A study of the association of childhood asthma with HLA alleles in the population of Siliguri, West Bengal, India

Asthma is a heterogeneous disease for which a strong genetic basis is firmly established. It is a complex disorder influenced by gene-environment interaction. Human leukocyte antigen (HLA) genes have been shown to be consistently associated with asthma and its related phenotypes in various populations. The aim of this study was to determine the frequency of the selected HLA classes I and II allelic groups in asthmatic and control groups. HLA typing was performed using polymerase chain reaction-sequence-specific typing (PCR-SSP) method. The allele frequency was estimated by direct counting. Frequency of each HLA allelic group was compared between asthmatic group and control group using χ(2) test. P-value was corrected by multiplying with the number of the allelic groups studied. Odds ratio (OR) and its corresponding 95% confidence interval (CI) for each allelic group were calculated using graphpad instat 3.10. The results of this study showed a significantly higher frequency of HLA-DRB1*03 in asthmatics than in controls (11.43% vs 3.64%, OR = 3.78, 95% CI = 1.61-8.85, P = 0.0025, Pcorr  < 0.05). Analysis of HLA alleles in low and high total serum immunoglobulin E (IgE) level in asthmatics revealed no significant association. HLA-DRB1*03 may be implicated in the susceptibility to asthma in the pediatric population.

[Primary antiphospholipid syndrome diagnosed in hemodialysis]

We present the next case: male, 30 years old, primary APLA syndrome diagnosed after 6 months of treatment with recurrent haemodialysis. The patient, who had a history of vascular thrombosis, presented with thrombotic problems in his arteriovenous fistula made as vascular access for hemodialysis. The discovery of celic trunk and superior mesenteric artery occlusions led us to the clinical diagnosis, which was confirmed by presence of a pathological type of lupus anticoagulant and anticardiolipin antibodies in plasma. We started treatment with oral anticoagulation, warfarin therapy. Since then there have been no more thrombotic events, though the period under observation is still short.

Management of childhood illness at health facilities in Benin: problems and their causes

OBJECTIVES

To prepare for the implementation of Integrated Management of Childhood Illness (IMCI) in Benin, we studied the management of ill children younger than 5 years at outpatient health facilities.

METHODS

We observed a representative sample of consultations; after each consultation, we interviewed caregivers and reexamined children. Health workers' performance was evaluated against IMCI guidelines. To identify determinants of performance, statistical modeling was performed and 6 focus groups with health workers were conducted to solicit their opinions.

RESULTS

Altogether, 584 children were enrolled and 101 health workers were observed; 130 health workers participated in focus group discussions. Many serious deficiencies were found: incomplete assessment of children's signs and symptoms, incorrect diagnosis and treatment of potentially life-threatening illnesses, inappropriate prescription of dangerous sedatives, missed opportunities to vaccinate, and failure to refer severely ill children for hospitalization. Quantitative and qualitative analyses showed various health facility-, health worker-, caregiver-, and child-related factors as possible determinants of health worker performance.

CONCLUSIONS

Action is urgently needed. Our results suggest that to improve health care delivery, interventions should target both the health system and the community level.

Middle meningeal artery aneurysm associated with meningioma

The aneurysms of the middle meningeal artery are extremely rare. 30 pseudoaneurysms of the middle meningeal artery (MMA) are reported in literature. These are post-traumatic lesions different from the true aneurysms that have a different origin. In fact they can be associated with arteriovenous malformations, Paget's disease and tumors; nevertheless in some cases the genesis remains unknown. Sometimes the berry aneurysm of MMA can cause non traumatic extradural hematomas. The association meningioma-aneurysm of the middle meningeal artery is extremely rare: only a case has been signalled till now in literature. In our case the patient was a 69 year-old woman admitted in our department following an epileptic seizure. Neuroradiological studies (post-contrast CT and RM) showed a meningioma of the right pterion. A preoperative angiography evidenciated a big blush from the afferences of meningioma by the middle meningeal artery and, proximally a small berry aneurysm of this artery. Selective embolization of the tumor and the aneurysm was performed preoperatively with polyvinyl particles and straight platinum coils. A craniotomy a surgical resection of the meningioma were performed. The role of the endovascular treatment in the management of these lesions is underlined to decrease the risks of morbidity.

A problem-solving method for 'unprotocolised' therapy administration task in medicine

This paper describes a problem-solving method for modelling the 'unprotocolised' treatment administration task in medicine. We argue that there are medical domains in which no well-established standard treatment protocols exist, and the physician has to decide on the therapy that is to be applied to each patient, in function of a set of therapeutic objectives to be fulfilled. For this reason, we propose the modelling of this type of task adapting the generic class of problem resolution methods for design task, labelled as Propose-Critique-Modify (PCM). In this paper, we are presenting a model of expertise which has been developed using the basic modelling components of the CommonKADS methodology.

