[The development of German social medicine in the nineteenth century]

In his influential treatise System einer vollständigen medizinischen Polizey, Johann Peter Frank (1745-1821) made significant contributions to the establishment of the concept of medical police, which has been understood as the forerunner of social medicine. Cameralism, the German version of mercantilism, became the very basis on which Frank and other German writers developed the framework of medical police. 'Medical reform' was the catchword of German medical men in the 1840s. The medical reform movement of 1848 was partially caused by a deep political, economic, and social crisis. Although Industrial Revolution began in Germany later than in England and France during the first half of the nineteenth century, by 1848 the formation of German industrial working-class made medical reformers recognize the causal relationships between social and health problems. The outstanding figures in the German medical reform movement of this period were Rudolf Virchow (1821-1902), Solomon Neumann and Rudolf Leubuscher. In his famous Report on the Typhus Epidemic in Upper Silesia, Virchow proposed several radical measures that could be used against the epidemic: the absolute separation of the schools from the church, the establishment of self-government in the state and community, unlimited democracy, road building, and the improvement of agriculture and horticulture. ...

The detection of the c-myc and ras oncogenes in nasopharyngeal carcinoma by immunohistochemistry

Forty-one paraffin embedded specimens of primary nasopharyngeal carcinoma (NPC) were examined to investigate the expression of c-myc and ras oncogenes. Sections were stained with the monoclonal antibodies myc 1-9E10 or ras Y13-259 and binding was detected using the ABC method. The intensity of staining for each tumour was assessed as nil, moderate or intense. The results indicated that 9 (22%) had intense staining for the c-myc oncogene, 28 (68%) had moderate staining and only 4 (10%) showed no staining. For the ras oncogene, 8 (19%) had intense staining, 22 (54%) moderate staining and 11 (27%) showed no staining. The patient's clinical data indicated no correlation between the expression of either c-myc or ras p21 and age, sex, smoking, tumour stage, antibody titre to EBV, or family history. No correlation was found between ras p21 expression and survival; however, overexpression of the c-myc oncogene correlated with a poor prognosis (p < 0.05). This study is consistent with investigations demonstrating that c-myc expression correlates with poor survival in head and neck tumours.

[A comparative analysis of two historical approaches to the formation of the modern clinical medicine]

From the perspective of research methodology, it may be said to exist two kinds of different historical approaches with regards to the formation of modern clinical medicine at the turn of the nineteenth century. One is to explain this in terms of the agency or structure that is associated with research topic. This historical view assumes that the Western scientific rationalism is characterized by the unity of Western tradition and its evolution as continuity. Its main focus is given either on how French revolution and war affected the growth of clinical medicine and the hospital reform movement or on how Paris Clinical School contributed to the birth of modern clinical medicine. The other is, according to Michel Foucault, to analyze how medical discourses are related to social (institutional) practices. Following Canguilhem's history of concepts, Foucault traces the historical development of the concept of disease. Elizabeth A Williams, another proponent of this method, conceptualizes the eighteenth-century medicine as three different medical discourses--anthropology, physiology and philosophical medicine, and analyzes how their structural fragmentation were transformed into the modern establishment of clinical medicine in the nineteenth century. ...

Superinfection-induced apoptosis and its correlation with the reduction of viral progeny in cells persistently infected with Hz-1 baculovirus

Differential induction of necrosis or apoptosis was found upon challenge of cells of the insect Spodoptera frugiperda productively or persistently infected with Hz-1 baculovirus, respectively. Unlike parental SF9 cells, which were essentially all killed by virally induced necrosis, persistently infected cells underwent a process of massive cell death by apoptosis; cells which were not killed by apoptosis then reestablished a cell monolayer. Upon viral challenge, the yield of viral progeny was reduced greatly in persistently virus-infected cells but not in parental cells. Immunolabelling of individual cells revealed that upon viral challenge, production of viral progeny was detectable only in necrotic cells and not in apoptotic cells. These results indicated that induction of apoptosis greatly reduces the yield of viral progeny in cells persistently infected with Hz-1 baculovirus. This is the first report of apoptosis induction in persistently infected cells upon viral superinfection.

