From the present study, we can conclude that both the formulations of B. monnieri i.e. Brahmi Ghrita and Saraswatarishta have promising anti-convulsive activity with better restorative effects. Phenytoin has been proven to be most significant as compared to herbal drugs in controlling convulsions but the oxidative damage by the drug can be controlled or sidelines by the use of concurrent Ayurvedic polyherbal treatments. This scientific evidence for the Ayurvedic therapies can make effective health care and patient friendly medication for convulsions. Further elucidation of mechanism of action and drug–drug interaction would open a new avenue in herbal

biotechnology. progestogen antagonist All authors have none to declare. “
“Enzymes are complex globular proteins found in living cells, acting as a bio-catalyst facilitating metabolic reactions in an organism’s body. In 1878 Kuhne coined the term ‘enzyme’ from the Greek word, “enzumas”, which refers to the leavening of bread by yeast. Enzymes catalytic nature is responsible for the functioning. It participates

in a reaction without being consumed in the reaction, attaining a high rate of product formation by lowering down the Gibb’s free energy (ΔG°) required for the reaction to occur.1 Because of their specific nature enzymes can differentiate between chemicals with similar structures and can catalyze reactions over a wide range of temperatures (0–110 °C) and selleck in the pH range 2–14. In industrial application, such qualities with an enzyme being non-toxic and biodegradable can result in high quality and quantity products, fewer by-products and simpler purification procedures. Also enzymes can be obtained from different microorganisms and that too in large amount without using any chemical resistant approaches.2 In the West, the industrial understanding of enzymes revolved around yeast and malt where traditional baking and brewing industries were rapidly Thalidomide expanding. Much of the early development of biochemistry

was centred on yeast fermentations and processes for conversion of starch to sugar.1 One such enzyme of our interest is “Invertase”. This article focuses on the extraction methods, purification approaches, catalytic nature and its application in today’s world. The primary source of energy in all living organisms is carbohydrates. Even non-reducing disaccharides like trehalose or sucrose also have other roles like acting as signalling molecule as well as stress protectants.3 Additionally monosaccharide like glucose or fructose plays regulatory functions in the central metabolic pathway of a cell’s metabolism.4 Thus, Invertase plays a central role as it is a sucrose hydrolyzing enzyme, named because of the inversion in the optical rotation during the hydrolysis of sucrose.

3%) [15] and [16]. To reduce the risk of bleeding, meticulous haemostasis irrespective of operative technique is critical and always applicable. Bleeding risk can be reduced by temporary discontinuation

of anti-platelet therapy. Certain haemostatic agents [6] and newer haemostasis technologies [7] may also be useful. Leaving some or even all of the strap muscles open to facilitate haematoma decompression and pre-closure valsalva are recommended by some [6] and [28] with head up recovery to reduce venous Selleckchem Enzalutamide bleeding and avoidance of arterial hypertension also sensible precautions. New anaesthetic techniques and agents to reduce the risk of postoperative vomiting and the use of deep extubation to

reduce coughing can be considered. Recognised risk factors for hypocalcaemia following thyroid surgery are total rather than hemi-thyroidectomy, hyperthyroidism, thyroid cancer and retrosternal extension [30]. National audit data demonstrates that up to a Selleck Autophagy inhibitor third of patients undergoing total thyroidectomy [10] and [11] may become hypocalcaemic and require calcium and/or vitamin D analogue supplements. As clinically significant hypocalcaemia usually occurs 48–72 hours after, thyroidectomy improved methods of detection have already been tested and refined to facilitate increasingly shorter lengths of stay. Several groups have utilised postoperative parathyroid hormone (PTH) levels as an early indicator of hypocalcaemia after total thyroidectomy [8]. Re-admission rates for hypocalcaemia should be less than 2% if appropriately treated [15]. Prophylactic calcium is used routinely in some centres [13] and [16] or patients may be taught to

manage their own hypocalcaemia [29]. It is particularly suitable to the outpatient setting where there MycoClean Mycoplasma Removal Kit is limited time to available to correct hypocalcaemia in a reactive fashion once it is discovered. Recurrent laryngeal nerve (RLN) paralysis is a recognized complication of thyroid surgery. Although temporary vocal cord paresis is common, the incidence of permanent RLN injury should be under 1–2% [10] and [11]. Where routine laryngoscopy is used, rates are much higher and in revision, thyroid surgery is approximately six times higher than in first time thyroid surgery [11]. For day case thyroidectomy, a unilateral nerve paralysis should not prevent discharge as the airway would not be unacceptably compromised unlike bilateral recurrent laryngeal nerve paralysis, which is a life threatening condition. Fortunately it is rare, reported as 0.2% (1 in 500) in Sweden’s national thyroid and parathyroid surgery registry [11] and should be apparent before discharge.

