Association of the ENPP1 rs997509 polymorphism with obesity in South African mixed ancestry learners

BACKGROUND

The Ectonucleotide Pyrophosphatase Phosphodiesterasel (ENPP1) polymorphisms have been associated with metabolic traits. There is no data on the effect of ENPP1 in South African children or adults.

OBJECTIVE

To investigate the role of K121Q (rs1044498), rs997509 and rs9402349 in obesity and other components of the metabolic syndrome.

DESIGN

A case-control study.

SUBJECTS

Sixty four obese and 64 lean mixed ancestry learners.

SETTING

Western Cape, South Africa.

MAIN OUTCOME MEASURE

The ENPP1 rs997509T allele is independently associated with obesity in children of mixed ancestry from South Africa.

RESULTS

The T allele frequency of the rs997509 differed significantly between obese and controls, p=0.0100 and increased the risk of being obese, p = 0.0238. Furthermore, the estimated effect of the T allele was an increase of 8.6 cm in waist circumference, 10.2 kg in weight and a corresponding 4.9 kg/m2 in BMI. Individuals carrying both the 121Q and the T allele of rs997509 were more associated with obesity (odds ratio = 3.85, 95% CI: 1.13 to 13.09) whilst those carrying the C allele of rs997509 in the presence of 121Q were likely to be lean with odds ratio of obesity 0.41 (95% CI: 0.19 to 0.87).

CONCLUSION

Our findings suggest that ENPP1 polymorphisms may contribute to different metabolic characteristics, all of which are associated with insulin resistance in mixed ancestry children of South Africa. However, a larger study is required to confirm findings of this study.

Broad reactive monoclonal antibodies for rapid identification of enteroviruses show cross-reactivity with chikungunya virus infected cells

In the past decade, enterovirus 71 (EV71) and chikungunya (CHIK) virus have re-emerged periodically causing serious public health problems in Malaysia, since their first emergence in 1997 and 1998 respectively. This study demonstrates that CHIK virus causes similar patterns of cytopathic effect in cultured Vero cells as some enteroviruses. They also show positive cross-reaction on direct immunofluorescence staining using monoclonal antibodies meant for typing enteroviruses. Without adequate clinical and epidemiological information for correlation, CHIK virus isolated from patients with acute febrile rash can be wrongly reported as untypeable enterovirus due to its cross-reactivity with commercial pan-enterovirus monoclonal antibodies. This is due to the diagnostic laboratory being unaware of such cross-reactions as it has not been reported previously. Final identification of the virus could be determined with specific antibodies or molecular typing using specific oligonucleotide primers for the CHIK virus.

Does conventional HRT protect from urogenital atrophy? A prospective study

Urogenital atrophy is a poorly defined entity. This prospective study looked at the effect of conventional HRT on urogenital atrophy. One hundred and sixty-three women were studied in a 12-month period. The incidence of urinary symptoms and clinical evidence of urogenital atrophy was found to be similar in both the 'HRT group' and the 'no HRT group'. This can be explained by the new oestrogen receptor theory. Conventional HRT does not seem to protect women from urogenital atrophy and receptor specific oestrogen therapy may be required to address the problem of urogenital atrophy and postmenopausal urinary symptoms.

Early oral intake after caesarean section performed under general anaesthesia

This study assesses the outcome and benefits of initiation of oral intake 4 hours after caesarean section done under general anaesthesia. After uncomplicated sections, 207 healthy women were alternately assigned either to start oral intake 4 hours after operation, with concurrent stoppage of infusions (n = 106) or to receive 'standard'postoperative care (n = 101). Early oral intake was not associated with increase in gastrointestinal morbidity. Compared with the control group the early intake group had a shorter mean time to first flatus and to first bowel evacuation; initiated breast feeding earlier; ambulated more and were more satisfied. Both groups had similar urine output in the first 24 hours. The nurse's work load decreased when they looked after the early intake group. It is concluded that post-caesarean mothers could be adequately hydrated orally after discontinuing infusions in the early postoperative period without apparent harm and with benefit.

A study on the usefulness of Techlab Entamoeba histolytica II antigen detection ELISA in the diagnosis of amoebic liver abscess (ALA) at Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia

Amoebic serodiagnosis at Hospital Universiti Sains Malaysia (HUSM), Kelantan employs an indirect haemagglutination assay (IHA) which detects anti-Entamoeba histolytica antibodies in patients' serum samples. In an amoebiasis endemic area such as Kelantan, interpretation of a positive IHA result can be problematic due to the high background antibody levels. The TechLab E. histolytica II ELISA is a commercial kit for detection of specific Gal/GalNAc lectin antigen in stool samples, and has been reported to be able to detect the antigen in serum samples from patients with amoebic liver abscess (ALA). Thus in this study we investigated the usefulness of TechLab E. histolytica II ELISA for diagnosis of ALA by comparing it with IHA. This is a cross sectional study involving 58 suspected ALA patients who were admitted to the surgical ward, HUSM, Kelantan. The diagnosis of ALA was established based on clinical symptoms and signs, ultrasound and/or CT scan results. The serum specimens obtained from the patients were tested with IHA (Dade Behring Diagnostics, Marburg, Germany) and TechLab E. histolytica II ELISA (Techlab, Blacksburg, Virginia, USA) according to the manufacturers' instructions. Of the 58 patients, 72.4% (42) were positive by IHA and only 8.6% (5) were positive by the TechLab E. histolytica II ELISA. Agreement between the IHA and ELISA was poor (kappa value 0.019, p=0.691). There was also no correlation between ELISA results and IHA antibody titers. The TechLab E. histolytica II ELISA was not sensitive in detecting amoebic antigen in samples from ALA patients. In addition the results of the test did not correlate with the IHA anti-E. histolytica antibody titres. Therefore, the TechLab E. histolytica II ELISA was found not to be useful for serological diagnosis of ALA at HUSM.

