Mycobacterium tuberculosis induces apoptosis in gamma/delta T lymphocytes from patients with advanced clinical forms of active tuberculosis

Antigens from inactivated Mycobacterium tuberculosis H37Ra induce activation in a subpopulation of gamma/delta (gamma/delta) T lymphocytes in a manner that resembles that of superantigens from alpha/beta T cells. After culture in vitro with H37Ra proteins, gamma/delta T lymphocytes from patients with advanced clinical forms of active tuberculosis (ACF-TBC) display cytotoxic activity against homotypic target cells exposed to H37Ra. Cytotoxicity by gamma/delta T lymphocytes from ACF-TBC patients occurs in a range similar to that observed in healthy subjects. Following activation, H37Ra-stimulated gamma/delta T lymphocytes from healthy subjects did proliferate in the presence of exogenous recombinant human interleukin 2. However, under the same conditions, gamma/delta T lymphocytes from ACF-TBC patients not only did not proliferate but died by apoptosis. These results suggest that in gamma/delta T lymphocytes from patients with ACF-TBC, antigens from M. tuberculosis may induce cell activation that leads to apoptotic cell death.

[The prevention of insulin-dependent diabetes mellitus]

At the present time, there are markers which we can use to identify individuals with a high susceptibility of developing insulin-dependent diabetes mellitus (IDDM) years before the onset of the disease. Insulin-dependent diabetes mellitus is an autoimmune disease strongly associated with HLA antigens DR3 and DR4. In this manuscript, we discuss the usefulness of several markers, such as islet cell antibodies, insulin autoantibodies and glutamic acid decarboxylase antibodies, to identify individuals with a high susceptibility to IDDM before the disease is clinically evident. Monitoring first phase insulin release during intravenous glucose administration is a useful index of residual beta cell function that can be used to detect individuals who are close to insulin dependence. Several drugs have been used to prevent the development of IDDM. These include immunodepressors, anti-inflammatory agents, non-specific immunomodulators and free radical scavengers. Due to their toxicity, studies employing aziothioprine and cyclosporin were discontinued. Other agents, such as tetrandrin and lymphotoxin, are now restricted to non-human trials. Currently, two large-scale multicentric human trials, one in Europe using nicotinamide (European Nicotinamide Diabetes Intervention Trial, ENDIT) and the other in the USA using insulin (Diabetes Prevention Trial), are now in full activity and will test the benefits of these drugs in the prophylaxis of IDDM in highly susceptible individuals.

[Electrical burns in children. 3 years of case histories]

The Burn Unit of Dona Estefânia Hospital admitted a total of 454 patients from January 1992 to January 1995, 24 of these patients suffered from electric shock. Of these 24 patients 3 suffered burns in the mouth, 15 in one or both hands and 6 multiple burns. In 19 patients the burns were up to 1%. A description is made of 5 cases, male children between the ages of 9 and 13 years, which were deemed severe. The incidents occurred outdoors with different voltages and in activities considered of ludic or experimental nature: two on the roof of a house, two with railway cables and one with an electrical cable in a port zone. The burnt areas vary between 4% and 70%, all of them 2nd and 3rd degree, with hospitalization lasting from 36 to 116 days. In addition to early and coordinated medical and rehabilitative treatment, according to individual needs, a description is also made of the cutaneous sequelae (deforming cicatrices, bridles), neurologic and psychologic sequelae, with emphasis on a patient who underwent amputation of the lower left leg and 4th and 5th ranges of the right foot. It was concluded that measures should be taken in education and legislation to prevent these accidents. Relevance is given to the need for a multidisciplinary team and specialized center for the treatment of these patients.

Renal transplant experience at king fahad national guard hospital

Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.