Susceptibility of intra-abdominal isolates at operation: a predictor of postoperative infection

Antimicrobial resistance of operative site flora was correlated with postoperative infection in 175 patients undergoing operation for intra-abdominal sepsis: Diagnoses for study patients were acute or gangrenous appendicitis in 48 (27%), complicated appendicitis in 98 (56%), perforated viscus other than appendix in 21 (12%), and eight (5%) had other intra-abdominal infections. One hundred thirty-six (78%) patients were males. The average age was 33 +/- 14 years, average number of hospital days was 11.6 +/- 13.5, and average number of days on antibiotics was 6.9 +/- 2.5. Overall recovery without infection was 75 per cent (131/175). Analysis of susceptibility of 939 intraoperative isolates indicated a significant relationship (P = 0.0002) between resistance to the empiric antimicrobials received and postoperative infection. Of 131 patients with resolution of the intra-abdominal infection, 57 (44%) had resistant isolates while 36 (82%) of 44 patients with postoperative infectious complications had resistant isolates. Streptococcus Group D, Escherichia coli, and Bacteroides fragilis were the most prevalent resistant organisms isolated from both intra- and postoperative cultures. Other variables that were significantly different between those without complications and those who had complications were, respectively: average age 31 versus 38; admission WBC 14.5 versus 16.7; and diagnosis, acute appendicitis 28 per cent versus 2 per cent. A stepwise logistic regression analysis confirmed the predictive value of intraoperative isolate resistance, age, and admission WBC, in that order, on outcome.

Nasopharyngeal carcinoma: genetic changes, Epstein-Barr virus infection, or both. A clinical and molecular study of 36 patients

BACKGROUND

The pathogenesis of nasopharyngeal carcinoma has been under intense investigation, especially of its peculiar predominance in southern China. The authors previously reported consistent loss of genetic material on the short arm of chromosome 3 in a few nasopharyngeal carcinoma cases. In this study, the authors examined the genetic changes as well as the presence of Epstein-Barr virus (EBV) genome on 36 nasopharyngeal carcinoma primary biopsy specimens of the undifferentiated type and the correlation of the findings to patients' clinical status.

METHODS

The authors examined the DNA from tumor tissue and from matched blood leukocytes of 36 patients who suffered from nasopharyngeal carcinoma by the restriction fragment length polymorphism analysis. The genotyping for EBV was carried out by polymerase chain reaction using primers complementary to both types of EBV and probes specific to EBNA-2A (EBV-A) or EBNA-2B (EBV-B).

RESULTS

A consistent deletion at two specific locus of the short arm of chromosome 3 was observed in all informative cases. The authors also found that EBV genome, especially type A, was present in 35 of 36 cases. In the remaining one case, EBV-B was detected.

CONCLUSIONS

As the same tumor tissue was used for both genetic and viral studies in each case, the results may represent sequential genetic lesions in the pathogenesis and/or summation of genetic events. Moreover, 7 of 32 informative tumors were from patients of early staging (Stages I and II), which suggests the genetic changes may occur in the early development of nasopharyngeal carcinoma. Difference in allele frequency in specific locus was also noted between Asian and white patients for the first time.

A quantitative study of the interphasic nucleolar organizer regions in two human cervical carcinoma cell lines

We have studied the relationship between interphase nucleolar organizer regions (NORs) distribution and nucleolar size in cancer cells under prolonged culture. Six morphometric parameters (NUCLEAR SIZE, NOR NUMB, AREA SUM, MEAN AREA, SIZE RATIO and SIZE RATIO MEAN) of AgNORs in cancer cells were analyzed by an image analyzing system. The results show that the parameters NORN NUMB, AREA SUM and NUCLEAR SIZE demonstrate the most consistent changes in the two cervical carcinoma cell lines studied. These three parameters of AgNORs appear to be correlated with the degree of "dedifferentiation" that occurred in tumor cells under prolonged culture.

