The post-prandial state and macrovascular disease: relevance to diabetes mellitus

There is increasing evidence that the post-prandial state is an important contributing factor to the development of atherosclerosis. In non-diabetic subjects the atherosclerotic risk factors comprised in the categories of lipids, coagulation system and endothelial function may be adversely modified in the post-prandial phase. The generation of an oxidative stress may be the common pathway through which eating may induce these alterations. In diabetic patients these phenomena may be amplified by post-prandial hyperglycemia. There is a growing thought that diabetes is a cardiovascular disease.

A randomized comparison of the efficacy and toxicity of epirubicin and doxorubicin in the treatment of patients with non-Hodgkin's lymphoma

BACKGROUND

Combination chemotherapy consisting of methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisolone, and bleomycin (MACOP-B) has been frequently used for the treatment of non-Hodgkin's lymphoma. This randomized study was undertaken to assess the efficacy and toxicity of this regimen when either doxorubicin or epirubicin was used as the anthracycline drug.

METHODS

Between April 1989 and December 1993, 211 previously untreated patients with intermediate grade and high grade non-Hodgkin's lymphoma were randomized to receive either doxorubicin (n=106) or epirubicin (n=105) with the MACOP-B regimen. These patients were followed through December 1996. Numerous clinical features predictive of response and survival were analyzed. Cardiac and noncardiac toxicity in the two treatment arms were compared.

RESULTS

The median age of the patients was 48 years. Complete remission was experienced by 122 patients (58.3%); 62 patients (58.5%) achieved complete remission in the doxorubicin arm and 60 (58.1%) in the epirubicin arm. Response rates, time to treatment failure, relapse data, and overall survival were comparable between the two arms. Morbidity due to mucositis, vomiting, peripheral neuropathy, and cardiotoxicity were also comparable. The overall mortality was 10%. Mortality due to neutropenic sepsis was considerably higher among patients who received epirubicin (10 patients) than among those who received doxorubicin (5 patients). Cardiac evaluation revealed no difference in toxicity between the two arms.

CONCLUSIONS

Epirubicin was as effective as doxorubicin in terms of patients' responses to therapy. There was no difference in cardiotoxicity between the two treatment arms. However, in this study, the mortality due to neutropenic sepsis was significantly higher among patients treated with epirubicin.

Reactivity of a transient autoantibody inhibited by ionized calcium

A 53-year-old female suffering from severe anaemia following falciparum malaria required blood transfusion. Her blood specimen in EDTA showed strong autoagglutination giving problems in the preliminary grouping by a slide test. She was grouped, however, as B Rh-D positive without difficulty by the cell and serum groupings done using clotted blood. Two units of B Rh-D positive blood compatible with the patient's serum were transfused without untoward reaction. The patient's blood collected a fresh in different anticoagulants showed autoagglutination in the plasma with EDTA or citrate, but not in heparin collection or in serum, indicating a possible role of ionized calcium as an inhibitor of reactivity. Addition of 0.02 M calcium chloride solution to the plasma remarkably weakened the strength of agglutination, evidently supporting this hypothesis. Autoantibody, identified as anti-Pra, was transient in nature and possibly associated with the malarial infection, as neither the antibody nor the malarial parasites were detected in her blood in follow up studies four months later.

Citrate-dependent auto-antibody causing error in blood grouping

BACKGROUND AND OBJECTIVES

Errors in blood grouping are occasionally due to anomalous antibodies or extraneous materials in the reagents. We investigated the case of a volunteer blood donor who was originally grouped as AB, Rh-positive, by slide grouping. However, her washed red cells showed group B, which agreed with her reverse serum grouping.

MATERIALS AND METHODS

Standard serologic techniques were employed throughout.