Inhibition of dras2/rop expression in Xenopus oocytes by Drosophila nuclear extract

Chloramphenicol acetyl transferase reporter plasmids driven by the Drosophila ras2/rop promoter were injected into Xenopus oocytes to study Dras2 and rop gene regulation by their bidirectional promoter. When injected without Drosophila nuclear extract, both Dras2 and rep were highly expressed. Dras2 and rop-CAT expression was very similar in Drosophila cells and Xenopus oocytes, suggesting the conservation of regulatory factors between the two species. When Drosophila nuclear extract was co-injected with Dras2 and rep promoter-CAT constructs, expression was inhibited. Inhibition decreased with elevation of plasmid concentration and was increased with an increase in nuclear extract concentration. Since specific DNA-protein interactions were diminished by the combination of oocyte and Drosophila nuclear extracts in gel retardation assays, a sequestering-type mechanism of repression has been proposed.

Stroke and pregnancy

OBJECTIVE

To study the controversial relationship between pregnancy and stroke. Old studies and those from developing countries suggest that pregnancy considerably increases the risk of stroke.

METHODS

The records of 946 consecutive cases of stroke observed in Saudi patients in 10 years were reviewed. Cases which occurred during pregnancy or during the first 15 days postpartum were included in the study.

RESULTS

Twelve patients (1.3%) were pregnant or in postpartum at stroke onset. They constituted 27% of women of childbearing age. Cerebral infarction was diagnosed in nine cases and cerebral hemorrhage in three. Four patients died.

CONCLUSION

The risk of stroke is only marginally increased (x 1.5) in pregnant compared with non-pregnant Saudi women. Many factors including peripartum cardiomyopathy, patent foramen ovale, changes in clotting factors, peripartum angiopathy and vasoactive steroid hormones, could be responsible for this increased risk.

Interferon-alpha facilitates renal transplantation in hemodialysis patients with chronic viral hepatitis

Interferon-alpha has not been used previously in hemodialysis patients with chronic hepatitis B and C. This uncontrolled report evaluates the biochemical and/or histologic profile resulting from the administration of interferon-alpha in seven hemodialysis patients, two with chronic hepatitis B and five with hepatitis C. Biochemical improvement was noted in all patients. Histologic progression did not occur in the two cases in which such assessment was made, and five of them were subsequently transplanted without recurrence of disease.

[Children and lead exposure. Preliminary study]

Lead poisoning is one of the most common and preventable childhood illness. The authors believe that the present study is the first evaluation of this problem in Portugal.

OBJECTIVES

a) to characterize blood lead levels in children aged 1 to 6 years living in the Oporto area; b) to identify risk groups and develop screening strategies.

MATERIAL AND METHODS

The authors studied an opportunistic sample of children that were observed at the Hospital Maria Pia and the Instituto Nacional de Saúde Dr. Ricardo Jorge (Porto) to whom blood testing was requested. All children with neurological or digestive symptoms were excluded (October-December 1991; n = 113).

RESULTS

One child had a blood lead level of 46.6 micrograms/dl (class-IV, CDC); 32% (n = 36) were between 20 e 44 micrograms/dl (class-III), while only four children (3.2%) presented values < = 9 micrograms/dl (class-I). Class II included the remainder (n = 73). The results clearly point out that lead poisoning is a real problem among Portuguese children, since the proportion of children not considered to be lead-poisoned is very small. Children in the other classes are at risk of developing acute and chronic toxicity.

Spontaneous rupture of renal allograft

Spontaneous rupture of a renal allograft was encountered in 3 male patients among 75 consecutive renal transplants over a three-year period. In 1 patient, the transplant was from a living related donor, while the other two were cadaveric kidneys from pediatric donors. In 2 patients, allograft rupture followed steroid-resistant rejection, while in the third with cadaveric kidney transplant, the rupture was associated with renal vein thrombosis. Two patients presented with classic symptoms of renal allograft rupture: sudden onset of severe pain and swelling over the allograft and hypotension, while in the third the rupture was found during exploration of the allograft with clinical diagnosis of renal artery thrombosis. Transplant nephrectomy was done in 2 patients, while successful surgical repair was performed in the third patient with living related transplant.