Anterior abdominal wall hydatid cyst; an unusual presentation

BACKGROUND

Hydatid disease is common in sheep rearing communities, often presenting with hepatic cysts in a majority of cases. Musculo-skeletal involvement as occurred in our patient is an unusual manifestation. Hydatid disease should be considered a differential of superficial and soft tissue swellings in our environment.

METHOD

A 27-year-old HIV positive widow on antiretroviral therapy, who presented with intramuscular hydatid cyst in the right lower quadrant of the anterior abdominal wall is presented.

RESULT

Following total excision and chemotherapy with albendazole, the patient did well and remained symptom free two years later.

CONCLUSION

Though a rarity, hydatid cyst does occur in the musculo-skeletal system, presenting as a superficial swelling. Correct surgical management, including the intra-operative avoidance of spillage of cyst fluid demands pre-operative diagnosis or at least a high index of suspicion. Hydatid cyst should therefore be kept in mind in the differential diagnosis of superficial swellings of musculo-skeletal origin in sheep rearing communities such as ours.

Massive lingual teratoma in a neonate

Teratoma of the tongue is a rare entity. We present a male newborn with massive lingual teratoma and cleft palate, which surprisingly did not cause immediate airway obstruction. This case illustrates a huge mass in the oral cavity, which was missed on antenatal ultrasonography because it did not present with polyhydramnios. The mass was excised under general anaesthesia. Histopathologically, it consisted of all three layers of embryonic elements with predominantly glial tissue. Postoperatively, the patient developed hypoglossal nerve palsy, and no recurrence was detected after four years.

Adenoid mast cells and their role in the pathogenesis of otitis media with effusion

INTRODUCTION

Otitis media with effusion (OME) is an inflammation of the middle ear in which a collection of liquid is present in the middle-ear space while the tympanic membrane is intact. The association between adenoid inflammation and OME has long been noted but the exact mechanism is still much debated. We studied the role of adenoid mast cells in the causation of OME.

OBJECTIVE

To study the distribution and role of adenoid mast cells in the causation of OME.

METHODOLOGY

A cross-sectional, prospective study was carried out in the otorhinolaryngologic clinic, department of otorhinolaryngology (ORL), Science University of Malaysia, from June 1999 to September 2001. A total number of 50 cases were studied. Twenty-five of these patients underwent adenoidectomy, while another 25 patients underwent adenoidectomy and myringotomy with ventilation tube insertion. The adenoid specimens from all patients were examined for the number of adenoid mast cells present, using light microscopy and toluidine blue as the staining agent. The results were analysed using SPSS version 10.0 computer software.

RESULT

The population of adenoid mast cells in children with OME was significantly greater than that in children without OME (p=0.000).

CONCLUSION

The increased number of adenoid mast cells in patients with OME suggests that inflammation may play a role in this condition.

The use of high-dimensional biology (genomics, transcriptomics, proteomics, and metabolomics) to understand the preterm parturition syndrome

High-dimensional biology (HDB) refers to the simultaneous study of the genetic variants (DNA variation), transcription (messenger RNA [mRNA]), peptides and proteins, and metabolites of an organ, tissue, or an organism in health and disease. The fundamental premise is that the evolutionary complexity of biological systems renders them difficult to comprehensively understand using only a reductionist approach. Such complexity can become tractable with the use of "omics" research. This term refers to the study of entities in aggregate. The current nomenclature of "omics" sciences includes genomics for DNA variants, transcriptomics for mRNA, proteomics for proteins, and metabolomics for intermediate products of metabolism. Another discipline relevant to medicine is pharmacogenomics. The two major advances that have made HDB possible are technological breakthroughs that allow simultaneous examination of thousands of genes, transcripts, and proteins, etc., with high-throughput techniques and analytical tools to extract information. What is conventionally considered hypothesis-driven research and discovery-driven research (through "omic" methodologies) are complementary and synergistic. Here we review data which have been derived from: 1) genomics to examine predisposing factors for preterm birth; 2) transcriptomics to determine changes in mRNA in reproductive tissues associated with preterm labour and preterm prelabour rupture of membranes; 3) proteomics to identify differentially expressed proteins in amniotic fluid of women with preterm labour; and 4) metabolomics to identify the metabolic footprints of women with preterm labour likely to deliver preterm and those who will deliver at term. The complementary nature of discovery science and HDB is emphasised.

The preterm parturition syndrome

The implicit paradigm that has governed the study and clinical management of preterm labour is that term and preterm parturition are the same processes, except for the gestational age at which they occur. Indeed, both share a common pathway composed of uterine contractility, cervical dilatation and activation of the membranes/decidua. This review explores the concept that while term labour results from physiological activation of the components of the common pathway, preterm labour arises from pathological signalling and activation of one or more components of the common pathway of parturition. The term "great obstetrical syndromes" has been coined to reframe the concept of obstetrical disease. Such syndromes are characterised by: (1) multiple aetiology; (2) long preclinical stage; (3) frequent fetal involvement; (4) clinical manifestations that are often adaptive in nature; and (5) gene-environment interactions that may predispose to the syndromes. This article reviews the evidence indicating that the pathological processes implicated in the preterm parturition syndrome include: (1) intrauterine infection/inflammation; (2) uterine ischaemia; (3) uterine overdistension; (4) abnormal allograft reaction; (5) allergy; (6) cervical insufficiency; and (7) hormonal disorders (progesterone related and corticotrophin-releasing factor related). The implications of this conceptual framework for the prevention, diagnosis, and treatment of preterm labour are discussed.

