Purification and characterization of a highly stable cysteine protease from the latex of Ervatamia coronaria

A highly stable cysteine protease was purified to homogeneity from the latex of Ervatamia coronaria by a simple purification procedure involving ammonium sulfate precipitation and ion-exchange chromatography. The molecular mass was estimated to be approximately 25,000 Da by SDS-PAGE and gel filtration. The extinction coefficient (epsilon 280 nm 1%) of the enzyme was 24.6. The enzyme hydrolyzed denatured natural substrates like casein, hemoglobin, azoalbumin, and azocasein with a high specific activity but showed low specific activity towards synthetic substrates. The pH and temperature optima were 7.5-8.0 and 50 degrees C respectively. The activity of the enzyme was strongly inhibited by thiol-specific inhibitors like leupeptin, iodoacetamide, PCMB, NEM, and mercuric chloride. The striking property of this enzyme was its stability over a wide pH range (2-12) and other extreme conditions of temperature, denaturants, and organic solvents. The N-terminal sequence showed marked similarity to known cysteine proteases.

Montelukast, a leukotriene-receptor antagonist, for the treatment of mild asthma and exercise-induced bronchoconstriction

BACKGROUND

Patients with mild asthma frequently have only exercise-induced bronchoconstriction, a symptom of inadequate control of asthma. We evaluated the ability of montelukast, a leukotriene-receptor antagonist, to protect such patients against exercise-induced bronchoconstriction.

METHODS

We randomly assigned 110 patients (age, 15 to 45 years) with mild asthma and a decrease in the forced expiratory volume in one second (FEV1) of at least 20 percent after exercise on two occasions during a placebo run-in period to receive 10 mg of montelukast (54 patients) or placebo (56 patients) once daily at bedtime for 12 weeks in a double-blind study. Treatment was followed by a two-week, single-blind washout period during which all patients received placebo. Exercise challenges were performed at base line; 20 to 24 hours after dosing at weeks 4, 8, and 12; and at the end of the washout period. The primary end point was the area under the curve for FEV1 (expressed as the percent change from base-line values) in the first 60 minutes after exercise. This measure summarized the extent and duration of bronchoconstriction after exercise.

RESULTS

At 12 weeks, montelukast therapy offered significantly greater protection against exercise-induced bronchoconstriction than placebo therapy (expressed as the percentage of inhibition of the end points), as evidenced by the improvement in the area under the FEV1 curve (degree of inhibition, 47.4 percent; P=0.002). Montelukast therapy was also associated with a significant improvement in the maximal decrease in FEV1 after exercise (P=0.003) and the time from the maximal decrease in FEV1 to the return of lung function to within 5 percent of pre-exercise values (P=0.04). The differences between groups in the various measures of lung function were similar at 4, 8, and 12 weeks; there was no evidence of rebound worsening of lung function in the montelukast group after the washout period. After 12 weeks of treatment, patients in the montelukast group were more likely to rate their asthma control as better and less likely to require rescue therapy with a beta-agonist during or after exercise challenge. The rates of adverse events were similar in the two groups.

CONCLUSIONS

As compared with placebo, once-daily treatment with montelukast provided significant protection against exercise-induced asthma over a 12-week period. Tolerance to the medication and rebound worsening of lung function after discontinuation of treatment were not seen.

Montelukast, a potent leukotriene receptor antagonist, causes dose-related improvements in chronic asthma. Montelukast Asthma Study Group

The leukotrienes are known to be important mediators of bronchial asthma. The ability of montelukast, a potent and selective CysLT1 leukotriene receptor antagonist, to cause a dose-related improvement in chronic asthma was investigated in a placebo-controlled, multicentre, parallel-group study. After a two week placebo run-in period, chronic asthmatic patients with a forced expiratory volume in one second (FEV1) 40-80% predicted with > or = 15% increase (absolute value) after beta2-agonist were randomly assigned to one of four treatment groups (placebo or montelukast 2, 10, or 50 mg once daily in the evening) for a three week, double-blind treatment period. For patient-reported end-points (daytime symptom score, use of as needed inhaled beta2 agonist, asthma-specific quality of life) and frequency of asthma exacerbations, montelukast 10 and 50 mg caused similar responses, superior to 2 mg and significantly (p<0.05; linear trend test) different from placebo. All three doses caused improvements in FEV1 and morning and evening peak expiratory flow rate (PEFR) that were significantly (p<0.05) different from placebo. Differences (least square mean) between the pooled 10 and 50 mg montelukast treatment groups and placebo were: 7.1% change from baseline in FEV1, 19.23 L x min(-1) in morning PEFR, -0.29 in daytime asthma symptom score (absolute value), and -0.82 in beta2-agonist use (puff x day(-1)). The incidence of adverse experiences was neither dose-related nor different between montelukast and placebo treatments. We conclude that montelukast causes a dose-related improvement in patient-reported asthma end-points over the range 2-50 mg. Montelukast causes benefit to chronic asthmatic patients by improving asthma control end-points.

