Evaluation of the Ez-HBT Helicobacter blood test to establish Helicobacter pylori eradication

BACKGROUND

The urea blood test (Ez-HBT) has been shown to compare favourably with the urea breath test in the diagnosis of active Helicobacter pylori infection.

AIM

To examine the performance characteristics of the Ez-HBT Helicobacter blood test in establishing success or failure of therapy in H. pylori-infected adults using the 13C urea breath test as the reference method.

METHODS

13C urea breath test and Ez-HBT Helicobacter blood test were performed 4-6 weeks after completion of treatment in H. pylori positive subjects. Basal urea breath samples were collected; basal Ez-HBT Helicobacter blood test samples were not. Ez-HBT Helicobacter blood test results were reported as positive, negative, or indeterminate.

RESULTS

Seventy patients generated 126 measurable sets of urea breath and blood tests. The H. pylori cure rate was 93%. The sensitivity, specificity, and accuracy of the Ez-HBT Helicobacter blood test were 100%, 97%, and 97%, respectively. Six of eight false positive and indeterminate Ez-HBT Helicobacter blood test results could be attributed to incomplete fasting or a 13C enriched diet. After correcting for the non-fasting state, the positive predictive value of the Ez-HBT Helicobacter blood test improved from 56% to 86%.

CONCLUSION

The performance characteristics of the Ez-HBT Helicobacter blood test are comparable with that of 13C-urea breath test in establishing H. pylori eradication after therapy. Errors related to incomplete fasting can be mitigated by collection of a basal blood sample.

Anti-inflammatory and antinociceptive activities of Lippia nodiflora Linn

The methanolic extract of leaves of Lippia nodiflora Linn. was tested for its anti-inflammatory and antinociceptive activities. The extract showed a significant (P < 0.001) anti-inflammatory activity comparable to phenylbutazone against carrageenin-induced paw edema in rats and a significant (P < 0.001) antinociceptive activity comparable to diclofenac sodium in acetic acid induced writhing in white albino mice.

Globe conserving treatment of the only eye in bilateral retinoblastoma

AIMS

To quantify the rates of eye preservation and patient survival, local tumour relapse and recurrence, and development of new tumours in the remaining eye of children with bilateral retinoblastoma with one eye already enucleated. Also, in the same children, to describe the types of primary and secondary treatment procedures, and to define the anatomical outcome.

METHODS

This is a retrospective observational case series report. The study participants consisted of 107 patients with bilateral retinoblastoma with one eye enucleated within 1 month of baseline examination and had their remaining eye treated conservatively. The main outcome measure were: primary treatment failures, new tumours, enucleation of the only eye, death, remission, and anatomical outcomes (retinal detachment, vitreous haemorrhage, and cataract).

RESULTS

The median age at diagnosis was 8.4 (range 0.2-44, SD 10.1) months with a median ophthalmic follow up of 44.3 (8.1-114, SD 10.1) months. In 22 of the 107 patients (21%) the treated eye was in Reese Ellsworth groups I or II and in the remaining 85 (79%) in groups III-V at diagnosis. The primary treatment was cryotherapy in 14% (15/107) of eyes, radioactive plaque brachytherapy in 3.7% (4/107), and chemotherapy in 10% (11/107). It was lens sparing radiotherapy in 37% (40/107), whole eye radiotherapy in 29% (31/107), combined radiotherapy and chemotherapy in 2.8% (3/107), chemothermotherapy in 0.9% (1/107), and combined focal therapy in 1.8% (2/107). The primary treatment failed to achieve local tumour control during the follow up period in 37% (40/107) of eyes. In 17 eyes failure was due to inadequate control of the presenting tumour, in 16 to development of a new tumour, and in eight eyes to a combination of both. 35 (88%) of the 40 failures were managed by secondary conservative treatment and the remaining five were treated by enucleation of the only eye. There were eight (7.4%) deaths and the 3 year survival rate was 93% (100/108). Anatomical results included vitreous haemorrhage in four cases, tractional retinal detachment also in four cases, and 24 children required cataract surgery.

CONCLUSIONS

Aggressive conservative treatment achieved a good rate of globe salvage without impairing survival.

Neutron activation analysis of ceramic tiles and its component and radon exhalation rate

The concentrations of 20 trace elements in several ceramics tiles and ceramic composites used in Egypt were elementally analyzed by neutron activation analysis(NAA) technique. The samples and standard were irradiated with reactor for 4 h (in the Second Research Egyptian Reactor(Et-RR-2)) with thermal neutron flux 5.9 x 10(13) n/(cm2 x s). The gamma-ray spectra obtained were measured for several times by means of the hyper pure germanium detection system(HPGe). Also a solid state nuclear track detector(SSNTD) CR-39, was used to measure the emanation rate of radon for these samples. The radium concentrations were found to vary from 0.39-3.59 ppm and the emanation rates were found to vary from (0.728-5.688) x 10(-4) kg/(m2 x s). The elemental analysis of the ceramic tiles and ceramic composites have a great importance in assigning the physical properties and in turn the quality of the material.

Radioactivity in local and imported kaolin types used in Egypt

Natural radioactive materials are present in all geological rocks in varying amounts, they are easily mobilized in the environment, and can reach hazardous radiological levels under certain conditions, requiring precautions to be taken. The present study deals with 50 geological samples of local (Tushki and Kalabsha in upper Egypt) and imported (southeast Asia and Turkey) kaolin types. The samples were analyzed by gamma-ray spectroscopy using a HPGe detector. The activity concentrations of 232Th and 238U series and 40K and the contents (in ppm) are given. The radium equivalent activity varied from 187.8 to 10185.19 Bq/kg. 137Cs was found in a range of 0.23-8.5 Bq/kg, for the local samples. The kaolin in Tushki area was suitable for industrial use.

