Faculty Bibliography

Background: Chronic pediatric malnutrition is a serious problem affecting low and middle income countries across the world. Within sub-Saharan Africa, Uganda in particular has an estimated prevalence of 33% of children under five years of age stunted, six percent wasted, and 14% underweight. Moreover, the nutrition transition, a shift from an active lifestyle with the consumption of fewer processed foods to a sedentary lifestyle with the consumption of high-calorie foods, is occurring in Uganda. We hypothesize that parental obesity, in correlation with education around nutrition, is further contributing to pediatric malnutrition, even in previously undescribed rural regions of Uganda. Methods: A cluster-sampling method will be utilized to conduct a household survey across randomly selected sub-counties in the Kabale Region of rural Uganda. The sub-counties selected for sampling will have households in a particular cluster identified, and thirty randomly selected for survey. It is expected that approximately 60% of homes will contain children under five years of age, these children will have anthropometric data obtained. Parents will also be assessed for body mass index, and asked a consensus approved survey based on Ugandan national guidelines. All household members will be offered deworming treatment, and all children will be offered micronutrient supplementation and/or inpatient management based on Ugandan clinical guidelines. The primary outcome of parental obesity and pediatric malnutrition will be assessed. Secondary outcomes of parental education around nutrition and medical comorbidities of children will be assessed. Findings: This study will be conducted in February of 2016, results are pending but will be available for the CUGH conference. Interpretation: As above, this study will not have results until February of 2016

The purpose of this study was to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve the metabolic control and quality of life in adolescents who are implementing intensive therapy. A total of 77 youths (age range, 12.5-20 years) who were beginning intensive insulin therapy were randomly assigned to one of two groups: intensive management with CST or without CST. CST consists of a series of small group efforts designed to teach problem solving skills and communication. Data were collected preintervention and at 3 and 6 months post-intervention by using established clinical and psychosocial indicators. Randomization produced equivalent groups. After 6 months, subjects who received CST had better metabolic control (F = 3.89, p = .02) and better general self-efficacy (F = 4.54, p = 0.01). They reported less negative impact of diabetes on their quality of life (F = 4.55, p = .01) and had fewer worries about diabetes (F = 3.82, p = .02). Thus, nurses may find CST useful in assisting youths with diabetes to achieve metabolic and quality of life goals.

The safety and immunogenicity of an inactivated hepatitis A vaccine (HM175) were evaluated in 151 seronegative health professionals (age range, 21-65 years; mean, 30). A 720-ELISA unit dose was administered to 78 vaccinees at 0, 1, and 6 months and to 73 vaccinees at 0, 1, and 12 months. Seroconversion rates were 90% in both groups 1 month after the first inoculation and 99% and 100%, respectively, 1 month after the second inoculation. Geometric mean antibody titers (GMTs) 1 month after the third inoculation were highest in the group vaccinated at 0, 1, and 12 months. GMTs were higher in women than in men. The vaccine was well tolerated; the most frequent side effect was transient soreness at the site of inoculation. No serious adverse reactions were observed. Thus, HM175 inactivated hepatitis A vaccine is safe and highly immunogenic

A single-blind, multicenter, phase II trial of yeast recombinant hepatitis B virus (HBV) vaccines containing surface antigen (S) alone or with PreS2 (PreS2 + S) was conducted in 282 healthy HBV-seronegative adults aged 20-59 years. Each volunteer was randomly assigned to receive HBV vaccine containing 10 micrograms of S or one of three doses of PreS2 plus S: 2 + 10 micrograms, 4 + 20 micrograms, or 8 + 40 micrograms. The level of antibody to HBV surface antigen reached depended on the dose of S, not PreS2, received. In each vaccine group, volunteers 20-39 years old had higher titers of anti-PreS2 and antibody to S than those 40-59 years old. The age-related effect on immune response to HBV vaccination suggests that adults should be immunized against hepatitis B at as early an age as possible and that older persons may need a higher dose or booster immunizations to achieve durable immunity.

