Risk for Alzheimer's disease in older late-onset cases is associated with HLA-DRB1*03

The allele frequency of the HLA-DRB1 gene was compared between groups of 48 clinically diagnosed elderly Alzheimer's disease (AD) cases and 44 pathologically confirmed elderly control cases. Specific primers were used to PCR amplify the highly polymorphic second exon of HLA-DRB1 using DNA extracted from blood samples or frozen brain tissue. The allele type was identified using sequence specific oligonucleotide probes. The results showed an increased frequency of DRB1*03 (P < 0.006) and decreased frequency of DRB1*09 (P < 0.049) in the AD cases compared with the controls. The results suggest that DRB1*03 is associated with an increased risk and DRB1*09 a possible decreased risk for the development of late-onset AD with first detectable clinical symptoms occurring at age 75 years or greater.

A study of the HLA-DR region in clinical subgroups of multiple sclerosis and its influence on prognosis

OBJECTIVE

To investigate the HLA-DR associations in relapsing-remitting/secondary progressive multiple sclerosis (RR/SPMS) and primary progressive MS (PPMS). The HLA-DR2 allele (or its split, HLA-DRB1*15) is felt to be a risk factor for MS, rather than a genetic marker for the population of origin. Some studies have indicated a different HLA-DR antigen profile in PPMS patients compared with those having an initially relapsing-remitting course, only those with relapsing disease showing an increase in HLA-DR2. Association of PPMS with DR4 has been suggested. Several DR alleles have also been felt to influence the prognosis in MS.

METHODS

Genomic DNA was prepared from peripheral blood of 202 RR/SPMS patients identified in a population-based prevalence study, 102 PPMS patients identified throughout Northern Ireland and 398 normal controls (Nor) matched for the postcode areas of those identified in the prevalence study. Samples were typed for the HLA-DR antigens using polymerase chain reaction (PCR) technology and sequence specific oligonucleotide probes (SSOP).

RESULTS

A high incidence of HLA-DRB1*15 was found in each MS group - PPMS (63.73%), RR/SPMS (66.83%) - compared with normals (32.41%), (PPMS vs. Nor, P<0.0001: RR/SPMS vs. Nor, P<0.0001). HLA-DRB1*04 occurred at a lower incidence in both MS groups compared with controls - RR/SPMS (22%), PPMS (30%), Nor (35%). Overall, highly significant differences existed across the full HLA-DR allele distribution (RR/SPMS vs. Nor, P<0.0001, df=12: PPMS vs. Nor, P=0.0007, df=12). No significant differences existed between PPMS and RR/SPMS (P=0.47, df=12), and the allele distributions in benign and aggressive MS were similar.

CONCLUSIONS

These data suggest that in this population, HLA-DRB1*15 is indeed associated with PPMS and that PPMS has a HLA-DR profile distinct from the normal population but not from those with an initially relapsing-remitting course. No single allele is associated with either a good or poor prognosis.

Frequency of HLA-A and B alleles in early and late-onset Alzheimer's disease

The frequency of various allele types of the class I Major Histocompatibility Complex (MHC) genes HLA-A and HLA-B were compared between pathologically confirmed groups of late and early-onset Alzheimer's disease (AD) and a control group. DNA was extracted from frozen brain tissue and the highly polymorphic second and third exons of the HLA-A and HLA-B genes were independently PCR amplified using specific primers. Individual allele types were identified using sequence-specific oligonucleotide probes. The results showed that the main frequency differences occurred between the late-onset AD and the control group however none of these reached statistical significance.

Application of an HLA-B PCR-SSOP typing method to a bone marrow donor registry

A previously reported HLA-B PCR-SSOP typing method has been applied to those individuals, from the local bone marrow registry, with only one detectable HLA-B antigen by serology. The PCR-SSOP method detected the serologically defined HLA-B antigen in all cases. In addition, PCR-SSOP detected the presence of a second HLA-B allele in 19.9% of these individuals. The method was also applied to all individuals where serology could only determine the HLA-B antigen as a broad specificity. All antigens were split by the PCR-SSOP method, indicating that the method is more specific than serology. Using a combination of PCR-SSOP and serologically determined types for 5000 individuals on the local bone marrow registry, HLA-B frequencies for the Northern Ireland population have been calculated.

Residues from long-acting antimicrobial preparations in injection sites in cattle

OBJECTIVE

To investigate tissue residues of two long-acting oxytetracycline (OTC) preparations in cattle.

DESIGN

A randomised drug residue trial.

ANIMALS

Two hundred and forty beef cattle in 24 groups of ten.