Altered expression of cell adhesion molecules in uninvolved gut in inflammatory bowel disease

Adhesion of circulating cells to vascular endothelium occurs in the early phase of inflammation, and is mediated by specific cell adhesion molecules. Many such adhesion molecules are increased in inflamed regions of ulcerative colitis (UC) and Crohn's disease (CD) but there is limited knowledge of their expression in the uninvolved gut, adjacent to inflammation. We investigated immunohistochemically the expression of platelet endothelial cell adhesion molecule-1 (PECAM-1), intercellular adhesion molecule-1 (ICAM-1) and lymphocyte function-associated antigen-1 (LFA-1) on resected specimens taken at a distance of 2-4 cm from the inflamed area and without histological signs of inflammation. Compared with normal gut, we found (i) a significant increase of PECAM-1-positive vessels in the mucosa of uninvolved UC (149.0 +/- 24.1 vessels/mm2 (mean +/- s.d.); normal colon = 123.1 +/- 21.6; P = 0.004); (ii) a significant decrease of ICAM-1-positive vessels in uninvolved CD (111.9 +/- 22.6 vessels/mm2; normal ileum = 136.9 +/- 27.6; P = 0.04); and (iii) a moderate but statistically insignificant increase of LFA-1-positive cells in the mucosa of uninvolved UC and Crohn's ileitis. This altered expression of cell adhesion molecules may contribute to the early lesion in inflammatory bowel disease and provide new therapeutic opportunities.

The growth and behaviour of pig retinal pigment epithelial cells in culture

The retinal pigment epithelium contains melanin and lipofuscin. It is believed that in the in vivo system, the incomplete degradation of phagocytosed outer segment discs leads to the formation of lipofuscin. Our results showed that pig RPE cells can be successfully cultured using standard culture techniques without addition of specific growth factors. In this system, the autofluorescent material is formed mainly from the degradation of pigment granules. This culture system may provide an excellent model for studying of diseases related to the retina.

Energetics of intersubunit and intrasubunit interactions of Escherichia coli adenosine cyclic 3',5'-phosphate receptor protein

Escherichia coli cAMP receptor protein (CRP) regulates the expression of a large number of catabolite-sensitive genes. The mechanism of CRP regulation most likely involves communication between subunits and domains. A specific message, such as the activation of CRP, may be manifested as a change in the interactions between these structural entities. Hence, the elucidation of the regulatory mechanism would require a quantitative evaluation of the energetics involved in these interactions. Thus, a study was initiated to define the conditions for reversible denaturation of CRP and to quantitatively assess the energetics involved in the intra- and intersubunit interactions in CRP. The denaturation of CRP was induced by guanidine hydrochloride. The equilibrium unfolding reaction of CRP was monitored by three spectroscopic techniques, namely, fluorescence intensity, fluorescence anisotropy, and circular dichroism. The spectroscopic data implied that CRP unfolds in a single cooperative transition. Sedimentation equilibrium data showed that CRP is dissociated into its monomeric state in high concentrations of denaturant. Unfolding of CRP is completely reversible, as indicated by fluorescence and circular dichroism measurements, and sedimentation data indicated that a dimeric structure of CRP was recovered. The functional and other structural properties of renatured and native CRP have also been examined. Quantitatively identical results were obtained. Results from additional studies as a function of protein concentration and from computer simulation demonstrated that the denaturation of CRP induced by guanidine hydrochloride proceeds according to the following pathway: (CRP2)Native<-->2(CRP)Native<-->2(CRP)Denatured. The delta G values for dissociation (delta Gd) and unfolding (delta G(u)) in the absence of guanidine hydrochloride were determined by linear extrapolation, yielding values of 12.0 +/- 0.6 and 7.2 +/- 0.1 kcal/mol, respectively. To examine the effect of the DNA binding domain on the stability of the cAMP binding domain, two proteolytically resistant cAMP binding cores were prepared from CRP in the presence of cAMP by subtilisin and chymotrypsin digestion, yielding S-CRP and CH-CRP, respectively. Results from an equilibrium denaturation study indicated that the denaturation of both CH-CRP and S-CRP is also completely reversible. Both S-CRP and CH-CRP exist as stable dimers with similar delta Gd values of 10.1 +/- 0.4 and 9.5 +/- 0.4 kcal/mol, respectively. Results from this study in conjunction with crystallographic data [McKay, D. B., Weber, I. T., & Stietz, T. A. (1982) J. Biol. Chem. 257, 9518-9524] indicate that the DNA binding domain and the C-helix are not the only structural elements that are responsible for subunit dimerization.(ABSTRACT TRUNCATED AT 400 WORDS)

CAP interacts with RNA polymerase in solution in the absence of promoter DNA

Protein-protein interactions between transcription activator proteins and RNA polymerase or basal transcription factors have been suggested to be important for transcription activation. Interactions between catabolite gene activator protein (CAP) and RNA polymerase have been proposed based on face-of-helix-dependent transcription activation by CAP and based on face-of-helix-dependent cooperative binding of CAP and RNA polymerase to promoter DNA. Mutants of CAP specifically defective in transcription activation have been isolated (mutants defective in transcription activation, but not defective in DNA binding and DNA bending). All such mutants contain amino-acid substitutions within a surface loop consisting of amino acids 152 to 166 of CAP. Here we use the thermodynamically rigorous technique of fluorescence polarization to show that CAP interacts with RNA polymerase in solution in the absence of promoter DNA (KD,app = 2.8 x 10(-7) M), whereas [Ala158]CAP, a mutant of CAP specifically defective in transcription activation, does not.

