Sporostatic effect of some oils against fungi causing otomycosis.

In vitro animycotic effect of mustard, groundnut, soybean, coconut and amla oils on five fungi i.e., Aspergillus niger, A. flavus, Absidia corymbifera, Penicillium nigricans and Candida albicans isolated from otitic fungal infection of external ear (Tympanic membrane) of human being was studied. Spore germination was evaluated in the oil samples as such after heating for two minutes & after boiling the oil. Data show that mustard and coconut oil seem to be effective as in these the spore germination was poor. Other oils were not found to be much effective. Sporostatic effect was noted only when the oils were used after heating or boiling this may be correlated by the synthesis of enzymes during spore germination.


Results of pars plana vitrectomy in 62 cases of vitreous haemorrhage.

62 Cases with unresolving Vitreous Haemorrhage due to varied etiology, underwent pars plana Vitrectomy. A vitreous rebleed on the table and post-operatively, was the main complication encountered. Despite limited equipment, a visual improvement was obtained in 59.68% eyes with visual acuity greater than FC 6 meters in 33.87% eyes. This is far better than not being able to offer any treatment at all.


Changes in pulmonary diffusing capacity and blood gases in chronic obstructive lung diseases.

Pulmonary diffusing capacity (TLco) of 19 cases of chronic obstructive lung diseases (Chronic obstructive bronchitis and chronic obstructive emphysema) in the age group of 39 to 58 years (mean age: 49.8 +/- 5.5 SD years) are reported at rest in this investigation. The diffusing capacity for carbon monoxide (TLco) measured by standard methods was significantly reduced in all cases. The mean was 13.1 +/- 2.3 SD ml/min/mmHg. The blood gas findings revealed low arterial oxygen saturation (mean value: 90.2 +/- 2.2%). Arterial carbon dioxide tension was higher than in normal subjects. The mean for this series was 44.8 +/- 4.9 SD mmHg. The mean for normal subjects was 37.5 mmHg and the range 28.2 to 41.5.


Differential identification of Mycobacterium tuberculosis from various clinical specimens from Sassoon General Hospital, Pune.

A total of 619 clinical specimens from cases of pulmonary and extrapulmonary tuberculosis were processed by smear, culture and biochemical tests. Acid fast bacilli could be demonstrated in 93 samples (15.02%) by Z.N. staining method. Culture yielded positive growth in 95 samples (15.35%) M. tuberculosis human type was the most predominient pathogen obtained from 82 cultures (13.40%) M tuberculosis bovine type was isolated from 2 cases of ascitic fluids (0.32%). Atypical Mycobacteria were isolated from 11 samples (1.73%). 5 turned out to be M. scrofulacium, 4 were M. Kansasii, 1 was M. phlei and 1 was M. smegmatis.


Study of bacterial pathogens causing diarrhoeal disease in Bombay with special reference to their antibiotic sensitivity pattern.

Diarrhoeal disease is an important cause of morbidity and mortality in developing countries, especially among children. In a study of 720 faecal samples from acute diarrhoeal patients various bacterial pathogens were isolated. An account is given of their antibiotic sensitivity pattern. Many of the E. coli, Salmonella and Shigella strains were found to be multidrug resistant. This resistance was transferable and plasmid mediated. A few of the E. coli strains isolated from healthy controls also showed multidrug resistance.


Correlation of microproteinuria and histopathological changes in kidney in diabetes mellitus.

Single attempt kidney biopsy was successful in 60 cases of diabetes mellitus out of 83. Histopathological evidence of nephropathy was found in 30 (50%) out of 60 (4 of IDDM and 56 of NIDDM). Microproteinuria was a sensitive indicator of histopathological evidence of nephropathy (by biopsy) and should be used as a non invasive method of evidence of kidney involvement in diabetes mellitus regardless of duration of the disease. Routine renal function tests--commonly used indicators of kidney disease in the presence of hypertension were of no value and should not be relied upon. Duration of diabetes mellitus was important correlation with the evidence of the disease and and its severity but nephropathy was found in newly detected cases of diabetes mellitus (NIDDM). Nephropathy was present in case of DM who had retinopathy and is a better factor of correlation.


Development outcome of Down's syndrome in eastern Libya.

The psychometric evaluations in 60 cases of Down's syndrome non-institutionalized children in the age group 1-15 years drawn after random selection was compared with 60 children with mental handicap from a residential institution drawn by matching for age, sex and sociocultural conditions. Results of the study show significant difference between the two groups in respect to IQ's but not in respect to DQ's.


Neutral sterol excretions in rats fed skim milk and skim milk yogurt diets.

Acceleration of cholesterol catabolism (through feces) has been proposed as one of the mechanisms for the hypocholesterolemic effect of dairy products. This study examined the effects of feeding two milk products (skim milk and skim milk yogurt) on fecal neutral sterol excretions in rats. Six groups of nine rats each were fed iso-caloric Chow-based diets containing water, 45% skim milk (SM), or 45% skim milk yogurt (SMY), without or with cholesterol. The results indicate that both SM and SMY increased the excretion of total neutral sterols under hyperlipemic conditions. The SMY diet (with cholesterol) also increased the excretion of coprostanol, a bacterial metabolite.


An epidemic of human anthrax--a study.

Twenty-five cases of human anthrax, occurring after contact with a Jercy cow infected with B. anthracis and consumption of its improperly cooked meat after death, were reported. Cutaneous anthrax was the predominant variety in 18 persons, 7 had intestinal anthrax, out of them 2 children died, 5 adults survived and one among them developed associated cutaneous anthrax also. All the persons with cutaneous anthrax recovered with treatment.


Chloramphenicol resistant Salmonella typhi: the cause of recent out-break of enteric fever in Calcutta.

Fifty one strains of Salmonella typhi were isolated during the recent outbreak of enteric fever in and around Calcutta. Forty strains were multidrug resistant including Chloramphenicol. Minimum inhibitory concentrations (MIC) of Chloramphenicol was between 200 mcg per ml and 500 mcg per ml. All these strains were sensitive to Cephalexine, Gentamicin, Furazolidine and Ciproflexacin. Widal test was done in all the cases but the result was inconclusive.


Quantitative immunological status of males of unexplained infertility in eastern U.P.

126 males of unexplained infertility and 75 fertile males were studied during a period of more than 2 years. Statistically significant increase in the levels of serum IgM was observed in cases of males of unexplained infertility. Level and percentage of cases showing semen IgM was more in study group (134.61 +/- 25.5 mg %, 41.26%) than control (24%, 99.3 +/- 8.3%). Semen IgA was found only in study group in 30.15% cases. Though definite correlation between serum and semen immunoglobulin was not observed, semen immunoglobulin was found to be 1-2 fold lower than serum. Results of the present study indicate towards a possible immunological role in cases of unexplained infertility in males.


A preliminary study on the interaction of cell-polymer extract towards biodegradation.

Two newly synthesised polyurethanes were subjected to a preliminary study, in-vitro, on the interaction of cell polymer extract to understand the phenomenon of biodegradation by employing VERO cells. VERO cells exposed to the saline extract of the polymer showed cytopathic effect with granulations in the digestive vacuoles. It is suggested that the long term material performance of an implant-material can be evaluated by using VERO cells and/or macrophages and by analysing metabolic products secreted by the cells during interaction.


Frozen sections--a retrospective study.

Two hundred and forty-four (244) specimens were examined by frozen section (FS) from 1987 through 1988 at the Kidwal Memorial Institute of Oncology. Of these, eleven (11) were performed for evaluation of the surgical margin of tumours and fifty four (54) for detection of lymph node metastasis. All these examinations (65) proved to be hundred percent (100%) accurate. The remaining 179 frozen sections were performed for the diagnosis of an unknown pathologic process. Of these, 44.69 percent were precisely diagnosed, in 41.9 percent the pathologic process was correctly but not precisely diagnosed, in 11.17 per cent the diagnosis was deferred and remaining 2.24 percent were incorrectly diagnosed with no harmful consequences to the patients. By eliminating the cases where diagnosis was deferred and combining results of "precise diagnosis" with those of "correct pathologic process", the overall accuracy rate was 98.2 percent. Thus, FS has greater benefit when used for the general diagnosis of an unknown pathologic process rather than for an exact or precise diagnosis.


Identification of family Enterobacteriaceae using a three tube method.

Four hundred isolates of Gram Negative bacilli from different samples were tested by three tube method and conventional tests. An overall agreement between the two methods was 89.5%. Non-agreement was in respect of less stable tests like gas production and motility. This does not reflect adversely on the efficacy and suitability of the method. The three tube method is simple, rapid, economical and accurate, saving both time and material.


Chronic granulomatous mastitis: review of 26 cases with special reference to chronic lobular mastitis.

Twenty six cases of chronic granulomatous mastitis are reported in a 5 year period and the slides are reviewed. They are sub-classified into Chronic lobular mastitis (CLM), Plasma cell mastitis and subareolar granuloma. There are 10 cases each of CLM and plasma cell mastitis and one of subareolar granuloma. All the three conditions are associated with duct ectasia. Fat necrosis and infective granulomas were 2 each and one of foreign body granuloma. These lesions can be easily differentiated by histology. While most of the CLM occurred in younger age group, plasma cell mastitis is seen in older women. Histologically, there is a florid inflammatory cell reaction of the stroma with dilatation and destruction of some ducts, with microabscess formation. In plasma cell mastitis, the lesion is more chronic with predominance of plasma cells and involutionary changes of the ducts are seen.


Serum adenosine deaminase activity in bacillary or paucibacillary pulmonary tuberculosis.

Serum Adenosine Deaminase (ADA) enzyme levels were estimated in 61 patients with symptoms and signs suggestive of Pulmonary Tuberculosis and correlated with "Gold standards" such as smear positivity of sputum for Acid Fast bacilli, Tuberculin skin testing and Radiological evidence. The mean ADA levels in smear and Tuberculin negative patients was 13.13 +/- 5.97 u/L, while in those with smear and/or strongly positive Tuberculin reaction, the mean levels of ADA were 33.52 +/- 15.22 u/L. The mean serum ADA levels in 25 healthy voluntary donors with no evidence of active or old Tuberculous lesion, were found to be 16.5 +/- 3.18 u/L. The specificity, sensitivity, positive predictive value and negative predictive value of the test was found to be 87%, 71%, 90% and 66.5% respectively. The results conclude that the serum ADA value is sufficiently useful in identifying those patients in whom the diagnosis of Pulmonary Tuberculosis should be actively considered.


MHA-Tp testing on HIV positive and negative women in vigilance home at Madurai.

In the study group of 94 cases of female prostitutes and their children 55 cases showed positive for HIV infection by ELISA and Western Blot tests. They showed positive also for syphilis in 37 cases by VDRL and in 43 cases by MHA-Tp tests among HIV positive and negative women. The association of HIV infection and syphilis was observed in this study due to sexual transmission of these infections. But congenital spread from infected mother to their children was not observed in this study since both mothers and their children were negative for these infections. MHA-Tp testing confirmed VDRL test results in 27 cases and also increased specificity of MHA-Tp test result over VDRL result in 16 cases and exclusion of biological false positive by VDRL in 10 cases were noticed in this study.


