Role of fever in infection: has induced fever any therapeutic potential in HIV infection?

Ancient societies had no rational understanding of fever. The Greeks were the first to recognise that it may be part of nature's method of effecting cure in some diseases. How best to assist nature went through many trials and errors. Appreciation of the prognostic value of fever and how it may be controlled was slow to appear. That there was a place in the therapeutic arsenal for induced fever came only with the 20th century. Finding a suitable, safe, and satisfactory means came slowly. The curative power of well controlled and reproducible levels of fever was proved by the arrest of one deadly and incurable complication of a sexually transmitted disease in the first half of this century. The purpose of this review is to promote discussion and, hopefully, well ordered laboratory and clinical trials aimed at learning whether or not induced fevers have a place in the care of patients with HIV/AIDS.

Synthesis of new d-propoxyphene derivatives and the development of a microparticle-based immunoassay for the detection of propoxyphene and norpropoxyphene

The synthesis of [S-(R,S)]-4-[[methyl[2-methyl-3-(1-oxopropoxy)-3, 4-diphenylbutyl]amino]-1-oxobutoxy]-2,5-pyrrolidinedione+ ++ (propoxyphene active ester, 2) is described. This was used as an intermediate to prepare a propoxyphene immunogen, [S-(R,S)]-4-[methyl][2-methyl-3-(1-oxopropoxy)-3,4-diphenylbuty l]-amino]- 1-oxobutyl-Bovine Thyroglobulin (3). This immunogen was then used to generate antibodies which demonstrate good cross-reactivity to d-propoxyphene, d-norpropoxyphene, and other propoxyphene metabolites. In addition, these antibodies were shown to have very low cross-reactivity to methadone, a structurally related compound. The introduction of an aminomethyl benzoate spacer into the propoxyphene active ester (2), followed by the activation of the carboxylic acid, provided for a more stable active ester (5). This stable active ester, together with the antibodies generated from the propoxyphene immunogen, has led to the development of an immunoassay based on the Kinetic Interaction of Microparticles in Solution (KIMS).

Spectrum of neuropsychiatric complications in 791 cases of typhoid fever

Over a 6-year period, we studied 791 patients with multidrug-resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo-encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo-encephalitis are associated with significant morbidity but very low mortality (0.5%).

Meningococcal carriage: prevalence and sex-related risk factors

A retrospective analysis was done to examine whether sexual behaviour was associated with meningococcal carriage. Over the 4 month period from January to April 1994, 136 (27.4%) of the 496 consecutive new/re-registered genito-urinary medicine clinic attenders showed meningococcal carriage. Two (15.4%) of 13 homosexual men compared with 134 (27.7%) of 484 heterosexual men and women had evidence of meningococcal carriage. Relative risk (RR) of meningococcal carriage was 1.8 with > 10 lifetime partners and 1.2 with 3-10 partners (P < 0.007). RR with age group of 16-25 was 4.2 and for 26-35 it was 3.5. There was no relationship with meningococcal carriage and pharyngeal symptoms, sexual orientation, intravenous drug use, number of partners per month and orogenital sex. Further longitudinal studies may be of value in order to determine whether a high number of sexual partners is a marker for meningococcal carriage. In addition, further study may show whether there is an increased risk of meningococcal carriage and disease in those who live with meningococcal carriers.

Reliability and reproducibility of breath hydrogen and methane in male diabetic subjects