PROCEDURE

Two blind-coded 200 mg/mL OTC preparations were used in five treatment regimens of various combinations of injection sites (from one to five) and administrations (one or two). Five cattle from each group were slaughtered at 21, 30 and 60 days after injection and the injection site, urine, kidney and diaphragm muscle analysed for residues.

RESULTS

The OTC concentration exceeded the maximum residue limit in kidney in animals slaughtered 21 days after treatment, which is the prescribed withholding period. Concentration at the injection site was much greater than the maximum residue limit 30 days post-treatment, but not 45 days post-treatment. The residue was smaller when OTC had been injected in multiple sites. There was no difference between the two OTC preparations.

CONCLUSION

A review of the maximum injection volume, site of injection and the withholding period is needed for long-acting OTC formulations.

The computer in the consulting room. What can it do for the physician?

Helen Mawhinney, M.D., of McLure, Moynihan and Associates and the University of California-Los Angeles, and Brad Dodge of Health Communication Services Inc., write about the use of computer-based medical records and their effects on patient care, decision making and data generation.

As-needed medication use in asthma usage patterns and patient characteristics

Daily inhaled bronchodilator medication usage was recorded using an electronic device and airway obstruction by daily peak flow measurement. The demographic, clinical, and psychological characteristics of the subjects were noted. Subjects were allocated to as-needed (prn) medication usage groups according to the mean number of inhaler activations on days with zero, moderate, and severe airway obstruction. Segregation into arbitrary and nonarbitrary use, and into overuse, appropriate use, and underuse resulted in six usage groups. Appropriate use was observed in only 10 of 39 subjects. The major psychological variable to differ among groups was the MMPI variable Pt, representing general anxiety. Arbitrary users had a significantly higher mean score than nonarbitrary users. The variable Specific Internal Awareness, representing a perceived difficulty in recognizing the premonitory symptoms of an asthma attack, also differed among the usage groups, with arbitrary users having the lowest scores. These findings raise the possibility that reliance on an objective measurement of airway obstruction rather than on subjective symptomatology might enhance compliance with prn medication in some patients.

Compliance in clinical trials of two nonbronchodilator, antiasthma medications

An electronic monitoring device was used to assess patient compliance during clinical trials of two new aerosolized nonbronchodilator, antiasthma drugs. Compliance was poor, but similar, in both trials. Patients took the study drug as instructed on a mean of 37.3% days (range 10% to 77%) in one trial and 37.4% days (range 0% to 63%) in the other. Both underuse and overuse were observed. Underuse was seen on a mean of 38.9% days (range 9% to 81%) and 46.0% (range 15% to 80%) respectively; overuse on a mean of 23.5% days (range 6% to 54%) and 16.6% days (range 0% to 41%). In some patients ten or more activations of the device were recorded at the same time. In six patients such multiple simultaneous activations were recorded on two or more separate days. These patients were among the most noncompliant in the study. Multiple simultaneous activations frequently followed underuse days or preceded followup visits, suggesting the possibility of duplicity. Overall compliance was such that valid conclusions about efficacy of the drugs could only have been drawn in six of 34 patients.

Differentiation of Bordetella avium and related species by cellular fatty acid analysis

The fatty acids of 18 strains of Bordetella avium, 3 strains of Alcaligenes faecalis, 5 strains of Bordetella bronchiseptica, and 12 strains of a B. avium-like organism were examined by gas chromatography-mass spectrometry. The presence of a significant amount of the acid 2-OH C14:0 characterized B. avium and the B. avium-like organism. B. avium and the B. avium-like organism differed in their relative concentrations of C16:1 and 3-OH C14:0 acids. B. bronchiseptica and A. faecalis were distinguishable by comparison of the relative concentrations of C18:0 and C18:1 acids.

Optimum management of asthma in pregnancy

In pregnancy complicated by asthma, the greatest risk to the fetus is severe and uncontrolled bronchospasm resulting in hypoxia. For this reason, the priority in management of the pregnant asthmatic should be effective control of asthma symptoms with an appropriate amount of asthma medication to accomplish this goal. In general, the management of the pregnant asthmatic does not differ greatly from that of the non-pregnant asthmatic. Virtually none of the commonly used asthma medications are totally contraindicated in pregnancy if their use is justified by the severity of the asthma in pregnancy. These include optimising non-pharmacological means of controlling symptoms, using the smallest doses of antiasthma drugs necessary to control symptoms, basing the decision to use a drug on its benefit-to-risk ratio, avoiding recently introduced drugs (for which safety in pregnancy has not been adequately established), and using the inhaled route in preference to the oral route of administration. Ideally any changes in management should be made before the anticipated pregnancy. Well-controlled asthma appears to pose little risk to either the pregnant mother or the fetus and a favourable outcome of the pregnancy should be anticipated. The patient's justifiable anxiety can often be alleviated by ensuring that she fully understands the objectives of her management and participates in it.