A study of humoral factors in carcinoma cervix.

Serum immunoglobulins, circulating immune-complexes and blocking effect of patients' sera on normal T lymphocytes were studied in 10 patients with chronic cervicitis, 25 with carcinoma cervix and 20 age matched healthy women. No significant difference was observed between the healthy controls and chronic cervicitis. In carcinoma, there was a significant increase in IgG and IgA in stage I, IgG and IgM in stage II and in all the three immunoglobulins in stage III as compared to chronic cervicitis. Circulating immune-complexes and T cell depression were also found to be increased and stage related. After radiotherapy, both these parameters and IgG were found to be significantly reduced. The study of these immune parameters seems to be a promising aid in the diagnosis and prognosis of patients with carcinoma cervix.


Hemostatic profile in septicemic neonates with and without bleeding.

Hemostatic profile was studied in 25 full term, non-asphyxiated neonates with blood culture-proven septicemia. Nine (36%) of these neonates manifested bleeding. Detailed coagulation tests and platelet studies were deranged in 24 (96%) of neonates with septicemia. Abnormalities in coagulation tests did not differ in those with and without bleeding. Only platelet aggregation with ADP was deranged to a significantly greater extent in those with bleeding as compared with those without bleeding.


Hepatitis B virus infection in pregnant mothers and its transmission to infants.

Screening for serological markers of hepatitis B virus infection was done on 500 pregnant mothers. HBsAg, AntiHBs and HBeAg were done. HBsAg was positive in 3.6%, AntiHBs in 17.4% and HBeAg in 0.4% cases. The infants born to the asymptomatic HBsAg carrier mothers were followed up to 6 months to determine the vertical transmission of HBV infection. Rate of transmission of infection from HBsAg positive mothers to infants were 16.66% irrespective of HBeAg status, whereas it was nearly 100% in case of HBeAg positive mothers. All of the HBsAg positive infants developed the antigenemia between 3-6 months of age, supporting the hypothesis that intrapartum transmission is the major mode of vertical transmission.


A screening tool for assessment of the home environment and psychosocial development of preschool children.

The purpose of this study was to develop a short tool for the assessment of home environment and psychosocial development of preschool children, based on the data collected on a sample of one hundred and fifty children in the age range of 2 years 10 months to 3 years 8 months. Co-relation analysis was used in identifying home environment and psychosocial development variables for the development of the tool.


Psycho-social aspects of HIV infection and AIDS in multiple transfused thalassemic children.

Two hundred and three multi-transfused children with thalassemia attending the thalassemia clinic of the Charak Palika Hospital, New Delhi were screened for human immuno-deficiency virus (HIV) antibodies by ELISA test. All positive cases were confirmed by the Western blot test. Of the 203 children screened, 17 (8.37%) were HIV seropositive and the other 3 children referred to the AIIMS were from neighbouring states. These children were compared with 20 age matched HIV negative thalassemics as controls. Of the 20 HIV positive children, four were diagnosed to have clinical AIDS according to the WHO criteria. The clinical features were similar to those described in pediatric AIDS from other parts of the world. This paper describes the clinical features, behavioural problems, cognitive functions and developmental milestones of the children with AIDS.


Epidemiological aspects of school dropouts in children between 7-15 years in rural Maharashtra.

A study on school dropouts from primary and secondary school children was undertaken in September '91 from 16 schools at the headquarters of 8 Primary Health Centres, where 172 school dropouts were identified. A home visit was paid and information about socio-economic and cultural aspects was collected and a psychological screening was undertaken. Although there was no significant difference in overall dropout rates for both sexes, it increased sharply at 11 years of age in girls. The majority of children dropped out due to financial problems or unsatisfactory scholastic performance, and 142 (82.5%) of the 172 children studied were poor performers in one or more function tests. Maximum difficulty was observed in concept formation 87 (50.5%), followed by numerical ability in 78 (45%). Identification of children with learning difficulties and intervention using special educational methods within the framework of existing network of primary and secondary schools in rural areas is suggested.


Pulmonary tuberculosis in Ahmedabad: epidemiology, diagnosis and short course chemotherapy.

Five hundred children below the age of 12 years suffering from lung tuberculosis viz., primary complex (PC) or progressive primary complex (PPC) were studied. Diagnosis was based on Kenneth Jones criteria; selected cases having score of 5 or more. One hundred and eighty cases of PC were given A-1 (6 RH) regimen, while 312 cases of PPC were given A-2 (2SHRZ/4 RH) or A-3 (2 SRH/4 RH) or A-4 (2 RHE/4 RH) regimen. Follow-up was done for 6 months after completing the treatment to observe the relapse rate. In cases of PC, 6 RH regimen appeared adequate and cheaper with no relapse rate. In cases of PPC with short course chemotherapy, compliance of patients had been very good. Relapse rate was up to 13% which is acceptable. Drug toxicity was very low.


Childhood myelodysplastic syndromes: clinical features, cytogenetics and prognosis.

Sixteen children with myelodysplastic syndrome as defined by the French-American-British co-operative group are presented. The mean age was 10.5 (2.5 to 16) years, with a male predominance. All patients belonged to the more aggressive subtypes of myelodysplastic syndromes. Seven patients presented with refractory anaemia with excess blasts, six had refractory anemia with excess blasts in transformation, and three had chronic myelomonocytic leukemia. Cytogenetic analysis done in 7 of the 16 patients, revealed karyotype abnormalities involving chromosomes 7, 8 and 17. One patient with Down's syndrome had karyotype of 47, XY, +21 (major clone) and 46, XY (minor clone). Five of these patients evolved to acute leukemia. The mean duration of survival was 5.5 months. Aggressive chemotherapy as a primary line of treatment induced remission in five out of six patients. Predominance of aggressive types of myelodysplastic syndromes in children and their good but short-lived response to aggressive chemotherapy suggests the need for early bone marrow transplantation following chemotherapy.


Reproductive profile of mothers in relation to hemoglobin E genotypes.

The reproductive profile of 190 Ahom-Kachari mothers belonging to Mongoloid ethnic stock of Assam has been studied in relation to hemoglobin (Hb) E genotypes. No significant variations have been observed in the reproductive performance between the normal population and abnormal hemoglobin homozygote (HbEE) and heterozygote (HbAE) mothers. However, the reproductive wastage among the hemoglobin homozygote (HbEE) mothers has been observed to be double than the normal hemoglobin (HbAA) and abnormal hemoglobin heterozygote (HbAE) mothers. The reproductive performance parameters have also been compared with the other available studies.


Risk factors for stillbirths in a rural community.

To determine the risk factors for stillbirth, a case-control study was carried out in a rural community of Haryana. Stillbirths (cases) were identified retrospectively from a household survey, while the controls, matched individually with each case for the month of birth, were live born infants from the same neighbourhood as the case. The stillbirth rate in the study population was 26.8 per 1000 (68/2539) births. The distribution of socio-economic and environmental factors was similar in the cases and the controls (P > 0.05). Multivariate analysis indicated higher risk of stillbirth for first order births (Odds Ratio [OR] 7.9, Confidence Interval [CI] 2.1-29.2, P 0.002), history of prior stillbirths/child deaths (OR 15.2, CI 2.3-98.2, P 0.004), and absence of antenatal care (OR 3.3, CI 0.9-14.3, P 0.07). Mothers' age, birth interval (< 24 months), delivery place (hospital or home) and type of birth attendant (trained vs untrained) did not show significant influence on the risk of stillbirth. An improvement in the coverage of antenatal care in socio-economically weaker rural community is suggested as the most appropriate strategy for reducing the high stillbirth rate.


Mixed gonadal dysgenesis and dysgenetic male pseudohermaphroditism--a critical analysis.

A 10 year prospective study of 14 patients with mixed gonadal dysgenesis (MGD) and six patients with dysgenetic male pseudohermaphroditism (DMP) is reported. All of them had internal mullerian structures, along with unilateral or bilateral dysgenetic testes, ambiguous external genitalia. Twelve had been brought up as male, nine of whom had a unilateral descended testis. Eight had been reared as females, as they had bilaterally undescended gonads, and ambiguous genitalia. Clinical examination, retrograde genito-urethrography and cytogenetic studies suggested the diagnosis in 16 patients, while four were diagnosed on inguino-abdominal exploration for undescended testis. This report delineates more clearly the clinical profile of these orders. All the patients reared as male were assigned the male gender following abdominal gonadectomy, retention of scrotal testis and male genitoplasty. The eight patients who were reared as females underwent bilateral salpingo-gonadectomy and female genitoplasty. This management differs from the usual recommendation that all such children should be reared as females. Ten patients (50%) had maternal history of previous abortion/stillbirth, or drug intake in the first trimester of pregnancy suggesting a role of these factors in the etiology. All cases of DMP had a 46,XY karyotype, while eight of 14 cases of MGD had mosaicism with 45X/46,XY cell lines in blood or gonadal cultures. The clinicopathological features of patients of MGD and DMP were similar. It is suggested that these two disorders represent different spectra of the same disorder. A unifying concept of etiopathogenesis is proposed.


Congenital adrenal hyperplasia: experience at intersex clinic, AIIMS.

During 1981-88, 63 cases of female pseudohermaphroditism (FPH) were seen at the Intersex clinic at AIIMS, of whom 34 (54%) were diagnosed as due to congenital adrenal hyperplasia (CAH). Though ambiguity was present at birth in most cases, only one child was brought immediately after birth, while 14 presented after one year. Family history of affected siblings and fetal wastage was present in 10. Salt wasting symptoms were present in 13 (38.2%), evidence of early virilization in 10 (29.4%) and generalised hyperpigmentation in 7 (20.6%). Clitoromegaly was present in 30 children with labial fusion in 10 and scrotalisation of labia in 6. The urogenital opening was single in 25 (73.5%). Buccal smear was positive for sex chromatin in 19. Chromosomal pattern showed 46 XX in 33. Dyselectrolytemia was present in 16 children. Bone age was advanced in all. Adrenal hyperplasia could be documented in 3 on CT scan. All the girls were put on hydrocortisone or prednisolone, and fluodrocortisone was given only to children with salt wasting CAH. Children with CAH are being brought to medical attention much too late and investigative and therapeutic facilities are grossly inadequate. There is a need to educate primary care physicians for early case detection and provide minimum diagnostic and therapeutic facilities in regional centres.


Pars plana vitrectomy in vitreous haemorrhage due to Eales' disease.

Repeated vitreous haemorrhage is a common occurrence in Eales disease. 25 eyes of unresolving vitreous haemorrhage were subjected to pars plana vitrectomy. 18 eyes improved to 1/60 or better. Vitreous rebleed was the commonest problem encountered. We discuss our experience, complications and limitations.


