Early exposure to thimerosal-containing vaccines and children's cognitive development : a 9-year prospective birth cohort study in Poland

The controversial topic of the early exposure to mercury is regarding ethylmercury, which is present in the thimerosal-containing vaccines (TCVs). The objective of this study was to determine the relationship between the early exposure to TCVs and cognitive development in children during the first 9 years of life. The cohort included 318 children vaccinated in an early period (neonatal and up to 6 months) against hepatitis B and diphtheria-tetanus-pertussis (DTP) using formulation with or without thimerosal. The children’s development was assessed using the Fagan test (6th month of life), the Bayley Scales of Infant Development (BSID)-II (12th–36th month), the Raven test (5th, 8th year), and the Wechsler Intelligence Scale for Children (WISC-R) (6th, 7th, 9th year). Results were determined by multivariable linear and logistic regression, adjusted to potential confounders. Children exposed and not exposed to TCVs in the neonatal period had similar outcomes of cognitive-developmental tests; only the results of BSID-II at the 36th month and WISC-R at the 9th year were significantly higher for those exposed to TCVs. Developmental test results in children exposed to TCVs up to the 6th month of life also did not depend on thimerosal dose. Conclusion: TCV administration in early infancy did not affect children’s cognitive development

The effectiveness of rotavirus vaccine in preventing acute gastroenteritis during rotavirus seasons among Polish children

Introduction: Rotavirus is the main etiological cause of intestinal infections in children. Voluntary rotavirus vaccines were included in the Polish vaccination schedule in 2007. The aim of this study was to assess the effectiveness of a completed rotavirus vaccination course in preventing acute gastroenteritis in Polish infants during their first five years of life. Material and methods: This was a retrospective cohort study conducted in Lesser Poland (Malopolska Province). The sample population included a group of 303 children who received the completed rotavirus vaccination course and 303 children not vaccinated against rotavirus. The date of the child’s acute gastroenteritis diagnosis and his or her vaccination history were extracted from the physicians’ records. Each kind of diagnosed acute gastroenteritis during winter-spring rotavirus seasons was treated as the endpoint. The relative risk of having gastrointestinal infection was assessed using the hazard ratio from the Cox proportional hazards regression model. Results: In the examined group, 96 (15.8%) children had winter-spring gastrointestinal infections. In the non-vaccinated children, the cumulative incidence of these infections in the first 5 years of life was 20.8%, whereas in the children vaccinated with Rotarix it was only 10.9%. Those who were vaccinated with Rotarix had a 44% reduction in the risk of a winter-spring acute gastroenteritis infection compared to those not vaccinated with Rotarix (p = 0.005). Birth weight less than 2500 g increased the risk of the infection twofold and also reached statistical significance (p = 0.044). Conclusions: The results showed that Rotarix is effective in preventing acute gastroenteritis in Polish children during rotavirus seasons

Whole-cell pertussis vaccine (DTwP) has no influence on allergic diseases and atopic sensitization in children

Introduction: Vaccine opponents indicate that the infant's immune system is inadequately developed to handle multiple vaccines which may overwhelm the immune system, leading to allergic diseases. Aim: To verify the association between the vaccine antigen overload derived from DTwP and the development of atopic sensitization and allergic diseases. Material and methods: Data from an earlier established birth cohort in Krakow, followed up to the 6th year of life were used. Allergic diseases such as eczema, hay fever and asthma were diagnosed by a physician and reported every half a year from the 1st to 6th year of life by the child’s parent. Skin prick tests (SPT) were performed in children at 5 years of age. The data on infants' vaccination were extracted from the physician's records. The status of vaccine antigen exposure was based on different types of vaccines against pertussis (DTwP or DTaP) in a primary course. Results were determined by multiple logistic regression, adjusted to potential confounders. Results: The analyzed population consisted of 234 children: 53.4% - boys and 46.6% - girls. Infants up to the age of 8 months were vaccinated with the primary course against pertussis, with DTwP - 60.7%, DTaP - 32.9% and further 6.4% with a mixed course (DTwP + DTaP). There were no significant relationships between any of vaccination groups and allergic disease and allergen sensitivity in the multiple logistic regression model with adjustment to potential confounders. Conclusions: The exposure to a large number of vaccine antigens derived from DTwP has no influence on the development of allergic diseases and atopic sensitization in children

Using student self-assessment to steer feedback

BACKGROUND Students might better engage with feedback if they are responsible for steering the feedback process. However, this requires them to first accurately assess the quality of their work. AIMS To determine whether providing students with a structured self-assessment method prior to submission influences their confidence with this process. DESCRIPTION OF INTERVENTION Students were asked to complete a brief self-assessment of one of their laboratory reports, which markers then used to guide their feedback to each student. DESIGN AND METHODS Participants were undergraduate students undertaking a second-year pharmacology unit in semester 2, 2018 (n=117/265 enrolled). Students were invited to complete an anonymous survey asking them about their perceptions of self-assessment. RESULTS 55% of respondents indicated that they found feedback useful following self-assessment. Of these respondents, 54% indicated that being able to first specify areas of difficulty was the reason why. However, 34% of all respondents indicated that they still lacked confidence in accurately evaluating their work. CONCLUSIONS Students’ lack of confidence in their ability to self-evaluate suggests that perhaps they are not given sufficient opportunity to practice this skill. Although our current model could be extended into any setting, the value of self-evaluation first needs to be understood by students in order to promote their full engagement with this process

