Batia Sarov

Maternal recall of infant feeding events is accurate.

STUDY OBJECTIVE--Retrospective infant feeding data are important to the study of child and adult health patterns. The accuracy of maternal recall of past infant feeding events was examined and specifically the infants age when breast feeding was stopped and formula feeding and solid foods were introduced. DESIGN AND SETTING--The sample consisted of Bedouin Arab women (n = 318) living in the Negev in Israel who were a part of a larger cohort participating in a prospective study of infant health and who were delivered of their infants between July 1 and December 15, 1981. Data from interviews conducted 12 and 18 months postpartum were compared to the standard data collected six months postpartum. MAIN RESULTS--As length of recall increased there was a small increase in the mean difference, and its standard deviation, between the standard and recalled age when breast feeding was stopped and formula feeding and solid foods were started. Recall on formula feeding was less accurate than recall on solid foods and breast feeding. In particular, among those 61% reporting formula use at the six month interview, 51% did not recall introducing formula when interviewed at 18 months. The odds ratio (95% CI) of stunting versus normal length for age for formula fed versus breast fed infants based on recall data (OR = 2.07; 95% CI 0.82-5.22) differed only slightly from those based on the standard data (OR = 2.21; 95% CI 0.77-6.37). The accuracy of a mothers recall varied with her childs nutritional status at the time of the interview, but not with other sociodemographic, infant, or interviewer characteristics. CONCLUSIONS--Retrospective infant feeding data based on maternal recall of events up to 18 months in the past can be used with confidence in epidemiological studies. However, data on formula feeding may not be as accurate as data on breast feeding and solid food feeding, and accuracy may decrease as length of recall increases.

Retinol concentration in maternal and cord serum : Its relation to birth weight in healthy mother-infant pairs

BACKGROUND Vitamin A is an essential micronutrient for the development and growth of the fetus. The objective of this study was to identify a possible association between low serum retinol and birth weight in healthy mother-infant pairs in Southern Israel. A secondary objective was to examine ethnic differences in maternal and cord serum retinol. METHODS Serum retinol was measured at delivery from pairs of healthy mothers and healthy mature newborns. RESULTS Of the 313 mother-infant pairs studied, 56% were Jews and 44% Bedouins. The proportion of infants with birth weight of 2500-2999 g was greater among mothers with lower serum retinol (<0.7 micromol/l) compared to mothers with normal serum retinol (> or =0.7 micromol/l) (p<0.001). Cord retinol <0.7 micromol/l was more frequent in infants with birth weight 2500-2990 g compared to infants with birth weight > or =3000 g (p=0.006). Using a split model and stepwise multiple regression analysis, infants birth weight was significantly influenced by cord retinol concentration in infants born to mothers with low serum retinol; gestational age and cord retinol alone explained 27% of the variability of birth weight in this group. A higher proportion of Bedouin than Jewish infants had serum retinol <0.7 and <0.35 micromol/l (both p<0.001). CONCLUSION Low cord and maternal serum retinol may reflect poor vitamin A status of the newborn and the mother, which in turn may affect fetal growth.

Which intercurrent infections are associated with maculopapular cutaneous drug reactions? A case-control study

Abstract

The association between chlamydial-specific IgG and IgA antibodies and pregnancy outcome in an in vitro fertilization program

Chammydial-specfic IgG and IgA antibodies were determined by a single serovar (L2) immunoperoxidase assay (IPA) in the serum of all patients that have conceived in an in vitro fertilization and embryo transfer (IVF & ET) progrom (n=106) and in a group of patients that went through the program at the same period of time and did not conceive (n=94). The prevalence rate of elevated IPA IgG (titers≥1∶128) and IPA IgA (titers≥1∶16) specific to chlamydiae was significantly higher (P<0.001) in the IVF&ET pregnancy loss and nonconception groups (“failures”) versus the IVF&ET term pregnancy group (“successes”) (74 vs 47%, odds ratio=4.1, and 34 vs 14%, odds ratio=4.3, respectively). Stepwise discriminant analysis revealed that elevated specific chlamydial IgG had the greatest effect on the variance between successes and failures in this study group. Our study indicates the possible role of past or chronic active chlamydiae infection on the “take-home baby rate” in an IVF&ET program.