Vitrectomy for intra ocular foreign body removal.

Ten consecutive cases of perforating ocular injuries with retained intraocular foreign bodies over a period of 2 years were reviewed retrospectively in this study. All cases were operated upon by a 3 port pars plana vitrectomy and if necessary endolaser done. All ten cases (100%) were successful in terms of intraocular foreign body removal through the pars plana sclerotomy but ultimately we lost three [3] [30%] cases of which two had retinal detachments with P.V.R. D-3 preoperatively and the other had endophthalmitis. Of the seven (70%) successful cases four eyes (40%) had a post-operative vision of 6/12 or better while 2 [20%] had 6/24 and the last had 6/60 [10%]. Nine cases [90%] had a magnetic Intraocular foreign body. Various complications of Intraocular foreign bodies like vitreous haemorrhage, retinal incarceration, cataract and retinal detachment were noted preoperatively. Silicone oil was used in three (30%) cases. Sulfur Hexafluoride was used in 5 cases (50%). Endolaser photocoagulation was done in 7 cases (70%).


Comparative results of limbal based versus fornix based conjunctival flaps for trabeculectomy.

Among 100 cases of primary glaucomas, 50 cases were operated for trabeculectomy by making fornix based flap and 50 cases were operated by fashioning limbal based conjunctival flap. Operative and post operative complications were studied thoroughly in the two groups. All the cases were followed up for six months to one year to assess control of intra ocular pressure, nature and functioning of filtering bleb, field changes and visual status in the two groups. It was found that the fornix based flap is much superior and carries various advantages over the limbal based flap. The operative and post operative complications are minimum in the fornix based flap as compared to the limbal based flap.


"A retrospective cohort study for prognostic significance of visual acuity for near over that for distance in anisometropic amblyopia.".

A cohort of 50 anisometropic amblyopes, between the ages of 2.5 to 10 years, was studied retrospectively to assess the prognostic significance of visual acuity for near over that for distance. There is ample evidence in the literature for a significantly lower accommodative response in the anisometropic amblyopic eye. It has been proposed that the efferent accommodative dysfunction may be a fundamental and causative factor in anisometropic amblyopia. A reduced visual acuity for near over that for distance was found in 17 [34%] patients and in 11 out of these the near vision improved after an addition of +3.0D sph. When a reduced visual acuity for near, was obtained it was difficult to determine whether the visual afferent system (due to insufficient visual input), or the accommodation efferent mechanism was responsible. However an improvement in corrected near vision by addition of +3.0D sph. suggested an accommodative dysfunction. In patients with reduced visual acuity for near over that for distance, not only was the final visual outcome poor but also the onset of visual improvement in response to amblyopia therapy was delayed.


Emergency surgery in orbital trauma: a neurosurgical view.

This study is an analysis of five cases of orbital trauma causing proptosis, paralysis of extraocular muscles with or without associated visual failure. All the cases were treated by a Neurosurgical team. Either a frontal craniotomy or a lateral orbitotomy was performed. Plain X-rays of the skull and Computerised Tomography (C.T. Scanning) were the main investigations. Results were encouraging both functionally and cosmetically. Early diagnosis and an aggressive approach to orbital decompression can achieve good results.


Conjunctival and corneal peroxidases in vitamin A deficiency.

Xerophthalmia is a commonly encountered nutritional disorder that affects the growing population of the world. Conjunctival and corneal epithelial cells contain peroxidase enzyme. In experimentally induced Vitamin A deficiency conjunctival and corneal peroxidases are markedly lowered indicating direct or indirect relation of Vitamin A to epithelial functional integrity.


A clinico-investigative profile in Graves' ophthalmopathy.

A clinico-investigative profile was studied in 30 patients with Graves' Ophthalmopathy (GO) (15 each with early and late). In accordance to the thyroid status 63.3% of patients were hyperthyroid and 36.7% euthyroid. There was slight female preponderence, with ratio being 1.5:1. Exophthalmometric readings were significantly high in GO patients as compared to controls. However, no significant diagnostic role of postural exophthalmometry was seen. Positional tonometery may have respectable place among the tests for early diagnosis of GO; however, it could not differentiate between hyperthyroid and euthyroid cases. Further the role of ultrasonography, if available could not be overemphasized.


Pharmacology of smooth muscle cell replication.

The suggestion that smooth muscle cell proliferation contributes to hypertension, atherosclerosis, and restenosis after angioplasty has led to a growing interest in the use of drugs to inhibit this process. This review summarizes pharmacological studies of smooth muscle cell proliferation in vitro and in vivo and identifies specific mediators of proliferation that are implicated by drugs binding with high affinity to enzymes or receptors.


Ocular motility disturbances (Duane retraction syndrome and double elevator palsy) with congenital heart disease, a rare association with Goldenhar syndrome--a case report.

This report is a case of a 4 year old male child who was admitted for meningitis. On clinical examination he was diagnosed as a case of oculo-suriculo-vertebral dysplasia with congenital heart disease, i.e., tetralogy of Fallots besides his presenting picture of meningitis. During his ophthalmic checkup for the conspicuous presence of epibulbar dermoid, he was discovered to have upper lid coloboma, double elevator palsy, and Grade 1 Duane retraction syndrome in his right eye while the pathognomic feature, a dermolipoma, was present in the left eye. The oculo-auriculo-vertebral dysplasia, as described by Goldenhar, is a disease complex of structures developed from the Ist and IInd branchial arch. The important feature of this case is the bilateral involvement of the disease complex over and above the presence of ocular motility disorders--Duane retraction syndrome and double elevator palsy.


Spontaneous extrusion of cysticercosis: report of three cases.

We report three cases of spontaneous extrusion of cysticercosis. In two cases, it got extruded from the orbit and in one case from the subconjunctival space. Extrusion of cysticercosis was associated with improvement in clinical signs and symptoms.


Role of angiotensin subtype 2 receptor in neointima formation after vascular injury.

The role of angiotensin receptor subtypes 1 and 2 was assessed on neointima formation after injury in rat carotid artery. The effects of angiotensin converting enzyme inhibition by perindopril (3 mg.kg-1 x day-1 p.o.) and selective blockade of angiotensin subtype 1 receptors by DuP 753 (5 and 30 mg.kg-1 x day-1 p.o.) were compared on proliferative response to balloon injury. In rats treated 6 days before and for 14 days after injury, perindopril significantly reduced (-76%, p < 0.01) myointimal hyperplasia. In contrast, DuP 753 at 5 mg.kg-1 x day-1 did not modify the hyperplastic response to balloon catheterization. Only at 30 mg.kg-1 x day-1 was DuP 753 able to reduce neointima formation (-47%, p < 0.05). This dose was equipotent to perindopril on the renin-angiotensin system as assessed by the pressor response to angiotensin II and angiotensin I. Therefore, blockade of subtype 1 receptors was a less effective means of suppression of myointimal growth than angiotensin converting enzyme inhibition, suggesting that another angiotensin receptor subtype or converting enzyme substrates are involved in this process. For the determination of whether angiotensin subtype 2 receptors were implicated, the specific subtype 2 receptor antagonist CGP 42112A (1 mg.kg-1 x day-1) was continuously infused perivascularly for 14 days in the vicinity of the injured carotid artery. CGP 42112A was as effective in preventing neointima formation as perindopril (-73%, p < 0.01, versus -76%, p < 0.01, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)


Receptor-mediated effects of angiotensin II on growth of vascular smooth muscle cells from spontaneously hypertensive rats.

This study examines the effects of angiotensin II on hypertrophy and proliferation of aortic smooth muscle cells from spontaneously hypertensive and Wistar-Kyoto rats and the receptor subtypes mediating these effects. In quiescent confluent cells, angiotensin II induced a dose-dependent increase in thymidine and leucine incorporation without stimulating cell proliferation. In nonconfluent cells, angiotensin II stimulated cell proliferation only in combination with a submaximal concentration of fetal calf serum. These effects were enhanced in cells from spontaneously hypertensive rats compared with Wistar-Kyoto rats. The effects of angiotensin II could be blocked by the AT1 receptor antagonist DuP 753 but not by the AT2 receptor ligand PD 123177. In receptor binding studies with cells derived from both rat strains, AT1-typical binding was observed. These data show that the angiotensin II receptors present in vascular smooth muscle cells in culture from both rat strains are of the AT1 receptor subtype. This receptor subtype appears to mediate vascular smooth muscle cell hypertrophy and proliferation as well as vasoconstriction. Although no difference in the receptor profile was detectable between the two rat strains, the affinity for the ligands to the receptor and the receptor density tended to be greater in cells from spontaneously hypertensive rats than in cells from Wistar-Kyoto rats. These results may partly explain the greater hypotensive response to angiotensin II receptor blockade in spontaneously hypertensive rats than in Wistar-Kyoto rats, although both rat strains have the same plasma concentrations of angiotensin II.


Bilateral optic nerve infarction following acute systemic hypotension and anemia--a case report.

Presented here are case reports of two patients who became completely blind in both eyes following acute systemic hypotension - in one following bouts of vomiting and in the other after repeated gastrointestinal bleeding. Both patients had severe degree of anemia. There were no other risk factors for vascular disease such as arteriosclerosis or vasculitis.


Blocking hypothalamic AT1 receptors lowers blood pressure in salt-sensitive rats.

Previous studies from our laboratory have shown that microinjection of DuP 753 (2-n-butyl-4-chloro-5-(hydroxymethyl)-1-[[2'-(1H-tetrazol-5-yl) biphenyl-4-yl]methyl]imidazole, potassium salt), a highly selective nonpeptide antagonist of type 1 angiotensin II receptors, into the anterior hypothalamic area produces a dose-related depressor response in salt-sensitive spontaneously hypertensive rats fed a basal (1%) salt diet. The current study tested the hypothesis that the depressor response to anterior hypothalamic type 1 angiotensin II receptor blockade with DuP 753 or its metabolite EXP 3174 is enhanced by high (8%) salt feeding in this model. DuP 753 or EXP 3174 (40 micrograms in 100 nl artificial cerebrospinal fluid vehicle) or vehicle alone was microinjected into the anterior hypothalamic area of conscious salt-sensitive spontaneously hypertensive and Wistar-Kyoto rats that had been fed 1% or 8% salt diets for 3 weeks. Both DuP 753 and EXP 3174 caused significant decreases in mean arterial pressure in spontaneously hypertensive but not in Wistar-Kyoto rats fed either diet. The magnitude and duration of the depressor responses to DuP 753 and EXP 3174 were significantly greater in the 8% salt-fed spontaneously hypertensive rats than in 1% salt-fed rats. Vehicle injections had no effect on blood pressure in either strain-diet group. Microinjection of angiotensin II (2 micrograms in 100 nl artificial cerebrospinal fluid vehicle) into the anterior hypothalamic area caused significant pressor and bradycardiac responses in all strain-diet groups; dietary salt supplementation enhanced these effects in salt-sensitive spontaneously hypertensive rats but not in Wistar-Kyoto rats. These responses were blocked by pretreatment with EXP 3174.(ABSTRACT TRUNCATED AT 250 WORDS)


Discovery of a well-absorbed, efficacious renin inhibitor, A-74273.