Prevalence and determinants of central obesity and age-specific waist:hip ratio of people in five cities: the Indian Women's Health Study

OBJECTIVE

To study the prevalence of central obesity and age-specific waist:hip ratio of urban women from five Indian cities.

DESIGN AND SETTING

Cross-sectional surveys were conducted in 6-12 urban streets in different parts of India using similar methods of sample selection and criteria of diagnosis.

SUBJECTS AND METHODS

We randomly selected 3212 women, aged 25-64 years, from Moradabad (n = 902), Trivandrum (n = 760), Calcutta (n = 365), Nagpur (n = 405), and Bombay (n = 780). Evaluation was by a questionnaire administered by a physician and a dietician, a physical examination, and anthropometric measurements.

RESULTS

The overall prevalence of central obesity among the total number of women was 55.0%, with the highest prevalence in Calcutta (62.2%) and the lowest in Bombay (47.4%). Waist:hip ratio was 0.85 +/- 0.13 (mean +/- SD) with the highest ratio for women in Calcutta (0.87 +/- 0.12) and the lowest for women in Moradabad (0.84 +/- 0.16). After pooling of data from all five cities, multivariate logistic regression analysis showed that, regardless of age, body mass index (> 23 kg/m2; odds ratio 1.12), sedentary lifestyle (odds ratio 2.51), and family history of obesity (odds ratio 2.15) were strongly associated with central obesity. Excess intake of fat was weakly associated with central obesity but age was not a risk factor for central obesity, although the prevalence was highest among those aged over 55 years in Moradabad, Calcutta, and Nagpur.

CONCLUSIONS

The overall prevalence of central obesity among the urban women of India has increased, more so in Calcutta and Trivandrum. Body mass index, sedentary lifestyle, and family history of excess intake of fat were significant risk factors for central obesity.

Utility of electron microscopy in the assessment of transthoracic needle lung biopsy specimens

RATIONALE AND OBJECTIVES

The authors determine the usefulness of electron microscopy (EM) in the workup of patients with certain intrathoracic masses undergoing transthoracic needle biopsy (TNB).

METHODS

Over a 4-year period, 1603 patients underwent TNB at our institution. Of these, 79 had EM examination of the aspirated material. The study is a retrospective review of this latter group. Previous use of EM for TNB had suggested that it may he helpful in those with pleural, chest wall, and mediastinal lesions. The 40 men and 39 women had pulmonary (n = 49), mediastinal (n = 17), pleural (n = 10), and chest wall (n = 3) lesions.

RESULTS

The adequate specimen rate was 59% (47 of 79) for light microscopy (LM) and 37% (29 of 79) for EM. Of the 28 patients with satisfactory specimens for both LM and EM, the correct diagnosis was obtained by LM 79% (22 of 28) and EM 96% (27 of 28) of the time. Electron microscopy was most helpful in patients with mediastinal (6 of 6 correct versus 3 of 6 for LM) and pleural (3 of 3 versus 1 of 3) lesions.

CONCLUSIONS

In specific circumstances, EM can be a very useful adjunct to LM in patients undergoing TNB. Problems with sample adequacy must be addressed.

Reperfusion edema after lung transplantation: radiographic manifestations

PURPOSE

To characterize the radiographic manifestations of reperfusion edema after lung transplantation and to correlate the severity of the radiographic findings with pulmonary physiology.

MATERIALS AND METHODS

Chest radiographs obtained after 45 lung transplantation procedures (20 single, 25 double) were reviewed retrospectively. Physiologic parameters (alveolar-arterial gradient, ratio of partial pressure of oxygen to fraction of inspired oxygen) were noted in patients who underwent intubation.