Appendicitis at Kenyatta National Hospital, Nairobi

BACKGROUND

Appendicitis still remains a diagnostic challenge particularly in women and extremes of age. The incidence of appendicectomy for suspected appendicitis is higher but declining in the developed countries in contrast with a low but increasing incidence in Africa.

OBJECTIVE

To describe the characteristics of appendicitis at Kenyatta National Hospital, with emphasis on epidemiological oddities.

DESIGN

A prospective descriptive study.

SETTING

Kenyatta National Hospital, a 2000 bed teaching and referral hospital in Nairobi, Kenya

SUBJECTS

One hundred and eighty nine patients managed for suspected acute appendicitis between July 2000 and June 2001.

RESULTS

There were 116 males and 73 females. The peak incidence was in the third decade. Sixty four percent of patients were below 30 years of age. The elderly (< 60 years of age) accounted for 1.6% of cases. The rate of false appendicectomy was 18.0%. This rate of negative appendicectomies was 12.9% for males and 30.1% for females. The rate of perforation/gangrene was 29.7%. Hospital stay averaged 6.4 days. Overall morbidity was 12.3%. It was 19.4% in perforated appendicitis and 7.6% in non-perforated appendicitis. There was no mortality.

CONCLUSION

The incidence of appendicitis has increased at Kenyatta National Hospital over the last 30 years. The disease is common in men in their third decade. These odd characteristics warrant further investigations.

Underlay myringoplasty: comparison of human amniotic membrane to temporalis fascia graft

Human amniotic membrane as a homograft material was compared to temporalis fascia to close tympanic membrane perforations in 50 patients with chronic otitis media. Human amniotic membrane was used in 20 patients while temporalis fascia was used in the remaining 30. Anatomical closure of the perforation and reduction of the air-bone gap was measured. The graft uptake showed a 65% success rate for the amniotic membrane and 56.7% for the temporalis fascia at 3 months post-operatively. Significant closure of air-bone gap was observed in the human amniotic group. These results indicate comparable outcomes between human amniotic membrane and the temporalis fascia graft.

Self reported alcohol use in an urban traffic trauma population in Kenya

BACKGROUND

Kenya has a soaring rate of road traffic fatalities. Available evidence suggests significant alcohol-relatedness to trauma. We know little about the prevalence of alcohol-related injuries in Nairobi.

OBJECTIVE

To determine the extent and pattern of alcohol use in subjects admitted following road traffic accident.

DESIGN

A descriptive hospital based survey.

SETTING

Kenyatta National Hospital (KNH)- a university affiliated hospital in Nairobi, Kenya.

RESULTS

The overall incidence of alcohol use was 26.3%. This was higher in males (29.6%) than females (9.1%). Use was 24.4%, 31.0%, 28.6% and 13.6% in the 16-25, 26-35, 36-45 and 46-55 age groups respectively. The mean ages, pre-hospital times and ISS were similar for the AUG and NAUG. The incidence of males, weekend injuries, night collisions, and pedestrian involvement was 94.4%, 69.4%, 41.7%, 77.8% in the AUG and 83.2%, 35.6%, 19.8% and 61.4% in the NAUG respectively. The incidence of head and extremity injuries in AUG was 27.8% and 50% respectively compared to 11.9% and 66.3% in the NAUG. Treatment costs were higher for the NAUG.

CONCLUSIONS

The results suggest a high incidence and potential alcohol-relatedness to road trauma in Nairobi. The study calls for objective evaluation of the extent, interactions and effects of this modifiable trauma factor.

The prevalence and clinical significance of amniotic fluid 'sludge' in patients with preterm labor and intact membranes

OBJECTIVE

To determine the prevalence and clinical significance of amniotic fluid (AF) 'sludge' observed during transvaginal ultrasound examination of the cervix in patients with preterm labor and intact membranes, and in those with uncomplicated pregnancies.

METHODS

This retrospective study included patients with preterm labor and intact membranes (n = 84) and those with uncomplicated term pregnancies (n = 298). The outcome variables included the occurrence of documented microbial invasion of the amniotic cavity (MIAC), histological chorioamnionitis, examination-to-delivery interval, admission to the neonatal intensive care unit (NICU), a composite neonatal morbidity, perinatal death, and delivery within 48 h, 7 days, and < 35 weeks and < 32 weeks. Statistical analysis included Chi-square test, stepwise logistic regression analysis and survival analysis.