The development of orally active renin inhibitors has been plagued by limited bioavailability in animals and humans. A-74273 is a novel, potent nonpeptide inhibitor of human renin (IC50 = 3.1 nM). This compound was absorbed into the portal and systemic circulations of anesthetized rats, ferrets, monkeys, and dogs after intraduodenal dosing. This favorable pattern also was observed after oral dosing in conscious animals, except in monkeys. Hepatic extraction of A-74273 was more efficient in rats and monkeys than in dogs or ferrets. A-74273 modestly inhibits dog renin, and when given orally as the base (0, 0.3, 1, 3, 10, and 30 mg/kg; n = 8 per dose) to conscious, salt-depleted dogs it induced dose-related reductions in mean arterial pressure and plasma renin activity. Peak falls in mean arterial pressure from normotensive baselines were -14 +/- 1, -26 +/- 3, and -44 +/- 3 mm Hg for the 3, 10, and 30 mg/kg groups, respectively (p < 0.05). Baseline plasma renin activity values (10.9 +/- 1.1-12.7 +/- 1.1 ng angiotensin I/ml/hr) were maximally inhibited, ranging from 43 +/- 8% at 0.3 mg/kg to 98 +/- 1% at 30 mg/kg. Bioavailability in this model was estimated to be 54 +/- 13% when plasma drug levels were determined by a renin inhibitory activity assay, but bioavailability was lower when compared with high-performance liquid chromatographic analysis of A-74273. This discrepancy was accounted for by the identification of structurally similar metabolites that are as active as the parent drug against human renin but much less potent against dog renin.(ABSTRACT TRUNCATED AT 250 WORDS)


Molecular determinants of human prorenin processing.

In humans, active renin is generated by the removal of a 43-amino acid prosegment from the zymogen prorenin. This cleavage event is highly specific, occurring at only one of the seven pairs of basic amino acids in the body of preprorenin. This cleavage site selectivity is also displayed by a number of other proteases in vitro and in mouse pituitary AtT-20 cells transfected with a human preprorenin expression vector, suggesting that specificity of cleavage is directed in part by the primary sequence, the higher order structure, or both of prorenin itself. To test this hypothesis, single amino acid mutations were introduced in the region of human preprorenin surrounding the natural cleavage site, and the resultant recombinant proteins were expressed in cultured Chinese hamster ovary and AtT-20 cells. The results suggest that amino acids in addition to the pair of basic amino acids surrounding the cleavage site affect the ability of both trypsin and the endogenous AtT-20 processing enzyme to cleave prorenin. Notably, although a proline at position -4 is essential for processing of prorenin in AtT-20 cells and is correlated with predicted formation of a beta-turn at this position, site-directed mutations suggest that this structural feature in addition to a pair of basic amino acids is not sufficient to lead to proteolytic activation of prorenin. Displacement of sequences surrounding the cleavage site to a position 10 amino acids toward the amino terminus led to partial processing of a mutated prorenin.(ABSTRACT TRUNCATED AT 250 WORDS)


Non-modulation as an intermediate phenotype in essential hypertension.

Non-modulation is a trait characterized by abnormal angiotensin-mediated control of aldosterone release and the renal blood supply. To determine whether non-modulation defines a specific subgroup of the hypertensive population and its utility as an intermediate phenotype, we have studied the distribution of this quantitative trait, whether its features are reproducible on repeated testing, and whether there is concordance of its multiple features. Essential hypertensive patients (224) and normotensive subjects (119) received an infusion of angiotensin II (Ang II) at 3 ng.kg-1.min-1 for 30-45 minutes. p-Aminohippurate (PAH) clearance was assessed as an index of renal plasma flow while the subjects were on a 200 meq sodium diet; plasma aldosterone levels were measured while the subjects were on a 10 meq sodium diet. In 54 subjects, diuretic-induced volume depletion superimposed on a low salt diet was substituted for the Ang II infusion. The results of each study were submitted to maximum likelihood analysis to assess bimodality. In response to both diuretic-induced volume depletion (p < 0.000023) and Ang II infusion (p < 0.0009), aldosterone responses were bimodally distributed in the essential hypertensive but not in the normotensive subjects, suggesting that this trait identifies a discrete subgroup. In the 59 subjects who had both an adrenal and renal study, 50 (85%) were concordant. Finally, in 27 subjects studied two to six times over a span of 1-60 months, the intraclass correlations of the adrenal, PAH, or both responses were highly significant (p values between 0.001 and 0.00007), indicating high reproducibility of results on repeated testing.(ABSTRACT TRUNCATED AT 250 WORDS)


Fasting insulin in relation to subsequent blood pressure changes and hypertension in women.

The role of hyperinsulinemia in the development of hypertension is not well understood, particularly insofar as both conditions relate to obesity. The present analysis examines the hypothesis that hyperinsulinemia, independent of obesity, precedes hypertension and natural blood pressure increases in women. The subjects were 50-year-old women from a prospective population study in Gothenburg, Sweden. Fasting insulin levels were determined at baseline (1968-1969) and were evaluated in relation to subsequent hypertension. Blood pressures were measured at the initial physical examination and at the 6- and 12-year follow-up examinations. The first analysis presented here (n = 278) identified incident cases of hypertension during the 12-year follow-up period, whereas the second analysis (n = 219) examined continuous changes in blood pressure. In both analyses, degree, type, and changes in obesity were considered as possible confounding factors. High fasting insulin values were predictive of subsequent incidence of hypertension over the 12-year follow-up period. Subjects with insulin values above the 75th percentile experienced three times more hypertension than did those below the 25th percentile. There was also a significant association between insulin at baseline and increases in diastolic (but not systolic) blood pressure. The positive relations between fasting insulin, on one hand, and diastolic blood pressure changes and hypertension, on the other, could not be explained by confounding effects of body mass index, waist/hip ratio, or weight gain. These findings are consistent with the hypothesis that fasting insulin levels may be one predisposing factor in the etiology of hypertension.


Hyperdynamic circulation and the insulin resistance syndrome ("syndrome X").

The insulin resistance syndrome ("syndrome X") consists of hyperinsulinemia, glucose intolerance, dyslipidemia, and hypertension, although the inclusion of hypertension has been challenged. Insulin has biological effects that could produce a hyperdynamic circulation. We therefore postulated that an insulin-induced hyperdynamic circulation is an early feature of the insulin resistance syndrome and that this circulatory abnormality leads to later fixed hypertension. The San Antonio Heart Study cohort, a population-based cohort of 3,301 Mexican Americans and 1,857 non-Hispanic whites, was used to define individuals who were hyperdynamic (pulse pressure and heart rate in the upper quartile of their respective distributions), intermediate, and hypodynamic (pulse pressure and heart rate in the bottom quartile). The characteristics of the insulin resistance syndrome were then examined according to these three hemodynamic categories. We also examined the 8-year incidence of hypertension and of type II diabetes according to these hemodynamic categories. A hyperdynamic circulation was associated with statistically significant increases in body mass index (BMI) (p < 0.001), subscapular-to-triceps skinfold ratio (p = 0.042), triglyceride (p = 0.002), 2-hour glucose (p = 0.002), and fasting and 2-hour insulin (p = 0.019 and 0.006). When hemodynamic status was examined separately in lean (BMI < 27 kg/m2) and obese (BMI > or = 27 kg/m2) individuals, the above effects persisted, although they were somewhat attenuated. The odds ratio for the hyperdynamic state as a predictor of future hypertension was 1.66, although this was not statistically significant (p = 0.304). The odds ratio for predicting future type II diabetes was 3.97, which was statistically significant (p = 0.047).(ABSTRACT TRUNCATED AT 250 WORDS)


Silent cerebral infarction as a form of hypertensive target organ damage in the brain.

The incidence, number, size, and location of silent cerebral infarction on 0.1 T magnetic resonance imaging was investigated in 66 hypertensive patients (63 +/- 9 years old; mean +/- SD) and 42 age-matched normotensive subjects (61 +/- 9 years old) to determine the clinical significance of hypertension in silent cerebral infarction. Cerebrovascular risk factors and the severity of hypertensive changes in other major target organs were also investigated. The incidence of silent infarction in hypertensive patients (47%) tended to be higher than that of normotensive subjects (33%) and increased significantly with advancing age. In hypertensive patients, a significantly higher incidence of silent lesions was noted in patients with hypertensive changes in major target organs (72-73% in patients with organ involvement versus 33-39% in those without). The average number of lesions in hypertensive patients was significantly higher than that in normotensive subjects (6.0 versus 2.1), and the lesions in the hypertensive patients were more frequently detected in the brain areas supplied by perforating arteries than those in normotensive subjects (47% versus 24%). These results clearly demonstrate that silent cerebral infarction is frequently seen in older hypertensive patients, especially when moderate hypertensive changes are noted in major target organs, and suggest that hypertensive arterial changes play a crucial role in the occurrence of silent infarction.


Morphology of renal afferent arterioles in spontaneously hypertensive rats.

We present a new perfusion technique that allows arteries down to the level of capillaries to be fixed while relaxed and under a known intravascular pressure. Through a catheter inserted into the right renal artery of 12-week-old male spontaneously hypertensive rats (n = 9) and control Wistar-Kyoto rats (n = 11), the kidney vessels were rinsed with human plasma, relaxed by papaverine, and perfused with a casting resin containing microspheres. The microspheres (12 microns) became trapped in the glomeruli of the kidney and, together with a closing of the venous outflow, they caused the flow through the kidney to stop, so that the intravascular pressure was raised to the level of the input perfusion pressure (100 mm Hg). The resin material was allowed to harden, and the kidney was immersion-fixed and prepared for histomorphometrical investigations. This technique made it possible to measure both the structurally determined lumen diameter and the corresponding media thickness under clearly defined conditions. The lumen diameter of afferent arterioles close to the glomeruli showed a 17% reduction in spontaneously hypertensive rats (15.4 +/- 0.6 microns; mean +/- SEM) compared with Wistar-Kyoto rat arterioles (18.5 +/- 0.3 microns, p < 0.001). However, this was not due to media hypertrophy, because media cross-sectional area was smaller (p < 0.001) in spontaneously hypertensive rats (210 +/- 6 microns 2) compared with Wistar-Kyoto rats (274 +/- 16 microns 2). We conclude that the lumen reduction in renal afferent arterioles in spontaneously hypertensive rats is not the result of an encroachment on the lumen by a hypertrophic media.


Development of hypertension in animals with reduced total peripheral resistance.