We studied the variability and reliability of breath hydrogen and methane as well as the alterations in intestinal gas profile in response to lactulose ingestion in 13 asymptomatic male patients with diabetes mellitus (DM). Seventeen healthy subjects served as controls. The prevalence of methane producers was 33% in DM and 45% among control subjects (P = NS). The prevalence of nonhydrogen producers was 7.7% and 5.9%, respectively. The coefficient for interday variation of H2 was 72.6 +/- 9.8% in DM and 49.7 +/- 9.8% in controls (P < 0.05). Similarly, the coefficient for interday variation of CH4 was 94.3 +/- 18.8 and 69.4 +/- 16.8% respectively (P = NS). The reproducibility of basal H2 and CH4 among diabetics as assessed by r1 (measure of reliability) was poorer among diabetics when breath analysis was performed on different days (P < 0.001). There was no significant difference between diabetics and controls with respect to basal or peak or area under the curve for H2 and CH4 in response to lactulose. We conclude that there is poor reproducibility of fasting breath gas levels among asymptomatic male subjects with diabetes. In addition, DM is not associated with alterations in hydrogen- or methane-producing potential.

Spontaneous splenic rupture in typhoid fever

Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.

Detection of autonomic nervous dysfunction by SL manoeuvre

We have evaluated the immediate heart rate response to standing and lying and in 100 Diabetic subjects aged 43 +/- 10 years who underwent five other cardiovascular autonomic tests. Using a specially devised scoring system the patients were divided into three groups: a) 58 subjects without autonomic neuropathy, b) 15 borderliners, c) 27 with autonomic neuropathy. The results were compared with 50, sex and age matched controls. We studied SL1 = ratio between R-R mean before lying and R-R maximum between the 20th to 25th beat and R-R minimum over the first 5 beats after lying. In controls SL1 was 1.35 +/- 0.18 and SL2 was 1.52 +/- 0.23. In diabetic subjects without autonomic neuropathy SL1 was 1.20 +/- 0.86 (p < 0.01), SL2 1.50 +/- 0.02 (p < 0.001). In the group with autonomic neuropathy SL1 was 1.04 +/- 0.02 (p < 0.001) and SL2 was 1.20 +/- 0.09 (p < 0.001). We propose that the lowest normal and highest abnormal limits of SL1 are 1.12 and 1.08 respectively and that normal and highest abnormal limits of SL2 are 1.23 and 1.18 respectively. We suggest the use of SL1 as a pure parasympathetic test and SL2 as a mixed but predominantly sympathetic test in the diagnosis of autonomic neuropathy.

Screening of some Turkish medicinal plants for their analgesic activity

Nine crude extracts of various parts of eight medicinal plants from different regions of Turkey were evaluated for their analgesic activities by tail flick method in mice. The analgesic activities of these extracts were compared with acetylsalicylic acid (300 mg/kg) which is used as a standard drug. Extracts were given orally in doses of 300, 500 and 1000 mg/kg. 0.9% saline was also administered in control group of animals. Results showed that four extracts were having highly significant analgesic activity at all the three doses tested. Three showed significant effects at higher doses while two extracts did not show any significant results.

Multiple drug resistant typhoid fever outbreak in Kashmir Valley

We report the first ever report of multiple drug resistant salmonella typhi epidemic from Asia. The outbreak started in April 1988 and virtually ended by June 1988. The outbreak occurred in Baramullah town of Kashmir valley. In an epidemiological survey 230 cases were diagnosed as enteric fever. 46 cases (20%) were culture positive. A very rare multiple drug resistant strain of S. typhi was identified as phage type biotype II untypeable (UVS2). The strain was sensitive to Norfloxacin. This outbreak of S. typhi has many similarities with Mexico epidemic. Ingestion of contaminated water seems to be the possible cause for the outbreak.

Misoprostol healed a benign nonsteroidal antiinflammatory drug-induced gastric ulcer in a patient with pentagastrin-fast achlorhydria

A patient with rheumatoid arthritis, who also had documented achlorhydria, first had the diagnosis of an antral ulcer made by barium meal in 1980. She did well taking cimetidine intermittently after that, along with various nonsteroidal antiinflammatory drugs (NSAIDs). In 1988, a shallow antral ulcer was found, but the patient did not respond to H2 blockade or to sucralfate. At that time misoprostol therapy was prescribed. Despite the continued use of NSAIDs, the ulcer healed. It has remained healed for the past 3 years.