Randomisation of 195 participants allocated 65 to each of the Tai Chi, resistance, and stretching groups. Interventions: The Tai Chi group

underwent a Tai Chi program, the resistance group 8 to 10 leg muscle strengthening exercises, while the stretching group performed stretching exercises involving the upper body and lower extremities. All three groups trained for 24 weeks (60 minutes per session, two sessions per week). Outcome measures: The primary outcomes were two indicators of postural stability – maximum excursion and directional control derived from dynamic posturography. The secondary outcomes were stride length, gait velocity, knee flexion and extension peak torque, functional reach, timed-up-and-go test, and motor section of the Unified Parkinson’s selleck products Disease Rating Scale (UPDRS III). The outcomes were measured at baseline, at 12 and 24 weeks, and 3 months after termination of the intervention. selleck chemicals Results: 185 participants completed the study. At the end of the 24-week training period, the change in maximum excursion in the Tai Chi group was significantly more than that in the resistance group (by 5%, 95% CI 1.1 to 10.0) and the stretching group (by 12%,

95% CI 7.2 to 16.7). Direction control improved significantly more in the Tai Chi group compared with the resistance group (by 11%, 95% CI 3.9 to 17.0) and the control group (by 11%, 95% CI 5.5 to 17.3). The Tai Chi group also had significantly more improvement in stride length and functional reach than the other two groups. The change in knee flexion and extension peak Olopatadine torque, timed-up-and-go test, and UPDRS III score in the Tai Chi group was only significantly more than that in the stretching group, but not the resistance group. The falls incidence was also lower in the Tai Chi group than the stretching group during the 6-month training period (incidence-rate

ratio: 0.33, 95% CI 0.16 to 0.71). Conclusion: Tai Chi training is effective in reducing balance impairments in patients with mild to moderate Parkinson’s disease. Li et al report a well-conducted randomised clinical trial using Tai Chi as an intervention among patients with Parkinson’s disease. The Li study builds on previous research which has shown that limits of stability are better in community-dwelling older Tai Chi practitioners in both maximum excursion and directional control (Tsang and Hui-Chan 2003, Gyllensten et al 2010). The findings reflect the training specificity of Tai Chi in which the practitioners are required to shift their body weight to different positions as far as possible in a smooth and co-ordinated manner, whereas the other two exercise groups (resistance training group and stretching group) did not have such features. This is also the first study investigating whether Tai Chi has any positive impact on fall incidence in patients with Parkinson’s disease.

Similar controversial brain volume findings have been reported previously and one hypothesis is that Enzalutamide in vivo it might have to do with the intervention helping to dissolve specific cerebral pathology (eg, amyloid plaques). If β-amyloid were measured it could have helped to explore this hypothesis further. This RCT encourages us not only to recommend physical activity for the ageing brain, but also to investigate further what type, frequency, and intensity of physical activity might be optimal. “
“Summary of: Bischoff-Ferrari

HA, Dawson-Hughes B, Platz A, Orav EJ, Stahelin HB, Willett WC, et al (2010) Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip facture. Arch Intern Med 170: 813–820. [Prepared by Nora Shields, CAP Editor.] Question:

Do additional physiotherapy and high dose vitamin D3 therapy reduce the rate of falls and hospital admissions in patients with hip fracture? Design: Randomised, controlled trial with blinded outcome assessment. Setting: One large hospital centre in Switzerland. Participants: 173 patients with acute hip fracture. All participants had to have a mini-mental examination score of at least 15, have had no prior hip fracture at the newly fractured selleck chemical hip, have undergone surgical repair, have creatinine clearance of more than 15 mL/min and to have been able to walk 3 m before their hip fracture. Key exclusion criteria included metastatic cancer or chemotherapy, kidney stones, hypercalcaemia, primary parathyroidism,