RESULTS

The prevalence of AF 'sludge' was 1% (3/298) in patients with uncomplicated term pregnancies and 22.6% (19/84) in those with preterm labor and intact membranes. Among patients with preterm labor and intact membranes: (1) cervical length < or = 15 mm was present in 58.3% (49/84) of the patients; (2) the prevalence of MIAC and histological chorioamnionitis was 12.1% (7/58) and 32.9% (25/76), respectively; (3) the rate of spontaneous preterm delivery within 48 h, 7 days, and < 32 weeks and < 35 weeks of gestation was 13.6% (8/59), 28.8% (17/59), 39.5% (17/43) and 50.8% (30/59), respectively; (4) patients with AF 'sludge' had a higher frequency of positive AF cultures [33.3% (6/18) vs. 2.5% (1/40), P = 0.003] and histological chorioamnionitis [77.8% (14/18) vs. 19% (11/58), P < 0.001] than those without AF 'sludge'; (5) a higher proportion of neonates born to patients with AF 'sludge' was admitted to the NICU [64.3% (9/14) vs. 12.9% (8/62), P < 0.01], had a composite neonatal morbidity [36.8% (7/19) vs. 13.8% (9/65), P = 0.04] and died in the perinatal period [36.8% (7/19) vs. 4.6% (3/65), P = 0.001] than those born to women without 'sludge'; (6) a higher proportion of patients with AF 'sludge' had spontaneous delivery within 48 h [42.9% (6/14) vs. 4.4% (2/45), P = 0.001], within 7 days [71.4% (10/14) vs. 15.6% (7/45), P < 0.001], < 32 weeks [75% (9/12) vs. 25.8% (8/31), P = 0.005] and < 35 weeks [92.9% (13/14) vs. 37.8% (17/45), P < 0.001] than those without AF 'sludge'; and (7) patients with AF 'sludge' had a shorter examination-to-delivery interval than those without AF 'sludge' [AF 'sludge' median, 1 (IQR, 1-5) days vs. no AF 'sludge' median, 33 (IQR, 18-58) days; P < 0.001].

CONCLUSION

The presence of AF 'sludge' in patients with preterm labor and intact membranes is a risk factor for MIAC, histological chorioamnionitis and impending preterm delivery.

Primary breast sarcoma: case report

Primary breast sarcoma is a rare entity occurring in 0.5% of women with breast malignancy. Like in breast carcinoma, delay in its diagnosis has important clinical and treatment implications. The subject of this report presented at our breast unit with advanced breast lesion months after she noticed a small lump in her right breast. She had no clear diagnosis despite several consultations, in-patient treatments at two facilities in the city, breast ultrasonography, breast mammography and three fine needle aspiration cytology (FNAC) examinations. The patient needed multiple blood transfusions. A final FNAC showed ductal carcinoma. Histology following wide excision confirmed high-grade primary stromal breast sarcoma. She required adjuvant combination chemotherapy. A combination of diagnostic failures and patient fault caused delay in subject's treatment. Lesion progression during delay which influenced the pattern of physical morbidity, tumour prognosis and need for adjuvant treatment. Embracing the concept of breast care in dedicated breast units may minimise such treatment delays.

Indirect immunofluorescence test: role in seroepidemiology and serodiagnosis of herpes simplex viral infections

A study was carried out to find out a) the seroprevalence of herpes simplex viral infections (HSV) in and around Chandigarh city, North India and the probable age of acquisition of infection; b) the usefulness of salivary antibody detection in seroprevalence studies; c) role of HSV immunofluorescence antibodies in the sero-diagnosis of herpes simplex encephalitis (HSE) patients. Single blood samples from 306 and paired blood and saliva samples from 48 apparently healthy individuals as well as paired blood and C.S.F. samples from 50 clinically suspected patients of HSE were included in the study proper. The subjects belonged to <6 months to > 30 years age group. Serum, saliva and C.S.F. samples were subjected to in house standardized indirect immunofluorescence test for the detection of HSV antibody. The overall seropositivity was 59.3%, which increased from 37.5% in children less than 10-years of age to 88.9% in individuals above 30 years of age (p<0.001). The maximum titer in less than 10 years children and above 10 years subjects were found to be 40 and 160 respectively. The difference in percentage positivity of HSV antibody in these groups was statistically significant (p<0.001). No difference in the seroprevalence rate was observed between different socio-economic groups and sex. Saliva in comparison to serum showed a sensitivity of 44% and specificity of 100% for the detection of HSV antibodies. Among the suspected HSE patients 4 (8%) could be serologically confirmed. This study indicated the endemicity of HSV infection in this locality. Indirect immunofluorescence test could detect intrathecal HSV antibodies in 8% of suspected HSE patients proving it to be a very useful rapid serodiagnostic tool. However, saliva testing showed limited sensitivity in HSV sero surveys.

Maternal and fetal inflammatory responses in unexplained fetal death

OBJECTIVE

The role of intra-amniotic infection in the etiology of fetal death has been proposed. This study was conducted to determine the prevalence of microbial invasion of the amniotic cavity (MIAC) and the frequency of maternal and/or fetal inflammation in patients presenting with a fetal death.

METHODS

A prospective study was conducted in patients with a fetal death. Amniocenteses were performed for clinical indications (karyotype), as well as to assess the microbiological and cytological state of the amniotic cavity. Fluid was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. An amniotic fluid white blood cell count and glucose determinations were also performed. Histological examination of the placenta was conducted to identify a maternal inflammatory response (acute chorioamnionitis) or a fetal inflammatory response (funisitis).

RESULTS

This study included 44 patients with intrauterine fetal death. The median gestational age at diagnosis was 30.1 weeks (range 16.3-40.4 weeks). One patient had documented MIAC (1/44). Acute histological chorioamnionitis was found in 20.9% (9/43), but a fetal inflammatory response was observed in only 2.3% (1/43) of cases. One patient had a positive amniotic fluid culture for Streptococcus agalactiae (group B streptococcus).

CONCLUSION

Histological chorioamnionitis was present in 20.9% of cases, but MIAC could be demonstrated with conventional microbiological techniques in only one case. A fetal inflammatory response was nine times less frequent than a maternal inflammatory response (maternal 20.9% vs. fetal 2.3%, p = 0.008) in cases of fetal death.

Mature cystic teratoma: unusual presentation as anterior neck swelling

The unusual presentation of a mature mediastinal cystic teratoma as an anterior neck swelling in a 29-year-old Malay woman is reported.

Cervical changes associated with progestagen-only contraceptives: a team approach

OBJECTIVES

To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up.

