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Biotech / Medical : XOMA. Bull or Bear? -- Ignore unavailable to you. Want to Upgrade?

To: Robert K. who wrote (9276)	3/19/1999 4:43:00 PM
From: aknahow	Read Replies (1) \| Respond to of 17367

Read meningococcemia portion> suffolk-maag.ac.uk Enhanced meningococcal surveillance The three main sources of information on the incidence of meningococcal disease (notifications, laboratory-confirmations and laboratory isolates) have been returning increasingly divergent results over recent years. A study to address this divergence is now underway in Anglia and Oxford Region. It does not require anything of GPs - now read on! Much of the thrust is to secure a positive diagnosis wherever possible by taking a goodly range of specimens from the patient on admission. Lumbar puncture is under a bit of a cloud after a number of reports of brainstem herniation after diagnostic taps in persons suspected of having meningitis, but this is balanced by the findings that, in meningococcal disease, the organism can be cultured from the throat in 50% of cases and from the rash, where present, in 60% of cases. Polymerase Chain Reaction techniques are getting cleverer too. The end result of all this is to be a clearer view of the incidence of meningococcal disease by type to allow an estimate of the health gain to be expected of the new meningococcus C conjugate vaccines which will become generally available over the next few years. Meningococcal Deaths Getting underway in parallel with the above study is one comparing case-management in those children (under 17s) who die of meningococcal disease with those who survive it. Each death is matched by three survivor controls selected by the Regional Epidemiologist. The stimulus to the study was the observation from St. Mary's that roughly half the cases referred to their Paediatric Intensive Care Unit showed factors in their earlier care that might have borne on the eventual outcome. The protocol for this study states that the GP who saw the case at presentation will be approached to recall timing and nature of the child's presentation and the type and timing of any interventions. The child's parents will also be approached for their perspective of the early aspects of the case. The aim of the study, predictably enough, is to assess: The impact of early recognition and treatment of meningococcal disease The impact of hospital-based care on survival and to provide: evidence-based guidelines for the management of meningococcal disease in childhood My comment was invited on the November 1996 iteration of the protocol and I was (and remain) unhappy with the aspect of approaching the child's parents, feeling that those parents whose children had good outcomes will tend to view the early handling of the case more favourably than those whose children died. Unfortunately, the timing of the study doesn't seem to allow for the views of those whose children developed sequelae as it approaches the parents too soon - before the impact of the sequelae is apparent. Overall, I think it would have been better to ditch the subjective elements (which require the study to be done in 'real time') and go back in time to compare the management of past fatal and survivor cases. As it stands this study will not yield its final result for two years. Bob read this last part twice. Seems like he is saying wait for the data to determine changes in fatalities. b3e.jussieu.fr In Spanish about Scotland 96-97. Interesting info. Will comment later. O.K. same in English b3e.jussieu.fr