Use of ultra-low dose computed tomography versus abdominal plain film for assessment of stone-free rates after shock-wave lithotripsy: implications on emergency room visits, surgical procedures, and cost-effectiveness

The aims of this investigation were: (1) to compare residual stone-fragment (RSF) detection rates of ultra-low dose computed tomography (ULD-CT) and abdominal plain film (KUB) in urolithiasis patients undergoing shock-wave lithotripsy (SWL), and (2) to evaluate the downstream sequelae of utilizing these two disparate imaging pathways of differing diagnostic fidelity. A retrospective chart-review of patients undergoing SWL at two high-volume surgical centers was undertaken (2013-2016). RSF diagnostic rates of ULD-CT and KUB were assessed, and the impact of imaging modality used on subsequent emergency room (ER) visits, unplanned procedures, and cost-effectiveness was investigated. Adjusted analyses examined association between imaging modality used and outcomes, and Markov decision-tree analysis was performed to identify a cost advantageous scenario for ULD-CT over KUB. Of 417 patients studied, 57 (13.7%) underwent ULD-CT while the remaining 360 underwent KUB. The RSF rates were 36.8% and 22.8% in the ULD-CT and KUB groups, respectively (p = 0.019). A 5.6% and 18% of the patients deemed stone-free on ULD-CT and KUB, respectively, returned to the ER (p = 0.040). Similarly, 2.8% and 15.1% needed an unplanned surgery (p = 0.027). These findings were confirmed on multivariable analyses, Odds ratios CT-ULD versus KUB: 0.19 and 0.10, respectively, p \u3c 0.05. With regards to cost-effectiveness, at low ULD-CT charges, the ULD-CT follow-up pathway was economically more favorable, but with increasing ULD-CT charges, the KUB follow-up pathway superseded. ULD-CT seems to provide a more \u27true\u27 estimate of stone-free status, and in consequence mitigates unwanted emergency and operating room visits by reducing untimely stent removals and false patient reassurances. Further, at low ULD-CT costs, it may also be economically more favorable

Role of chemokine RANTES in the regulation of perivascular inflammation, T-cell accumulation, and vascular dysfunction in hypertension.

Recent studies have emphasized the role of perivascular inflammation in cardiovascular disease. We studied mechanisms of perivascular leukocyte infiltration in angiotensin II (Ang II)-induced hypertension and their links to vascular dysfunction. Chronic Ang II infusion in mice increased immune cell content of T cells (255 ± 130 to 1664 ± 349 cells/mg; P \u3c 0.01), M1 and M2 macrophages, and dendritic cells in perivascular adipose tissue. In particular, the content of T lymphocytes bearing CC chemokine receptor (CCR) 1, CCR3, and CCR5 receptors for RANTES chemokine was increased by Ang II (CCR1, 15.6 ± 1.5% vs. 31 ± 5%; P \u3c 0.01). Hypertension was associated with an increase in perivascular adipose tissue expression of the chemokine RANTES (relative quantification, 1.2 ± 0.2 vs. 3.5 ± 1.1; P \u3c 0.05), which induced T-cell chemotaxis and vascular accumulation of T cells expressing the chemokine receptors CCR1, CCR3, and CCR5. Mechanistically, RANTES(-/-) knockout protected against vascular leukocyte, and in particular T lymphocyte infiltration (26 ± 5% in wild type Ang II vs. 15 ± 4% in RANTES(-/-)), which was associated with protection from endothelial dysfunction induced by Ang II. This effect was linked with diminished infiltration of IFN-γ-producing CD8(+) and double-negative CD3(+)CD4(-)CD8(-) T cells in perivascular space and reduced vascular oxidative stress while FoxP3(+) T-regulatory cells were unaltered. IFN-γ ex vivo caused significant endothelial dysfunction, which was reduced by superoxide anion scavenging. In a human cohort, a significant inverse correlation was observed between circulating RANTES levels as a biomarker and vascular function measured as flow-mediated dilatation (R = -0.3, P \u3c 0.01) or endothelial injury marker von Willebrand factor (R = +0.3; P \u3c 0.01). Thus, chemokine RANTES is important in the regulation of vascular dysfunction through modulation of perivascular inflammation.-Mikolajczyk, T. P., Nosalski, R., Szczepaniak, P., Budzyn, K., Osmenda, G., Skiba, D., Sagan, A., Wu, J., Vinh, A., Marvar, P. J., Guzik, B., Podolec, J., Drummond, G., Lob, H. E., Harrison, D. G., Guzik, T. J. Role of chemokine RANTES in the regulation of perivascular inflammation, T-cell accumulation, and vascular dysfunction in hypertension