Reversible cardio-pulmonary changes due to adeno-tonsilar hypertrophy

Adeno-tonsillar hypertrophy, with signs of upper airway obstruction is a common presentation in ENT clinics. Recently it is identified as a major cause of sleep apnea syndrome. Several isolated case reports of pulmonary hypertension and corpulmonale appeared in the literature. The authors report two such children aged less than 2 years with cardio-pulmonary changes occurring secondary to chronic adeno-tonsillar hypertrophy that were successfully treated with the surgical removal.

Sloppy paired acts as the downstream target of wingless in the Drosophila CNS and interaction between sloppy paired and gooseberry inhibits sloppy paired during neurogenesis

Wingless (Wg) and other Wnt proteins play a crucial role in a number of developmental decisions in a variety of organisms. In the ventral nerve cord of the Drosophila embryo, Wg is non-autonomously required for the formation and specification of a neuronal precursor cell, NB4-2. NB4-2 gives rise to a well-studied neuronal lineage, the RP2/sib lineage. While the various components of the Wg-signaling pathway are also required for generating NB4-2, the target gene(s) of this pathway in the signal-receiving cell is not known. In this paper, we show that sloppy paired 1 and sloppy paired 2 function as the downstream targets of the Wg signaling to generate the NB4-2 cell. Thus, while the loss-of-function mutations in wg and slp have the same NB4-2 formation and specification defects, these defects in wg mutants can be rescued by expressing slp genes from a heterologous promoter. That slp genes function downstream of the Wg signaling is also indicated by the result that expression of slp genes is lost from the neuroectoderm in wg mutants and that ectopic expression of wg induces ectopic expression of slp. Finally, previous results show that Gooseberry (Gsb) prevents Wg from specifying NB4-2 identity to the wg-expressing NB5-3. In this paper, we also show that gsb interacts with slp and prevents Slp from specifying NB4-2 identity. Overexpression of slp overcomes this antagonistic interaction and respecifies NB5-3 as NB4-2. This respecification, however, can be suppressed by a simultaneous overexpression of gsb at high levels. This mechanism appears to be responsible for specifying NB5-3 identity to a row 5 neuroblast and preventing Wg from specifying NB4-2 identity to that cell.

Safety and efficacy of Hartone in stable angina pectoris--an open comparative trial

OBJECTIVES

To evaluate the safety and efficacy of 'Hartone'--a proprietary herbal product primarily containing Terminalia arjuna in stable angina pectoris patients.

PATIENTS AND METHODS

Ten patients with stable angina pectoris were given Hartone 2 caps twice daily for 6 weeks and 1 cap twice daily for the next 6 weeks. Haematological and biochemical investigations to assess safety were carried out on day 0, day 42 and day 84. Serum lipid profile was done before and after therapy. Efficacy was assessed by considering the reduction in the number of anginal episodes and improvement in stress test. The results were compared with 10 patients of stable angina pectoris on isosorbide mononitrate (ISMN) 20 mg twice daily.

RESULTS

Hartone afforded symptomatic relief in 80% of patients and ISMN in 70%. The number of anginal attacks were reduced from 79/wk to 24/wk by Hartone and from 26/wk to 7/wk by ISMN. Although patients of both groups showed improvement in several stress test parameters compared to base line, the difference was not statistically significant. Hartone improved BP response to stress test in two patients and ejection fraction in one. Hartone was better tolerated than ISMN and showed no evidence of hepatic or renal impairment. Its effects on lipid profile was not consistent.

CONCLUSION

Hartone is a safe and effective anti-anginal agent comparable to ISMN and is better tolerated. Large scale, randomised, double blind trials are needed to prove its efficacy.