Evaluation of hospitalized infants and young children with bronchiolitis - a multi centre study

Four hundred and twenty nine young children with bronchiolitis admitted consecutively in different hospitals of Bangladesh were evaluated. Three hundred and forty eight children studied for their putative risk factors, clinical profile, management and the outcome. Both cases and controls were examined for respiratory syncytial virus (RSV) antibody status. The diagnosis of bronchiolitis was made on the basis of first attack of wheeze in previously healthy children below two years of age. Detailed history including the possible risk factors, the management and daily follow-up on the ward and the outcome at discharge were documented through a structured questionnaire. Chest x-ray was done in each case to find out the radiological changes. Blood of 266 patients and 30 controls were studied for RSV IgM and IgG antibody by ELISA. There were 66% male and 34% female children. The median age of the children was 3.0 months and 82.7% were below 6 months of age. Most of the babies were born term (88%), with ABW (73%), by normal vaginal delivery (88%). Exclusive or predominant breast-feeding were given in 72% cases. The location of the patient was rural in 55% cases. Around half of the parents were illiterate or slightly educated (up to 5 years schooling) fathers 46.5% and mothers 56% and majority of the parents were poor (74%). In 52% cases the number of family members in one room were four or more. Half of the parents (52%) were smokes and there was atopy in 26.5% families. The clinical features of bronchiolitis were mostly cough (99%), respiratory distress (97%), feeding difficulty (93%) and fast breathing (96%) (median RR 68/min). Fever (1000F or more) was in only 33% cases, though parents complained in 90% cases. All children (100%) had wheeze and crackles in lungs in 96% cases. Liver could be palpable in 83% and spleen in 42% cases. Important radiological features were increased translucency (96%), increased interstitial markings (87%), hyperinflation (75%) and streaky densities (61%). In 69.6% cases TLC was 12,000 or less and only 15% with a neutrophil fraction greater than 60%. Children were positive for IgM antibody in 43.6% cases and both IgM and IgG in 5.3% cases. The main modalities of treatment were antibiotics (99%) (Ampicillin, 76%), oxygen therapy (83%), nebulised salbutamol (76%) and intravenous fluid (51%). The median duration of hospital stay was 4 days. Most of the children were discharged with improvement (96%) with 2% mortality. Not a single case was diagnosed as bronchiolitis in hospitals outside Dhaka. Cefrtiaxone (72.5%) and parenteral steroids (70.5%) were the mainstay of therapy there.

Over-the-counter H(2)-receptor antagonists do not compromise intragastric pH control with proton pump inhibitors

BACKGROUND

Proton pump inhibitors effectively suppress intragastric acid. Nocturnal acid breakthrough occurs on any dosing regimen of oral proton pump inhibitors. Histamine(2)-receptor antagonists (H(2)RA) suppress intragastric acidity independently of meals and help to control nocturnal acid breakthrough. Because proton pump inhibitors require an acid intragastric milieu for activation, nocturnal dosing of H(2)RA might decrease the effect of proton pump inhibitors taken in the morning by decreasing their gastric-acid-driven activation.

AIM

Assess intragastric acid control on omeprazole, 20 mg, taken every morning, after variable dosing of over-the-counter famotidine, 10 mg.

METHODS

Twelve Helicobacter pylori-negative, healthy volunteers received omeprazole, 20 mg, every morning before breakfast for 15 days. Baseline studies on omeprazole, 20 mg, in the morning, were done on day 7. On nights between days 8-9, 11-12 and 14-15, famotidine, 10 mg at bedtime, and 10 mg at bedtime and/or at 05.30 h, was given in a three-way, crossover, double-blind randomized design. Intragastric pH monitoring was performed on days 9, 12 and 15, starting at 08.00 h.

RESULTS

Percentage times intragastric pH < 4 on omeprazole, 20 mg, in the morning of the day after receiving famotidine, 10 mg, at bedtime (58.6 +/- 4.8); at 05.30 h (54.1 +/- 5.1); or at bedtime and at 05.30 h (54.3 +/- 5.0) did not differ significantly (P=0.65) from percentage times intragastric pH on day 7 of omeprazole, 20 mg, in the morning (49.5 +/- 5.1).

CONCLUSION

Concerns over inhibition of next-day daytime proton-pump inhibitor effect should not preclude use of nocturnal H(2)RAs in patients with gastro-oesophageal reflux disease.

The ability of poloxamers to inhibit platelet aggregation depends on their physicochemical properties

Poloxamers, block copolymers of polyethylene glycol (PEG) and polypropylene glycol (PPG), are thought to reduce cell-cell adhesion during vascular disorders. We examined how the amphiphilic nature of these polymers may contribute to their ability to inhibit ADP-induced platelet aggregation. Four Poloxamers (184, 188, 335 and 338) with varying PEG and PPG block lengths were examined. Of these, Poloxamer 184 at 2 mM markedly inhibited platelet aggregation. We observed that: i) Typically, less than 10% of the platelet surface is covered by Poloxamers, and greater than 99% of the polymer either remains in solution or binds soluble components in blood plasma. ii) Increasing the PEG side-chain length does not significantly augment the ability of Polox-amers to inhibit platelet aggregation. iii) Poloxamer 184, but not Polox-amers 188 and 335, significantly reduces the ability of stimulated platelets to bind fibrinogen and antibody PAC-1. The study demonstrates that the physical adsorption of some Poloxamers may allow them to inhibit platelet aggregation. The inhibition mechanism involves either binding of Poloxamers to platelet GPIIb-IIIa or inhibition of cellular activation pathways.

