State, local, tribal, and territorial emergency managers and public health officials must address the specific needs of people with disabilities in their pandemic influenza plans. Evidence from Hurricane Katrina indicated that this population was disproportionately affected by the storm and aftermath. People with disabilities, particularly those who require personal assistance and those who reside in congregate care facilities, may be at increased risk during an influenza pandemic because of disrupted care or the introduction of the virus by their caregivers. Emergency and public health planners must ensure that personal assistance agencies and congregate care operators make provisions for backup staffing and that those who provide critical care are given adequate antiviral drugs and vaccines as they become available.
Background Conventional practice is to reduce or eliminate copper supplementation in the parenteral nutrition of infants with cholestasis due to the increased risk of hepatotoxicity. However, there are reports of copper deficiency in cholestatic infants due to copper reduction in their parenteral nutrition. Objectives 1) To determine the proportion of cholestatic infants who develop elevated serum copper while receiving a non-reduced dose of parenteral copper, 2) To evaluate potential clinical factors that affect serum copper in cholestatic infants, and 3) To evaluate the impact of serum copper on liver disease. Methods This is a retrospective review of 28 cholestatic infants receiving 20 mcg/kg/d of copper via parenteral nutrition. Age-adjusted references were used to determine normality of serum copper levels. Multiple linear regression analyses were performed to determine predictors of serum copper and alanine aminotransferase. Results Serum copper levels were elevated in 2 infants (7%). On average, infants received 80% of their energy intake from parenteral nutrition for 3 months. Intestinal failure was present in 50% of the patients. Birth weight, gestational age and alanine aminotransferase were identified as predictors of serum copper (R2=0.53; p= 0.0001). Serum copper, gestational age and total bilirubin were associated with serum alanine aminotransferase (R2 = 0.43; p = 0.001). Conclusion Supplementation of parenteral copper at 20 mcg/kg/day does not lead to a significant increase in copper toxicity or worsening of liver disease in cholestatic infants.
Background: Although IgA endomysial antibodies (EMA) and tissue transglutaminase (TG) are sensitive and specific serologic tests for the diagnosis of celiac disease, there is limited information on the association of the magnitude of antibody level with the severity of the histological abnormalities of the intestine. Purpose: To determine if EMA and TG titers correlate with the severity of histological changes in patients with celiac disease. Methods: We identified 148 children from our laboratory database that had EMA, TG and intestinal biopsies performed. IgA EMA was determined by indirect immunofluorescence with results expressed as a dilutional titer with positivity determined at 1:5. IgA TG was determined by an enzyme linked human immunosorbent ELISA assay with results expressed in standardized units. A modified Marsh histological grading system was used to describe the duodenal biopsies: Type 0 normal, I increased intraepithelial lymphocytes (IEL), II hyperplastic crypts, IIIa partial villus atrophy, IIIb subtotal villus atrophy, IIIc total villous atrophy. Results: Mean values for EMA (Table 1) and TG (Table 2) progressively increased with increasing Marsh score. Conclusion:There was considerable variability in EMA and TG levels for each Marsh grade, so that an individual level could not be utilized to predict histological severity. The data show that as a group, increasing severity of the histological lesion in celiac disease was associated with increased levels of both IgA EMA and TG antibodies.
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