Expression of human apolipoprotein E reduces amyloid-beta deposition in a mouse model of Alzheimer's disease

The epsilon4 allele of apolipoprotein E (apo E) is associated with an increased risk for developing Alzheimer's disease (AD). This may be due to interactions between apo E and the amyloid-beta protein (Abeta). To assess the effects of human apo E isoforms on Abeta deposition in vivo, we bred apo E3 and apo E4 hemizygous (+/-) transgenic mice expressing apo E by astrocytes to mice homozygous (+/+) for a mutant amyloid precursor protein (APPV717F) transgene that develop age-dependent AD neuropathology. All mice were on a mouse apo E null (-/-) background. By nine months of age, APPV717F+/-, apo E-/- mice had developed Abeta deposition, and, as reported previously, the quantity of Abeta deposits was significantly less than that seen in APPV717F+/- mice expressing mouse apo E. In contrast to effects of mouse apo E, similar levels of human apo E3 and apo E4 markedly suppressed early Abeta deposition at nine months of age in APPV717F+/- transgenic mice, even when compared with mice lacking apo E. These findings suggest that human apo E isoforms decrease Abeta aggregation or increase Abeta clearance relative to an environment in which mouse apo E or no apo E is present. The results may have important implications for understanding mechanisms underlying the link between apo E and AD.

Tubular cell and HIV-1 gp120 interaction products promote migration of monocytes

Renal interstitial accumulation of monocytes is an important feature of HIV-associated nephropathy. We studied the effects of proximal tubular cell products (TCP) and proximal tubular cell-gp120 interaction products (TC-120IP) on the migration of monocytes across a modified Boyden chamber. TC-120IP promoted (P < 0.001) the migration of monocytes when compared with TCP (TCP, 45.0 +/- 5.9 vs. TC-120IP, 192.3 +/- 39.5 migrated monocytes/field). This effect of TC-120IP on monocyte migration was dose dependent. Anti-MCP-1 (TCP, 24.7 +/- 2.6; TC-120IP, 82.3 +/- 5.5; TC120-IP + anti-MCP-1 antibody, 46.5 +/- 3.5 migrated monocytes/field) as well as anti-TGF-beta antibodies (TCP, 25.8 +/- 3.4; TC120-IP, 80.3 +/- 6.9; TC-120IP + anti-TGF-beta antibody, 43.8 +/- 5.6 migrated monocytes/field) partly attenuated TC-120IP-induced migration of monocytes across a filter. Moreover, anti-MCP-1 and anti-TGF antibodies showed an additive inhibitory effect on TC-120IP-induced migration of monocytes across a filter. These results suggest that TC-120IP-induced migration of monocytes may be mediated through the generation of MCP-1 and TGF-beta by tubular cells. The present study provides the basis for a hypothesis that HIV-1 gp120 protein may be contributing to the infiltration of monocytes in the renal interstitium of patients with HIV-associated nephropathy.

Laboratory abnormalities in patients with bacterial pneumonia

STUDY OBJECTIVES

This study was undertaken to evaluate the laboratory abnormalities observed in patients with bacterial pneumonia as predictors of the severity of illness.

DESIGN

Retrospective analysis.

SETTING

Tertiary care hospital.

PATIENTS AND PARTICIPANTS

We studied 302 consecutive patients who were admitted to the Long Island Jewish Medical Center from January through December 1993 and treated for bacterial pneumonia. The patients were subdivided into two groups based on their serum phosphorus level either on hospital admission or 4 days before the onset of pneumonia, if this was acquired in-hospital. Hypophosphatemia (group 1) was defined as serum phosphorus level of < or = 2.4 mg/dL and normophosphatemia > 2.4 mg/dL (group 2). Three hundred randomly selected hospitalized patients treated for conditions other than pneumonia comprised the control group (group 3).

MEASUREMENTS

Groups 1 and 2 were compared with respect to laboratory data, mortality rate, and duration of hospitalization. The laboratory data of patients in group 3 were compared with those treated for bacterial pneumonia (groups 1 and 2). Stepwise multivariate logistic regression analysis was employed to identify the variables that best predicted the onset of pneumonia.