Measurement of radioactivity and radon exhalation rate in different kinds of marbles and granites

Geological materials usually contaminated with naturally occurring radioactive materials (NORM) have become a focus of great attention. These NORM under certain conditions can reach hazardous contamination levels. Some contamination levels may be sufficiently severe that precautions must be taken. The present study deals with 60 geological samples (marble and granite) from both Egyptian and foreign locations. The studied samples were analyzed and the concentrations in Bq/kg dry weight of radioisotopes were determined by gamma-ray spectrometry using hyper-pure germanium (HPGe) detector in Bq/kg dry weight. The absorbed dose rate due to the natural radioactivity in the samples under investigation ranged from 2.45 +/- 0.07 to 64.44 +/- 1.93 nGy/h for marble and from 41.55 +/- 1.25 to 111.94 +/- 3.36 nGy/h for granite. The radium equivalent activity varied from 5.46 +/- 0.16 to 150.52 +/- 4.52 Bq/kg for marble samples and from 229.52 +/- 6.89 to 92.16 +/- 2.76 Bq/kg for granite. The representative external hazard index values for the corresponding samples are also estimated and given. The radon exhalation rates for marble and granite samples were also calculated by using solid state nuclear track detector (CR-39). The value of radium exhalation rate varied from 8.0 +/- 2.39 to 30.20 +/- 5.06 Bq/m2/d for marble and 6.89 +/- 1.72 to 25.79 +/- 4.38 Bq/m2/d for granite and the effective radium content was found to vary from 1.700 +/- 0.51 to 6.42 +/- 1.08 Bq/kg for marble and 1.29 +/- 0.32 to 5.63 +/- 0.96 Bq/kg for granite. The values of the radon exhalation rate and effective radium content are found to correspond with the values of uranium concentration measured by the HPGe detector in the corresponding sample.

Natural radioactivity and radon exhalation rate of soil in southern Egypt

The level of natural radioactivity in soil of 30 mining samples collected from six locations in southern Egypt was measured. Concentrations of radionuclides in samples were determined by gamma-ray spectrometer using HPGe detector with a specially designed shield. The obtained results of uranium and thorium series as well as potassium (K-40) are discussed. The present data were compared with data obtained from different areas in Egypt. Also, a solid state nuclear track detector SSNTD (Cr-39) was used to measure the radon concentration as well as exhalation rate for these samples. The radon concentrations were found to vary from 1.54 to 5.37 Bq/kg. The exhalation rates were found to vary from 338.81 to 1426.47 Bq/m2d. The values of the radon exhalation rate are found to correspond with the uranium concentration values measured by the germanium detector in the corresponding soil samples.

Changes in mRNA levels of the Myoc/Tigr gene in the rat eye after experimental elevation of intraocular pressure or optic nerve transection

PURPOSE

To isolate the rat Myoc/Tigr gene and investigate changes in its expression pattern in normal eyes and in eyes with either pressure-induced optic nerve damage or optic nerve transection.

METHODS

Expression pattern of the rat Myoc/Tigr gene was investigated by Northern blot hybridization. Optic nerve damage and death of ganglion cells in the retina were induced unilaterally, by injection of hypertonic saline solution, episcleral vein cauterization, or optic nerve transection. The levels of mRNA for Myoc/Tigr were compared between several tissues of the control and surgically altered eyes, by using semiquantitative RT-PCR, real-time PCR, and Northern blot analysis.

RESULTS

The rat Myoc/Tigr gene is 10 kb long and contains three exons. Among the eye tissues analyzed, Myoc/Tigr mRNA was detected in the combined tissues of the eye angle, sclera, cornea, retina, and optic nerve head. With pressure-induced optic nerve degeneration, the level of Myoc/Tigr mRNA decreased in the retina and the combined tissues of the eye angle, but increased in the optic nerve head. After optic nerve transection, the level of Myoc/Tigr mRNA increased in the retina, but did not change in the combined tissues of the eye angle.

CONCLUSIONS

The decreased level of Myoc/Tigr mRNA in the retina after induction of elevated intraocular pressure compared with that in the control retina cannot be explained by ganglion cell death alone. Differences in Myoc/Tigr mRNA levels in eye tissues after elevation of intraocular pressure or optic nerve transection may reflect the activation of different signaling pathways involved in regulation of this gene.

Rho family GTPases regulate mammary epithelium cell growth and metastasis through distinguishable pathways

BACKGROUND

Relatively few genes have been shown to directly affect the metastatic phenotype of breast cancer epithelial cells in vivo. The Rho family of proteins, incluing the Rho, Rac and Cdc42 subfamilies, are related to the small GTP binding protein Ras and regulated diverse biological processes including gene transcription, cytoskeletal organization, cell proliferation and transformation. The effects of Cdc42, Rac and Rho on the actin cytoskeleton suggested a possible role for Rho proteins in cellular motility and metastasis; however, a formal analysis of the role of Rho proteins in breast cancer cellular growth and metastasis in vivo had not previously been performed.

