and recurrences are common. OBJECTIVE: To develop a treatment method that minimizes scarring and subsequent recurrences. METHOD: Each syringoma is treated with short bursts of high frequency low voltage electrodesiccation delivered with a fine needle electrode that is inserted into the center of the syringoma, as deeply as the reticular dermis. RESULTS: Twelve patients treated over a 4-year period showed no permanent adverse effects postoperatively and no recurrences. CONCLUSIONS: Intralesional electrodesiccation is a safe, nonscarring and, reliable method that can be used to eradicate periorbital syringomas.

Adult↗
PubMed1997

Prognosis of acute otitis media: factors associated with poor outcome.

Factors associated with poor outcome of acute otitis media (AOM) were analysed in 131 children aged 1/4 to 7 1/2 (median 2 1/2) years. After AOM, altogether 37 (28%) of the children had poor outcome: 15 children (12%) clinical failure (unimprovement or worsening of pre-treatment signs and symptoms within 2 weeks of onset of therapy) and 31 (24%) persistent middle ear effusion (MEE) > or = 1 month post-treatment. Of the different variables studied in multivariate analysis, age < 2 years (p < 0.01), history of allergic skin or respiratory symptoms (p = 0.02), > or = 6 h duration of pre-treatment earache (p = 0.01) and B. catarrhalis in MEE (p = 0.05) were associated with clinical failure. Children with previous adenotomy or unilateral AOM had no failures. Persistence of MEE at 1 month was associated with age < 2 years (p = 0.05), otitis proneness (p = 0.03), bilaterality of AOM (p < 0.01) and S. pneumoniae in MEE (p = 0.01) in univariate but not in multivariate analysis.

Acute Disease↗
PubMed1997

Bacteriological findings and persistence of middle ear effusion in otitis media with effusion.

The bacteriology of middle ear effusion (MEE) of asymptomatic otitis media with effusion (OME) was studied in 165 children, aged 5 months to 12 years, from the MEE samples obtained during tympanostomy under general anaesthesia in 1993-1994. MEE had persisted for 1 to 12 (mean 3.5) months. Major otitis pathogens (S. pneumoniae, H. Influenzae, B. catarrhalis and S. pyogenes) were cultured in 41% of the children under 2 years of age and in 17% of older children (p < 0.001). Respiratory infections and attacks of acute otitis media (AOM) during the last 6 months were also more frequent in children younger than 2 years (p < 0.001). The proportion of S. pneumoniae (25%) and H. influenzae (38%), but not of other bacteria, was higher in the children with less than 2 months' persistence of MEE as compared with those with a longer duration (8% and 3%) (p < 0.01). After 2 months, the occurrence of different bacteria remained relatively unchanged until 6 months' persistence of MEE, and thereafter no pathogens were culturable. Among the children adenotomized earlier, the proportion of those with major otitis pathogens in MEE was 8% compared with 32% in non-adenotomized children (p = 0.02). S. pneumoniae, B. catarrhalis or S. pyogenes were not culturable in any of the adenotomized children, while MEE grew them in 25% of the non-adenotomized children (p < 0.001). Since the MEE bacteriology of OME with less than 2 months' persistence resembles that of AOM, it may be that these cases represent a transitory phase between AOM and an established OME.

Adenoidectomy↗
PubMed1997

Extended high frequency hearing and history of acute otitis media in 14-year-old children in Finland.

We studied the extended high frequency hearing of 573 white, urban, mean 13.8-year-old unselected children in Tampere, Finland. All their ear-related morbidity had been recorded since their birth and they had been examined at the ages of 7 months, 2 years, and some of them at 5 years. The extended high frequency audiometry was measured from 10 to 18 kHz, with 1 kHz steps, and the results were related to the number of attacks of acute otitis media (AOM) (0, 1-2, 3-7 and > or = 8) they had experienced. The mean pure tone hearing thresholds varied from 10.7 dB at 10 kHz to 37.0 dB at 18 kHz in the right ears and between 11.6 dB at 10 kHz and 37.4 dB at 18 kHz in the left ears. Among those with > or = 8 attacks of AOM the the thresholds were highest, the difference between them and each of the first 3 groups being statistically significant at 13 and 14 kHz. From 11 to 16 kHz the same difference was significant between the last (> or = 8 AOM) and at least 2 of the first 3 AOM groups. Numerous attacks of AOM may have a harmful effect on high frequency hearing in the long term.