RESULTS

Reperfusion edema appeared on day 1 in 39 transplants and by day 3 in 44. One patient's lungs remained clear. Peak severity occurred by day 4 in 43 of 44 transplants. At peak severity, reperfusion edema appeared as reticular interstitial disease in the upper (19%), middle (33%), and lower (34%) lung zones or air-space disease in the upper (31%), middle (61%), and lower (57%) zones. Reperfusion edema was asymmetric after double-lung transplantation in nine patients. The process cleared by day 10 in five transplants and by day 21 in another seven. There was a poor correlation between the severity of radiographic findings and physiologic measurements.

CONCLUSION

Reperfusion edema is almost invariable after lung transplantation and most often appears as air-space disease in the middle and/or lower lung zones. The severity of radiographic findings is a poor indicator of pulmonary physiology.

Clarithromycin-induced ventricular tachycardia

Clarithromycin is a relatively new macrolide antibiotic that offers twice-daily dosing. It differs from erythromycin only in the methylation of the hydroxyl group at position 6. Although the side-effect profile of erythromycin is established, including gastroenteritis and interactions with other drugs subject to hepatic mixed-function oxidase metabolism, experience with the newer macrolides is still being recorded. Cardiotoxicity has been demonstrated after both intravenous and oral administration of erythromycin but has never been reported with the newer macrolides. We report a case of ventricular dysrhythmias that occurred after six therapeutic doses of clarithromycin. The dysrhythmias resolved after discontinuation of the drug.

Immunoassays to study prevalence of antibody against GB virus C in blood donors

Immunoassays were developed to determine the seroprevalence of antibody against human GB virus C (GBV-C). The antigenic target in each assay was a 44.6-kDa glycosylated protein representing the first 315 amino acids encoded by the GBV-C E2 gene. Sera or plasma were assayed for E2 antibody using an anti-human EIA format in which antigen-coated polystyrene beads were reacted with sample, and bound antibody was detected by addition of enzyme labelled goat anti-human IgG. The presence of anti-E2 antibody was confirmed using a sandwich EIA format in which samples were reacted with antigen coated polystyrene beads, followed by addition of solution phase biotinylated antigen. Detection of antibody captured biotinylated E2 was accomplished by addition of enzyme-conjugated anti-biotin antibody. Antibody against the E2 antigen was detected in 7.4 and 7.8% of 500 sera and 500 plasma, respectively, from US volunteers donating to a Wisconsin blood center, and in approximately 10.7% of hepatitis and retrovirus marker-negative volunteer blood donors from a Missouri blood center. The rate in 1018 sera from US commercial donors at multiple US blood centers was 36.7%. These results indicated a relatively high prevalence of GBV-C exposure in US volunteer donors, and particularly in commercial donors. The clinical implication of the high exposure rate is unclear. These immunoassays are being combined with nucleic acid detection to assess prevalence of GBV-C world wide and to determine if GBV-C plays a role as an etiologic agent.

Capillary electrophoresis for purity estimation and in-process testing of recombinant GB virus-C proteins

Protein purity estimation by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) coupled with scanning densitometry is a critical component in the manufacture of recombinant proteins for commercial diagnostic assays. However, the procedure is time consuming and often difficult to reproduce because commercial dyes that are used for visualizing proteins do not bind in a stoichiometric fashion for all proteins. The present report describes the use of a rapid and dye-independent SDS polymer-filled capillary gel electrophoresis (CE-SDS) method to estimate protein purity. The CE-SDS method was used for in-process and final purity testing of GB virus-C (GBV-C) fusion proteins produced in E. coli, and was directly compared with the conventional SDS-PAGE method using purified Coomassie blue dye to reduce protein staining anomalies. The CE-SDS method may serve as an alternative or replacement method to the lengthy and tedious SDS-PAGE method. This study also demonstrates that the observed molecular weight of the fusion protein, determined by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), provides higher accuracy than values estimated by either CE-SDS or SDS-PAGE methods.

