Novel monoclonal antibodies to cyclosporine A: Characterization and epitope mapping with cyclosporine analogs and cyclophilin

Monoclonal antibodies to cyclosporine A (Cs), a potent immunosuppressant, were generated in BALB/c mice using a novel antigen prepared by linking Cs to a protein carrier via a photoactive cross-linking reagent, 4-benzoylbenzoic acid (BBa). Twenty-two monoclonal anti-Cs antibodies were generated, using Cs-BBa-bovine serum albumin (Cs-BBa-BSA) as the immunogen. They were characterized with respect to affinity by Scatchard analysis of a radioimmunoassay (RIA), and with respect to specificity by an ELISA in which a series of singly substituted Cs derivatives were examined as inhibitors. McAb affinities ranged from 5 x 10(-8) M to 2 x 10(-10) M. Based on ELISA inhibition data with Cs analogs, and on the binding to two Cs-BSA conjugates in which opposite sides of the Cs molecule are exposed, the antibodies fell into five epitope recognition groups. Binding to Cs was also studied by ELISA in competition with cyclophilin (CyP), a Cs-binding protein whose epitope specificity has been well characterized. Competition by CyP was found to correlate with antibody specificity, not with affinity, i.e. CyP competed best with antibodies having specificities most similar to that of CyP. Epitope mapping can, therefore, be accomplished in a system in which two different species of binding proteins compete for the same antigen. This type of characterization may be useful in identifying antibodies whose combining sites mimic those of a receptor.

A large waterborne viral hepatitis E epidemic in Kanpur, India

In 1991 the largest epidemic of viral hepatitis E yet reported occurred in Kanpur (population, 2.1 million), India. The incidence of icteric hepatitis from December 1990 to April 1991 among the inhabitants of 420 randomly sampled houses in seven of the city's 50 wards was 3.76% (138 out of 3666 individuals), i.e., an estimated 79,091 persons in the city as a whole were affected. The attack rate was higher for males than females (5.3% versus 3.3%; P = 0.013) and for adults than children aged < 10 years (4.26% versus 1.29%; P = 0.0006). The incidence of hepatitis was higher in those city wards that were supplied with drinking-water consisting of a mixture of river Ganges and tubewell water than in those wards supplied only with tubewell water (5.6% versus 1.2%; P = 10(-6)). In the mixed-water areas, the incidence decreased as the drinking-water source changed from only tap to both tap and handpump, to only handpump (7.8%, 6.8%, and 4.3% respectively; P = 0.023). None of the sera collected from 41 hepatitis patients during the epidemic showed evidence of hepatitis virus A or B. There were two peaks in the epidemic (in February and April 1991). The first peak was probably caused by faecal contamination of river water, indicated by water analysis data, and the second, by inadequate chlorination of water in a reservoir. There was no evidence of secondary intrafamilial spread.

Hepatitis E virus genome in stools of hepatitis patients during large epidemic in north India

Stool samples from patients affected during a large epidemic of hepatitis in north India were examined for the presence of hepatitis E virus (HEV) genome by means of reverse transcription-polymerase chain reaction. 6 of 10 samples studied were positive for the HEV genome, which suggest that HEV caused this large epidemic.

An appraisal of the quality and presentation of scientific papers at the 31st annual conference of the Indian Society of Gastroenterology

To assess the quality of papers presented at the annual conference of the Indial Society of Gastroenterology, a proforma was completed by selected assessors regarding the time taken to present the paper, the quality of the paper and other aspects of presentation. Forty-six papers were evaluated; fifteen of 38 (39%) papers took more than the prescribed time of 8 minutes; 10% were rated unsatisfactory in quality. The quality and content of slides were rated as unsatisfactory in 17% and 7% respectively. The quality and relevance of the questions asked from the floor were graded as unsatisfactory in 20% and 14% respectively. Of the responses from authors to these questions, 33% were graded as unsatisfactory. In all, 28 (61%) of 46 papers assessed were unsatisfactory on one or more counts. Thus, efforts are needed to improve the quality of papers presented and of their presentation.