sarcoidosis, or severe vision or hearing impairment. Randomisation of 173 participants allocated 42 to standard physiotherapy and high dose vitamin D3 therapy, 44 to additional physiotherapy and high dose vitamin D3 therapy, 44 to standard physiotherapy and standard vitamin D3 therapy, and 43 to additional physiotherapy and standard vitamin D3 therapy. Interventions: Both groups received 30 min per day of physiotherapy and 800 IU per day vitamin D3 therapy. why In addition, the additional physiotherapy groups received an extra 30 minutes of home program instruction each day during acute care and an instructional leaflet at discharge. The high dose Vitamin D therapy groups also received an additional 1200 IU per day vitamin D3 therapy. Outcome measures: The primary outcomes were rate of falls and the rate of hospital readmission at 12 months, assessed by monthly telephone calls and a patient diary. All analyses were based on intention to treat and included 173 patients. Results: 128 participants completed the study. At 12 months, the falls rate in the patients who had received additional physiotherapy was 25% less (95% CI –44% to –1%). High dose vitamin D3 therapy did not reduce the rate of falls. At 12 months, the rate of hospital readmission was 39% less in patients who received the high dose vitamin D3 therapy (95% CI –62% to –1%). Additional physiotherapy did not reduce the rate of hospital admission.

aureus ATCC 25923, local isolates of methicillin resistant S. aureus BHU 011 and Enterococcus faecalis were used in this study. Antibiotic sensitivity Docetaxel order pattern of these test organisms were tested by using FDA recommended antibiotics and standard methodology. The freshly collected leaves were washed with distilled water and air-dried at 40 °C

and powdered. The powdered material was extracted with different solvents (Hexane, Methanol and water) by freeze- thaw method. The extracts were collected in sterile bottles, reduced to dryness and stored at 2–8 °C until use. Qualitative antibacterial assays were performed by agar well diffusion method. Different volumes (50–300 μl) of extracts dissolved in distilled water (10 mg/ml) were directly applied to the wells made on surface of MHA containing bacterial lawn. Control wells received only distilled water. Positive control wells received streptomycin

(10 μg) except in case of MRSA and E. faecalis, where streptomycin (300 μg) was used as positive control. After diffusion, plates were incubated at 37 °C for 18 h and zones of growth inhibition were measured. Antimycobacterial activity of the plant extracts was tested by Indirect proportion method. The assay was performed on LJ medium with or without the plant extracts (05–20 mg ml−1). The minimum inhibitory concentration (MIC) was determined by agar Talazoparib supplier dilution method. The concentration of plant extracts used were in the range of 0.25–08 mg ml−1 and plates without any extracts were used as control for MIC determination. 75% methanol extracts of A. paniculata leaves were subjected to thin layer chromatography (TLC) for separation of antibacterial fraction. Silica gel-60 was used as stationary phase

whereas the mobile phase was the mixture of chloroform and methanol (7:3). The bands were visualized in a UV transilluminator and the position of bands was marked. The bands were scratched from TLC plates, dissolved in methanol, reduced to dryness, redissolved in deionized water and tested for its antibacterial activity against S. aureus ATCC 25923 by Macrobroth dilution method. The active fraction was subjected to various phytochemical tests according to conventional methods 7 to determine its chemical nature. Primary screening test, the qualitative antibacterial assay revealed those that out of the nine different extracts, only methanol extract of A. paniculata leaves posses antibacterial activity against S. aureus ATCC 25923. The methanol extracts of leaves from other two plants, A. maculatum and T. cardifolia exhibited no activity against the pathogens tested ( Table 1). Further, A. paniculata leaves were extracted using different concentrations of methanol as solvent and were assayed for antibacterial activity. These assays revealed the highest activity in 75% methanolic extract ( Table 2). Moreover, 75% methanolic extract of A.

Forty-eight patients with acute bacterial rhinosinusitis participated in the trial; 24 were allocated to the experimental group to receive ultrasound and 24 to the control group to receive antibiotics. In the short-term, there were 3 dropouts so that 94% of data was collected and in the long-term there were 6 dropouts so that 88% of data

was collected. Figure 2 shows the flow of participants through the trial and reasons for dropping out. The baseline characteristics of the participants are presented in Table 1. The groups were similar in age, gender, smoking habits, duration of current symptoms, previous episodes of sinusitis, and previous intervention except that the experimental group had more experience with nasal irrigation than the control group. Three out of four participants (77%) reported having symptoms for more this website than 7 days and 41 participants (85%) had had sinusitis previously. White blood cell counts at baseline showed an increase in granulocytes indicative of bacterial infection. One general practitioner in general practice recruited all the participants and prescribed the antibiotics for the control group.