RESULTS

Investigation revealed an unusual autoantibody in the donor's blood that preferentially agglutinated the red cells in the presence of citrate. Because the grouping reagents contained citrate, this led to a false grouping when whole blood was tested rather than washed red cells. The antibody reacted at 37 degrees C and at 4 degrees C, but failed to agglutinate red cells when 0.1 M solution of monosaccharides was added to the reaction mixture. The antibody agglutinated all red cells except 6 examples of the 'Bombay' phenotype included in the panel. The antibody was neutralized by H secretor saliva, and its activity was abolished by DTT reagent, indicating its possible IgM nature.

CONCLUSION

These findings suggest that this anomalous antibody has anti-H specificity.

Cefuroxime axetil in the treatment of Salmonella typhi infection (enteric fever) in adults

A study to evaluate the efficacy and safety of Cefuroxime Axetil in enteric fever was carried out in 30 adult hospitalised patients of either sex. A positive blood culture for S. typhi and sensitivity to cefuroxime axetil were confirmed prior to treatment. On admission, the baseline signs and symptoms were recorded and treatment initiated with cefuroxime axetil in a dose of 500 mg bd; which was continued for 7 days after normalization of temperature. The various clinical parameters were followed up daily during the treatment period and discharge permitted on normalization of temperature. Blood culture for S. typhi was repeated 3 days after stopping treatment. Follow-up Widal, stool and urine cultures were done wherever possible to check for relapse or carrier state. All the patients responded clinically to treatment and had bacteriologically negative blood cultures by the end of 14 days treatment. 87% of the patients responded within 7 days of treatment of which 60% were graded as Excellent responders as they responded within 4 days itself; while 13% took a longer time to respond. There were no relapses or carrier state as indicated by negative follow-up stool cultures. Only one patient reported a side-effect of mild headache confirming the safety of the drug. We conclude that Cefuroxime axetil in a dose of 500 mg bd is an effective and safe drug in the treatment of multi drug resistant enteric fever.

Prediction of runoff transport of fallout 90Sr

A model is described for the prediction of runoff transfer of fallout 90Sr without recourse to long-term measurements. The values of model parameters can be readily established from few field measurements of the solid/solution partitioning of 90Sr and a natural, atmospherically delivered radionuclide such as 210Pb, and the usually well documented fallout and hydrologic data. The model-generated profiles of 90Sr for two major Canadian watersheds compare favorably to those established through long-term monitoring of receiving waters.

Immediate haemolytic transfusion reaction due to anti-Inb

An immediate haemolytic transfusion reaction was investigated in a patient with intestinal cancer. The causative antibody was directed against a high-frequency antigen Inb that was presumably produced as a result of pregnancies. This is the first case of a severe transfusion reaction due to this alloantibody.

Determination of plutonium 240/239 ratios in Lake Ontario sediments

A thermal ionization mass spectrometric procedure was developed for determination of 240/239 ratios in subpicogram quantities of plutonium (Pu), and was applied to Pu extracted from Lake Ontario sediment. The detection limit was ∼ 4 fg of Pu and the precision of 240/239 ratio measurement was ∼ 7% in the 0.07-0.42 pg range. Results of sediment analyses at various depths showed in all cases 240/239 ratios near the mean global fallout value of 0.176 ± 0.014. The lack of variability of the ratios with depth negated the use of Pu, present in excess in the near-surface samples due to leakage from a nearby reprocessing plant, as a geochronological meter. The 240/239 ratio of the leakage Pu appeared to be very similar to that of fallout Pu.

Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischemia

Epidural spinal cord electrical stimulation (ESES) was performed on 10 patients with severe limb ischemia due to atherosclerotic disease. Microcirculatory parameters were assessed before and after ESES. Bright field microscopy was used to assess capillary diameters and red blood cell (RBC) velocity in the dorsum of the foot. Fluorescein microscopy was used with intravenously injected sodium fluorescein to study capillary density and sodium fluorescein appearance time in the dorsum of the toe. The systolic ankle/arm pressure ratio and toe pressure measurements were used as macrocirculatory parameters. After ESES, clinical improvement was confirmed by intravital microscopy. Capillary density increased (p less than 0.001), RBC velocity in capillaries already perfused before ESES increased from 0.054 mm/sec to 0.762 mm/sec (p less than 0.001), and sodium fluorescein appearance time decreased from 72 to 45 seconds (p less than 0.001). Capillary diameter did not change significantly so that the increase in RBC velocity may be interpreted as enhanced volume flow. Systolic ankle/arm pressure ratios and digital arterial pressure did not change significantly. The current results show that in patients with severe occlusive arterial disease of the lower limbs, ESES recruits capillaries not perfused in the control situation and enhances skin blood flow, improvements that may explain the beneficial clinical effects of ESES.