RESULTS

In groups 1 and 2, a greater (p < 0.0001) number of patients (135 of 302 patients with pneumonia, 44.7%) developed hypophosphatemia compared with patients in group 3 (31 of 300 control subjects, 10.3%). Patients with pneumonia (groups 1 and 2) had higher levels (p < 0.01) of bicarbonate compared with control subjects. Moreover, patients with pneumonia demonstrated lower levels (p < 0.01) of calcium, phosphorus, albumin, cholesterol, and alanine aminotransferase compared with control patients (group 3). Among patients with pneumonia, those with hypophosphatemia (group 1) had significantly lower levels (p < 0.05) of potassium, calcium, and albumin compared to those subjects with normophosphatemia (group 2). Furthermore, hypophosphatemic subjects manifested higher levels of glucose (p < 0.01) and creatine phosphokinase (p < 0.05) compared to their normophosphatemic counterparts. In addition, hypophosphatemic patients experienced a longer duration of hospital stay (hypophosphatemia, 24.6 +/- 2.0 days, vs normophosphatemia, 14.1 +/- 1.0, p < 0.001) and higher (p < 0.001) mortality compared to normophosphatemic subjects. The incidence of nosocomial pneumonia was higher (p < 0.0001) in hypophosphatemic patients compared to those with normophosphatemia.

CONCLUSION

We conclude that hypophosphatemia, hypocalcemia, hypokalemia, and hypoalbuminemia may be predictors of the severity of illness in patients admitted to the hospital with bacterial pneumonia.

Evaluation of safety and efficacy of azithromycin in lower respiratory tract infections (LRTI)

Azithromycin was given to 55 cases of lower respiratory tract infections in the doses of 500 mg on day 1, followed by 250 mg on days 2-5. It produced bacteriological cure in 70.8% patients and clinical cure or improvement in 69.09% of patients. 4.27% of patients had throat colonisation with new organisms, of which 9.09% needed a second antibiotic. The drug was well tolerated and minor side effects were noted. Gastrointestinal disturbances (16.36%) headache and giddiness (14.55%), rash (3.64%) were the noted side effects. Reduction of platelet count by 50% occurred in 12.29% of the cases compared to 0.2% reported earlier. But this thrombocytopenia was clinically not significant, as it did not cause any symptoms.

Coagglutination and counter immunoelectrophoresis in the rapid diagnosis of typhoid fever

The efficacy of two methods--coagglutination (COAG) and counter immunoelectrophoresis (CIE)--in the rapid diagnosis of typhoid fever was studied in parallel with blood and clot cultures on 114 clinically suspected cases. Retrospective analysis showed that only 58 eventually were discharged and had typhoid fever. Antigen detection on their sera was done by both methods, concomitant with antigen detection on culture supernates by CIE. Sera from 50 controls were subjected to both tests. Agglutinating anti-serum being unsatisfactory in the CIE system, anti-serum to the LPS fraction of Salmonella typhi "O" 901 was used in both tests after absorption with Escherichia coli and Salmonella paratyphi A. Analysis of data with reference to retrospectively confirmed typhoid cases show that S. typhi was isolated in 58.6% and 58.3% of blood and clot cultures; antigen detection by CIE in their supernates was 81.1% and 79.2%, respectively. This correlated closely with serum COAG (81.0%) in contrast to serum CIE (5.7%). Thus, COAG was superior to CIE for serology. However, CIE done on culture supernates precludes such tedious procedures as absorption of staphylococcal agglutinins and the confirmatory blocking test.

A common-source epidemic of mixed bacterial diarrhea with secondary transmission

An epidemic of acute diarrhea in a village in southern India in 1972 was associated with a high rate of isolation of enteric pathogenic bacteria from the patients and lasted for three months. There was no significant association between the prevalence of enteroviruses or parasites and cases of diarrhea. The epidemic started as a common-source outbreak due to the contamination of well water, and there were many secondary cases probably due to a person-to-person spread. The illness did not produce chronic diarrhea or malabsorption.