MATERIALS AND METHODS

We generated a panel of MTLn3 rat mammary adenocarcinoma cells that expressed similar levels of dominant inhibitory mutants of Cdc42-, Rac- and Rho-dependent signaling, to examine the contribution of these GTPases to cell spreading, guided chemotaxis, and metastasis in vivo. The ability of Rho proteins to regulate intravasation into the peripheral blood was determined by implanting MTLn3 cell stable dominant negative lines in nude mice and measuring the formation of breast cancer cell colonies grown from the peripheral blood. Serial sectioning of the lungs was performed to determine the presence of metastasis in mice in which mammary tumors expressing the dominant negative Rho family proteins had grown to a similar size.

RESULTS

Cell spreading of MTLn3 cells was selectively abrogated by N17Rac1. N19RhoA and N17Cdc42 reduced the number of focal contacts (FCs) and disrupted the co-localization of vinculin with phosphotyrosine at FCs. While N17Rac1 and N17Cdc42 preferentially inhibited colony formation in soft agar, all three GTPases affected cell growth in vivo. To distinguish effects on tumorigenicity from intravasation into the bloodstream, implanted tumors were grown to the same size in nude mice. Each dominant inhibitory Rho protein reduced intravasation into the peripheral blood. Lung metastasis of MTLn3 cells was also abrogated by the dominant inhibitory Rho proteins, despite the presence of residual CFU.

CONCLUSIONS

These studies demonstrate for the first time a critical role for the Rho GTPases involving independent signaling pathways to limit mammary tumor cellular growth and metastasis in vivo.

Concomitant supplemental vitamin A enhances the response to weekly supplemental iron and folic acid in anemic teenagers in urban Bangladesh

BACKGROUND

Iron deficiency is the most common micronutrient deficiency and affects >2 billion persons worldwide, leading to anemia in >40% of women of reproductive age in the developing world.

OBJECTIVE

The objective was to determine whether weekly supplementation with iron and folate would reduce the frequency of anemia in teenage women in urban Bangladesh before they became pregnant.

DESIGN

Participants with a hemoglobin concentration of 80-120 g/L were entered into a randomized, double-blind, placebo-controlled trial and received supplements of placebo, vitamin A, iron + folic acid, or iron + folic acid + vitamin A weekly for 12 wk. The supplements contained 2.42 mg vitamin A (retinol) as retinyl palmitate, 120 mg elemental Fe as ferrous sulfate, and 3.5 mg folic acid.

RESULTS

Hemoglobin concentrations increased significantly more after supplementation with iron + folic acid or iron + folic acid + vitamin A than after either the placebo or vitamin A alone. There was a significantly greater increase in hemoglobin after iron + folic acid + vitamin A than after iron + folic acid, but the additional effect disappeared after adjustment for baseline hemoglobin, serum vitamin A, and ferritin and the number of supplements taken. Those with the lowest baseline hemoglobin had the greatest increase in hemoglobin. Compared with the placebo, iron + folic acid + vitamin A reduced anemia by 92%, iron deficiency by 90%, and vitamin A deficiency by 76%.

CONCLUSION

There may be significant health benefits from a program that enhances the nutritional status of iron, folate, and vitamin A in poor urban young women before they become pregnant.

Epidemiology of postshigellosis persistent diarrhea in young children

BACKGROUND

Dysentery accounts for 20% of the 4.6 million diarrhea-associated deaths among children in developing countries, with the risk from death in dysenteric persistent diarrhea 10-fold higher than that in acute dysentery. Although Shigella accounts for the majority of dysenteric episodes, very little is known about the epidemiology of postshigellosis persistent diarrhea.

METHODS

Rural Bangladeshi children younger than 5 years of age (n = 1,756) were followed for 1 month after exposure to sentinel cases of Shigella dysentery. The likelihood of an acute diarrheal episode becoming persistent was assessed.

RESULTS

Diarrhea caused by Shigella was significantly associated with an increased risk of persistent diarrhea (age-adjusted relative risk, 1.83; 95% confidence interval, 1.19 to 2.81). Despite the use of nalidixic acid in dysenteric episodes, persistent diarrhea occurred in 23% of children with shigellosis. Infection by multiply antibiotic-resistant Shigella isolates (age-adjusted relative risk, 3.76; 95% confidence interval, 1.51 to 9.36) and occurrence of shigellosis during infancy were observed to be risk factors for initiation of Shigella diarrhea persistence. However, 88% of the persistent shigellosis episodes occurred in older children, 50% were associated with nondysenteric shigellosis and 79% were caused by Shigella species other than Shigella dysenteriae 1.

CONCLUSIONS

These data demonstrate the importance of Shigella as a cause of persistent diarrhea and indicate that strategies to prevent postshigellosis persistent diarrhea must be broad-based, with a focus on older children as well as infants, management of nondysenteric as well as dysenteric disease and prevention of diarrhea caused by multiple Shigella species.

Intragastric acidification reduces the occurrence of false-negative urea breath test results in patients taking a proton pump inhibitor

OBJECTIVE

The aim of this study was to investigate whether reducing intragastric pH, at the time of urea ingestion, decreases the likelihood of false-negative (FN) urea breath test (UBT) results in patients taking a proton pump inhibitor (PPI).