Effects of montelukast (MK-0476); a potent cysteinyl leukotriene receptor antagonist, on bronchodilation in asthmatic subjects treated with and without inhaled corticosteroids

BACKGROUND

Cysteinyl leukotriene release in association with airway inflammation is a feature of clinical asthma. The acute effects of montelukast (MK-0476), a potent, orally administered, specific cysteinyl leukotriene receptor antagonist, on airways obstruction was assessed in patients with mild to moderately severe asthma.

METHODS

Twenty two asthmatic subjects were randomised to receive montelukast, 100 mg or 250 mg, or placebo in a double blind, three period, crossover trial. Ten of the patients were using concomitant inhaled corticosteroids.

RESULTS

Montelukast increased the forced expiratory volume in one second (FEV1) from predose baseline values compared with placebo, the percentage point differences between montelukast and placebo being 8.6% (95% CI 3.6 to 13.6) and 8.5% (95% CI 3.5 to 13.5) for the 100 mg and 250 mg doses, respectively.

CONCLUSION

Single oral doses of montelukast 100 mg and 250 mg produced significant increases in FEV1 irrespective of the concurrent use of inhaled corticosteroids in asthmatic subjects with airflow limitation.

Montelukast causes prolonged, potent leukotriene D4-receptor antagonism in the airways of patients with asthma

Montelukast, a new specific oral cysteinyl LT3-receptor antagonist was evaluated for its activity in attenuating inhaled leukotriene D4 (LTD4) bronchoconstriction in patients with asthma. In two double-blind, placebo-controlled, randomized crossover studies, patients with mild asthma (forced expiratory volume in 1 second [FEV1] > or = 70%) were studied. In trial A, LTD4 challenge began 4 hours (peak plasma concentration) after a single dose of placebo or 5, 20, 100, and 250 mg montelukast. In trial B, and LTD4 challenge was started 20 hours after administration of placebo, 40 mg montelukast, or 200 mg montelukast. During each challenge, twofold increasing concentrations of LTD4 were inhaled until specific airways conductance (sGaw) decreased by at least 50% (PC50) or the highest concentration of LTD4 was inhaled. In trial A with all doses and in trial B with the 200 mg dose, bronchoconstriction was attenuated (50% fall in sGaw was not observed) up to the highest dose of LTD4 administered. In trial B, during the 40 mg period, only two of six patients exhibited a 50% fall in sGaw; PC50 ratios (montelukast 40 mg/placebo) were 18 and 45 in these two patients. These results indicate that montelukast is a highly potent and long-lasting antagonist of LTD4-induced bronchoconstriction in patients with asthma.

Purity testing of recombinant proteins by capillary electrophoresis

Purity testing of recombinant DNA (rDNA) proteins using slab gel electrophoresis in conjunction with scanning densitometry is time consuming and labor intensive and is difficult to reproduce because the dyes used for visualizing proteins do not bind in a stoichiometric fashion for all proteins. The present report describes a micellar capillary zone electrophoresis (MCZE) procedure that overcomes these difficulties. The MCZE method was evaluated to estimate protein purity of hydrophobic cytomegalovirus proteins, expressed E. coli, and highly glycosylated hepatitis C virus proteins, expressed in Chinese hamster ovary cells. The results obtained by the MCZE procedure correlated very well with the purity results quantitated by the conventional slab gel electrophoresis method using purified Coomassie Brilliant Blue dye to reduce anomalies. MCZE may serve as an alternative method for in-process and purity testing of rDNA proteins.

Comparative peptide mapping of a hepatitis C viral recombinant protein by capillary electrophoresis and matrix-assisted laser desorption time-of-flight mass spectrometry

Capillary electrophoresis (CE) and matrix assisted laser desorption time-of-flight mass spectrometry (MALDI-TOF-MS) were investigated as alternatives to sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis for peptide mapping with Staphylococcus aureus protease (V8) of a hydrophobic recombinant hepatitis C virus antigen, HC-31, which required 0.1% SDS for solubility. Controls (V8 only) or HC-31 digests were extracted with chloroform-methanol-water (1:4:3) to remove SDS, which interferes with MALDI-TOF, and high salt content, which affects CE. In two different runs by CE, the elution times of each of 11 peptide peaks were very reproducible (R.S.D. < 0.016). 25 fragments were resolved by MALDI-TOF-MS, including six smaller peptides (M(r) < 13 000) resulting from V8 autodigestion. MALDI-TOF-MS indicated that partial cleavages occurred, primarily at sites where there are paired glutamic and/or aspartic acid residues.