Acute Disease↗
PubMed1997

Prognosis of acute otitis media. Factors associated with the development of recurrent acute otitis media.

Clinical factors associated with the development of recurrent acute otitis media (RAOM) (> or = 3 recurrences during 6 months' follow-up period) after acute otitis media (AOM) were analysed in 121 children aged 3 months to 7 years (median 2 years 6 months). After AOM, 19 (16%) children had primary recurrence (pre-treatment signs and symptoms firstly improved or cured, but worsened or recurred within 30 days' post-treatment) and 33 (27%) developed RAOM during 6 months' follow-up period. It seemed that children < 2 years of age (p = 0.04), children with bilateral disease (p = 0.007), strong infection status (p = 0.05), primary clinical failure (p = 0.04) and development of primary recurrence after AOM (p = 0.001) were significantly related to the development of RAOM in univariate analysis, but only children < 2 years of age (OR 1.5, 95% CI 1.0-5.7, p = 0.04) and the development of primary recurrence (OR 5.1, 95% CI 1.8-14.1, p = 0.002) related to the development of RAOM in multivariate analysis. None of the bacteria cultured from middle ear effusion were related to the development of RAOM.

Acute Disease↗
PubMed1997

Prognostication of Bell's palsy using transcranial magnetic stimulation.

Transcranial magnetic stimulation (TMS) provides a method to noninvasive excitation of the facial nerve in its intracranial segment close to the internal acoustic meatus. Thus, the site of facial nerve activation with TMS is proximal to or within the site of the lesion in Bell's palsy. To evaluate the prognostic capability of TMS in unilateral Bell's palsy we examined 137 patients with this method, and compared the results with electroneuronography (ENoG). Within 0-4 days from the onset of palsy, the patients with elicitable TMS responses recovered better than those in whom TMS responses were not elicitable. If TMS was performed 5-9 days or 10-28 days after the onset of palsy, it did not provide any prognostic information. Based on amplitude side-to-side differences, ENoG did not contribute prognostic information during the first 9 days from the onset of palsy. Later on, 10-28 days after the onset of palsy, ENoG showed an increased capability to discriminate the patients with poor prognosis. Thus, elicitable facial motor response with TMS predicts good prognosis of Bell's palsy at an early stage whereas poor response with ENoG predicts less favorable prognosis at a later stage.

Electric Stimulation↗
PubMed1996

Interferon production by leukocytes in children with otitis media with effusion.

We have previously shown that leukocyte cultures of children suffering from recurrent respiratory tract infections produce less interferon (IFN) than those of healthy children. In the present study this tentative marker of recurrent infections was used to study the pathogenetic background of otitis media with effusion (OME). Altogether 57 consecutive children, aged 2-11 years, who came for tympanostomy and/or adenoidectomy were divided into three subgroups: 25 of them had OME and a history of recurrent acute otitis media (rAOM/OME+), 20 had OME without an infectious background (inf-/OME+), and 12 had a history of recurrent upper respiratory infections (inf +/OME-) without OME. All the children were free of acute illness at the time of sampling. Differences between the groups were seen in IFN yields when leukocyte cultures were stimulated with adeno-, rhino-, corona-, respiratory syncytial or influenza A viruses. Leukocytes from inf-/OME+ children produced more IFN than those of the other two groups. Though no sex differences in the IFN responses were seen among rAOM/OME+ and inf +/OME- children, leukocytes from inf-/OME+ girls produced significantly higher amounts of IFN than those of inf-/OME+ boys, or rAOM/OME+ and inf +/OME- children. These differences between clinically different groups of children support the view that the etiology of OME can be heterogeneous.

Acute Disease↗
PubMed1996

Virus-induced interferon production in leukocyte cultures from children with recurrent respiratory infections. A follow-up study.

BACKGROUND: Lowered yields of virus-induced interferon (IFN) by leukocyte cultures were previously suggested to be associated with recurrent respiratory infections in children (Pitkaranta et al. (1993) Clin. Diagn. Virol. 1, 101-108). OBJECTIVES: To investigate if the observed lowered IFN producing capacity was secondary to the underlying disease and, consequently, would be normalized after recovery of the child from the chain of infections. STUDY DESIGN: Forty-eight 3-12-year-old children suffering from recurrent upper respiratory tract infections (acute otitis media included) were followed-up for 2 years. Their clinical condition and virus-induced interferon production in cultures of peripheral blood leukocytes were examined at the beginning and end of this period. RESULTS: In 24 children the health improved strikingly during the follow-up, in 12 children a mild improvement took place, while 12 children remained constantly ill. IFN yields in cultures stimulated with corona- and respiratory syncytial viruses improved along with the clinical situation of the children. Parallel cultures induced with adeno-, influenza A or rhinoviruses did not show a similar correlation. CONCLUSION: These results suggest that the relationship between interferon production by leukocyte cultures and recurrent infections is complex and may be virus-specific.