Conserved cis-elements bind a protein complex that regulates Drosophila ras2/rop bidirectional expression

The Drosophila ras2 promoter region exhibits bidirectional activity, as has been demonstrated for the human c-Ha-ras1 and the mouse c-Ki-ras. Here we address a unique case of ras regulation, as Drosophila ras2 provides the only example to date in which the flanking gene (rop) and its product have been isolated. A linking mechanism of control suggests a mutual interaction between the two gene products. Our studies indicate that the Drosophila ras2 promoter region shares with the human c-Ha-ras1 promoter a CACCC box and an AP-1-like sequence. A 14 bp promoter fragment which holds a CACCC element is demonstrated to interact with a specific transcription factor (factor B). This CACCC promoter element represents a stretch of imperfect palindrome. We present evidence that this factor can form a complex with another specific DNA-binding protein (factor A). The binding sites (A + B) for these protein factors are essential for 95% expression of both genes flanking the promoter (ras2 and rop). Region A consists of four overlapping consensus sequences: a TATA-like element, a DSE-like motif (the core sequence of the serum response element), a DRE octamer, which has been shown to play a role in cell proliferation, and a 5 bp direct repeat representing the GATA consensus sequence. Factor A has a very weak affinity to the full promoter region, but when complexed with factor B binding efficiency is enhanced. We also show that alterations of DNA-protein binding specificities can be achieved by supplementing the growth media with different sera.

Aetiology of acute diarrhoea in hospitalized children in Rio de Janeiro City, Brazil

Enteropathogens were investigated in 406 children aged 0-3 years with diarrhoea attending the Salles Neto Municipal Hospital. Enteric bacterial pathogens were isolated from 49 per cent of the children. Enterotoxigenic Escherichia coli (ETEC) (20.9 per cent), enteropathogenic E. coli (EPEC) (16.5 per cent), rotavirus (11.6 per cent), and Campylobacter (9.9 per cent) were the most common agents. Among clinical features, vomiting and fever were significantly associated with Rotavirus isolation (50.0 per cent), respiratory infection with Adenovirus (14.3 per cent), bloody diarrhoea with Campylobacter (12.5 per cent), and dehydration with EPEC (71.6 per cent).

[Living with an ostomy: a preliminary study]

This study reveals some aspects of ostomy patients life experience. The data were obtained by using the participant observation technique during the monthly meeting session of the Ostomy Patients Association from July 1989 to August 1991. The findings showed that the ostomized patients were concerned with: 1) the ostomy pouch (how to get it); 2) other persons opinion about ostomized patients; 3) their sexuality, and stoma care. The patients perceived themselves as physically disable and inferior persons. Some of them perceived themselves as having a normal life. Other patients also had to cope with the stigma of cancer.

[The quality of life of individuals with chronic cardiovascular diseases and diabetes mellitus]

The purpose of this study was to verify the chronically ill patient's quality of life. The study conceptual framework was deryged from the quality of life conceptualization according to Wenger et al. (1984). In this framework the main components of quality of life were viewed as a functional capacity, perception and symptoms. The study sample consisted of 94 chronically ill patients. Of these, 35 were in and outpatients with cardiovascular diseases (GROUP I), 29 patients were on a special rehabilitation program for cardiovascular patients (GROUP II), and 30 were diabetic patients (GROUP III). The McMaster Health Index questionnaire developed by Chambers (1984) was used for data collection. The findings revealed that patients of the GROUP II showed better quality of life than the patients of GROUP I and GROUP III in relation to the physical function, health perception, and life satisfaction.

Blood pressure, ventilation and lipid imbalance during hemodialysis: effect of dialysate composition

Regular hemodialysis with either acetate or bicarbonate dialysate can be associated with the development of hypotension and hypoxemia. Hypotension, which is more commonly observed during acetate dialysis, is usually the result of unfavorable alterations in the cardiac output, the peripheral vascular resistance, or both. Complement-mediated leukocyte embolization and hypoventilation represent the major causes of hypoxemia. No consistent long-term effects on lipid balance have been observed with either dialysate.