Effects of in vitro and in vivo growth conditions on expression of type 8 capsular polysaccharide by Staphylococcus aureus

Type 8 capsular polysaccharide (CP8) is widely prevalent among clinical isolates of Staphylococcus aureus, but the role that the capsule plays in the pathogenesis of staphylococcal infections is unclear. This study was performed to identify growth conditions that would optimize the production of CP8 and to determine whether enhanced CP8 expression would influence staphylococcal virulence. S. aureus Becker grown in a chemically defined broth medium with < 1 microM ferric nitrate produced up to eightfold more CP8 per milligram of biomass than did bacteria cultivated in the same medium containing 20 microM ferric nitrate. The bacteria produced > 350-fold more cell-associated CP8 per milligram of biomass when grown on the surface of Columbia agar than when grown in Columbia broth. Most of the CP8 produced by broth-grown cells was secreted into the culture medium. S. aureus cultivated on the surface of nitrocellulose membranes floating on Columbia broth produced levels of CP8 similar to those produced by cells grown on Columbia agar. Similarly, bacteria harvested from endocardial vegetations of rabbits infected with S. aureus produced high levels of CP8. These results indicate that staphylococci grown on surfaces, both in vitro and in vivo, produce larger quantities of cell-associated CP8 than those grown in liquid cultures. However, no differences were observed in the 50% lethal dose for mice of strain Becker grown on solid medium (high levels of capsule expression) or in liquid medium (low levels of capsule expression).

Effects of pyridinyl imidazole compounds on murine TNF-alpha production

The effects of SK&F 86002 and other pyridinyl imidazole compounds on murine cytokine production were investigated. In vitro, SK&F 86002 inhibited LPS stimulated TNF-alpha production by the RAW 264.7 cell line and by oil elicited peritoneal macrophages with an IC50 of 5 microM. In general, the activity was reflective of previous results obtained with human monocytes as SK&F 86002 and its analogs demonstrated identical rank order potency for TNF-alpha inhibition in both species. These compounds also inhibited TNF-alpha in vivo in a murine model of endotoxin shock. Following oral administration, SK&F 86002 and its analogs reduced serum TNF-alpha levels by > 80% and afforded 100% protection from lethality. In contrast, tenidap, a novel anti-inflammatory drug, had minimal to no effect on murine TNF-alpha production in the same assays. These data further extend the pharmacological profile of the pyridinyl imidazoles by demonstrating that these compounds potently inhibit murine TNF-alpha production both in vitro and in vivo.

Effect of protein kinase inhibitors on IL-8/NAP-1 release from human umbilical vein endothelial cells

Several protein kinase inhibitors (PKIs) were investigated for their effects on IL-1 beta, TNF alpha and PMA-induced IL-8 production from human umbilical vein endothelial cells (HUVEC). IL-1 beta (ED50 0.07 ng/ml), TNF alpha (ED50 100 ng/ml) and PMA (ED50 20 ng/ml) induced IL-8 production that could be detected as early as 2 h following stimulation. Staurosporine, a potent but non-specific inhibitor of protein kinases, inhibited PMA-induced (IC50 2 nM) but not IL-1 beta or TNF alpha (IC50 > 200 nM) induced IL-8 production. Neither the cAMP-dependent PKI, KT5720, nor the tyrosine PKIs, genistein, tyrphostin (1-100 microM) or lavendustin A (0.0001-1 microM), inhibited IL-8 production elicited by IL-1 beta. However, the macrolide protein kinase inhibitor geldanamycin (IC50 = 30 nM), but not the closely related analog herbimycin A (5-500 nM), inhibited IL-8 production by 60%. Northern blot analysis of IL-8 mRNA revealed that staurosporine suppressed mRNA increase following stimulation by PMA but not by IL-1. It is proposed that a novel protein kinase susceptible to geldanamycin inhibition may be involved in IL-1-mediated signal transduction.