DESIGN

A prospective cross-sectional comparative study.

SETTING

Family-planning clinic of a tertiary care university hospital.

SUBJECTS

A total of 325 current users of contraceptive methods for more than 3 years.

INTERVENTIONS

Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush.

MAIN OUTCOME MEASURES

Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer.

RESULTS

Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant.

CONCLUSIONS

Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.

Antimicrobial peptides in amniotic fluid: defensins, calprotectin and bacterial/permeability-increasing protein in patients with microbial invasion of the amniotic cavity, intra-amniotic inflammation, preterm labor and premature rupture of membranes

OBJECTIVE

Neutrophil defensins (HNP 1-3), bactericidal/permeability-increasing protein (BPI) and calprotectin (MRP8/14) are antimicrobial peptides stored in leukocytes that act as effector molecules of the innate immune response. The purpose of this study was to determine whether parturition, premature rupture of the membranes (PROM) and microbial invasion of the amniotic cavity (MIAC) are associated with changes in amniotic fluid concentrations of these antimicrobial peptides.

STUDY DESIGN

Amniotic fluid was retrieved by amniocentesis from 333 patients in the following groups: group 1, mid-trimester with a subsequent normal pregnancy outcome (n = 84); group 2, preterm labor and intact membranes without MIAC who delivered at term (n = 36), or prematurely (n = 52) and preterm labor with MIAC (n = 26); group 3, preterm PROM with (n = 26) and without (n = 26) MIAC; and group 4, term with intact membranes in the absence of MIAC, in labor (n = 52) and not in labor (n = 31). The concentrations of HNP 1-3, BPI and calprotectin in amniotic fluid were determined by specific and sensitive immunoassays. Placentae of patients in both preterm labor with intact membranes and preterm PROM groups who delivered within 72 h of amniocentesis were examined. Non-parametric statistics, receiver-operating characteristic (ROC) curves and Cox regression models were used for analysis. A p value of < 0.05 was considered statistically significant.

RESULTS

Intra-amniotic infection was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin in both women with preterm labor and intact membranes, and women with preterm PROM. Preterm PROM was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Preterm parturition was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin, while parturition at term was associated with a significant increase in amniotic fluid concentrations of immunoreactive HNP 1-3. Among patients with preterm labor and intact membranes, elevation of amniotic fluid HNP 1-3, BPI and calprotectin concentrations was associated with intra-amniotic inflammation, histological chorioamnionitis and a shorter interval to delivery.

CONCLUSION

MIAC, preterm parturition and preterm PROM are associated with increased amniotic fluid concentrations of immunoreactive HNP 1-3, BPI and calprotectin. Moreover, elevated amniotic fluid concentrations of BPI, immunoreactive HNP 1-3 and calprotectin are associated with intra-amniotic inflammation, histological chorioamnionitis and shorter amniocentesis-to-delivery interval in patients presenting with preterm labor with intact membranes.

First Report of Twenty-two New Hosts of Potato leafroll virus

The known host range of Potato leafroll virus (PLRV, genus Polerovirus, family Luteoviridae) is narrow, consisting of 21 species in 5 families: 3 Amaranthaceae, 2 Cruciferae, 1 Nolanaceae, 1 Portulacaceae, and 14 Solanaceae. Over a period of years, we identified 22 additional host species of PLRV in 5 new families and 1 previously identified family: 1 Chenopodiaceae, 2 Compositae, 1 Cucurbitaceae, 1 Labiatae, 2 Malvaceae, and 15 Solanaceae. The 22 additional host species are Cucurbita pepo L., Datura fastuosa L., Hibiscus golfrosens L., H. moscheutos L., Hypercymus niger L., Lactuca sativa L., Lycopersicon pimpinefolium (Jusl.) Mill., L. peruvianun L., Nicotiana accuminata Grah., N. agustifolia Comes, N. rustica L., N. tabacum L., N. glutinosa L., Ocimum basilicum L., Physalis ixocarpa Brot., P. lanceifolia Michx., P. peruvianum L., Solanum rostratum Dund., S. sarrachoides Sendtner, S. demissum L. (P.I. 230579), Spinacia oleraceae L., and Zinnia elegans Jaeq. In light of these new hosts, reevaluation of the epidemiology of PLRV may be advisable in regions where new virus hosts also host aphid vectors and where a virus host may ensure perennial survival of PLRV. Two new hosts were found naturally infected in the Columbia Basin of the Pacific Northwest. The potential impact of one of these, S. sarrachoides, a predominant and widespread weed in potatoes and an excellent host of the major PLRV vector, Myzus persicae Sulzer, may be very important. The second naturally infected host, Z. elegans, is of doubtful importance since it is largely confined to cultivated gardens, is a summer annual, and rarely is colonized by M. persicae. The new hosts were initially discovered in various experiments over a period of years. In confirmatory tests, the hosts were inoculated with six different isolates of PLRV collected from different regions of the United States. A portion of leaflet from the virus source plant, P. floridana Rydb., containing approximately 25 M. persicae, was placed on each test plant. Virus infection was assessed based on visual symptoms and double-antibody sandwich-enzyme-linked immunosorbent assay (DAS-ELISA) and confirmed by aphid transmission from inoculated test plants to a diagnostic host (P. floridana). Infection of the diagnostic host was confirmed based on symptoms and enzyme-linked immunosorbent assay (ELISA). Symptom severity varied markedly among symptomatic host species. Asymptomatic hosts included C. pepo, N. rustica, S. demissum, and Z. elegans. Field collections of two nonhosts, Malva neglecta Wallr. and Cardaria draba, often produced false-positive ELISA assays, but PLRV could not be isolated from these plants by aphid transmission nor detected using a polymerase chain reaction (PCR) assay. Species infected by some virus isolates but not others included C. pepo, H. golfrosens, H. moscheutos, N. rustica, N. tabacum, Lactuca sativa, O. basilicum, S. demissum, S. oleraceae, and Z. elegans. The variability in symptoms and host range indicates a considerable degree of variability in PLRV and may provide a much needed basis for PLRV strain separation and characterization. This work more than doubles the known host range of PLRV.

