To identify risk factors for uterine fibroids, a case-control design used to analyze data from control subjects enrolled in the Cancer and Steroid Hormone Study. Case patients were 201 women who reported a history of uterine fibroids, and control subjects were 1503 women without fibroids, individually matched by age to case patients. Reporting of fibroids was more frequent among premenopausal women, women who had frequent Papanicolaou (Pap) smears, women who used oral contraceptives and had infrequent Pap smears, and women with higher education. Reporting of fibroids was less frequent among women with a lower body mass index who were current or long-time smokers.
Plasmid profiles, the location of cholera toxin subunit A genes, and the presence of the defective VcA1 prophage genome in classical Vibrio cholerae isolated from patients in Bangladesh in 1982 were compared with those in older classical strains isolated during the sixth pandemic and with those in selected eltor and nontoxigenic O1 isolates. Classical strains typically had two plasmids (21 and 3 megadaltons), eltor strains typically had no plasmids, and nontoxigenic O1 strains had zero to three plasmids. The old and new isolates of classical V. cholerae had two HindIII chromosomal digest fragments containing cholera toxin subunit A genes, whereas the eltor strains from Eastern countries had one fragment. The eltor strains from areas surrounding the Gulf of Mexico also had two subunit A gene fragments, which were smaller and easily distinguished from the classical pattern. All classical strains had 8 to 10 HindIII fragments containing the defective VcA1 prophage genome; none of the Eastern eltor strains had these genes, and the Gulf Coast eltor strains contained a different array of weakly hybridizing genes. These data suggest that the recent isolates of classical cholera in Bangladesh are closely related to the bacterial strain(s) which caused classical cholera during the sixth pandemic. These data do not support hypotheses that either the eltor or the nontoxigenic O1 strains are precursors of the new classical strains.
OBJECTIVES. Tetanus continues to be a leading cause of neonatal death in Bangladesh as in other developing countries, yet little is known about risk factors or the efficacy of tetanus toxoid in this setting. METHODS. In May 1990, mothers of 6148 infants born alive between March 15, 1989, and March 14, 1990, in 30 rural unions of Rajshahi Division in Bangladesh were interviewed. Three surviving controls for each neonatal tetanus death were matched for sex, residence, and date of birth. RESULTS. Of 330 neonatal deaths, 112 met the case definition for tetanus. Risk was increased with a history of neonatal tetanus in a previous child, application of coconut oil to the vagina, and use of multiple ties on the umbilical cord. Risk was reduced by the birth attendant washing hands and using a cleaned cord-cutting tool. Risk was not reduced by a maternal history of two doses of tetanus toxoid (TT2), although estimated efficacy of TT2 was 45% (95% confidence interval = 16% to 64%). Subsequent to the survey, a reference laboratory reported to potency in three consecutive lots of tetanus vaccine from the production laboratory in Bangladesh. CONCLUSIONS. These findings identify high-risk mothers, stress the importance of washing hands and cleaning the cord-cutting tool, and demand improved quality control of tetanus vaccine production.
Strains of Shigella dysenteriae type 1 and Sh. flexneri isolated during 1981-82 from children with shigellosis and also from asymptomatic excretors were examined for drug resistance and for the presence of plasmids. Shigella strains isolated from dysenteric children showed multiple plasmid bands. Thirty-eight percent of the strains transferred the drug resistance factor(s), either partially or fully to a recipient Escherichia coli K12 strain. Plasmids in the molecular weight range from between 44-76 Mdal were correlated with drug resistance. It was found that multi-resistant clinical isolates generally harbour a single large transmissible plasmid. Strains isolated from asymptomatic excretors demonstrated plasmid patterns different from those isolated from children with shigellosis although the bands were relatively homogeneous within each group. Both the groups showed the presence of a 140 Mdal plasmid band conferring invasiveness and such strains gave a positive Sereny test. This study thus shows that Shigella strains from asymptomatic excretors also retain invasiveness.
Detection of rotavirus in handwashings of attendants of children with diarrhoea Rotavirus diarrhoea is common in infants and young children and appears to have a worldwide distribution. While faecal-oral route of transmission has been reported,' potential vehicles of transmiission are not known. Nosocomially acquired outbreaks of rotavirus diarrhoea have occurred in nurseries2 and paediatric wards3 in developed countries. None the less, we have detected rotavirus in handwashings of attendants of patients with rotavirus diarrhoea more often than in those of attendants of children with non-rotavirus diarrhoea.
Data on the cholera patients admitted monthly to the ICDDR, B, hospital in Dhaka (Bangladesh) from 1964 through 1980 have been studied and analysed. Although Vibrio cholerae variant El Tor did not enter Bangladesh until 1963, it has completely displaced classical cholera since 1973. There have also been changes in seasonality, which are discussed.
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