Effect of preload and heart rate manipulation on Doppler transmitral flow velocity pattern: search for load--independent parameters

Pulsed Doppler transmitral flow-velocity provides a non-invasive method for serial evaluation of diastolic function. However confounding influence of loading conditions and heart rate on transmitral flow makes many conclusions suspect. To study the effect of preload, various parameters of Doppler mitral spectrum were studied in 11 patients with stable effort angina, angiographic coronary artery disease and intact global and segmental systolic function, before and after administration of sublingual isosorbide dinitrate (group 1). Following isosorbide dinitrate administration, there was a significant increase in heart rate (p less than 0.001), decrease in left ventricular end-diastolic volume (p less than 0.01), no change in left ventricular ejection fraction and systolic blood pressure. Peak E velocity, E velocity-time integral, E/A velocity time integrals ratio, acceleration and deceleration rates and diastolic filling period were significantly reduced whereas peak A velocity, A velocity time integral, acceleration and deceleration times and atrial filling period were unchanged. In 10 age-matched patients (group 2), atrial pacing performed to achieve similar degree of increase in heart rate as in group 1 (10 +/- 1 vs 12. +/- 4, p = NS), resulted in a decrease in E velocity time integral, E/A velocity time integrals ratio and diastolic filling period (p less than 0.01) without any significant change in any other parameter. Absolute A velocity time integral, acceleration and deceleration times are the only parameters of transmitral diastolic flow-velocity profile which are relatively independent of preload and heart rate provided the change is small.

Successful treatment of Prototheca peritonitis complicating continuous ambulatory peritoneal dialysis

We describe the second reported case of peritonitis caused by the alga Prototheca wickerhamii in a patient on continuous ambulatory peritoneal dialysis (CAPD). This organism, which grows slowly on agar media, is recognised as a race cause of other infections. The condition is clinically similar to cases of fungal peritonitis, but there are important differences, particularly when choosing the best treatment.

Radiation-induced proctosigmoiditis. Prospective, randomized, double-blind controlled trial of oral sulfasalazine plus rectal steroids versus rectal sucralfate

In a prospective study, 37 consecutive patients with radiation-induced proctosigmoiditis were randomized to receive a four-week course of either 3.0 g oral sulfasalazine plus 20 mg twice daily rectal prednisolone enemas (group I, N = 18) or 2.0 g twice daily rectal sucralfate enemas plus oral placebo (group II, N = 19). The two groups were comparable with respect to demographic features, duration of symptoms, and clinical and endoscopic staging of the disease. Fifteen patients in group I and 17 in group II completed the trial. At four weeks, both groups showed significant clinical improvement (P less than 0.01 for group I and P less than 0.001 for group II) and endoscopic healing (P less than 0.01 for group I and P less than 0.001 for group II). When the two groups were compared, sucralfate enemas showed a significantly better response as assessed clinically (P less than 0.05), although endoscopically the response was not statistically different (P greater than 0.05). We conclude that both treatment regimens are effective in the management of radiation proctitis. Sucralfate enemas give a better clinical response, are tolerated better, and because of the lower cost should be the preferred mode of short-term treatment.

Controlled trial of twice a day versus once a day cimetidine therapy for duodenal ulcer

A randomized controlled trial was carried out to compare the efficacy of conventional 400 mg twice daily dose of cimetidine with single bedtime 800 mg dose, in 40 patients with endoscopically proven duodenal ulcer. At repeat endoscopy after four weeks of therapy, complete ulcer healing was achieved in 78% of patients on twice daily dosage and 79% of patients on single daily dosage. A more convenient single nocturnal dosage of cimetidine is as effective in the treatment of duodenal ulcer as a twice daily dosage in the Indian population.