The object of the present study was to determine whether deoxycorticosterone acetate (DOCA)-salt hypertension can be produced in rats in the presence of low total peripheral resistance (TPR) induced by long-term administration of minoxidil, a vasodilator. The rats were divided into four groups: sham-control, DOCA-salt, minoxidil, and DOCA-salt with minoxidil. The rats in both DOCA groups had DOCA pellets implanted subcutaneously and were given saline to drink. The rats in both minoxidil groups were given minoxidil (3 mg/day) in the drinking water throughout the experiment. Final measurements, including mean arterial blood pressure, cardiac index, and renal blood flow were made after 4-6 weeks. Flow measurements were made using radioactive microspheres. Cardiac index (ml.min-1.100 g-1) in sham-control rats averaged 18 +/- 2 and was higher in the other groups: 23 +/- 4 (DOCA-salt), 25 +/- 2 (minoxidil), and 30 +/- 2 (DOCA-salt plus minoxidil). Mean arterial pressure (mm Hg) was increased in both DOCA-salt rats (160 +/- 8) and DOCA-salt plus minoxidil rats (153 +/- 5) as compared with sham-control (116 +/- 2) and minoxidil (113 +/- 3) rats. There was no significant difference in TPR between the sham-control and DOCA-salt rats, but TPR in minoxidil and DOCA-salt plus minoxidil rats was 30% and 28% lower than that in untreated sham-control and DOCA-salt hypertensive rats, respectively. In contrast, renal vascular resistance was significantly increased in both DOCA-salt groups as compared with non-DOCA-salt groups.(ABSTRACT TRUNCATED AT 250 WORDS)


Twenty-four-hour blood pressure profiles in normotensive sons of hypertensive parents.

We investigated whether blood pressures are higher in normotensive offspring of hypertensive parents than in normotensive offspring of normotensive parents outside the physician's office and, if so, whether these higher blood pressures are dependent on the level of dietary sodium intake. We compared 24-hour ambulatory blood pressure profiles between 11 normotensive sons of two hypertensive parents and 11 normotensive sons of two normotensive parents; profiles were recorded after 1 week of a low sodium diet (10 meq/day) and after 1 week of a high sodium diet (200 meq/day). The sons of hypertensive parents were on average 6 years older than the sons of normotensive parents (47 +/- 5 [SD] versus 41 +/- 4 years, p < 0.05). The shift from low to high sodium diet did not significantly change the magnitude of differences in office or ambulatory blood pressures between the groups (i.e., no group-by-diet interaction); thus, we assessed group effects by contrasting blood pressure means for each group pooled across diets. Age-adjusted office blood pressure was higher in sons of hypertensive parents than in sons of normotensive parents (116 +/- 7/80 +/- 6 versus 111 +/- 7/75 +/- 6 mm Hg; p = 0.020 for systolic and p = 0.003 for diastolic blood pressure).(ABSTRACT TRUNCATED AT 250 WORDS)


Sodium-lithium countertransport and probability of hypertension in Caucasians 47 to 89 years old.

The objectives of the present study were to determine whether sodium-lithium countertransport contributes to predicting the probability of having hypertension and to determine whether it does so after other predictor traits have been considered. We used logistic regression to model the relation between sodium-lithium countertransport and the probability of having hypertension, estimated by the prevalence of hypertension among 172 men and 252 women, aged 47-89 years, from the Caucasian population of Rochester, Minn. When sodium-lithium countertransport was the only predictor trait considered, it made a statistically significant contribution to prediction both in men (model chi(2)1df = 20.50, p < 0.001) and in women (model chi(2)1df = 16.69, p < 0.001). For each standard deviation increase in sodium-lithium counter-transport, the expected odds of having hypertension increased 2.25 times in men (95% confidence interval [CI], 1.44-3.51) and 1.77 times in women (95% CI, 1.32-2.37). When sodium-lithium countertransport was not considered, the other traits identified as predictors were age, body mass index, and plasma apolipoprotein CII and CII squared; plasma apolipoprotein AI was an additional predictor in women but not in men. When sodium-lithium countertransport was added to models that included the other predictors, it improved prediction both in men (increase in model chi(2)1df = 12.29, p < 0.001) and in women (increase in model chi(2)1df = 4.86, p < 0.027). Based on these complete models, when the other predictors remained at their mean values, each standard deviation increase in sodium-lithium countertransport increased the expected odds of having hypertension 2.06 times in men (95% CI, 1.31-3.22) and 1.48 times in women (95% CI, 1.04-2.21). These results establish that sodium-lithium countertransport provides information that is helpful in predicting the probability of having hypertension and is not reflected in other identified predictor traits.


Routine hematological values in term newborns.

Routine hematological parameters were investigated in 240 term normal neonates, 40 neonates in the first week of life and 49 infants between 3 and 6 months of age. Term normal neonates were selected on the basis of well defined criteria. Cord blood Hb values of 16.2 +/- 1.5 g/dl compared well with some of the recent Indian studies and Caucasian figures. Cord blood hemoglobin was lower in the presence of low maternal hemoglobin and in newborns delivered by Cesarean section. A wide variation existed in the total and differential leucocyte counts, thus limiting the clinical utility of white cell counts in the newborn period. Platelet counts were within the adult normal range.


Micro-invasive management of neonatal bilirubinemia.

The present study aims at analyzing the suitability of transcutaneous approach and filter paper technique using Minolta Jaundicemeter in the management of neonatal bilirubinemia. I compared serially measured values of Serum Bilirubin Index (SBI) by using filter paper technique and transcutaneous bilirubin index (TcBI) with serum bilirubin level determined by Diazo Method in 100 clinically jaundiced newborns and in 25 neonates at birth. The estimation of TcBI is simple, quick, reliable and non-traumatic to the newborn with no workload on the laboratory and technician. However, different nomograms are to be prepared for different laboratories, as also for the newborns with difference in skin pigmentation, gestational age and after phototherapy. SBI determined by filter paper technique eliminates these limitations. Moreover, the linear correlation was stronger between SBI and Diazo values (r = 0.9343, p < 0.001) in comparison to TcBI with Diazo values (r = 0.9090, p < 0.001). Further SBI readings almost correspond with actual serum bilirubin levels while corresponding TcBI values were much higher especially at higher diazo values. Thus TcBI can be used routinely for the surveillance of neonatal jaundice till it reaches a level corresponding to critical serum bilirubin level at which active management is required. At this point, serum bilirubin level may be confirmed by SBI.


Prognostic score for kerosene oil poisoning.

Ninety five consecutive children with kerosene oil poisoning were studied, the first 70 retrospectively (internal group) and the rest 25, prospectively (external group) over a period of 3 years and 8 months. Based on clinical features and severity of illness in initial 70 cases, a weighted scoring system to determine the outcome was evolved. This included: (i) fever--absent 0, present 1; (ii) severe malnutrition--absent 0, present 1; (iii) respiratory distress--absent 0, present 2, with cyanosis 4; and (iv) neurological symptoms--absent 0, present 2, with convulsions 4. The scores ranged from 0 to 10 in the internal group. Using discriminate function analysis, a score of 4 or more was found to be associated with prolonged hospital stay and complications. The risk of dying increased if the score was equal to or more than 8. The predictive value of the score was 85.7%. For validation, this scoring was applied to the external group as well and 84% of cases could be correctly predicted.


Congenital heart disease in Down syndrome: an echocardiographic study.

We evaluated the utility of echocardiography in assessing the frequency and nature of cardiac malformations in children with Down syndrome. Fifty cases of chromosomally proven Down syndrome were studied. A physical examination, electro cardiogram, radiograph of chest and two-dimensional echocardiography was performed on all patients. Twenty-two (44%) children had heart diseases. Endocardial-cushion-defect was the commonest anomaly, followed by ventricular septal defect. Three children with heart disease were asymptomatic and had normal X-ray films of chest and ECGs. The prevalence and specific type of congenital heart disease in this study is comparable to the studies using invasive means for diagnosis. The study further suggests that clinical examination of the cardiovascular system alone may not be sufficient in detecting heart disease. Two-dimensional echocardiography offers an excellent non-invasive tool for diagnosing cardiac malformations in Down syndrome.


A study of hepatitis B and C prevalence and liver function in multiply transfused thalassemic and their parents.

A series of clinics were conducted in Delhi, India, in January, 1990. Of 54 patients with beta thalassemia major (mean age 7.6 years), 11.1% (6 out of 54) tested positive for antibodies to hepatitis C virus (anti HCV antibodies) and 66.6% (36 out of 54) showed evidence of hepatitis B virus (HBV) infection. Only 7.4% (4 out of 54) were hepatitis B surface antigen (HBsAg) positive. Of their parents, 2.2% (2 out of 90) tested positive for anti HCV antibodies, 28.9% (26 out of 90) showed evidence of previous HBV infection and 11.1% (10 out of 90) were HBsAg positive. We argue that HCV constitutes a greater long term threat than HBV in these patients due to the higher incidence of chronic liver disease. We would advocate the introduction of HCV screening of donated blood as well as reinforcing the importance of HBV screening and immunization.


Shigellosis in children: a prospective hospital based study.

From 1985 to 1988, fecal samples of 950 hospitalized children suffering from diarrhea or dysentery were screened for Shigella species using standard methods. Shigella species were isolated as sole pathogen from 192 (20.2%) cases and S. flexneri type 2 was the predominant serotype. Shigella infection was prevalent throughout the year with high isolation rate during the summer and early monsoon months. Shigella strains isolated during the period were resistant to most of the commonly used drugs for the treatment of shigellosis. Nearly 16% of the Shigella strains were also resistant to nalidixic acid. Presence of blood and mucus in stools (dysentery) was the common clinical presentation of shigellosis cases. Malnutrition was associated with longer duration of illness. High cases fatality rate (16.7%) was observed among hospitalized children infected with Shigella.


Osteoarticular tuberculosis in children.

One hundred and four cases of osteoarticular tuberculosis were studied. There were 74 boys (71.2%) and 30 girls (28.8%). The mean age at the onset of symptoms was 7.3 years, ranging from 9 months to 18 years. Seventy four cases (71%) reported 3 months after onset of symptoms. The spine was the commonest site involved (43%) followed by hip (14.9%) and knee joints (10.3%). Evidence of active or inactive pulmonary tuberculosis was found in 16.2%. All cases were treated by three drug regimen of rifampicin, isoniazid and ethambutol; rifampicin was discontinued after 6 months, ethambutol after 12-14 months. In 12 cases (11.5%) isoniazid was continued for 18 months. Along with chemotherapy suitable braces, splints, tractions, exercises and other form of physical therapy produced satisfactory results. Seventy eight patients (75%) showed clinical and radiological improvement with one year of treatment. The follow up period ranged between 4 months to 24 months with an average of 17 months. Children because of capacity to grow, showed progressive deformity in knee in 3 cases (2.8%), hip in 98 cases (8.6%), shortening of limbs in 14 cases (13.4%) and kyphosis in 13 cases (12.5%).