Effects of montelukast (MK-0476), a new potent cysteinyl leukotriene (LTD4) receptor antagonist, in patients with chronic asthma

BACKGROUND

Cysteinyl leukotrienes mediate signs and symptoms of asthma. In a double-blind, placebo-controlled, crossover study, a new potent and specific cysteinyl leukotriene (LTD4) receptor antagonist, montelukast (MK-0476), was evaluated for tolerability and clinical efficacy in patients with chronic asthma (receiving and not receiving inhaled corticosteroids).

METHODS

Twenty-nine nonsmoking patients with asthma (15 treated concomitantly with inhaled corticosteroids) with FEV1 percent predicted values between 50% to 80% received MK-0476, 200 mg, or placebo three times daily for 10 1/3 days (31 doses) in a random, crossover manner, after a 2-week, open, baseline period. Comparisons in FEV1 (mean percent change from baseline after the first and last dose), mean daily daytime asthma and nocturnal awakening scores, and mean daily beta-agonist use were made between treatment periods.

RESULTS

Montelukast, compared with placebo, caused improvements in FEV1 (mean percentage point difference of the percentage change from baseline) 3 and 4 hours after dosing on day 1 (hour 3, 9.0%; 95% confidence interval [CI] 0.53, 18.72; hour four, 10.9%; 95% CI -0.25, 20.20) and day 11 (hour 3, 14.0%; 95% CI 0.76, 31.43; hour 4, 13.4%; 95% CI 1.24, 28.83). Reductions were observed in mean daily beta-agonist use (1.0 puff/day [95% CI -1.61, -0.26]), mean daytime symptom scores, and nocturnal awakenings over the 10 1/3 day treatment period. There were no important differences between the groups receiving and those not receiving inhaled corticosteroids. Montelukast was well tolerated with no serious clinical adverse events reported.

CONCLUSIONS

In this study Montelukast, 200 mg, administered three times daily for 10 1/3 days, compared with placebo, was generally well tolerated and resulted in significant improvement in chronic asthma, irrespective of the presence of inhaled corticosteroids.

A randomized, placebo-controlled study of the immunogenicity of human immunodeficiency virus (HIV) rgp160 vaccine in HIV-infected subjects with > or = 400/mm3 CD4 T lymphocytes (AIDS Clinical Trials Group Protocol 137)

Immune responses provoked by human immunodeficiency virus (HIV) infection ultimately are insufficient to control the disease and do not include strong lymphocyte-proliferative responses to HIV antigens or antibodies to many viral epitopes. A randomized double-blind, placebo-controlled trial evaluated the immunogenicity of recombinant HIV envelope vaccine (rgp160) in HIV-infected subjects with > or = 400/mm3 CD4 T cells. Controls received hepatitis B vaccine. Of subjects receiving rgp160, 98% developed lymphocyte-proliferative responses to the immunogen, 33% to a different envelope protein, and 56% and 60% to p24 and p66, respectively. All doses of vaccine (20, 80, 320, 1280 microgram) induced new responses. New antibodies to epitopes on rgp160 developed only in recipients of higher doses of rgp160. CD4 T cell percentages declined less rapidly in recipients of rgp160 than in controls. Vaccination of HIV-infected subjects with rgp160 results in cellular and humoral immune responses to HIV that infection itself had not stimulated.

Isoelectric focusing of monoclonal antibodies by capillary electrophoresis

The isoelectric points (pIs) of murine monoclonal antibodies (MAbs) determined by published one-step capillary isoelectric focusing (CIEF) methods using simultaneous focusing and electroosmotic mobilization showed appreciable deviation from the pI values determined by the slab gel electrophoretic method. The present report describes a modified one-step CIEF method that accurately determines the pIs of MAbs. The modifications include use of internal standards with pIs below and above the pI ranges of MAbs and calculation of pIs from a fitted nonlinear standard curve. Proteins with pIs in the same range as MAbs were first used to establish the efficacy of the method. The present CIEF procedure is highly reproducible and easy to perform for MAbs.