METHODS

Patients with active Helicobacter pylori infection underwent a baseline 14C-UBT (UBT-1) followed by treatment with lansoprazole 30 mg/day for 14 to 16 days. On day 13, patients returned for a repeat standard UBT (UBT-2). Between days 14 to 16, patients underwent a modified UBT (UBT-3), which included consuming 200 ml of 0.1 N citrate solution 30 min before and at the time of 14C-urea administration. Breath samples were collected 10 and 15 min after 14C-urea ingestion. Mean 14CO2 excretion and the number of FN and equivocal UBT results were compared for the three UBTs.

RESULTS

A total of 20 patients completed the study. Lansoprazole caused a significant decrease in mean breath 14CO2 excretion (disintegrations per minute) between UBT-1 (2.96 +/- 0.23) and UBT-2 (2.08 +/- 0.52, p < 0.05). Lansoprazole caused six (30%) FN and eight (40%) equivocal UBT-2 results. Mean breath 14CO2 excretion for UBT-3 (677 +/- 514) was greater than for UBT-2 (234 +/- 327, p = 0.001). UBT-3 caused only two (10%) FN and three (15%) equivocal results. The 15-min breath sample caused fewer FN and equivocal results than the 10-min sample for both UBT-2 and UBT-3.

CONCLUSIONS

Giving citrate before and at the time of 14C-urea administration increases mean breath 14CO2 excretion and decreases FN and equivocal UBT results in patients taking a PPI. These observations suggest that it may be possible to design a UBT protocol that will remain accurate in the face of PPI therapy.

Infectious complications following abdominal hysterectomy in Karachi, Pakistan

OBJECTIVE

In this paper we studied the prevalence of post-operative infections after total abdominal hysterectomy in Karachi, Pakistan and their associated risk factors.

METHOD

A retrospective analysis was conducted by reviewing the case notes of 827 consecutive total abdominal hysterectomies.

RESULTS

The post-operative infection rate was 22%. Of the patients, 6% (49) developed operative site infections including wound and vaginal cuff infections and pelvic abscesses while 16% (133) developed non-operative site infections including urinary tract infections and thrombophlebitis. Six risk factors were found to be significantly associated with post-operative infections: a pre-operative hospitalization of more than 2 days (P<0.02); additional non-gynecological procedures performed intra-operatively (P<0.02); indwelling catheterization for more than 7 days (P<0.001); patient's age greater than 50 years (P<0.02); an underlying malignancy (P<0.0001); and developing a hematoma post-operatively (P<0.04).

CONCLUSION

The results of this study may serve as a baseline for future comparison and indicate interventions which may contribute to a reduction in the post-operative infection rate.

Geometry of chemically modified silica

The effect of alkyl chain length on adsorbent pore volume and void volume of HPLC columns is described. The results provide evidence that alkyl chains attached on silica surface are densely packed. A correlation of a decrease of pore volume with an increase of the alkyl modifier chain length was found. Effective molecular volume of bonded chains was found to be similar to the molecular volume of corresponding liquid alkanes. An absence of noticeable penetration of acetonitrile, methanol, or tetrahydrofuran molecules between bonded chains at any water-organic eluent composition was found.

Volume-load capacity in fast-gradient liquid chromatography

We studied the effects of sample solvent composition and injection volumes on the chromatographic performance of ODS-bonded silica columns under fast-gradient running conditions. Chromatographic performance is compromised as a function of both sample injection volume and sample solvent strength, with earlier-eluting analytes being much more affected than later-eluting ones. In general, when injecting samples dissolved in a strong solvent, performance was improved by diluting the strong injection solvent and injecting a proportionally larger volume. Volume loading capacity can be increased by using a longer column, or by using a column of equivalent length, but with a larger inner diameter. Data also suggest that sample solvent strength, not viscosity, is responsible for the noted effects.

Quantification of the common deletion in human testicular mitochondrial DNA by competitive PCR assay using a chimaeric competitor

The "common" 4977 bp deletion in mitochondrial DNA (Delta4977) is commonly used as an indicator of tissue deterioration in ageing and bioenergetic diseases. Deletion levels are normally measured by a serial dilution polymerase chain reaction (PCR) approach, where test reactions are compared with dilutions of control amplifications of DNA from a similar sized stable region of the mitochondrial genome. The end-point of this assay is the dilution that can just detect any PCR product; however, this is an inherently unstable measure. We constructed a chimaeric DNA construct that binds to both control and deletion primers with similar annealing properties. This was used in a competitive PCR assay to quantify Delta4977 in human testicular tissues that had been well-characterized using the serial dilution approach. We found the competitive assay to be highly replicable as it compares the PCR product of the construct with that of test DNA samples during the linear growth phase of the PCR reaction. Moreover, the serial dilution assay was shown to significantly overestimate the amounts of deleted mitochondrial DNA present. The assay promises to throw new light on the role of mitochondrial DNA deletions in tissue dysfunction and ageing, as such deletions can now be determined with high accuracy and repeatability and is much cheaper to apply than real-time fluorescent quantitative PCR.

The retinoblastoma family member, p107, is active in non-dividing monocyte-derived dendritic cells

A member of the retinoblastoma family of cell cycle regulatory proteins, p107, is not normally expressed in non-cycling cells. We demonstrate here that p107 is expressed in monocytes as they differentiate into dendritic cells under the influence of granulocyte-macrophage colony-stimulating factor and interleukin 4, a process shown not to involve cellular proliferation. We show that p107 is localized to the nucleus of these cells and is active, in that it binds an E2F-DNA binding site, together with E2F transcription factors. These findings suggest a hitherto unknown role for p107 in non-proliferating dendritic cells that warrants further investigation.