Immunogenicity of conjugate vaccines consisting of pneumococcal capsular polysaccharide types 6B, 14, 19F, and 23F and a meningococcal outer membrane protein complex.

In an effort to prepare pneumococcal (Pn) capsular polysaccharide (Ps) vaccines that would be immunogenic in infants, covalent conjugates were prepared for Pn types 6B, 14, 19F, and 23F. Each Ps type was covalently bound to an outer membrane protein complex from Neisseria meningitidis serogroup B and evaluated for immunogenicity in mice and infant monkeys. The conjugates induced specific anti-Ps antibody responses in mice and in infant rhesus and African green monkeys; a conjugate of 6B and outer membrane protein complex was immunogenic at Ps doses as low as 20 ng. Although low levels of the Pn group-common cell wall polysaccharide were present in all type-specific Ps preparations, anti-cell wall polysaccharide responses induced by covalent conjugates were < 1% of the total anti-Ps response after two doses of vaccine. In contrast, the anti-cell wall polysaccharide response of a noncovalent conjugate represented 41% of the anti-Ps response after two doses. Relative T-cell dependence, a requirement for the human target population of infants less than 18 months old, was demonstrated for all four Pn Ps conjugates in an athymic mouse model. Therefore, these Pn Ps-outer membrane protein complex conjugate vaccines are excellent candidates for evaluation in human infants.


Effect of Pasteurella multocida toxin on bone resorption in vitro.

Pasteurella multocida toxin (PMT), which is the primary etiologic factor in the pathogenesis of progressive atrophic rhinitis in pigs, was found to stimulate bone resorption in vitro. This stimulation was observed both in cultures of murine calvaria by measuring the release of calcium and of the lysosomal enzyme beta-glucuronidase and in murine long bone cultures by measuring the release of calcium. Both systems showed the same dose response curve, with the maximal effect at a concentration of 5 ng/ml. The effect on calvaria was studied in more detail. PMT increased bone resorption 24 h after its addition and always had to be present to express an effect. Calcitonin was able to inhibit this increase of resorption completely, and inhibitors of prostaglandin synthesis suppressed it partially. Although the data show an effect of PMT on bone tissue, the results do not exclude an action on cells in the nasal cavity, which could indirectly stimulate bone resorption.


Protection of neonatal mice from group B streptococcal infection by maternal immunization with beta C protein.

Group B streptococci (GBS) cause the majority of cases of neonatal sepsis and meningitis in the United States. Immunization of women of childbearing age is one strategy under consideration for the prevention of neonatal disease. The beta C protein, a 130-kDa antigen present in many clinical isolates of GBS, was purified from GBS by extraction into sodium dodecyl sulfate (SDS)-containing buffer, preparative SDS-polyacrylamide gel electrophoresis, and electroelution. Purified beta C protein antigen (25 micrograms) with Freund's adjuvant was used to immunize rabbits. Rabbits developed enzyme-linked immunosorbent assay titers of > 1:1.6 x 10(6), and sera from immunized rabbits were administered to pregnant mice. Their neonatal pups were then challenged with a strain of GBS expressing beta C protein; 68% of these pups were protected by immune antiserum, whereas no controls were protected (P < 0.001). The immune serum (diluted 1:100) facilitated opsonophagocytic killing of GBS strains expressing the beta C protein but not those that do not express the antigen (mean log kill +/- standard deviation = 0.71 +/- 0.8 log10 CFU for beta+ strains and 0.09 +/- 0.2 for beta- strains; P = 0.02). In subsequent experiments, adult female mice were actively immunized with two doses of 2, 5, or 10 micrograms of beta C protein 2 months prior to mating. One- to two-day-old offspring of these dams were challenged with GBS and were protected in a dose-dependent manner, with 96% survival in the high-dose (10-micrograms) group and 20% survival in a sham-immunized control group (P < 0.001). Thus, active immunization of mice with the GBS beta C protein confers protection against lethal infection with beta+ GBS to their offspring.


Purification and immunological characterization of a major low-molecular-weight lipoprotein from Borrelia burgdorferi.

Borrelia burgdorferi resembles gram-negative bacteria in having both cellular and outer membranes. We previously showed that a lipopolysaccharide (LPS)-like material could be extracted from B. burgdorferi with phenol-chloroform-petroleum ether (PCP). The PCP extract of B. burgdorferi exhibited biological activity in several in vitro assays (e.g., mitogenicity, pyrogenicity, and cytokine release). These activities suggested the presence of endotoxin. The PCP extract of B. burgdorferi, however, also contained a small amount of protein. Preliminary studies showed that monoclonal antibody prepared against this protein inhibited the mitogenic activity of the PCP extract toward murine spleen cells. The current study was therefore undertaken to characterize this protein and to establish methods for its separation from the LPS. The PCP-extracted protein consisted of a single, low-molecular-weight lipoprotein (apparent M(r), 10,000 by sodium dodecyl sulfate-polyacrylamide gel electrophoresis) (SDS-PAGE). By protein analysis, it accounted for 2% of the dry weight of defatted cells, thus making it a major constituent of the spirochete. It was purified from the LPS by initial extraction into 10% Triton X-100 followed by immunoaffinity chromatography in the presence of detergent. On removal of the LPS, the purified lipoprotein formed aggregates stable to SDS-PAGE which were detectable on Western blots (immunoblots) probed with either the monoclonal antibody or polyclonal antiserum. From a plot of the aggregate molecular weight versus aggregate size, a monomer molecular weight of 7,500 was obtained. Indirect immunofluorescence with the monoclonal antibody showed that the lipoprotein was exposed at the surface of the spirochete in only a small percentage of cells. The lipoprotein was present in several strains of B. burgdorferi but absent in other Borrelia spp., treponemes, and gram-negative human pathogens, indicating species specificity.


Phagolysosomes of Coxiella burnetii-infected cell lines maintain an acidic pH during persistent infection.

Coxiella burnetii, the agent of Q fever, is an obligate intracellular bacterium that multiples within vacuoles of phagolysosomal origin. Persistently infected cell lines were maintained in continuous culture for months. We studied the pH of the phagolysosomes by using two murine cell lines during early propagation of the bacteria and after establishment of persistent infection. Three strains of C. burnetii were studied because of the purported propensity of each strain to cause acute or chronic disease and to be resistant or susceptible to antibiotics. The pHs were calculated from fluorescence experiments with fluoresceinated dextran as a lysosomal probe. Phagolysosomal vacuoles maintained an acidic pH during a 36-day infection. Minimal variation of the pH occurred over the duration of the experiment with strains that caused either acute or chronic disease. Phagolysosomal pH remained stable for as long as 153 days with the Nine Mile phase II isolate. Thus, neither the course of C. burnetti infection nor the diversity of antibiotic susceptibility of the strains is related to variations in the phagolysosomal pH.


Pathogenesis of Providencia alcalifaciens-induced diarrhea.

Providencia alcalifaciens is a member of the family Enterobacteriaceae. There are reports that P. alcalifaciens can cause diarrhea, but the mechanism(s) by which it causes diarrhea is known. We studied P. alcalifaciens isolated from a child and two adults with diarrhea for enteropathogenicity. The three isolates did not exhibit any characteristic adherence to cultured HEp-2 cell monolayers, and they did not produce enterotoxins, cytotoxins, or keratoconjunctivitis in the Sereny test. Two isolates invaded cultured HEp-2 cell monolayers, producing localized bacterial clusters and actin condensation. The pattern of actin condensation was different from that produced by enteropathogenic Escherichia coli but similar to that produced by Shigella flexneri. Invasion and actin condensation were poor for the third isolate. Histology of adult rabbit small intestinal loops inoculated with all three isolates revealed bacterial attachment to, penetration of, and microulcer formation on the surface epithelium and hyperemia, edema, and polymorphonuclear cell infiltration of lamina propria. All the isolates produced diarrhea in rabbits with removable intestinal ties, and some of these rabbits developed hindlimb paralysis. Intestinal histology of the rabbits with removable intestinal ties which developed diarrhea showed changes similar to that in adult rabbits on which ileal loop assays had been performed. Transmission electron microscopy of intestinal tissues also confirmed tissue penetration by the isolates. Nerve tissue histology of two rabbits that developed hindlimb paralysis showed focal mononuclear cell infiltration around peripheral nerve sheaths. It is concluded that some strains of P. alcalifaciens are enteropathogenic and that they cause diarrhea by invading the intestinal mucosal epithelium. However, the relevance to human disease of the hindlimb paralysis observed in this animal model is not clear.


Relative abilities of distinct isotypes of human major histocompatibility complex class II molecules to bind streptococcal pyrogenic exotoxin types A and B.

The relative ability of distinct isotypes of human leukocyte antigen class II molecules to bind streptococcal pyrogenic exotoxins A and B (SPE A and SPE B, respectively) was investigated by a direct-binding assay with 125I-labeled toxin for SPE A and by a functional assay system measuring the accessory cell activity of human leukocyte antigen class II transfectants in toxin-induced T-cell activation for SPE A and SPE B. SPE A binding was observed in L cells transfected with DQw1 genes. By contrast, it was not detected in L cells transfected with DR2, DR4, DPw4 or DP(Cp63) genes. All the transfectants supported SPE-induced interleukin-2 production by human T cells except the DP transfectants for SPE B. Levels of accessory cell activity were low in the DP transfectants induced by stimulation with SPE A and in the DR and DP transfectants induced by SPE B. The results indicate that SPE A and SPE B bind well to DQ molecules, less well to DR molecules, and very weakly to DP molecules.


Complement and antibody participation in opsonophagocytosis of type IV and V group B streptococci.

Requirements for complement and antibody in neutrophil-mediated killing of serotype IV and V group B streptococci were investigated. Neutrophils from adults were tested in an opsonophagocytic assay with sera from healthy adults, healthy newborns, and hypogammaglobulinemic, agammaglobulinemic, and C4-deficient patients. For all serum sources, the bactericidal index for both serotypes exceeded 84% after 40 min of incubation. Heat inactivation of sera ablated killing. Blockade of neutrophil receptor FcIII effected a maximum of 16% inhibition of opsonophagocytosis, and FcII receptor blockade demonstrated negligible inhibition. When neutrophil complement receptor 1 or 3 blockade was employed, the maximum inhibition detected was 26%. Simultaneous blockade of complement receptors 1 and 3 effected maximum inhibition levels of 25 and 65% for serotypes IV and V, respectively. Blockade of complement receptor 3 and neutrophil receptor FcIII inhibited opsonophagocytosis by 56% for both serotypes. When serum complement concentrations were restricted, neutrophil-mediated killing diminished but was restored by the addition of hyperimmune rabbit antiserum. These findings suggest that complement and antibody are major participants in the opsonophagocytosis of serotypes IV and V group B streptococci. A low prevalence of carriage or mediation of efficient phagocytosis by interactions of neutrophil complement and Fc receptors may contribute to the rarity of human infections caused by these two serotypes.