Viruses infecting winter tomato crops in the North West Frontier Province of Pakistan

Malakand Agency is a unique production area in the North West Frontier Province (NWFP) of Pakistan that is frost-free and in which tomato is grown as a winter crop. Tomato production in this area has been affected by virus-like diseases for the last 10 years. Tomato nurseries and fields at 11 locations in Malakand Agency were surveyed for tomato viruses during 1994–95. A total of 1071 samples from nurseries and 5083 samples from 142 fields were tested by indirect enzyme-linked immunosorbent assay (ELISA). In nurseries, 3 viruses, Potato virus X (PVX), Potato virus Y (PVY), and Tomato mosaic virus (ToMV), were detected with an incidence range of 9.8–22.3, 0–36.6, and 16.5–51.3%, respectively. In the field, 5 viruses [Cucumber mosaic virus (CMV), PVX, PVY, ToMV, and Tomato yellow top virus (TYTV)] were frequently found with an incidence range of 0–13.3%, 2.6–16.7%, 0.4–13.8%, 26.1–41.3%, and 1.7–11.3%, respectively. All 5 viruses except TYTV were also detected from weed species in tomato fields or in the nearby vicinity. Of 12 commercial tomato varieties screened against CMV, PVX, PVY, and ToMV, 2 varieties (Florist and Forset) were resistant to 4 of the viruses including ToMV, for which the highest incidence was recorded in nurseries and field. These 2 varieties represent a previously undescribed and potentially useful source of resistance to the 4 inoculated viruses.

Transforming growth factor-beta 1 stimulates vascular smooth muscle cell L-proline transport by inducing system A amino acid transporter 2 (SAT2) gene expression

Transforming growth factor-beta1 (TGF-beta 1) is a multifunctional cytokine that contributes to arterial remodelling by stimulating vascular smooth muscle cell (SMC) growth and collagen synthesis at sites of vascular injury. Since l-proline is essential for the synthesis of collagen, we examined whether TGF-beta 1 regulates the transcellular transport of l-proline by vascular SMCs. l-Proline uptake by vascular SMCs was primarily sodium-dependent, pH-sensitive, blocked by neutral amino acids and alpha-(methylamino)isobutyric acid, and exhibited trans-inhibition. Treatment of SMCs with TGF-beta 1 stimulated l-proline transport in a concentration- and time-dependent manner. The TGF-beta 1-mediated l-proline uptake was inhibited by cycloheximide or actinomycin D. Kinetic studies indicated that TGF-beta 1-induced l-proline transport was mediated by an increase in transport capacity independent of any changes in the affinity for l-proline. TGF-beta 1 stimulated the expression of system A amino acid transporter 2 (SAT2) mRNA in a time-dependent fashion that paralleled the increase in l-proline transport. Reverse transcriptase PCR failed to detect the presence of SAT1 or amino acid transporter 3 (ATA3) in either untreated or TGF-beta 1-treated SMCs. These results demonstrate that l-proline transport by vascular SMCs is mediated predominantly by the SAT and that TGF-beta 1 stimulates SMC l-proline uptake by inducing the expression of the SAT2 gene. The ability of TGF-beta 1 to induce SAT2 expression may function to provide SMCs with the necessary levels of l-proline required for collagen synthesis and cell growth.

The young 'elderly' primipara revisited

A 1970 analysis of labour ward data to determine whether primiparas in the 30 to 34 year age group should be considered 'at risk' due to age was repeated in 1997. Control groups were primiparas aged 20 to 23 and multiparas 2 and 3. Incidence of operative delivery, several other obstetric outcomes and the condition of the infant at birth were compared in various age groups. Both studies showed that the 30 to 34 age group was at increased risk of operative delivery

Can latissimus dorsi muscle stimulation benefit heart during training period after vascular delay?