One physiotherapist in a private physiotherapy practice delivered all ultrasound interventions (Table 1). All participants in the experimental group completed the four sessions of ultrasound. Compliance with PI3K inhibitor taking the antibiotics was not formally assessed, but there were no reports of interruption. The side-effects reported by the experimental group were nausea/stomach pain (n= 1)

and headache (n = 2), and by the control group were nausea/stomach pain (n = 1), fungal infection (n = 1), headache (n = 1) and allergy (n = 1). Group data for pain and congestion in the short-term is presented in Table 2 and satisfaction, preferred future intervention, side-effects, and relapses in the long-term are presented in Table 3. By Day 4, pain and congestion had decreased markedly in both groups. Pain around the nose had decreased by 1.5 points out of 10 (95% CI 0.6 to 2.5) more in the experimental group than in the control group. There was also a trend for pain in the teeth to decrease more in the experimental group than the control group (mean difference −1.5 points out of 10, 95% CI −3.3 to ALOX15 0.3). There were no other differences in decrease in pain and congestion between the groups. By Day 21, pain and congestion had decreased to low levels in both groups. However, there were no differences in decrease in pain and congestion between the groups in any area. At one year follow-up, there were no differences between the groups in terms of satisfaction with intervention (RR 0.77, 95% CI 0.50 to 1.04), number of side-effects (RR 0.71, 95% CI 0.20 to 2.56), or number of relapses (RR 1.83, 95% CI 0.87 to 4.12). However, the experimental group were more likely to prefer ultrasound than the control group were to prefer antibiotics for a future episode (RR 2.75, 95% CI 1.19 to 7.91).

Tous les sports collectifs avec décompte de points ou chronométrés avec classement sous-entendent une notion de dépassement de soi et sont donc concernés, quel que soit le niveau de pratique. Ces compétitions peuvent être officielles ou « sauvages » comme le classique sprint final dominical réalisé entre ami(e)s. À l’inverse, il est possible de participer à des compétitions souvent de masse (course à pied, ski de fond, cyclotourisme…), chronométrées, selleckchem sans but de performance. Faire la part des choses peut ne pas être aisée pour le praticien

qui doit alors savoir s’appuyer sur le profil psychologique du demandeur pour guider ses conclusions. En France, les textes légaux varient selon le mode de pratique sportive. Celle d’activités

physiques et sportives de loisir, quelles que soient sa quantité et son intensité, y compris dans les centres de « remise en forme », n’est soumise à aucun texte réglementaire officiel. Pour l’obtention d’une licence fédérale ou la pratique d’un sport en compétition, avec ou sans licence, un certificat médical de non-contre-indication est obligatoire. Ceci même si le sportif ne participe qu’à une seule compétition dans l’année. Le contenu de la VNCI dépend des caractéristiques et surtout du niveau de performance de l’athlète concerné. Pour les sportifs « amateurs » classés annuellement comme les meilleurs de leur discipline par leur fédération, le bilan doit être réalisé par un médecin du sport et des spécialistes. Un arrêté ministériel de 2004 (revu en 2006) précise le contenu de leur VNCI : deux bilans médicaux annuels et sur le plan cardiovasculaire, un électrocardiogramme (ECG) annuel, une épreuve selleck chemical d’effort tous les 4 ans et au moins un échocardiogramme dans la carrière (2 si le premier est réalisé

avant l’âge de 15 ans). Les commissions médicales des ligues des Dipeptidyl peptidase sports professionnels fixent le contenu de leur bilan cardiovasculaire. Le coût des VNCI est supporté par le sportif, sa fédération ou son club concerné. Pour tous les autres sportifs désireux de participer à une ou à des compétitions officielles, la VNCI peut être réalisée par tout médecin qui se sent compétent. Son contenu, légalement libre, est à la discrétion du praticien. Depuis 2005 en Europe et 2009 en France, les sociétés de cardiologie ont revu le bilan cardiovasculaire de la VNCI pour qu’il soit le plus efficace possible pour détecter les cardiopathies à risque potentiel de mort subite et celles pouvant être aggravées par une pratique sportive intense. Pour tout compétiteur entre 12 et 35 ans, il est ainsi recommandé la pratique de trois examens complémentaires, un interrogatoire familial et personnel, un examen physique et un ECG de repos. L’ECG devra être réalisé lors de la première VNCI, puis répété tous les 3 ans jusqu’à 20 ans, puis tous les 5 ans jusqu’à 35 ans [26]. La Société européenne de cardiologie recommande que l’ECG soit répété tous les 2 ans [27].