Inhibition of interleukin-1 (IL-1) and tumor necrosis factor (TNF) production by pyridinyl imidazole compounds is independent of cAMP elevating mechanisms

Exposure of human monocytes (HM) to E. coli lipopolysaccharide (LPS) results in measurable production of both IL-1 beta and TNF alpha in culture supernatants. It has previously been reported that the elevation of cAMP levels in HM selectively suppresses the LPS-induced TNF alpha but not IL-1 beta production. In this study we investigated whether the novel anti-inflammatory drug, SK&F 86002 [5-4(-pyridyl)-6(4-fluorophenyl)-2,3-dihydroimidazole(2,1-b)thi azol] and related analogs of the pyridinyl imidazole class, inhibit IL-1 and TNF production via a cAMP-dependent mechanism. These compounds, when added together with LPS result in inhibition of IL-1 and TNF production with equal-rank-order potency. Although the pyridinyl imidazole compounds were found to be generally weak phosphodiesterase inhibitors, they did not affect cAMP levels in HM, alone or in the presence of LPS. In contrast, PGE2, which significantly elevated intracellular cAMP levels, inhibited TNF but not IL-1 production at the transcriptional level. Taken together, these results suggest that the pyridinyl imidazoles inhibit the production of IL-1 beta and TNF alpha through pathways independent of cAMP elevating mechanisms.

Papillary cystic tumor of the pancreas: a case indistinguishable from oncocytic carcinoma

A case of papillary cystic tumor (PCT) of the pancreas in a 55-year-old woman is described. She presented with a gradually enlarging and painless abdominal mass for > 26 years. The tumor was encapsulated and measured 16 x 12 x 10 cm. The gross features and conventional light microscopic appearance of this tumor were consistent with the previously reported cases of PCT. Perineural and capsular invasions were found. In addition to the densely packed blue granules in the cytoplasm demonstrated by phosphotungstic acid-hematoxylin stain, ultrastructural study revealed the tumor cells to be packed with numerous mitochondria. These oncocytes comprised almost all the non-necrotic tumor areas. Therefore, this case was indistinguishable pathologically from oncocytic carcinoma of the pancreas. DNA flow cytometry showed a diploid pattern and low S phase fraction, indicating that the tumor has a low proliferative activity and a favorable prognosis.

VLSI neuroprocessors for video motion detection

The system design of a locally connected competitive neural network for video motion detection is presented. The motion information from a sequence of image data can be determined through a two-dimensional multiprocessor array in which each processing element consists of an analog neuroprocessor. Massively parallel neurocomputing is done by compact and efficient neuroprocessors. Local data transfer between the neuroprocessors is performed by using an analog point-to-point interconnection scheme. To maintain strong signal strength over the whole system, global data communication between the host computer and neuroprocessors is carried out in a digital common bus. A mixed-signal very large scale integration (VLSI) neural chip that includes multiple neuroprocessors for fast video motion detection has been developed. Measured results of the programmable synapse, and winner-takes-all circuitry are presented. Based on the measurement data, system-level analysis on a sequence of real-world images was conducted.

Structure analysis of the 5' external transcribed spacer of the precursor ribosomal RNA from Saccharomyces cerevisiae

Full-length precursor ribosomal RNA molecules were produced in vitro using as a template, a plasmid containing the yeast 35 S pre-rRNA gene under the control of the phage T3 promoter. The higher-order structure of the 5'-external transcribed spacer (5' ETS) sequence in the 35S pre-rRNA molecule was studied using dimethylsulfate, 1-cyclohexyl-3-(2-morpholinoethyl)-carbodiimide metho-p-toluenesulfonate, RNase T1 and RNase V1 as structure-sensitive probes. Modified residues were detected by primer extension. Data produced were used to evaluate several theoretical structure models predicted by minimum free-energy calculations. A model for the entire 5'ETS region is proposed that accommodates 82% of the residues experimentally shown to be in either base-paired or single-stranded structure in the correct configuration. The model contains a high degree of secondary structure with ten stable hairpins of varying lengths and stabilities. The hairpins are composed of the Watson-Crick A.T and G.C pairs plus the non-canonical G.U pairs. Based on a comparative analysis of the 5' ETS sequence from Saccharomyces cerevisiae and Schizosaccharomyces pombe, most of the base-paired regions in the proposed model appear to be phylogenetically supported. The two sites previously shown to be crosslinked to U3 snRNA as well as the previously proposed recognition site for processing and one of the early processing site (based on sequence homology to the vertebrate ETS cleavage site) are located in single-stranded regions in the model. The present folding model for the 5' ETS in the 35 S pre-rRNA molecule should be useful in the investigations of the structure, function and processing of pre-rRNA.