Role of fibrinogen in complement inhibition by streptococcal M protein.

M protein, the major virulence factor of group A streptococci, has antiopsonic activity in that it inhibits activation of the alternative complement pathway on the streptococcal surface. Two properties of M protein have been claimed to account for the inhibitory activity, namely, (i) its binding affinity for complement factor H, which is an inhibitor of alternative pathway activation, and (ii) its high binding affinity for fibrinogen. We have recently shown that fibrinogen, like M protein, inhibits alternative pathway activation by possessing binding affinity for factor H. Here we report that fibrinogen effectively competes with factor H for binding to M protein but retains its own binding affinity for factor H. The presence of fibrinogen did not significantly affect alternative pathway inhibition on the streptococcal surface.


eNAP-2, a novel cysteine-rich bactericidal peptide from equine leukocytes.

We purified a novel cysteine-rich antibiotic peptide, eNAP-2 (M(r), approximately 6,500), from acid extracts of equine neutrophils by sequential gel filtration and reversed-phase high-performance liquid chromatography and determined its partial N-terminal amino acid sequence. Although its cysteine motif distinguished eNAP-2 from all other currently known endogenous antibiotic peptides, including defensins and granulins, it showed substantial sequence similarity to WDNM1, a putative member of the four-disulfide-core protein family that also includes animal and human antiproteases, snake venom neurotoxins, and rat and mouse whey proteins. The antibacterial properties of eNAP-2 were tested against several equine uterine pathogens, namely, Streptococcus zooepidemicus, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. Killing of S. zooepidemicus was very efficient, as evidenced by a 94% decrease in numbers of CFU per milliliter after exposure to 100 micrograms of eNAP-2 per ml (approximately 15 microM) for 2 h. Exposure of E. coli and P. aeruginosa to 200 micrograms of eNAP-2 per ml for 2 h resulted in 90.2 and 77.6% reduction, respectively, in the numbers of CFU per milliliter. Bacteriostasis, without bactericidal activity, occurred after K. pneumoniae was incubated with 200 micrograms of eNAP-2 per ml. Additional studies will be required in other species and cell types to determine whether eNAP-2 is restricted to equine neutrophils or is the index member of a larger family of endogenous antibiotics.


Characterization of a polysaccharide capsular antigen of septicemic Escherichia coli O115:K "V165" :F165 and evaluation of its role in pathogenicity.

Escherichia coli strains of serogroup O115:K(-):F165 have been associated with septicemia in calves and piglets. These strains express a capsular antigen referred to as K"V165" which inhibits agglutination of the O antigen by anti-O115 serum. We used hybrid transposon TnphoA mutants M48, 18b, and 2, and a spontaneous O-agglutinable mutant, 5131a, to evaluate the role of K"V165" in the pathogenicity of E. coli O115. Mutant M48 was as resistant to 90% rabbit serum and as virulent in day-old chickens as the parent strain 5131, mutants 18b and 5131a were less resistant to serum and less virulent in chickens, and mutant 2 was serum sensitive and avirulent. Analysis of outer membrane protein and lipopolysaccharide profiles failed to show any difference between the transposon mutants and the parent strain. In contrast, the spontaneous O-agglutinable mutant showed additional bands in the 16-kDa region of the polysaccharide ladder-like pattern. Mutants 2 and 5131a produced significantly less K"V165" capsular antigen than the parent strain, as demonstrated by a competitive enzyme-linked immunosorbent assay with adsorbed anti-K"V165" serum. In addition, electron microscopic analysis revealed that mutants 2 and 5131a had lost the capsular layer observed in the parent strain after fixation with glutaraldehyde-lysine. This capsule contained carbohydrate compounds and resembled an O-antigen capsule since it prevented O-antigen agglutination before the bacteria were heated at 100 degrees C and induced bacterial serum resistance. The capsule-defective mutants colonized the intestinal epithelium of experimentally infected gnotobiotic pigs but failed to induce clinical signs of septicemia. We concluded that E. coli strains of serogroup O115 expressed a polysaccharide capsular antigen which induced serum resistance and consequently contributed to the pathogenicity of the bacteria.


Proteins with molecular masses of 25 to 40 kilodaltons elicit optimal protective responses against Plasmodium chabaudi adami infection.

The presence of the CD4+ T cell has been shown to be crucial for resolution of acute infection in the Plasmodium chabaudi adami murine malaria model. This model is, therefore, suitable for the isolation of malaria antigens that are capable of activating protective T cells. In light of this, we set out to identify P. chabaudi adami molecules that activate protective responses in this model. Denatured P. chabaudi adami proteins were isolated by continuous-flow electrophoresis on the basis of their apparent molecular masses and then sequentially assessed for the ability to protect mice in immunization experiments. We report here that low-molecular-mass P. chabaudi adami polypeptides in the range from 25 to 40 kDa are most effective at immunizing mice against a challenge infection with viable P. chabaudi adami. The method used to obtain these proteins could also be applied to identify molecules that activate protective cell-mediated responses in other infectious disease models.


Construction of a diphtheria toxin A fragment-C180 peptide fusion protein which elicits a neutralizing antibody response against diphtheria toxin and pertussis toxin.

A genetically engineered gene fusion was constructed which encoded a nontoxic derivative of the A fragment of diphtheria toxin joined to the C180 peptide of the S1 subunit of pertussis toxin. The product of this gene fusion, termed the DTA-C180 protein, was purified from the periplasm of Escherichia coli to approximately 80% purity. The DTA-C180 protein possessed an apparent molecular weight of 43,000 by reduced sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The DTA-C180 protein was cleaved into two tryptic peptides, which migrated with apparent molecular weights of approximately 22,000. One tryptic peptide reacted with diphtheria antitoxin, while the other tryptic peptide reacted with anti-C180 peptide immunoglobulin G. The DTA-C180 protein did not inhibit protein synthesis or stimulate clustering morphology in Chinese hamster ovary cells. The DTA-C180 protein elicited an immune response, in guinea pigs, against both the DTA and C180 peptide components of the fusion protein, with alum being a more efficient adjuvant than Freund's adjuvant for eliciting neutralization titers. Neutralization titers elicited by DTA-C180 protein were weaker than those elicited by diphtheria toxoid and pertussis toxin 9K/129G, a genetically engineered double mutant of pertussis toxin. Three doses of DTA-C180 protein yielded a neutralization titer of 1/750 against pertussis toxin in Chinese hamster ovary cells and a neutralization titer of 1/50 against diphtheria toxin in Vero cells. This is the first report of a protein derived from a recombinant S1 subunit that elicits a neutralizing titer against pertussis toxin.


Differences in the binding specificities of Pseudomonas aeruginosa M35 and Escherichia coli C600 for lipid-linked oligosaccharides with lactose-related core regions.

Membrane glycolipids contain the lactose sequence (galactose linked to glucose), and the oligosaccharide is variously extended such that there is a cell-type-specific repertoire. In this study, binding of Pseudomonas aeruginosa M35 to lipid-linked lactose (Gal beta 1-4Glc [structure 1]), lacto-N-neotetraose (Gal beta 1-4GlcNAc beta 1-3Gal beta 1-4Glc [structure 2]), lacto-N-tetraose (Gal beta 1-3GlcNAc beta 1-3Gal beta 1-4Glc [structure 3]), and asialo GM1 (Gal beta 1-3GalNAc beta 1-4Gal beta 1-4Glc [structure 4]) was evaluated and compared with binding of Escherichia coli C600 to these compounds. Oligosaccharides were linked to the lipid phosphatidylethanolamine dipalmitoate, and the resulting neoglycolipids were resolved on thin-layer chromatograms or coated onto plastic microtiter wells. Lipid-linked structures 1 to 4 were bound by P. aeruginosa and E. coli in the chromatogram assay, but only structure 4 was bound in the microtiter well assay. As shown previously for E. coli binding to lipid-linked structures 1 to 3, binding to lipid-linked structure 4 was not inhibited with oligosaccharide, indicating a requirement for lipid and oligosaccharide. With few exceptions, sialylation and fucosylation of structures 1 to 4 resulted in impaired or abolished binding. Comparisons of binding intensities in the chromatogram assay indicated that recognition by P. aeruginosa and recognition by E. coli are not identical. Presence of the additional disaccharide unit, as in structure 2, resulted in enhanced binding of P. aeruginosa but diminished binding of E. coli relative to lactose binding; fucosylation at galactose of lactose resulted in markedly diminished binding of P. aeruginosa only. In the microtiter well assay, binding of E. coli to asialo GM1 was much weaker than P. aeruginosa binding. The saccharide-plus-lipid-dependent adhesion may be an important factor in increased susceptibility to infection of epithelia already damaged by microbial and chemical agents; the differing strengths of adhesion to the structural variants may relate to tissue tropism.


Interaction of pertussis toxin with human T lymphocytes.

The binding of pertussis toxin (PT) to the human T-cell line Jurkat was examined by using flow cytometry. Fluorescein isothiocyanate (FITC)-labeled PT bound rapidly to the cells in a specific manner as determined by blocking experiments with unlabeled toxin, B oligomer, and the S2-S4 and S3-S4 dimers. Monoclonal antibodies against the S3 subunit of the toxin also significantly inhibited the binding of FITC-PT. Sialidase treatment of the cells resulted in decreased binding of FITC-PT, indicating that sialic acid residues are involved in the binding process. In addition, we studied the effect of PT binding on the expression of cell surface molecules. On binding of PT to the cell surface, a rapid down-regulation of the T-cell receptor (TCR)-CD3 complex was observed. The modulation of the TCR-CD3 complex was independent of the toxin's enzymatic activity, as the B oligomer and a nonenzymatic toxin mutant induced modulation comparable to that caused by the native holotoxin. Isolated dimers did not cause down-regulation. Stimulation of the TCR-CD3 complex, leading to reduced cell surface expression of this complex, provides a possible explanation for the second messenger production associated with the interaction of PT or B oligomer with T lymphocytes. We therefore conclude that PT activates T cells by divalent binding to the TCR-CD3 complex itself or by binding a structure closely associated with it.


Identification of p60 antibodies in human sera and presentation of this listerial antigen on the surface of attenuated salmonellae by the HlyB-HlyD secretion system.

Antibodies directed against the major secreted protein of Listeria monocytogenes, termed p60, were found more frequently than antilisteriolysin antibodies in sera of listeriosis patients. Anti-p60 antibodies were also identified in all tested sera from healthy individuals. To test whether p60 provides protection against L. monocytogenes, we constructed an attenuated Salmonella typhimurium aroA strain which secretes p60 via the Escherichia coli hemolysin secretion pathway. Application of this Salmonella strain to BALB/c mice prior to an L. monocytogenes infection induced p60 antibodies in these mice and led to a significantly reduced number of viable bacteria in the spleen compared with that in control animals which were primed with the S. typhimurium aroA strain alone.


