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1.  Immunoglobulin-containing cells in jejunal mucosa of children with protein-energy malnutrition and gastroenteritis. 
Archives of Disease in Childhood  1980;55(5):380-383.
Jejunal biopsies from 20 well nourished children (average age 12.8 months) with gastroenteritis, and 20 children (average age 20 months) with protein-energy malnutrition were examined by immunofluorescent technique for immunoglobulins A, G, M, E, and D, and for epithelial glycoprotein secretory component. Compared with previous studies on normal infants, the children with gastroenteritis showed a moderate increase in IgA-containing cells, a large increase in IgM-containing cells, and no change in IgG-containing cells. These findings are similar to previously recorded findings on adults with gastroenteritis. In contrast there was a pronounced and highly significant decrease in IgA-containing cells in the jejunal mucosa of the children with protein-energy malnutrition. No significant differences were noted between the populations of IgG-, IgM-, IgE-, and IgD-containing cells in the two groups. It is suggested that this selective deficiency in mucosal IgA results from a delay in maturation of the secretory IgA system, and the mechanisms of such a deficiency are discussed.
PMCID: PMC1626876  PMID: 6776903
2.  Neonatal vaccination with 'universal strength' BCG vaccine. 
Archives of Disease in Childhood  1977;52(6):503-504.
'Universal strength' BCG vaccine was given to 219 neonates and 2 months later 159 infants were Mantoux-tested with 5 Tu PPD-S and their BCG scars measured. The results showed a satisfactory conversion rate of over 90%. Though 30% of the lesions discharged, this only lasted for a few days and the vaccine was well tolerated and acceptable for use in neonates.
PMCID: PMC1544706  PMID: 879836
3.  Anthrax in the Gambia: an epidemiological study 
British Medical Journal  1975;4(5988):79-82.
Epidemiological data on 448 cases of human cutaneous anthrax from the Gambia showed that this particular strain of anthrax bacillus causes widespread morbidity and some mortality with, at the same time, subclinical infection. Analysis also showed that anthrax is not an occupationally related disease in the Gambia.
The possibility of human-to-human spread, affecting all age groups and both sexes, by means of a communal toilet article was also shown. The fact that the strain is a good toxin producer but contains a weak antigen may have accounted for the repeated clinical infection and the fact that antibody titres were generally transient. Subclinical infection in animals was also found, particularly in sheep and goats, and also, with an unusually low mortality, in cows. Insect vectors were not excluded, but were unlikely. Vultures may spread the disease from village to village. Some possible public health and immunization procedures are discussed, with a view to containing this difficult problem in this part of west Africa.
PMCID: PMC1674945  PMID: 810213
4.  Jejunal microflora in malnourished Gambian children. 
Growth of bacteria greater than 10-5 organisms/ml was found in 22 children, of whom 17 gave a histroy of chronic diarrhoea. The other 8 children had either no diarrhoea or where having an acute attack lasting for a few days. In those with chronic diarrhoea, Esch. coli, bacteroides, and enterococci tended to occur more frequently, whereas streptococci occurred more frequently in those with acute diarrhoea. Bacilli, staphylococci, micrococci, klebsiellas, pseudomonads, and candidas often occurred in both groups and in large numbers in those with chronic diarrhoea. This confirms previous reports in other parts of the world that some children with malnutrition have considerable bacterial contamination of the jejunum, and that this may be of aetiological significance as a cause of much of the diarrhoea seen in malnourished children. It is possible too that this may be important in the pathogenesis of malnutrition. The presence of intestinal parasites in these malnourished children is also noted. A double-blind trial in the use of antibiotics in this condition is advocated to determine whether it is possible to break the diarrhoea-malabsorption-malnutrition cycle. At the same time the effect of simply removing the child to a more sanitary environment, together with an estimate of the natural clearance of bacteria from the upper intestine, should be evaluated.
PMCID: PMC1544478  PMID: 1092272
5.  Letter: Pathogenesis of measles. 
British Medical Journal  1973;3(5882):693.
PMCID: PMC1586995  PMID: 4200479
6.  Cross-infection in Infantile Gastroenteritis 
Archives of Disease in Childhood  1971;46(250):815-818.
It is not entirely possible to prevent hospital cross-infection in infantile gastroenteritis by the use of conventional barrier-nursing techniques, even with experienced staff in well-designed wards. An incident of double cross-infection due to enteropathic Esch. coli types O119 and O126 and the measures that were taken to control it are described. The type O119 infections were clinically severe, and the cases showed significant levels of serum antibody to the organism, while the type O126 infections were clinically mild and no antibody was produced. The use of the antibiotic colistin, to which both organisms were originally sensitive, may have been of some value in clearing the type O119 infection but was without effect on the type O126 infection, which continued to spread during treatment. A degree of resistance to colistin was found in some strains of the type O126 organism isolated after treatment. The outbreaks largely ended spontaneously, but may have been limited in extent by the administrative measures described. The use of antibiotics in infantile gastroenteritis is reviewed and a plea is made for a modern large-scale trial to reassess their value.
PMCID: PMC1647885  PMID: 4942943
7.  Crohn's Disease and Pregnancy 
British Medical Journal  1970;2(5705):363-364.
PMCID: PMC1700098  PMID: 4317054

Results 1-7 (7)