Persistence of antichlamydial antibodies after treatment of acute salpingitis with doxycycline

The effect of treatment with doxycycline on serum IgG and IgA antichlamydial antibodies was evaluated in 33 women who had had acute salpingitis associated with high titers of serum IgG (> or = 1:128) and/or IgA (> or = 1:16) antichlamydial antibodies. Overall, 29 women (87.9%) remained with high titers of IgG and/or IgA antibodies. No change or insignificant change in IgG antibody titer was demonstrated in 21 women (63.6%) and in IgA antibody titer in 21 women (63.6%). Positive seroconversion or a significant increase (> or = 4-fold) in IgG antibody titer was demonstrated in eight women (24.2%) and in IgA antibody titer in six women (18.1%). Negative seroconversion or a significant decrease in IgG antibody titer was demonstrated in four women (12.1%) and in IgA antibody titer in six women (18.1%). It is concluded that in most patients who had acute salpingitis associated with pretreatment high titers of serum antichlamydial antibodies, posttreatment titers may remain high even if treatment with doxycycline results in complete resolution of clinical signs and symptoms of the disease.

Serum reactivity to Chlamydia trachomatis and C. pneumoniae antigens in patients with documented infection and in healthy children by microimmunofluorescence and immunoblotting techniques

Chlamydia trachomatis and C. pneumoniae are both important human pathogens. Antigenic cross‐reactivity between the two species may complicate serologic diagnosis of infection with one or the other agent. In this study we examined sera of persons with chlamydial infections and of healthy children by microimmunofluorescence (MIF) against C. trachomatis L2 antigen and against C. pneumoniae TW‐183 antigen to explore the degree of cross‐reactivity found by these two methods. Likewise, the cross‐reactivity seen by immunoblot with sera of rabbits immunized against one of the antigens when tested on the other was examined. While among healthy children stratified by age, MIF seropositivity to C. pneumoniae TW‐183 increased with age, no such trend was observed with respect to seropositivity to C. trachomatis L2 antigens, and 81% of children seropositive to TW‐183 did not react on L2 antigen. Moreover, 27% of those positive on L2 antigen were negative on TW‐183. Immunoblot analysis showed much greater antibody cross‐reactivity than that detected by MIF. The immunoblot cross‐reactivity was probably not attributable solely to double infection since sera of rabbits immunized to only one species of chlamydia reacted strongly with both chlamydiae in immunoblot analysis. The data presented need to be taken into account in the development of serologic tests based on a small number of antigens or on partially denatured antigens.

Differences in cord serum retinol concentrations by ethnic origin in the Negev (southern Israel).

Subclinical vitamin A deficiency is related to increased morbidity and mortality in infants and children. Previous studies indicate that the traditional diet of Moslem Bedouins, an important ethnic group in Southern Israel, is low in vitamin A content. Cord serum retinol (vitamin A) concentration was measured by HPLC in samples from 251 apparently healthy (birth weight > 2500 g, gestational age > 37 weeks) neonates with no abnormal perinatal events, 138 Jews and 113 Bedouins. Retinol < 15 micrograms/dl was measured in a total of 14% of infants: in 7% of Jewish and 26% of Bedouin newborns (P < 0.001). However, mean cord serum retinol was only slightly lower in Bedouins than in Jews (30 +/- 26 vs. 37 +/- 27 micrograms/dl mean +/- S.D., n.s.). Cord serum retinol was not related to socioeconomic indices. Cord serum retinol < 15 micrograms/dl was measured in 25% and in 12% of infants with birth weight less than and equal or greater than 3000 g, respectively (P = 0.01), and in 28% and 13% of infants with gestational age 37-38 weeks and 39-41 weeks, respectively (P = 0.03). Low cord serum retinol was found to be prevalent in Southern Israel, particularly in Bedouin infants. In the population of healthy neonates studied, very low cord serum retinol concentrations were found more frequently in infants born with a lower weight and/or after a shorter gestation.