We hypothesized that a two-stage vascular delay procedure followed by 5 weeks of conditioning of the latissimus dorsi muscle (LDM) could benefit the heart during the training period and greatly increase cardiac assistance when examined with maximum potential. In mongrel dogs (n = 10), left ventricle (LV) dysfunction was induced by intracoronary injections of latex microspheres [90 +/- 2 micro diameter]. Vascular delay of the LDM was performed in one group (n = 6), whereas the other group (control, n = 4) did not undergo vascular delay. After 2 weeks, CMP was performed in all animals followed by LDM conditioning. After 5 weeks of muscle training, we examined left ventricular function at 20 Hz-4 volts, 33 Hz-4 volts, and 50 Hz-10 volts stimulation by assessing peak aortic pressure (AoP), left ventricular pressure (LVP), maximum LV +dP/dt, stroke volume (SV), stroke work (SW), stroke power (SP), and aortic flow. LDM assisted beats were compared with nonstimulated beats. LDM stimulation caused significant increases in pressure and flow in the vascular delay group. At 20 Hz-4 volts, absolute increases were LVP (10.2 +/- 0.6) mm Hg, AoP (9.8 +/- 1.7) mm Hg, SV (1.8 +/- 0.4) ml, SW (5.3 +/- 1.0) gm x m, SP (40.8 +/- 12.7) gm x m/sec, max LV dP/dt (104.8 +/- 53.2) mm Hg/sec, and peak aortic flow (0.9 +/- 0.3) L/min. At 33 Hz-4 volts, the absolute increases were LVP (13.6 +/- 1.3) mm Hg, AoP (12.1 +/- 2.4) mm Hg, SV (2.7 +/- 0.7) ml, SW (7.4 +/- 1.4) gm x m, SP (72.7 +/- 16.5) gm x m/sec, max LV dP/dt (294 +/- 19) mm Hg/sec, and peak aortic flow (1.8 +/- 0.5) L/min. At 50 Hz-10 volts, the absolute increases were LVP (17.7 +/- 0.7) mm Hg, AoP (21.1 +/- 1.9) mm Hg, SV (6.0 +/- 1.1) ml, SW (14.6 +/- 2.2) gm.m, SP (128.2 +/- 15.3) gm x m/sec, max LV dP/dt (352 +/- 62) mm Hg/sec, and peak aortic flow (3.3 +/- 0.4) l/min (p < 0.05). The percentage increases were significantly larger in the vascular delay group compared with controls at 50 Hz-10 volts LDM stimulation. By using a two-stage vascular delay procedure, LDM stimulation can provide meaningful cardiac assistance during training periods. Furthermore, brief periods of maximal potential benefit (demand cardiomyoplasty) can be achieved during the training period.

Tegumental alterations in Schistosoma mansoni worms induced by treatment of infected mice with naproxen pre- and/or post-infection

Schistosoma mansoni infected mice were treated with naproxen (CAS 22204-53-1) in a dose of 3-4 mg/kg body weight. Treatment was conducted for 7 days before and/or 28 days post infection. Adult worms, developed 7 weeks post infection, were studied by electron microscopy. In both groups, the dorsal surface of the male worms was much more affected by the drug than that of female ones. The most significant morphological degeneration was the change in the aspect and the form of tubercles. Moreover, shrinkage and loss of spines from the ventral surface were also observed. A small portion of the posterior end of female worms showed loss of spines. However, in the first group given naproxen 7 days before infection, the level and extent of changes increased particularly in male worms. There was pronounced oedema, swelling, wrinkling with constriction and collapse of sensory bulbs.

Endoscopic diagnosis of colonic tuberculosis

BACKGROUND

GI tuberculosis is a diagnostic challenge, particularly in the absence of evidence of pulmonary infection. It may mimic many other abdominal diseases such as other infectious processes, tumors, and Crohn's disease. In the absence of positive laboratory and radiologic tests, the diagnosis is often established definitively by obtaining a surgical specimen. Colonoscopy, however, has been used successfully to diagnose the disease and thus avoid the morbidity and mortality associated with exploratory laparotomy.

METHODS

An evaluation was conducted of colonoscopic features in 10 patients with colonic tuberculosis.

OBSERVATIONS

In all cases there was ileocecal involvement; total colonic involvement was found in only 1 case. The colonoscopic appearance included the following: ulcerated lesions, sessile firm polyps, masses, and small diverticula, ranging from 3 to 5 mm in diameter. In 5 of our patients the diagnosis was confirmed bacteriologically, in 3 with endoscopic biopsy material, and in 2 by sputum examination. In all cases antituberculous therapy produced remarkable symptom and endoscopic improvement.

CONCLUSION

This report highlights the importance of colonoscopy in the diagnosis of tuberculous involvement of the GI tract.

Recent advances in surgery for snoring-somnoplasty (radiofrequency palatoplasty) a pilot study: effectiveness and acceptability

A prospective study was designed to investigate the effects of Somnoplasty (Radiofrequency palatoplasty) in patients with snoring. A group of 22 patients fulfilling the inclusion and exclusion criteria outlined underwent somnoplasty performed by a single surgeon. Every patient completed a standard questionnaire containing visual analogue scales at six weeks post operatively. The parameters assessed were post-operative pain, change in snoring score, effects on sleep of the patient and bed partner, speech and swallowing, alteration in weight, acceptance of the procedure and recommendation to friends and family. Results of improvement in snoring score were correlated to body mass index (BMI) kg/m2. We conclude that somnoplasty is an effective procedure in elimination of snoring and the success is closely linked to BMI. Best response is obtained in those with BMI < 25 and moderate response is obtained in those with BMI between 25-30. Obese (BMI > 30) patients are more likely to have a poor response. Morbidity associated with the procedure is minimal and patient acceptance is 100%. The long-term success of this procedure needs to be confirmed with further follow up.

The efficacy and safety of cefaclor in respiratory infections amongst Pakistani children

PURPOSE

To evaluate the efficacy and safety of Cefaclor in respiratory tract infections amongst Pakistani children.

PATIENTS AND METHODS

Multicenter, open label and non-comparative study was done to evaluate the response in terms of symptoms (In vivo) and bacterial cultures (In Vitro) to Cefaclor amongst children with respiratory tract infection between the ages 2 months to 12 years. Each patient was asked to visit the doctor on three occasions i.e., Day 0 (Initial evaluation prior to commencement of study), Day 4 (During therapy assessment and confirmation of compliance) and Day 10 (End of therapy assessment and compliance evaluation). Representative swab specimens (Throat swabs, Ear swabs or Sputum) were collected from the infected site on day 0 and day 10 for culture and sensitivity. Patients were also assessed by the evaluators on each visit in terms of clinical symptomatic response and information collected was documented on a prescribed data base form.