Female BALB/c wild-type (wt) mice (6–8 weeks) were purchased from Harlan Laboratories, Zeist, The Netherlands. Six to eight weeks old C57BL6/J (wt) and B6.129-Tlr2tm1Kir/J mice (TLR2KO) were purchased from Jackson Laboratories, France. All mice were kept under standard housing conditions at the University of Groningen, The Netherlands. Animal experiments were evaluated and approved by the Committee for

Animal Experimentation of the University of Groningen, The Netherlands, according to the guidelines provided by Dutch Animal Protection Act. Influenza monovalent split vaccines of strain A/Beijing/262/95 (H1N1) and A/Sydney/5/97 (H3N2) were purchased from AdImmune Corp, Taiwan (egg derived, formalin inactivated). The concentration of the Protein Tyrosine Kinase inhibitor haemagglutinin (HA) in the vaccine was determined using the single radial immunodiffusion this website assay. The standard BLP-SV vaccines consisted of influenza monovalent SV containing 5 µg HA antigen mixed with BLPs (0.15 mg dry-weight). BLPs were prepared as described before [13] and [14]. BLPs were stored at -80 °C until use. BLPs and SV, were

mixed just prior to i.n. administration. All i.n. vaccine doses were delivered in a final volume of 10 µl of PBS. Mice to be i.n. immunized were lightly anaesthetized with 2.5%, v/v, isoflurane over oxygen (0.8 L/min). Once anaesthetized, the mice were vaccinated i.n. every 10 days with 10 µl of sterile PBS containing BLP-SV (BLPs mixed with the influenza A strain (A/Beijing/262/95 (H1N1)) or SV alone and sacrificed at day

34 of the experiment. Mice were vaccinated i.n. 3 times on day 0, 14 and 28 with 10 µl of sterile PBS containing BLP-SV (BLPs mixed with the influenza A strain (A/Sydney/5/97(H3N2)) or SV alone and sacrificed at day 42 of the experiment. SV without BLPs was administered i.m. in 50 µl of PBS as a positive control for the immunogenicity of the antigenic materials. Blood was collected via puncture of the orbital plexus for antibody measurements and the mice were sacrificed on day 34 or 42 via exsanguination by heart puncture under O2/isoflurane anaesthesia. Subsequently, nasal, lung and vaginal washes were conducted for SIgA antibody measurements. For nasal and lung lavages, 1 ml PBS that contained Roche Rutecarpine “complete” protease inhibitor (according to manufacturer’s description) was used. The tube containing the lavage fluid was placed on ice and centrifuged at 300–400 × g for 5 min at 4 °C and supernatants were collected. Vaginal lavages were conducted by repeated pipetting of 0.2 ml of PBS supplemented with Roche “complete” protease inhibitor. All lavage samples were stored at -20 °C. ELISA was performed as previously described [27]. Briefly, ELISA plates (Greiner, The Netherlands) were coated overnight at 4 °C with influenza monovalent split vaccines of strain A/Sidney/5/97 H3N2 or A/Beijing/262/95 H1N1 (AdImmune). The plates were washed twice and blocked in 200 µl of a 2.5% solution of Protifar Plus (Nutricia™) in coating buffer (0.

Each state and territory independently evaluated which vaccine to implement. Victoria, Queensland, Western Australia and South Australia currently use RotaTeq™, New South Wales, the Northern Territory, Tasmania and the Australian Capital Territory use Rotarix™ [15]. MLN0128 Prior to vaccine introduction in Australia, 115,000 GP consults, 22,000 emergency department presentations and 10,000 hospitalisations in children under five years of age could be attributed to rotavirus infection annually [16]. In this study we report the characterisation and molecular analysis

of a G9P[8] strain responsible for a large outbreak of rotavirus gastroenteritis in the Northern Territory of Australia in 2007, five months after the commencement of the Rotarix™ vaccination program. A total of 107 stool samples were collected from paediatric patients hospitalised with severe gastroenteritis

during a rotavirus outbreak in the Alice Springs Selleckchem ABT888 region of the Northern Territory between the 12th of March and the 11th of July 2007. Patient information including date of birth, date of sample collection, sex and rotavirus immunisation status was obtained. Samples were stored frozen and forwarded to the Australian Rotavirus Reference Centre (ARRC) in Melbourne. Ninety-nine samples had adequate sample for analysis and were characterised using a combination of serotyping EIA and hemi-nested multiplex RT-PCR. Seventy-eight samples were found to be rotavirus positive and typed as G9P[8] and were analysed further in this study [25]. Rotavirus dsRNA was extracted from clarified