Extraction efficiency of saturated-gain high-power dye laser amplifiers: effect of nonlinear signal absorption

The effect of nonlinear signal absorption (NLSA) due to ground-state absorption and excited-state absorption in a transversely pumped high-power dye laser amplifier is theoretically examined with a one-dimensional steady-state model for a dye amplifier pumped by a copper vapor laser. A well-approximated analytical expression for the extraction efficiency is derived, from which the effect of NLSA in reducing the amplifier efficiency can be appreciated immediately and can also be interpreted in terms of certain characteristic lengths. The reduction in efficiency due to NLSA is found to be largely independent of the pump power, provided that the signal power is increased linearly with the pump power to continue to saturate the amplifier gain and suppress amplified spontaneous emission.

Early fine motor and adaptive development in high-risk appropriate for gestational age preterm and healthy term children

The development of fine motor and adaptive skills during the first 2 years of life is reported in 97 high-risk preterm children and 94 healthy term children. Most stages of fine motor and adaptive development were found to occur at slightly later ages among preterm children. Neurological development was significantly correlated with fine motor and adaptive development in preterm children only. No significant influence of prenatal, perinatal and postnatal variables on fine motor and adaptive development was noted. No significant sex differences were observed in both the term and preterm group. The strongest predictors of later intellectual functioning were fine motor performance at 9 months and fine motor and adaptive skills at 18 to 24 months.

Neurological outcome in high risk weight appropriate for gestational age preterm children at early school age

Neurological development in preterm children with birth weight appropriate for gestational age is reported in two separate groups: a longitudinal study of 97 preterm children and 93 term children as a control group and a cross-sectional study of 249 preterm children. Both preterm groups were regarded as high risk with respect to number of outborns, distribution of gestational age and perinatal risk factors. Neurological outcome at 5-6 years of age in the majority of the preterm children was comparable to that of the term children. However, 15% of boys and 9% of girls in the preterm group were diagnosed as having cerebral palsy. Mild diplegia was most frequently observed; 4% of the children were severely impaired. Fourteen percent of the preterm vs 2% of the term boys and 6-9% of the preterm vs none of the term girls received motor therapy during early school age. There was a small but consistent sex difference in neurological outcome in favour of the term and preterm girls. Effects of drop out rate and of incompleteness of ascertainment are reported in detail.

Intellectual outcome, speech and school performance in high risk preterm children with birth weight appropriate for gestational age

Intellectual development, speech and school performance of preterm infants with birth weight appropriate for gestational age are reported in two separate investigations: a longitudinal study of 97 preterm children and 93 term children as a control group, and a cross-sectional study of 249 preterm children. Both preterm groups were regarded as high risk groups with respect to number of outborns, distribution of gestational age and perinatal risk factors. Intellectual outcome at 5 and 7 years of age in the majority of the preterm children was comparable to that of the term children. However, 8% of the preterm boys and 2% of the preterm girls achieved lower IQ scores than any of the term children. Between 15% and 17% of the preterm boys and 9%-12% of the preterm girls did not attend school at grade level, compared to 4% and 2% in the term group, respectively. Intellectual and neurological development and school performance were higher interrelated in the preterm than in the term children. Articulation defects, stuttering and dysgrammatism occurred more frequently in the preterm than in the term children and in boys more so than in girls.

Predicting developmental outcome at school age from infant tests of normal, at-risk and retarded infants

The predictive validity of developmental testing was investigated in term, preterm and retarded children. Verbal, performance and locomotor development were assessed at various ages and individual development curves constructed. Inter-age correlations between development tests at nine to 24 months and intellectual assessment at seven years revealed a strong effect on prediction for age at testing and level of mental performance. Categorisation by level of mental performance demonstrated that at seven years 98.6 per cent of the children with developmental quotients (DQs) greater than 85 at 24 months achieved IQs greater than 85, while 98.7 per cent of the seven- to eight-year-old children with DQs greater than 85 at nine to 24 months achieved IQs greater than 85. The Griffiths language and performance scores and their combination were the strongest predictors of later intellectual functioning. The social score was of moderate significance, while the locomotor score had no predictive value. Analysis of individual development curves revealed that prediction was hampered in some children by factors not detectable by statistical analysis, such as dissociations in development, organic impairment and major life events. Among the prenatal, perinatal and postnatal variables studied, only socio-economic status was of predictive significance; its effect depended on the level of mental performance and was most marked in term children, but it had no effect on retarded children.