Demonstration and partial characterization of antigens of Rickettsia rhipicephali that induce cross-reactive cellular and humoral immune responses to Rickettsia rickettsii.

The relatively unrelated spotted fever group rickettsia Rickettsia rhipicephali conferred on guinea pigs protective immunity against challenge with virulent R. rickettsii. Immunity was conferred at all doses of R. rhipicephali used in the study. Because of the serologic unrelatedness of these two rickettsiae, determined by the use of microimmunofluorescence and other serological assays, further studies were performed to define the nature of the immune response elicited by R. rhipicephali and the characteristics of the rickettsial antigens that evoke cross-reactive antibody responses. Animals immune to R. rhipicephali tested at the time of challenge showed a complete cross-reactive lymphocyte proliferative response to rickettsial antigens prepared from each species. In fact, spleen cells from R. rhipicephali-immune animals responded better to R. rickettsii antigens than to homologous immunizing antigens. Serum samples were obtained from R. rhipicephali-infected animals at various times after infection and tested by the use of Western immunoblot assay for antibodies that were cross-reactive with antigens of R. rickettsii. By 10 days after infection with R. rhipicephali, antibodies to antigens of both species were noted, and by 37 days after infection, sera from immune animals showed strong reactivity to antigens of R. rhipicephali with apparent molecular masses of 107 and 151 kDa. The cross-reactive antibody response to antigens of R. rickettsii was relatively strong and involved predominantly the rOmpB protein and the rickettsial lipopolysaccharide. These findings establish the presence of T-cell-dependent epitopes associated with antigens of R. rhipicephali, which confer protective immunity against challenge with R. rickettsii. Results of Western immunoblot assays support the contention that the R. rickettsii rOmpB surface antigen contains important protective epitopes.


Endogenous tumor necrosis factor alpha is required for enhanced antimicrobial activity against Toxoplasma gondii and Listeria monocytogenes in recombinant gamma interferon-treated mice.

In vitro studies have shown that macrophages stimulated with recombinant gamma interferon (rIFN-gamma) produce tumor necrosis factor alpha (TNF-alpha), which in an autocrine fashion activates these cells. The aim of the present study was to determine whether endogenously formed TNF-alpha also is required for rIFN-gamma-induced macrophage activation and enhanced antimicrobial activity in vivo. After an intraperitoneal injection of rIFN-gamma into CBA/J mice, their peritoneal macrophages released enhanced amounts of NO2- and inhibited the intracellular proliferation of Toxoplasma gondii. Injection of neutralizing antibodies against TNF-alpha simultaneously with the rIFN-gamma completely inhibited both the release of NO2- by macrophages and their toxoplasmastatic activity. Similar results were observed after intraperitoneal injection of a competitive inhibitor of L-arginine, NG-monomethyl-L-arginine, together with rIFN-gamma, demonstrating that in vivo L-arginine-derived reactive nitrogen intermediates are essential for the induction of toxoplasmastatic activity. Intravenous injection of rIFN-gamma inhibited the growth of Listeria monocytogenes in the livers and spleens of mice; this effect was abrogated by antibodies against TNF-alpha. Intravenous injection of a large dose of rTNF-alpha resulted in a decrease in the number of bacteria in the liver and spleen, but an injection of rIFN-gamma and rTNF-alpha did not result in enhanced inhibition of the proliferation of L. monocytogenes. Together, the results of the present study are the first to demonstrate that endogenous TNF-alpha is required in vivo for the expression of macrophage activation with respect to the release of reactive nitrogen intermediates and toxoplasmastatic activity and for enhanced listericidal activity in the livers and spleens of mice stimulated with rIFN-gamma.


Expression of protein F, the fibronectin-binding protein of Streptococcus pyogenes JRS4, in heterologous streptococcal and enterococcal strains promotes their adherence to respiratory epithelial cells.

In a previous study we reported the identification of protein F, a fibronectin-binding protein that was essential to the ability of Streptococcus pyogenes JRS4 to adhere to respiratory epithelial cells (E. Hanski and M. Caparon, Proc. Natl. Acad. Sci. USA, 89:6172-6176, 1992). To further evaluate the role of protein F in the adherence of the group A streptococci, we screened other group A streptococcal strains, including six recent clinical isolates, and one strain of Enterococcus faecalis for their capacity to bind fibronectin and for the presence of the gene encoding protein F (prtF). Seven of eight group A streptococcal strains analyzed, including all recent clinical isolates, both bound fibronectin at high affinity and contained DNA sequences that hybridized with a prtF-specific probe. One group A streptococcal isolate and the strain of E. faecalis examined neither contained a prtF-related gene nor bound fibronectin. These two strains also could not efficiently adhere to respiratory epithelial cells. However, upon the introduction of the cloned prtF gene, both of these strains gained the capacity to bind fibronectin and to adhere to respiratory epithelial cells. These results suggest that protein F is an important adhesin, which may have a general role in the virulence of the group A streptococci.


The arginine-dependent cytolytic mechanism plays a role in destruction of Naegleria fowleri amoebae by activated macrophages.

Mouse peritoneal macrophages activated by different immunomodulators (Mycobacterium bovis bacillus Calmette-Guérin or Propionibacterium acnes) destroy Naegleria fowleri amoebae by a contact-dependent process and by soluble cytolytic molecules secreted by macrophages in response to lipopolysaccharide. The goal of this study was to determine whether the arginine-dependent cytolytic mechanism which results in the production of nitric oxide from arginine by activated macrophages destroys the amoebae. Amoebicidal activity of activated macrophages was determined by coculturing macrophages with N. fowleri amoebae radiolabeled with 3H-uridine. The percent specific release of radiolabel was used as an index of cytolysis of the amoebae. The inhibitors NG-monomethyl-L-arginine and arginase were used to determine whether the arginine pathway was a major effector mechanism responsible for amoebicidal activity of activated macrophages. Both the arginine analog NG-monomethyl-L-arginine and arginase, which breaks down arginine, decreased macrophage amoebicidal activity. Addition of arginine to arginine-free medium restores amoebicidal activity to activated macrophage cultures. These results demonstrate that the arginine pathway is an important mechanism for the destruction of susceptible N. fowleri amoebae.


Characterization of a > 900,000-M(r) Cryptosporidium parvum sporozoite glycoprotein recognized by protective hyperimmune bovine colostral immunoglobulin.

Cryptosporidium parvum, a zoonotic Apicomplexan pathogen, causes profound diarrhea, malnutrition, and dehydration in patients with AIDS. A less severe, self-limited disease occurs in immunocompetent individuals, particularly children, animal handlers, and residents of the developing world. Very little is known about the biology of the organism, the pathophysiology of the disease process, or the mechanism of protective immunity. There is no effective therapy for cryptosporidiosis, but hyperimmune bovine colostrum raised against Cryptosporidium oocysts and sporozoites has ameliorated infection and disease in some patients with AIDS, and a variety of monoclonal antibodies, as well as hyperimmune bovine colostrum, have significantly reduced cryptosporidial infection of mice and calves. We report here the identification and initial characterization of a > 900,000-M(r) Cryptosporodium sporozoite glycoprotein (GP900) that is a prominent antigen recognized by protective hyperimmune bovine colostral immunoglobulin. Three of six murine anticryptosporidial monoclonal antibodies reacted with GP900, indicating that the molecule is highly immunogenic in mice as well as in cows. GP900 is Triton X-100 soluble and N glycosylated. Western blotting of the N-deglycosylated protein, detected with antibodies eluted from recombinant clones expressing a partial GP900 fusion protein, suggested that the polypeptide backbone of the glycoprotein has an M(r) of < 190,000. GP900 is encoded by a single-copy gene that resides on the largest Cryptosporidium chromosome.


Lack of vessel wall elastolysis in human invasive pulmonary aspergillosis.

In experimental studies, the apparent ability of Aspergillus fumigatus isolates to produce elastase in agar plates correlates with their ability to cause invasive pulmonary aspergillosis in mice pretreated with cortisone. Thus, elastase production may govern the pathogenicity of particular isolates. If this is so, then disruption of the elastic layers within blood vessel walls in invasive aspergillosis would be expected. To test this hypothesis, tissue blocks were prepared from nine patients with invasive pulmonary aspergillosis. Separate but immediately adjacent histological sections were stained by the Grocott and periodic acid-Schiff methods for fungal hyphae and by the elastic van Gieson technique for elastic tissue. Comparison of those segments of vessel walls infiltrated by hyphae with those not infiltrated by hyphae showed no overall loss of elastic tissue. Material from five of the cases was also stained with an unconventional combination of histochemical stains, allowing accurate identification of both fungal hyphae and elastic laminae in the same histological sections. The results showed no more disruption of elastic laminae than would be expected from simple physical displacement of elastic laminae. We conclude that if elastolysis contributes at all to invasion of vessel walls by aspergilli, then it seems to be very localized and/or transient.


Respiratory epithelial cell invasion by group B streptococci.

Group B streptococci (GBS) are the most common cause of pneumonia and sepsis during the neonatal period; however, the pathogenesis of this infection is poorly understood. We investigated the ability of GBS to enter epithelial cells in culture. Two strains of GBS were capable of invading immortalized respiratory epithelial cell lines in vitro at different levels, suggesting strain differences in invasiveness. Intracellular replication was not observed. Invasion required actin microfilaments but not microtubular cytoskeletal elements. Active bacterial protein, DNA, and RNA syntheses were required for invasion. These findings are consistent with our previous observation of intracellular GBS in the lungs of infected primates. We hypothesize that this organism may access the bloodstream by direct invasion of the epithelial cell barrier.


Early pathogenesis of infection in the liver with the facultative intracellular bacteria Listeria monocytogenes, Francisella tularensis, and Salmonella typhimurium involves lysis of infected hepatocytes by leukocytes.

The results show that Listeria monocytogenes, Francisella tularensis, and Salmonella typhimurium are facultative intracellular bacteria with a capacity to invade and grow in nonphagocytic cells in vivo. In the liver, all of these pathogens were seen to invade and to multiply extensively in hepatocytes. In all three cases, inflammatory phagocytes were rapidly marshalled to foci of infection where they appeared to cause the destruction of infected hepatocytes, thereby releasing bacteria into the extracellular space, in which presumably they could be ingested and destroyed by the phagocytes. If phagocytic cells were prevented from accumulating at foci of liver infection by treatment of the mice with a monoclonal antibody (NIMP-R10) directed against the type 3 complement receptor of myelomonocytic cells, then lysis of hepatocytes failed to occur and bacteria proliferated unrestrictedly within them. Under these circumstances, otherwise sublethal infections became rapidly lethal. These findings strongly suggest that lysis of infected hepatocytes by phagocytic cells is an important general early-defense strategy against liver infection with at least three different intracellular bacteria.