Biochemical evidence of a kallikrein-like activity in rat reproductive tissues

We performed this study to examine the presence of a kallikrein-kinin system in rat fetal and maternal tissues. Uteri and placenta from Wistar pregnant and nonpregnant rats were perfused to eliminate blood, and fetal membranes were washed several times with saline. Amniotic fluids were obtained without blood contamination by amniocentesis from eight rats. The different samples were homogenized and centrifuged (2000g during 20 minutes), and the supernatant was incubated with dog kininogen and 0.1 mol/L Tris-HCl buffer (pH 8.5) in the presence of peptidase inhibitors. Kinins released were measured by radioimmunoassay. Kininogenase activity was found in rat uteri, placental vessels, amniotic fluids, and fetal membranes. The enzymes were present in active but mostly in inactive forms. The kallikrein-like enzymes found in the different preparations and rat urinary kallikrein used as control had similar molecular weights, immunologic characteristics, and inhibition profiles with protease inhibitors. We conclude that kallikrein-like enzymes are present in rat organs of reproduction. These data suggest that kinins released locally may act as paracrine hormones in the regulation of blood pressure during pregnancy.

Humoral and cellular immune response to influenza virus vaccination in aged humans

Aging is characterized by an increased susceptibility to infectious diseases; influenza virus infection, which is easily managed by an intact immune system, represents a life-threatening disease in aged subjects. We studied 18 healthy aged subjects (> 65 years of age), vaccinated yearly with conventional anti-influenza vaccine, and 9 healthy young volunteers (mean age 26 years), without previous anti-influenza vaccination, who were vaccinated with the conventional trivalent 1990 anti-influenza preparation. Six out of the 18 aged individuals received a second boost of the same vaccine about 4 months later. In all subjects, we analyzed the humoral response to type A and B influenza viruses and the influenza type A virus-specific CTL generation. Among the elderly population with a single vaccination, 6 and 5 subjects seroconverted against type A and type B influenza virus respectively. Young subjects seroconverted in 5 cases against type A, and in 5 cases against type B influenza virus. Seroconversion took place after the second vaccination in only one subject, and the antibody production was type A specific. Influenza type A virus-specific CTL activity was significantly lower in aged subjects, compared with the values observed in the young volunteers (p = 0.017). The second vaccination partially restored this immunological impairment. These data clearly demonstrate that the elderly do not have the same ability as younger subjects to mount an antibody response, and generate influenza type A virus-specific CTL after conventional anti-influenza vaccination. Moreover, a double anti-influenza vaccination generates CTL activity levels comparable to young subjects, although it does not seem to substantially modify the antibody production.

Hepatic abscess in sickle cell anaemia: a rare manifestation

A child with sickle cell anaemia developed a hepatic abscess, which was managed successfully by percutaneous drainage under ultrasound control. A history of attacks of pain dissimilar to usual vaso-occlusive crises should be treated with suspicion and investigated appropriately.

[Postoperative lumbar discitis]

The authors report our experience on 19 cases of discitis developed after operations for herniated lumbar disc. Because of the negativity of the neuroradiological studies in the acute stage, the recognition of the typical syndrome (severe back pain, spasm of the paravertebral lumbar muscles, limited spinal motility, fever) beginning 3-30 days post-operatively and the study of some laboratory tests (elevated Erythrocyte sedimentation rate (ESR) and midly to moderately elevated white blood cells (WBC) are very important for diagnosis. The first radiographic findings (disc space narrowing, ecc.) are detectable only 4 to 6 weeks after the first symptoms; other X-ray findings are not seen post-operatively before 6 months-2 years. The CT-scan is diagnostic of discitis only when the following three specific signs are present: a) anterior paravertebral soft tissue swelling with obliteration of paravertebral fat planes; b) fragmentation or erosion of vertebral end plates; c) paravertebral fluid collection (abscess). In our experience a period of immobilization of the spine with a plaster body jackets and the use of adequate antibiotic therapy are the more effective treatment. Undoubtedly the discits are the results of an infection that must be prevented adhering to the aseptic principles not only during surgery but also during the procedures performed in the radiology suite.

[Hypertensive pneumocephalus, postoperative complication of chronic subdural hematomas]

The authors report 3 cases of subdural tension pneumocephalus developed after surgery for subdural chronic hematomas. The mechanisms involved in the pathogenesis of this complication are discussed; the importance of the computed tomography in the assessment of the subdural tension pneumocephalus is stressed. Surgery is always indicated in cases of increased tension of the air collection and generally resolves the neurological deficits.

Prevalence of liver disease in cystic fibrosis

To assess the prevalence, demography, and clinical features of liver disease among patients with cystic fibrosis the case notes of 524 patients of all ages who were attending the cystic fibrosis clinic were studied. Computer databases were used to establish the condition of the liver in a further 576 such patients. The overall prevalence of overt liver disease indicated by the presence of an enlarged liver or spleen (or both) was 4.2%. The age related prevalence rose to a peak in adolescence, and then fell in patients over 20 years old. The implied increase in mortality among those with liver disease was not explained by deaths from liver disease, which were rare. Male patients were significantly more affected than female, the ratio being 3:1 among adolescents. Increasing prevalence of liver disease in patients with cystic fibrosis is, therefore, not just a result of longevity.

1-substituted 5-dialkylaminomethyl-1,5,6,7-tetrahydroindazol-4-ones with antiinflammatory and analgesic activity

The synthesis of 1-phenyl- and 1-methyl-5-dialkylamino-methyl-1,5,6,7-tetrahydroindazol-4-ones (III) and (IV) by Mannich reaction of the corresponding 1-substituted 1,5,6,7-tetrahydroindazol-4-ones (I) and (II) is described. Some compounds (III) showed a good antiinflammatory and analgesic activity in rats and mice, respectively. Infiltration anesthesia in mice and antiacetylcholine activity in vitro are also reported.