Dose equivalent commitments from fallout radionuclides in the open waters of the Great Lakes. 1973-1981

The levels of (144)Ce, (137)Cs, (125)Sb, and (90)Sr in the open waters of the Great Lakes were measured over the period 1973-81. The levels were found to be very low. (144)Ce was detected only up to 1975 after which it dropped below the detection limit. The data indicate that the concentrations of the remaining three radionuclides have decreased with time. (90)Sr and (137)Cs provide essentially all of the radiological dose from drinking Great Lakes water. The dose equivalant commitments have been calculated from these measurements and found to be well within the Great Lakes Water Quality Agreement's water quality objective for radioactivity.

I-i- phenotype in a large kindred Indian family

The I-i- phenotype was found to be a familial character up to three generations in a large Indian family having 93 members. 15 members showed highly depressed Ii antigens while 6 of the members had partial depression of the Ii antigens on their red cells. It was evident in the family that the phenotype is associated with A1 antigen. The A1 antigen score on the red cells was significantly higher among the subjects with depressed Ii antigens. The I-i- status was not considered as a dominant or a recessive character nor does the partial depression of the Ii antigens indicate a heterozygous state of the variant gene.

The identification, assay and purity determination of chlorpropamide, glibenclamide and tolbutamide and their tablet preparations by thin-layer chromatography

A thin-layer chromatographic procedure is described for the identification and quantitative determination of chlorpropamide, glibenclamide and tolbutamide in both powder and tablet form. The coefficient of variation of the method is 0.6-0.7%, and results show good agreement with those obtained by the B.P. methods of assay. The TLC procedure has the advantage of greater specificity, and can also be used to identify and limit degradation products that may be present.

Airborne radioactive materials and plants: a review

Airborne radioactive materials readily contaminate plant surfaces and thus are incorporated into the food chains. Most of the nuclear fission products and naturally occurring radionuclides in the air are carried on solid particles ranging in size from a few submicrons to several millimetres in diameter. Of many available mechanisms, rainfall plays a dominant role in the deposition and removal of radioactive particles from plants. Mechanisms for the deposition of submicron particles, which carry significant amounts of radioactivity, are still not very well understood. Available information on the physicochemical aspects of the retention of radionuclides by plants is inadequate in explaining radionuclide uptake and desorbability. Much of the work reported so far has been carried out on selected fission products only. There is a dearth of data pertaining to naturally occurring radionuclides, especially 222Rn and its daughters, significant amounts of which are released to the environment during uranium mining and milling operations. Radiation damage in plants is difficult to detect except at levels of contamination thousands of times higher than those attained in most real life situations. Existing reports five conflicting accounts of the damage induced by low-level radiation in plants. The literature data discussed in this review are presented as basic information needed for the conduct and interpretation of useful research.

Relationship between I and H antigens. II. Study of the H and I deficient phenotypes

H and I substances are present in the plasma and the saliva. In the plasma there is no quantitative relationship between H and I substances, whereas in the saliva only non-secretors produce I substance [shown by anti-Is serum, (Sti.)]. The study of I and H substances in the plasma and the saliva of H and I deficient subjects gives a better understanding and enables the completion of the classification of these rare phenotypes. The results also allow the proposal of a synthetic scheme of Is and H substances in the saliva.