The safety and immunogenicity of an inactivated hepatitis A vaccine (HM175 strain) were evaluated in 150 seronegative health professionals. The age range was 21-65 years and the mean age was 30 years. The vaccine was administered at a dose of 720 ELISA units (EU) to 73 vaccinees at 0, 1 and 6 months, and to 77 vaccinees at 0, 1 and 12 months. The seroconversion rates were 88 and 90% in the two groups, respectively, one month after the first inoculation and 99 and 100% one month after the second inoculation. The geometric mean antibody titres were similar in both groups, exceeding 3000 mIU/ml one month after the third inoculation. The vaccine was well tolerated. The most frequent side effect was transient soreness at the site of the inoculation. No serious adverse reactions were observed. The study demonstrated that the HM175 inactivated hepatitis A vaccine was safe and highly immunogenic

Lancefield group G streptococcus is now recognized as a pathogen and has been reported to cause severe infections, including meningitis. We describe the first case of meningitis caused by this organism in a patient with acquired immunodeficiency syndrome (AIDS) and the direct transmission of the pathogen to a technologist accidentally exposed to the cerebrospinal fluid. To prove the identity of the two strains, we have tested them employing the Vitek system. We have also tested 13 other strains of group G streptococci obtained from different sources. Our results yielded 14 different biotypes with the 15 strains tested. The only identical ones were the two suspect strains from the index case and the technologist. We conclude that the biotyping system employed in our study appears to be a useful epidemiological tool for marking group G streptococci

The duration of hepatitis B vaccine-induced immunity was studied in a group of 54 seronegative health professionals who received plasma-derived hepatitis B vaccine (Merck's Heptavax) in 1978 and 1979. Five to seven years later, 52 vaccinees received a booster dose of yeast recombinant hepatitis B vaccine (Merck's Recombivax). Of 54 vaccinees, 47 (87 percent) had a favorable anti-HBs response (greater than 10 S/N RIA units) and 7 (13 percent) had low (2.1-10 S/N) or undetectable levels (less than 2.1 S/N) one year after primary immunization. After five to seven years, the anti-HBs values had declined to undetectable levels in 25 percent and to low levels in 23 percent. A booster dose of vaccine induced an anamnestic response in 90 percent of vaccinees by two weeks. The results of this study indicate that persons who respond favorably to primary immunization may be protected for at least seven years

The immunogenic effect of recombinant yeast and plasma-derived hepatitis B vaccines administered at 0, 1 and 6 months was evaluated in 334 seronegative health professionals. The seroconversion rates following 10 micrograms, 5 micrograms and 2.5 micrograms doses of recombinant vaccine were similar to those observed after 20 micrograms doses of plasma-derived vaccine. The geometric mean antibody titres (G.M.T.) induced by 10 micrograms and 5 micrograms doses of recombinant vaccine were similar to those observed after 20 micrograms doses of plasma-derived vaccine. The G.M.T. values were lowest after 2.5 micrograms doses of recombinant vaccine. However, the recipients of the 2.5 micrograms had a significant anti-HBs response after a fourth (booster) dose of recombinant vaccine was given at 12 months. A booster dose of recombinant hepatitis B vaccine was given to 31 health professionals who had been successfully immunised with plasma-derived vaccine 5-7 years previously. A significant anamnestic response was observed in 30 (97%) of these individuals in spite of the fact that 16 (52%) had low or undetectable levels of anti-HBs before the booster dose was given

Production of interferon (IFN)-gamma by peripheral blood leukocytes (PBL) was examined in cultures of unseparated fresh whole blood exposed to phytohemagglutinin (PHA), concanavalin A (Con A), or pokeweed mitogen (PWM). The yield of IFN-gamma was measured by a newly developed immunoradiometric assay. Nine of 14 patients with acute pulmonary tuberculosis (TB) showed a depressed IFN-gamma response to Con A and/or PWM. Only four of these TB patients also showed a depressed IFN-gamma response to PHA. Stimulation of the patients' PBL cultures with PHA in the presence of exogenous interleukin 2 (IL 2) produced normal IFN-gamma yields in all but the most severely depressed patients. PBL cultures of TB patients with defective IFN-gamma production in response to mitogenic lectins also produced less IFN-gamma after stimulation with tuberculin PPD. Although some patients showed a moderate degree of lymphopenia, their OKT4/T8 lymphocyte ratios were mostly normal or close to normal, with the notable exception of one TB patient who has been diagnosed to have the acquired immune deficiency syndrome (AIDS)