Compliance of patients with asthma with an experimental aerosolized medication: implications for controlled clinical trials

A Nebulizer Chronolog, a portable device that houses a standard nebulizer canister, was used in a unique method to measure compliance with aerosolized medication. Each actuation is tabulated to within 4 minutes of the actual time of usage and can subsequently be displayed in a day-hour-minute format. Of the 19 patients studied for 12 weeks with a cromolyn-like agent, appropriate usage four times a day ranged from 4.3% to 94.8%. Underusage exceeded overusage and ranged from 5.2% to 95% of the study days. Younger subjects and male subjects were less likely to use the aerosol appropriately. Patients failed to write the truth in their diaries with overreporting of appropriate usage more than 50% of the times. Lack of compliance with aerosolized medication represents an important medical issue for the physicians caring for patients with asthma. The Nebulizer Chronolog elicits new insight into the disparity between reported and observed compliance.

Dieldrin poisoning and botulism in Australian pelicans (Pelecanus conspicillatus)

Autopsies and laboratory examinations of material from 24 Australian pelicans found sick or dead in southern coastal Queensland in 1977 to 1979 revealed dieldrin poisoning in 8 from the Brisbane region and botulism in 8 from Brisbane, Bundaberg and Gladstone. In those diagnosed as dieldrin poisoning, brain and liver samples contained 12.1 to 27.4 and 34.0 to 48.1 mg/kg dieldrin respectively. All of these birds were emaciated, 2 had convulsed and 1 had muscle tremors. Low and probably insignificant residues of DDE were detected in many birds. Type C botulism was confirmed in 4 of the 6 birds tested with specific antiserums. A large number of parasites including mites, lice, nematodes, cestodes, trematodes, coccidia and Sarcocystis sp were found but were thought to have had only a limited effect on the health of these birds.

The nodular form of polymyositis--a possible manifestation of vasculitis

A case of the nodular form of polymyositis is reported in which muscle necrosis and inflammation, and fibrosis of subcutaneous fat were observed. Although the patient had a short history, the presence of extensive fibrosis with acute lesions indicated that the disease had been present for some time. In addition to the nodular lesions, the patient had clinical, electrophysiological and pathological evidence of a more generalised myopathy. The subsequent development of a rash resembling that of vasculitis and a peripheral nerve lesion, suggested that the localised nodular myositis was associated with systemic vasculitis. Although immunoglobulin and complement deposits were not detected in blood vessel walls in muscle or skin, a positive reaction to intradermal injection of autologous serum suggested the presence of circulating immune complexes.

HL-A3 and HL-A7 in pernicious anaemia and autoimmune atrophic gastritis

Increased frequencies of HL-A7 and the HL-A3,7 haplotype have been demonstrated in pernicious anaemia. There was no significant increase in any HL-A specificity in autoimmune atrophic gastritis. In the whole series of patients with either pernicious anaemia or atrophic gastritis there was a significant increase in the frequency of HL-A3. No association has been found between any HL-A specificity and an increased incidence of either serum gastric parietal cell or intrinsic factor antibody compared with the overall incidence in pernicious anaemia, atrophic gastritis or in the whole series.

Anti-reticulin antibody in jejunal juice in coeliac disease

Anti-reticulin antibody has been demonstrated in the jejunal juice of eight out of fourteen (57%) untreated coeliac patients, one out of twelve (8%) patients with normal jejunal biopsies and none of ten normal control subjects. The jejunal juice antibody was invariably of the IgA class. It is suggested that the presence of anti-reticulin antibody in the jejunal juice in coeliac disease supports the hypothesis that this antibody is secreted in response to reticulin antigens present in the diet.

The immunoglobulin class responses to oral poliovaccine in coeliac disease

An indirect immunofluorescent technique has been used to study the incidence and immunoglobulin class distribution of the serum antibody response to type II oral poliovaccine in patients with adult coeliac disease and matched control subjects. Nineteen out of thirty-eight (50%) patients with coeliac disease showed an antibody response compared with only seven out of thirty-eight (18%) control subjects. Poliovirus-specific IgA responses were observed in sixteen out of thirty-eight (42%) coeliac patients compared with seven out of thirty-eight (18%) control subjects, while poliovirus-specific IgG responses were observed in only ten out of thirty-eight (26%) coeliac patients and four out of thirty-eight (11%) control subjects. No poliovirus-specific IgM responses were observed. The pre-immunization poliovirus-specific IgA titres of those subjects who showed an antibody response were significantly higher in the coeliac group than in the control group.

Dysgammaglobulinaemia complicated by disseminated measles

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