Effect of a human immunodeficiency virus protease inhibitor on human monocyte function

Human immunodeficiency virus (HIV) is the cause of acquired immunodeficiency syndrome (AIDS). Encoded by the HIV genome are several precursor proteins that undergo proteolytic cleavage to yield functional proteins. The env precursor protein is cleaved by a cellular protease. The gag precursor protein of HIV (p55), however, is cleaved by a virally encoded aspartate protease (HIV Protease). Cleavage of p55 is required for viral maturation and infectivity. There are also several host cell aspartate proteases that serve important homeostatic functions. Cathepsins D and E are lysosomal aspartate proteases which are believed to play an important role in macrophage function, and it has been suggested that inhibition of these enzymes by an HIV protease inhibitor may exacerbate immunosuppression in AIDS patients. We have studied the effect of SK&F 107461 (a hydroxyethylene dipeptide isostere inhibitor of HIV protease), on various host defense functions of human monocytes. Pepstatin A (an inhibitor of most aspartate proteases) and leupeptin (an inhibitor of serine and cysteine proteases) were included as controls. Although less potent than the prototypic aspartate protease inhibitor pepstatin, SK&F 107461 inhibited partially purified cathepsin D in vitro. However, in cell-based assays, SK&F 107461 had no effect on the degradation of hemoglobin, antigen processing of the protein antigen streptokinase, or secretion of 17-kD IL-1 beta by monocytes at concentrations which inhibit maturation of intracellular virus in HIV infected monocytes. Furthermore, SK&F 107461 had no effect on constitutive candidacidal activity. In contrast, leupeptin and pepstatin A partially inhibited accessory cell function of monocytes in the proliferative response to the recall antigen streptokinase. In addition, leupeptin partially inhibited degradation of hemoglobin.(ABSTRACT TRUNCATED AT 250 WORDS)

Yeast 5S rRNA binding to ribosomal protein L1a alters the fluorescence of tryptophan residues lying outside the binding site

The yeast ribosomal protein L1a contains two tryptophan residues located at positions 95 and 183. Spectrofluorometric analysis showed that the average tryptophan environment is moderately polar. Quenching studies of the yeast 5S rRNA-L1a protein complex (RNP) with acrylamide and iodide revealed tryptophan heterogeneity. The two tryptophan residues are located in the non-RNA-binding region of the L1a molecule. However, dissociation of the yeast 5S rRNA-L1a protein RNP complex to its components resulted in a decline of tryptophan fluorescence. The observation implied that the environment of the tryptophan-containing L1a regions which were not known to be involved in RNA binding was influenced by association with the 5S rRNA molecule.

Analysis of peripheral blood lymphocyte subsets in normal Saudi males by flow cytometry

Lymphocyte immunophenotyping using flow cytometer has become an important tool for clinical patient management as well as for research and epidemiological studies. We examined the distribution of CD3 (all T cells), CD4 (T helper/inducer cells), CD8 (T suppressor/totoxic cells), CD16 (natural killer cells) and CD19 (B cells) in 150 healthy Saudi male blood donors using flows cytometry. The two-color labeled cells were analyzed by using the flow cytometer (FACScan, Becton-Dickinson, San Jose, California, USA) and the dual fluorescent subsets were discriminated by Simultest software. The distribution of T lymphocytes, B lymphocytes, and natural killer (NK) cells were similar to those reported in other populations as well as in normal Caucasian expatriate donors (all males) (n = 40) who were included in this study as controls. However, a significantly decreased CD4/CD8 ratio was observed in most Saudi blood donors. These lower ratios were due to decreased CD4 together with an increase in CD8 cells. Significant (P<0.00001) difference in CD4/CD8 ratio in our study may be due to environmental factors such as ultraviolet radiation and stress (heat) as well as some genetic factors.