Management of foreign bodies in the upper gastrointestinal tract

Records of 55 consecutive patients who had ingested foreign bodies were reviewed retrospectively. Foreign bodies were located in the esophagus, stomach and duodenum in 25, 27 and 3 patients respectively. Eleven of these passed through the entire gastrointestinal tract spontaneously and uneventfully. Endoscopic extraction was successful in 36 patients while 8 needed surgical removal of the ingested object. Only one death was encountered. We conclude that using simple guidelines, foreign body ingestion can be managed with a low incidence of complications and mortality.

Sucralfate enema in ulcerative rectosigmoid lesions

To assess the efficacy of sucralfate enemas in distal colonic ulcerative lesions, 22 patients with radiation proctitis (n = 8), idiopathic ulcerative proctitis (n = 5), and solitary rectal ulcer (n = 5) unresponsive to conventional medical therapy, and those with ulcerated and bleeding rectal polyps awaiting polypectomy (n = 4) were studied. Enemas of sucralfate suspension (2 gm in 20 ml water) were administered twice daily for a period of three weeks. Clinical and sigmoidoscopic improvements were observed in 19 and 18 of the 22 patients, respectively (86 and 82 percent, respectively). No side effects were seen. The authors conclude that sucralfate enemas are useful in the treatment of ulcerative lesions of the rectosigmoid.

Clinical experience with low profile fixed wire balloon catheter system for percutaneous transluminal coronary angioplasty

Clinical records of the first 45 consecutive patients (66 lesions) in whom the Probe TM a balloon on the wire, was used for percutaneous transluminal coronary angioplasty have been reviewed. The aim of this analysis was to establish the efficacy and safety of this device. Majority of the lesions taken up were considered severe and difficult to cross. The probe was the 1st catheter used in 51 lesions (77%) and in 15 lesions (23%) it was used after other balloon catheters. In 88% (58/66) of lesions treated the Probe reduced the stenosis to less than 50% of the luminal diameter. Of the 45 patients treated 39 (87%) had a successful result. Of the 19 patients with multiple lesions 74% (14/19) had complete revascularisation and in 16% (3/29) had the most significant vessel dilated. Two patients (3%) required urgent coronary artery bypass surgery for acute occlusions. There was no hospital death. Of 50 probe devices used 5 (10%) malfunctioned: the balloon ruptured (at 5 Bars pressure) in 2 instances, balloon twisted causing "Volvulous" in 1 and balloon failed to deflate in 2 cases. The probe has significant advantages over other balloon systems for treating severe coronary lesions because of its low profile. It is however a delicate catheter system and prone to malfunction if not handled with care. Our results show that it is an excellent system for opening difficult and tight coronary lesions.

Antenatal diagnosis of partial agenesis of the corpus callosum: a benign cause of ventriculomegaly

Dilation of the posterior horns of the cerebral ventricles may be an early finding of fetal hydrocephalus, but it is also the hallmark of partial agenesis of the corpus callosum. Reported is the first precise prenatal diagnosis of posterior agenesis of the corpus callosum. Accurate diagnosis allows for appropriate obstetric management.

Exporting labor: the impact of expatriate workers on the home country

The economic impact of emigration on the source country is analyzed through a literature review and a discussion of costs, benefits, and public policy implications. It is noted that "information collected from different sources and settings is needed for cross-validation of assessments and conclusions. Second....the cost/benefit analysis of emigration should be undertaken on a case by case basis. Third...these costs and benefits must be assessed in a long-term framework that considers the socio-economic conditions and the goals of the country....Fourth, effective governmental policies...need to recognize that emigrants generally are highly motivated people [who] are adept at overcoming legal or other obstacles in their path." (SUMMARY IN FRE AND SPA)

Synthesis of two-party error-recoverable protocols

We have developed a correct, general, and efficient procedure of synthesizing two-party error-recoverable protocols for noisy channels where messages could be lost, corrupted, and/or missequenced. The state explosion problem has been tackled by synthesizing the error-recoverable protocol (ERP) from its noiseless local entity model using certain rules. This reduction arises from the approaches of local modeling and elaboration. We expect that these two approaches will also play a major role in tackling the complexity problems in designing multi-party protocols. Measures of efficiency and functionality improvements have been discussed.