20% faecal suspensions using a RNA extraction Kit (QIAamp® Viral RNA mini Kit (spin protocol), Qiagen, Inc., Hilden, Germany) in accordance with the manufacturer’s instructions for use in RT-PCR. Rotavirus dsRNA was extracted from 20% faecal suspensions using phenol-chloroform extraction and purified using hydroxyapatite as previously described for use in Polyacrylamide Gel Electrophoresis (PAGE) [17]. The dsRNA genome segments were separated on 10% (w/v) polyacrylamide gel and the genome migration patterns (electropherotypes) were Phosphoprotein phosphatase visualised by silver staining according to the established protocol [18] and [19]. Of the 78 rotavirus positive samples collected during the outbreak, 14 were selected for further analysis including five from vaccinated patients. Samples were evenly selected during the outbreak period. Portions of gene segment 4 (VP4), 9 (VP7) and 10 (NSP4) were reverse transcribed and amplified by PCR using the Superscript III One Step RT-PCR with Platinum Taq DNA Polymerase (Invitrogen, Carlsbad, CA, USA). RNA was denatured and reverse transcribed at 45 °C for 30 min followed by PCR activation at 95 °C for 15 min.

Furthermore, our study highlights the importance of understanding the role of T helper cells in vaccine responses in paediatric populations, all the more so considering the expanding use of polysaccharide conjugate vaccines [33] and increasing interest in using vaccine

adjuvants to enhance cellular immune responsiveness [34]. We would like to thank the parents and guardians of the study children for their participation and ongoing support; the members of the Data Safety Monitoring Board (J. Vince, I. Kevau, J. Matthews, and D. Isaacs) and Independent Safety Monitors (A. Rongap and I. Betuela) for their ongoing monitoring of the safety of the study; vaccine manufacturers for providing us with single batch vaccines and vaccine antigens for in vitro studies; the Wellcome Trust and Australian National Health and NVP-AUY922 order Medical Research Council for funding this trial;

P. Jacoby for statistical support; and all staff of the Papua New Guinea Neonatal Pneumococcal Conjugate Vaccine Trial Team (in particular G. Saleu, C. Opa, J. Francis, T. Orami, P. Namuigi, A. Javati, A. Sie, B. Nivio, J. Totave, R. Sehuko, L. Pui, N. Fufu, M. Dreyum, G. Inapero, and J. Reeder and village reporters in the Asaro Valley). Conflicts of interest statement: A van den Biggelaar received a Robert Austrian Research Award in Pneumococcal Vaccinology sponsored by Wyeth to perform part of this work; she is currently employed by Crucell in the Netherlands. learn more D. Lehmann is a member TCL of the GlaxoSmithKline Australia Pneumococcal-Haemophilus influenzae-protein D conjugate vaccine (‘PHiD-CV’) Advisory Panel. P. Richmond has received research funding from GlaxoSmithKline and previously has been a member of the Wyeth Australia advisory board. All other authors have no conflicts of interest to declare. “
“Tuberculosis (tb) is one of the leading causes of death in the developing world [1]. BCG vaccination in the first year of life offers excellent protection against extra pulmonary forms of tuberculosis (EPTB) in childhood [2] but protection from pulmonary tuberculosis (PTB) varies from 0 to 80% [3]. WHO recommends neonatal BCG vaccination

[4] which is routine in many countries [5]. The evidence so far suggested that revaccination confers no additional protection to neonatal vaccination. In Malawi, a trial of the effect of a second BCG vaccination in children and adults showed no protection against tuberculosis [6]. The BCG REVAC trial focusing on school aged children, conducted in Brazil and reported in 2005 also showed no additional protection of a second BCG vaccination against tuberculosis (VE 9% (−16 to 29%)) or leprosy [7] and [8]. It is not known whether protection given by a second BCG vaccination would vary according to the setting or the age at revaccination; or if protection will be higher with longer follow up after revaccination.