Pharmacokinetics of orally administered camptothecins

Phase I trials of oral camptothecins, including camptothecin (CPT) and irinotecan (CPT-11), have reported substantial interpatient variability in systemic exposure, which could result in suboptimal antitumor activity in some patients or enhanced risk for toxicity in others. This investigation evaluates the contribution of intestinal absorption and first-pass metabolism in the disposition of oral CPT and CPT-11, respectively. The transport of CPT in Caco-2 cell lines (validated model of intestinal drug transport) was concentration dependent and saturable (Vmax: 34 x 10(-5) cm/sec and Km: 20 microM), and was temperature dependent with an activation energy (Ea) of 11.7 kcal/mole. Cumulatively, this data was indicative of carrier-mediated intestinal transport. In addition, a reduction of transport in the presence of sodium azide plus deoxyglucose suggested ATP dependence. Thus, variable expression and availability of intestinal transporters could contribute to the observed wide variability in the exposure to oral CPT. CPT-11 is hydrolyzed by the ubiquitous enzyme carboxyl esterase to active SN-38, and first-pass metabolism of oral CPT-11 would include both intestinal and hepatic hydrolysis. Incubation of CPT-11 with S9 fractions of human liver and intestinal tissues resulted in variable rates of formation of SN-38. The mean (+/- SD) specific activities (pmoles/min/mg) were: liver (8.57 +/- 10.4, n = 8), duodenum (5.06 +/- 3.7, n = 4), jejunum (6.44 +/- 2.8, n = 5), ileum (4.81 +/- 2.4, n = 5), colon (1.93 +/- 1.5, n = 6), and rectum (0.82, n = 1). Interestingly, there was a decrease in SN-38 formation by tumor tissue compared to matched normal liver and colon tissues. Therefore variable first-pass metabolism could contribute to the substantial differences in the systemic exposures to CPT-11 and SN-38 in patients receiving oral CPT-11.

Acquired inhibitor to factor VIII in small cell lung cancer: a case report and review of the literature

Acquired hemophilia (antibodies or inhibitors to factor VIII) is the most common acquired disease affecting clotting factors. It has been described in association with autoimmune disease, malignancy, dermatologic disorders, in the postpartum period, and with drug interactions. Factor VIII inhibitors have been previously described with lung cancer, three with squamous cell and one with adenocarcinoma. A 54-year-old woman presented with weight loss and shoulder pain. A chest X-ray revealed a right hilar mass, confirmed by computed tomography (CT) scan and biopsy revealed small cell lung cancer. Coagulation panel prior to bronchoscopy showed an increased partial thromboplastin time (aPTT). The presence of factor VIII inhibitor was demonstrated at 5 Bethesda units. The patient was treated with fresh frozen plasma twice for hemorrhagic episodes, and six cycles of chemotherapy were begun with carboplatin and etoposide 16. Eight months after the diagnosis, her aPTT was normal and the factor VIII inhibitor titer was undetectable. This is the first case report of small cell lung cancer and acquired hemophilia. A causal relationship between the malignancy and the presence of factor VIII inhibitors is suggested by the response to therapy.

Increase in serum beta-carotene following dark green leafy vegetable supplementation in Mebendazole-treated school children in Bangladesh

OBJECTIVE

To study the effect of consumption of dark green leafy vegetables (DGLV) and sweet pumpkin on serum beta-carotene and retinol concentrations in children treated for Ascaris lumbricoides.

DESIGN

Experimental study with a randomised design.

SUBJECTS

A total of 110 primary school children aged 8-12 y in northwestern Bangladesh.

INTERVENTIONS

All children were de-wormed and 2 weeks later randomly assigned to one of three groups to receive for 6 days per week, for 6 weeks, one complete meal containing either: (1) 4.4 mg beta-carotene from DGLV (n=37, after 18 dropouts); (2) 1.5 mg beta-carotene from sweet pumpkin (n=36, 18 dropouts); or (3) vegetables containing virtually no beta-carotene (control) (n = 37, 18 dropouts).

RESULTS

Significant increases (P < 0.001) in mean serum beta-carotene concentrations were seen in all three study groups, with a statistically higher increase (micromol/l) in the DGLV group (0.44; 95% confidence interval (CI) 0.32, 0.55) compared to the control group (0.20; 95% CI 0.14, 0.26; P = 0.002). The increase in serum retinol (micromol/l) was statistically significant (P=0.04) only in the DGLV group (mean 0.066; 95% CI 0.002, 0.13), but this increase was not different from the increase in the control group.

CONCLUSION

In children successfully treated for Ascaris lumbricoides, a substantial increase in serum beta-carotene was seen after feeding with a moderately high cumulative dose of DGLV for 6 weeks.

Evaluation of the routine hepatitis B immunization programme in Palestine,1996

The objectives of this study were to evaluate routine hepatitis B immunization in Palestine. Blood samples of 119 children [89 fully immunized and 30 non-immunized]were analysed. The protective antibody levels among immunized children were greater than the non-immunized children. Antibody levels among the immunized children were lower in the older age group [>36 months], but no sex differences in antibody level were apparent. Thus, hepatitis B immunization had an excellent impact on preventing hepatitis B transmission [85% preventive]. The non-responders constituted 14.6% of the sample, which is higher than other studies.