RESULTS

A total of 160 patients were enrolled in the study, of whom 15 were lost to follow-up between the first and second visit and a further 38 were lost by the 3rd visit. Thus 107 patients completed the study as per protocol. Otitis media and Upper respiratory tract infection were the predominant ailments amongst the cases enrolled. One or more bacteria were isolated in 75 (46%) instances, the maximum number of isolates being from ear swabs of Otitis media patients. Beta haemolytic Streptococcus (group A,C,F,G) seen in 18 cases was the most common pathogen reported followed by Staphylococcus aureus, H. influenzae and Streptococcus pneumoniae in 13,12 and 11 cases respectively. Sensitivity of Cefaclor for bacteria commonly seen in the respiratory tract was greater than 90% in most of the cases. Evaluation of the 42 culture proven cases for patients who completed the study showed that Cefaclor had a 93% efficacy for indicated bacteria and 54% for non-indicated bacteria. In Vivo analysis of Cefaclor (i.e. on the basis of symptomatic response) showed that 96% cases had a symptomatic response by the second visit, which improved to 97% by the third visit. Only 15 non-serious adverse events were observed in 160 patients, none of the cases necessitated discontinuation of drug. Mild gastrointestinal symptom was the most common adverse event reported.

CONCLUSION

Cefaclor was found to be a safe and efficacious drug in the treatment of bacterial respiratory tract infections amongst Pakistani children.

A study on fatty acid composition of fish oil from two marine fish, Eusphyra blochii and Carcharhinus bleekeri

Two species of marine fish found in coastal waters of Karachi (Pakistan) were studied, Eusphyra blochii (Hammer-headed Shark) and Carcharhinus bleekeri (Shark) for their fatty acid composition. The isolation, identification and characterization of these fatty acids were carried out by gas liquid chromatography (GLC) and a combination of TLC-GLC technique. A large variation was observed between hammer-headed shark liver oil and shark liver oil. Twenty five individual fatty acids from the oil of marine fish were analyzed among those the palmitic acid was a major saturated fatty acid while stearic acid was the other major constituent. Among unsaturated fatty acids monoenoic e.g. oleic and palmitoleic acids were the major constituents and traces of dienoic and trienoic fatty acids were also found. In addition medicinally important polyunsaturated fatty, acid eicosapentaenoic and docosahexaenoic acids were also identified.

Mutation analysis and embryonic expression of the HLXB9 Currarino syndrome gene

The HLXB9 homeobox gene was recently identified as a locus for autosomal dominant Currarino syndrome, also known as hereditary sacral agenesis (HSA). This gene specifies a 403-amino acid protein containing a homeodomain preceded by a very highly conserved 82-amino acid domain of unknown function; the remainder of the protein is not well conserved. Here we report an extensive mutation survey that has identified mutations in the HLXB9 gene in 20 of 21 patients tested with familial Currarino syndrome. Mutations were also detected in two of seven sporadic Currarino syndrome patients; the remainder could be explained by undetected mosaicism for an HLXB9 mutation or by genetic heterogeneity in the sporadic patients. Of the mutations identified in the 22 index patients, 19 were intragenic and included 11 mutations that could lead to the introduction of a premature termination codon. The other eight mutations were missense mutations that were significantly clustered in the homeodomain, resulting, in each patient, in nonconservative substitution of a highly conserved amino acid. All of the intragenic mutations were associated with comparable phenotypes. The only genotype-phenotype correlation appeared to be the occurrence of developmental delay in the case of three patients with microdeletions. HLXB9 expression was analyzed during early human development in a period spanning Carnegie stages 12-21. Signal was detected in the basal plate of the spinal cord and hindbrain and in the pharynx, esophagus, stomach, and pancreas. Significant spatial and temporal expression differences were evident when compared with expression of the mouse Hlxb9 gene, which may partly explain the significant human-mouse differences in mutant phenotype.

A comparative study of omega-3-fatty acids obtained from marine fish and bezafibrate alone and in combination as hypolipidemic agents

The fish oil and its constituents have been studied in detail with special reference to ailments. The discovery of omega-3 fatty acids led to a detailed investigation about its effect and role as anti-cholesterolemic agents. The effect of fish oil alone and in combination with acid derivatives was found to be a potent cholesterol and triglycerides lowering agent. Comparative studies of fish oils and bezafibrate led to the formulation of new therapeutic combination having lesser side effects and toxicity.

Entomogenous fungi as promising biopesticides for tick control

When ticks were sealed in nylon tetrapacks and infected with the entomogenous fungi, Beauveria bassiana and Metarizium anisopliae and maintained in potted grass in the field, the fungal oil formulations (10(9) conidia per ml) induced 100% mortality in larvae of Rhipicephalus appendiculatus and Amblyomma variegatum, whereas mortalities in nymphs varied between 80-100% and in adults 80-90%. The aqueous formulations (10(9) conidia per ml) induced mortalities of 40-50% and reductions in egg hatchability of 68% (B. bassiana) and 48% (M. anisopliae) when sprayed on Boophilus decoloratus engorging on cattle. The strains of B. bassiana and M. anisopliae isolated from naturally infected ticks were also found to induce high mortalities in both R. appendiculatus and A. variegatum in tetrapacks placed in potted grass. Both aqueous and oil-based formulations were found to be effective, although the latter induced higher mortalities. These fungal strains in aqueous formulation (10(8) conidia per ml) suppressed on-host populations of adult R. appendiculatus by 80% (B. bassiana) and 92% (M. anisopliae) when sprayed on tick-infested grass once per month for a period of 6 months. The feasibility of using entomogenous fungi for tick control in the field is discussed.