Serological and immunoglobulin studies in autoimmune haemolytic anaemia with emphasis on the nature of biphasic antibodies

55 cases of autoimmune haemolytic anaemia with positive direct Coombs' test were investigated for the nature of autoantibodies. The studies involved characterization of the autoantibodies on the basis of their thermal amplitude, serological specificity, nature of immunoglobulin and light chain specificity. The findings showed that the autoantibodies could be classified as cold autoantibody (18 cases), warm autoantibody (5 cases) and biphasic autoantibody which reacted at 37 degrees C as well as at 6 degrees C (32 cases). Further classification of these cases was made on the basis of antibody specificity to blood groups, immunoglobulin type in relation to the optimum temperature of their reaction.

A new red cell phenotype I-i-: red cells lacking both I and i antigens

When blood samples from 5,864 healthy Indian blood donors were tested with anti-I, seven samples failed to react or reacted only weakly. Further studies with a number of anti-I and anti-i sera suggested that these samples had the phenotype I-i- and reacted weakly with anti-IT. In one family, the I-i- phenotype was present in three generations.

Selective induction of intestinal tumors in rats by methyl(acetoxymethyl)nitrosamine, an ester of the presumed reactive metabolite of dimethylnitrosamine

Methyl(acetoxymethyl)nitrosamine (DMN-OAc) was synthesized and tested for toxicity and carcinogenicity in rats to test the hypothesis that alpha-hydroxylation is required for metabolic activation of dimethylnitrosamine (DMN) to a reactive, proximate carcinogen. The acute median lethal doses (LD50) of DMN-OAc and DMN injected ip into 5-week-old male Sprague-Dawley (Charles River (CD) rats were determined to be 0.19 and 0.59 mmole/kg body weight or 25 mg DMN-OAc/kg and 44 mg DMN/kg body weight, respectively. Single ip injections of one-half the LD50 DMN-OAc (13 mg/kg body weight) in 5-week-old rats of both sexes resulted in a high incidence of epithelial tumors of the intestinal tract. Mean survival times for rats with intestinal tumors were 353 days for males and 433 days for females. Tumors were rarely found at other sites. DMN at equivalent toxic (one-half the LD50, 22 mg/kg) and molar (= one-sixth LD50, 7.0 mg/kg) dose levels, yielded (as expected) tumors of kidneys, lungs, and occasionally other organs, but at a much lower incidence. The finding of the potent carcinogenicity of DMN-OAc supported the postulate that alpha-hydroxylation of DMN in vivo generates a proximate carcinogen.

A population genetic study of the Kota in the Nilgiri Hills, South India

A population genetic study among the Kota of the Nilgiri Hills, South India, involved tests for abnormal haemoglobins, 5 red cell antigen systems, 4 serum protein and 13 red cell enzymes systems. Twelve systems are invariant in the Kota. The most distinctive characteristics are extremely low frequency of the A1 gene and complete absence of A2 in the ABO system, r(cde) in the Rh system, LDH cal-1 among the enzyme systems as well as absence of abnormal haemoglobins. A comparison of gene frequencies in those systems, which show variation, suggests that the Kota are more similar to the Toda than to any other tribal or caste population of the area. Genetic distance as well principal component analysis also reveals that the Toda and Kota are close to each other, in agreement with tradition.

Population genetic studies in kerala and the nilgiris (South West India)

A total of nearly 1,000 persons belonging to a number of caste, religious and tribal groupings in Kerala and the Nilgiri Hills of South India have been tested for genetic variation in 4 blood group, 5 serum protein and 17 enzyme systems as well as haemoglobin. The distribution of blood groups, serum protein and enzyme groups is similar to that reported for other South Indian populations. Abnormal haemoglobins were detected in several populations. Abnormal haemoglobins were detected in several populations, HbS being present in more than 20% of the Irula and Kurumba in the Nilgiri Hills. In the Kerala populations there were 4 examples of Hb AD and 1 of Hb AE. Genetic distance estimates using the gene frequency data indicate that the closest groups are the Nayar and Izhava and the Brahmin and Nayar. The tribal populations are approximately twice as far from the Nayar as they are from the Izhava. The Todas of the Nilgiri Hills are somewhat closer to the Brahmin of Kerala than they are to the other tribal populations.