Antibody Pattern to Human Cytomegalovirus in Patients with Adenocarcinoma of the Colon

The role of human cytomegalovirus (CMV) was examined according to serological patterns in 37 patients with adenocarcinoma of the colon (ACC). The sera were examined for the presence of IgG antibodies by the immunoperoxidase antibody to membrane antigens (IPAMA) method and by the complement-fixation (CF) test. Antibody determinations were also performed by the IPAMA method for three other members of the herpesvirus group: Epstein-Barr virus (EBV), herpes simplex virus (HSV) and varicella-zoster virus (VZV). Comparison groups included normal subjects, ACC patients treated with chemotherapy, and patients operated on for benign diseases. No significant difference was found in the geometric mean titers (GMTs) for CMV and the other herpesviruses in the sera of nontreated ACC patients when compared with the control groups. However, a significantly elevated antibody titer to CMV was found in chemotherapy-treated ACC patients by both the IPAMA and CF methods. In this group, elevated titers were found by the IPAMA method for EBV and HSV, but not for VZV. The significance of serological studies in elucidating the role of CMV in ACC patients is discussed.

Association between prenatal exposure to metals and neonatal morbidity.

An association between prenatal exposure to (semi-)metals and of neonatal morbidity was assessed by introducing an oxidative stress as a possible intermediate step. An oxidative stress was measured by cell proliferation (CP) ratio in umbilical cord blood cells. Urine samples of 18 out of 58 enrolled women (31%) were positive for (semi-)metals; 25.9% of women were positive for aluminum (Al). The CP ratio was higher (1) in subjects with Al, (2) in mothers to newborns diagnosed as small-for-gestational age (p value = .052), (3) neonates that weighed less (p value = .079), and (4) in women who experienced repeated abortions (p value = .049). Our findings suggest the possibility of metal-induced oxidative stress.

Use of Seroconversion Panels To Estimate Delay in Detection of Anti-Human Immunodeficiency Virus Antibodies by Enzyme-Linked Immunosorbent Assay of Pooled Compared to Singleton Serum Samples

ABSTRACT The transfusion of unsafe blood worldwide accounts for 5 to 15% of new human immunodeficiency virus (HIV) infections, most of which occur in sub-Saharan Africa. While developed countries now apply PCR testing of pooled samples, some developing countries still do not have universal screening policies. More efficient low-cost procedures for the screening of pooled samples have the potential to encourage mass screening efforts in resource-poor settings. The aim of this study was to estimate the delay in the detection of HIV antibodies in pooled serum samples compared to that in singleton serum samples by enzyme-linked immunosorbent assay (ELISA) and to evaluate the risk of transfusion-transmitted HIV infection during the window period. Serial blood samples obtained from five HIV seroconversion panels were mixed with HIV-seronegative blood samples to create pools of 6, 12, 16, 24, 32, and 48 samples. The delay in detection of the first anti-HIV antibody-positive sample in tests with pooled samples was calculated for each pool size and compared to that obtained by testing of singleton samples and statistically evaluated by a robust log-linear regression analysis. The risk of a false-negative (FN) result caused by dilution was estimated by use of the incidence risk/window period model. The additional risk of transmission related to ELISA screening of pooled samples for HIV did not exceed 9% of the current risk of an FN result (estimated to be 1/1,067,000). The countries with virus prevalence rates in donors of less than 15% are expected to save up to 30% in the number of tests. ELISA screening of pooled samples could be considered in settings where the testing of blood supplies for HIV is not routinely done.