Anaemia in Bangladesh: a review of prevalence and aetiology

OBJECTIVE

: This paper provides a comprehensive review of the changes in the prevalence and the extent of anaemia among different population groups in Bangladesh up to the present time. The report also focuses on various factors in the aetiology of anaemia in the country.

DESIGN AND SETTING

: All the available data have been examined in detail, including data from national nutrition surveys, as well as small studies in different population groups.

RESULTS

: Over the past three decades a number of studies including four national nutrition surveys (1962/64; 1975/76; 1981/82 and 1995/96) have been carried out to investigate the prevalence of anaemia among different population groups in Bangladesh, and have demonstrated a significant public health problem. Since the 1975/76 survey the average national prevalence of anaemia has not fallen; in 1995/96, 74% were anaemic (64% in urban areas and 77% in rural areas). However, age-specific comparisons suggest that the rates have fallen in most groups except adult men: in preschool children in rural areas it has decreased by about 30%, but the current level (53%) still falls within internationally agreed high risk levels. Among the rural population, the prevalence of anaemia is 43% in adolescent girls, 45% in non-pregnant women and 49% in pregnant women. The rates in the urban population are slightly lower compared with rural areas, but are high enough to pose a considerable problem. It appears that severe anaemia in the Bangladeshi population is less frequent, possibly present among only 2-3% of the population. The data on the aetiology of anaemia reveal that iron deficiency may be a substantial cause of anaemia in the Bangladeshi population. Other dietary factors in addition to parasitic infestations may also precipitate the high prevalence of anaemia.

CONCLUSIONS

: While the overall prevalence of anaemia among the Bangladeshi population is still very high, the rates of severe anaemia are almost non-existent. A large proportion of anaemia can be attributed to iron deficiency. There is a need for a comprehensive strategy for the prevention and control of anaemia in Bangladesh.

p107 is active in the nucleolus in non-dividing human granulosa lutein cells

Cells are maintained in a quiescent state by members of the retinoblastoma protein family, pRb and p130. Both are phosphoproteins and hypophosphorylated forms of pRb and p130 bind and repress the activity of E2F transcription factors, thereby preventing entry into the cell cycle. Mitogenic stimulation causes activation of cyclin dependent kinases (cdk) that phosphorylate both pRb and p130, thereby releasing E2F factors which stimulate the transcription of a number of genes that are required for DNA synthesis and for regulating the cell cycle. In non-dividing cells, cdks are maintained in an inactive state by cdk inhibitor proteins such as p27(Kip1). The aim of our study was to determine how E2F complexes are regulated during the differentiation of human primary granulosa lutein cells (GLC) of the corpus luteum (CL). The CL is formed in the ovary after ovulation at the terminal stage of folliculogenesis after completion of maturation and differentiation of Graafian follicles. As shown by flow cytometry GLC are not dividing, being predominantly in the G(0)/G(1) phase of the cell cycle and, consistent with this, they contain the cdk inhibitor protein, p27(Kip1), but not E2F-1 which is normally expressed only in proliferating cells. The GLC do express E2F-4, hypophosphorylated pRb, p130 forms 1 and 2 and, surprisingly, hypophosphorylated p107. p107 is normally present only in dividing cells where it regulates E2F activity during the cell cycle. These forms of pRb, p130 as well as p107, together with E2F-4 are all active in that they can bind an E2F DNA-binding site in a pull-down assay. Immunocytochemistry shows that these proteins are expressed in almost all GLC but have different sub-cellular distribution: p107 is concentrated in nucleoli, while p130 and E2F-4 show relatively even nuclear and cytoplasmic distributions. Both pRb and p130 have been implicated previously in repressing E2F activity in many different cell types during cell cycle arrest in G(0)/G(1). We conclude that p107 is active in human primary GLC but its nucleolar localisation would suggest that it represses ribosomal RNA synthesis rather than E2F activity.

Campylobacter fetus fetusabortions in vaccinated ewes

AIMS

To investigate the cause of an outbreak of ovine abortion in 1996 in a flock of 300 two-tooth (rising 2-year-old) ewes vaccinated against Campylobacter fetus fetus infection and to subsequently characterise the strain of C. fetus fetus isolated from aborted foetuses.

METHODS

Standard bacteriological methods were used to identify C. fetus fetus isolates which were then antigenically typed and subjected to pulsed-field gel electrophoresis (PFGE) and compared to the vaccine strain.

RESULTS

C. fetus fetus was identified as the causal agent of the abortions despite the ewes having been vaccinated before ram introduction and at the time of ram removal. Four isolates cultured from aborted material were indistinguishable when compared using antigenic typing and PFGE, but all differed from the vaccine strain.

CONCLUSIONS

Within the limitations of the available typing systems, it is proposed that PFGE may be a useful tool to establish the distribution and strain variation of C. fetus fetus.

CLINICAL RELEVANCE

This field case indicates the need for further study of non-vaccine C. fetus fetus strains which cause abortion in vaccinated ewes, and of the importance of these strains to the New Zealand sheep industry.

Evaluation of the routine hepatitis B immunization programme in Palestine, 1996

The objectives of this study were to evaluate routine hepatitis B immunization in Palestine. Blood samples of 119 children (89 fully immunized and 30 non-immunized) were analysed. The protective antibody levels among immunized children were greater than the non-immunized children. Antibody levels among the immunized children were lower in the older age group (> 36 months), but no sex differences in antibody level were apparent. Thus, hepatitis B immunization had an excellent impact on preventing hepatitis B transmission (85% preventive). The non-responders constituted 14.6% of the sample, which is higher than other studies.

Anaemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh

OBJECTIVE

To investigate the prevalence of anaemia and iron deficiency among adolescent schoolgirls in peri-urban Bangladesh, and to identify various factors associated with anaemia in this population.

DESIGN

A cross-sectional design.

SETTING

Girls' high schools in five sub-districts of Dhaka.

SUBJECTS

Adolescent girls (n=548) aged 11-16 y from nine schools in Dhaka district participated in the study. Socio-economic, anthropometric and dietary information were collected. Blood haemoglobin (Hb), serum iron, total iron binding capacity (TIBC), transferrin saturation (TS), serum ferritin (SF) and serum retinol (vitamin A) were determined.

RESULTS

The prevalence of anaemia (Hb<120 g/l) among the participants was 27%. Seventeen percent had depleted iron stores (SF<12 microg/l). Of all anaemic girls, 32% had iron deficiency anaemia (Hb<120 g/l and SF<12 microg/l). When the girls were classified by serum vitamin A, the third with the lowest serum retinol levels had significantly lower Hb and SF levels. Significant positive correlations were observed between Hb and serum iron, TS, SF and retinol, while there was a negative correlation with serum TIBC. Occupancy, frequency of consumption of large fish, serum iron, TIBC, TS, SF and serum vitamin A were strongly related to Hb by multiple regression analysis. For 1 microg/l change in SF concentration, there was a 0.046 g/l change in Hb, when adjusted for all other factors.

CONCLUSION

Anaemia among these adolescent schoolgirls in peri-urban Bangladesh cannot be explained by iron deficiency alone, and other causes may also exist in this population.

Guillain-Barré syndrome: An unusual presentation of West Nile virus infection

West Nile fever is a mosquito-borne febrile illness seen in Africa, Asia, and Europe, but reported in North America only once. The recent outbreak in New York City represents the first time this virus has been detected in North America. West Nile virus usually causes mild symptoms, though rarely it can cause neurologic diseases, with a fatal outcome or permanent neurologic sequelae. We describe an elderly patient with West Nile virus infection who presented with Guillain-Barré syndrome.

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.

Effect of clinical events on plasma HIV-1 RNA levels in persons with CD4+ T-lymphocyte counts of more than 500 x 10(6) cells/l

OBJECTIVE

Immune stimulation of CD4 lymphocytes is thought to enhance HIV-1 replication in vivo. Therefore, we sought to define the impact of clinical events identified as putative immune activators on the variability of plasma HIV-1 RNA levels in persons with CD4 cell counts greater than 500 x 10(6) cells/l.

DESIGN

We prospectively recorded clinical events and measured plasma HIV-1 RNA levels weekly for 24 weeks in 16 HIV-1-infected adults who were not receiving antiretroviral therapy and who had CD4 cell counts greater than 500 x 10(6) cells/l.

METHODS

Standard weekly interviews were conducted to capture potential immune activators (e.g., infections, immunizations, and allergic reactions). All plasma HIV-1 RNA levels were measured using the Amplicor HIV-1 Monitor assay (Roche Diagnostics, Branchburg, New Jersey, USA) according to the manufacturer's instructions.

RESULTS

Participants had remarkably stable viral loads during the 6 month study period. Infections were significantly more frequent during the 7 days prior to individual HIV-1 RNA measurements that exceeded the assay variation thresholds determined for this study (+/- 0.324 log) than during the comparable time periods preceding stable measurements (P = 0.023). As a group, the eight participants who had one to four HIV-1 RNA measurements that exceeded the thresholds experienced more infections and declining CD4 cell counts over the study course compared to the eight participants whose measurements all fell within the thresholds (P = 0.058 and 0.053 respectively).

CONCLUSIONS

Our study suggests that in untreated HIV-1-infected persons with CD4 cell count greater than 500 x 10(6) cells/l, viral load is generally quite stable, although acute minor infections are associated with transient fluctuations generally lasting no more than 1 week.

Safety and immunogenicity of an oral, inactivated enterotoxigenic Escherichia coli plus cholera toxin B subunit vaccine in Bangladeshi adults and children

We have compared the B cell responses evoked in Bangladeshi, adults (n=11, median age 25 years) and children (n=21, median age 4.5 years), 7 days after intake of each of two doses of an oral, inactivated enterotoxigenic Escherichia coli (ETEC) vaccine composed of formalin-killed ETEC strains expressing the colonization factors, CFA/I, CFA/II and CFA/IV together with 1 mg of recombinant cholera toxin B-subunit (rCTB). The vaccine was well tolerated and only gave rise to negligible side effects. Peak antibody-secreting cell (ASC) response of the IgA isotype were seen 7 days after the first dose of the vaccine. The ASC responses to the different colonization factors (CFs) increased from a 29- to 46-fold (responder frequency 90-100%) in the adults and 13- to 24-fold (responder frequency 67-90%) in the children. The IgA-ASC response to rCTB also peaked after the first dose in the adults (426-fold, responder frequency 100%) and the children (46-fold, responder frequency 95%). Increased IgA antibody levels against CFA/I as well as IgA and IgG antibody levels to rCTB were seen in plasma after immunisation. About 86% of the children and 80% of the adults responded with faecal antibodies to rCTB, whereas about 67% of both groups responded to CFA/I. These results show that a single dose of the ETEC vaccine may elicit significant mucosal immune responses in both children and adults residing in an ETEC-endemic country such as Bangladesh.