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PubMed1992

Septicaemia among neonates with tetanus.

In a study of 149 cases of neonatal tetanus (NNT) admitted into the University of Calabar Teaching Hospital, 49 (33 per cent) were also found to have septicaemia. The dominant organisms were coliforms and Staphylococcus aureus. A comparison of the clinical features of the septicaemic and non-septicaemic neonates showed umbilical cord infection to be an indicator of septicaemia. There was no significant difference in the case fatality rates of the two groups of patients and the overall case fatality was low (37 per cent). This is attributable to early diagnosis and treatment of the septicaemia cases. It is suggested that paediatricians should have a high index of suspicion of septicaemia among cases of NNT as a means of reducing case fatality.

Ampicillin↗
PubMed1983

Therapy for status epilepticus.

Recent advances in understanding the pathophysiology of status epilepticus (SE) have increased the urgency with which the study of this disorder should be approached. The clinical pharmacology of anticonvulsants useful in treating SE is reviewed and their application in several of the different types of SE is discussed. The potential for future advances is briefly considered.

Acetazolamide↗
PubMed1988

Rectal anticonvulsants in pediatric practice.

Children with seizure disorders frequently are treated with anticonvulsant medications such as clonazepam, valproic acid, carbamazepine, and ethosuximide, which cannot be given parenterally. When the child is unable to take these anticonvulsants orally, he or she may be given parenteral doses of phenobarbital or phenytoin. In many cases, these two medications have failed previously to control seizures, leading to the use of the more recently developed drugs. The use of rectal preparations of some anticonvulsant medications is highly useful and effective when the child is unable to take oral medications because of repeated vomiting, gastrointestinal surgery, and status epilepticus associated with lack of venous access. Rectal use of anticonvulsants has a role in the management of hospitalized seizure patients and can be learned by parents needing to treat their children's seizures at home while awaiting other medical care.

Administration, Rectal↗
PubMed1993

Characterization of Ehrlichia risticii binding, internalization, and proliferation in host cells by flow cytometry.

The binding, internalization, and proliferation of Ehrlichia risticii in P388D1 cells and equine polymorphonuclear (PMN) leukocytes were studied by immunofluorescent staining and flow cytometric analysis. The binding of ehrlichiae to P388D1 cells at 4 degrees C was dose dependent, and the antigens of bound organisms were susceptible to pronase treatment. Additionally, the binding of ehrlichiae to P388D1 cells was diminished when either P388D1 cells or ehrlichiae were treated with 1% paraformaldehyde for 30 min or 0.25% trypsin for 15 min. These results indicate that the ehrlichial ligand and host cell receptor are likely surface proteins. Following incubation at 37 degrees C, bound E. risticii and/or its antigens were removed with pronase and indirect immunofluorescent staining in the presence of saponin was used to examine intracellular ehrlichiae. Our results indicate that E. risticii was internalized into P388D1 cells within 3 h and proliferated by 48 h of incubation. The microfilament-disrupting agent cytochalasin D and the transglutaminase inhibitor monodansylcadaverine were used to differentiate between phagocytosis (sensitive to cytochalasin) and receptor-mediated endocytosis (sensitive to monodansylcadaverine) of E. risticii by P388D1 cells. In concentrations that produced distinctive morphological changes and inhibited phagocytosis of polystyrene latex beads, cytochalasin D did not suppress the infectivity of E. risticii. Binding, internalization, or proliferation of E. risticii was not affected by cytochalasin D. However, monodansylcadaverine inhibited infection of E. risticii in a dose-dependent manner. The agent did not affect the attachment of ehrlichiae to host cells, but it did suppress internalization and proliferation. These results suggest that E. risticii is internalized by receptor-mediated endocytosis and that productive infection by E. risticii does not depend on phagocytosis by the P388D1 cells. Although E. risticii did not bind to the surface of equine PMN leukocytes at 4 degrees C, organisms were taken up by this cell at 37 degrees C. E. risticii, however, failed to survive in equine PMN leukocytes.

Animals↗
PubMed1974

Treatment of tetanus neonatorum with muscle relaxants and intermittent positive-pressure ventilation.

Intermittent positive-pressure ventilation and muscle relaxants were first used in Cape Town in 1958 in an attempt to reduce the mortality from tetanus neonatorum, which was then over 90%. Problems of effective ventilation, of tracheostomy, and of infection in the neonate were gradually overcome so that between 1967 and 1972 the mortality in 186 cases was 21%. In a consecutive series of 97 cases the mortality was 10%.

Airway Obstruction↗