Journal Article↗
PubMed1996

Antibody-secreting cells and their relation to humoral antibodies in serum and in nasopharyngeal aspirates in children with pneumococcal acute otitis media.

Mucosal and systemic antibody responses to pneumococcal capsular polysaccharide were studied in 17 children with culture-verified pneumococcal acute otitis media. Serotype-specific antibody-secreting cells (ASCs) in peripheral blood and antibodies in acute and convalescent sera and nasopharyngeal aspirates were measured. A polysaccharide-specific ASC response was induced in all subjects. The response was age dependent, and the dominant antibody class was IgA. Three children > 24 months old had > 100 IgA-class ASCs/10(6) cells and serum and nasopharyngeal IgA responses; 2 had only a nasopharyngeal IgA response. None of 8 children < 24 months old showed a systemic response; however, a nasopharyngeal IgA response was detected in 1. Results suggest that whole pneumococci can induce a mucosal polysaccharide-specific antibody response independent of the systemic response. Results are also in accordance with earlier studies suggesting that the mucosal immune system matures earlier in life than does the systemic immune response.

Acute Disease↗
PubMed1996

Comparison of serum antibodies to pneumolysin with those to pneumococcal capsular polysaccharides in children with acute otitis media.

BACKGROUND: Streptococcus pneumoniae is a major bacterial pathogens in acute otitis media. Pneumolysin is a species-specific protein toxin produced intracellularly by all clinically relevant pneumococcal strains, and antibodies to pneumolysin should therefore represent pneumococcal involvement in the disease, regardless of the serotype. METHODS: Antibodies to pneumococcal pneumolysin and capsular polysaccharides were measured by enzyme immunoassay in acute and convalescent sera of 121 children with acute otitis media. A pneumococcal otitis episode was defined by a positive middle ear fluid culture and/or pneumolysin PCR. RESULTS: Median age of the 10 children who developed a seroconversion response to pneumolysin was 1 year 8 months, and of the 21 children responding to polysaccharides it was 2 years 9 months. Eight of the 10 seroconversion responses to pneumolysin were of IgA class alone, whereas 17 of the 21 polysaccharide responses were of IgG class alone or IgG together with IgM and/or IgA. Of the 41 children with a pneumococcal otitis episode, 13 (39%) showed a seroconversion response, 3 (7%) to pneumolysin and 11 (27%) to capsular polysaccharides. The children with a pneumococcal otitis episode had lower titers of acute phase IgG to the capsular polysaccharide pool of S. pneumoniae (containing types 6B, 14, 19F and 23F), as compared with the titers in children with otitis caused by other pathogens and pneumococci only in the nasopharynx or not found at all (P = 0.04). CONCLUSIONS: Serum antibodies to pneumolysin can be detected at an earlier age than those to the capsular polysaccharides. However, a seroconversion is rare and therefore of no diagnostic value. The presence of serum IgG to the pneumococcal capsular polysaccharides seems beneficial in the prevention of pneumococcal otitis.

Acute Disease↗
PubMed1996

PCR assay for detecting Streptococcus pneumoniae in the middle ear of children with otitis media with effusion.

We compared a newly developed pneumococcal polymerase chain reaction (PCR) for Streptococcus pneumoniae (Pnc) to bacterial culture in 123 middle ear effusion (MEE) samples of 123 children with otitis media with effusion (OME). For the pneumococcal PCR assay, DNA of MEE samples was purified by a QIAamp blood kit. The outer primers used amplified a 348 basepair region of the pneumolysin gene, and the inner a 208. Pnc was cultured in 14 (11%) and pneumolysin PCR was positive in 57 (46%) of the 123 MEE samples. All the culture positive samples were also PCR-positive. Both the samples with culturable Pnc and with positive pneumolysin PCR increased with shorter duration of OME and a greater number of acute otitis media during the preceding 6 months. In conclusion, pneumolysin PCR suggests pneumococcal involvement in MEE even in OMEs with no evidence of Pnc in culture, and thus offers a good diagnostic tool when a more accurate and sensitive pneumococcal diagnosis is needed.

Acute Disease↗