Significance of prenatal, perinatal and postnatal factors in the development of AGA preterm infants at five to seven years

The effects of prenatal, perinatal and postnatal events on developmental outcome at five to seven years of preterm infants with birthweights appropriate for gestational age were investigated in two separate cohorts: one a longitudinal study of 97 infants, the other a cross-sectional study of 249 infants. Among the prenatal variables, the number of minor congenital anomalies was negatively correlated with neurological development, as was the deformation score. The pregnancy optimality score was not significantly related to outcome. Among the perinatal variables, gestational age and birthweight had some significant correlations with development, but birth and neonatal optimality scores were only inconsistently significant in relation to outcome. Socio-economic status was strongly related to language and intellectual development. Infants with gestations of 32 to 36 weeks had a more favourable neurological and intellectual outcome than those born before 32 weeks: however, the former group comprised about 80 per cent of the population studied, so the majority of children with lower function were found in that group.

Antibody response of infants in tropics to five doses of oral polio vaccine

Sixty-two infants 1-12 months of age were administered five doses of trivalent oral polio vaccine (TOPV) at intervals of 4 weeks. The seroconversion achieved were 88.7, 93.5 and 96.5 per cent for type I, II, and III polioviruses. These seroconversion rates are significantly better when compared to seroconversion achieved after two and three doses of trivalent oral polio vaccine. Factors which were considered in previous studies to be responsible for low seroconversion rates viz. interference by enteroviruses, breast feeding, malnutrition, and age were found to be insignificant when five doses of oral polio vaccine were given. It is possible that these effects were overcome by increasing the number of doses of trivalent oral polio vaccine.

Prolonged, progressive dementia with spongiform encephalopathy: a variant of Creutzfeldt-Jakob disease?

A 46-year-old female is described with prolonged, progressive dementia and a brain biopsy consistent with Creutzfeldt-Jakob disease (CJD). She had neither myoclonic jerks nor an electroencephalogram with periodic spikes and suppression. Five of her close relatives were also demented. The nosology of CJD was discussed in the light of this case in which histopathology was characteristic of spongiform encephalopathy but the clinical features were atypical. We concluded that it would be premature to expand the traditional diagnostic criteria to include such cases as having CJD but, at the same time, it would be prudent to handle tissue, linens and surgical instruments as if they were contaminated by the resistant agent of CJD.

Effects of phenobarbital on the distribution pharmacokinetics and biological half-lives of model nonmicrosomal enzyme metabolizable sulfonamides in rats

The pharmacokinetics of sulfisoxazole and sulfanilamide were studied in control rats and in rats treated for 5 days with a daily 100 mg/kg ip dose of phenobarbital. These drugs represent the organic anionic and nonionized drugs, respectively, whose nonmicrosomal enzymatic metabolisms were unstimulated by phenobarbital. Sulfisoxazole showed the characteristics of a two-compartment open model. However, its biological half-life and the apparent distribution volume of the central compartment were significantly lower and the intercompartmental transport rate constants and the urinary excretion rate constant were significantly greater, in phenobarbital treated rats than in control rats. The apparent steady-state distribution volume of sulfisoxazole was smaller in the phenobarbital treated rats at the 90% confidence level. Sulfanilamide showed characteristics of a one-compartment model in both the control and phenobarbital treated rats, but none of the pharmacokinetic parameters of the compound in the phenobarbital treated rats were significantly different from those in the control rats.

Clinical trial with rifampicin in the treatment of leprosy (final report)

A controlled trial of Rifampicin plus Dapsone had been in progress for two years in the Department of Leprology, School of Tropical Medicine, Calcutta. Interim results of this trial after six months treatment were reported in 1976. The present paper is the final report of the study after two years of treatment. The study reveals that with Rifampicin, MI falls rapidly after six months, but changes in BI are not better than in the DDS group. As a matter of fact, regarding BI, treatment with DDS has given better results as two cases have become negative in the DDS group while no case has become negative in the Rifampicin group. It is, therefore, concluded that clinical improvement with Rifampicin is similar to that with DDS.

Clinical trial with rifampicin in the treatment of leprosy

Rusults of treatment with Rifampicin in ten untreated and uncomplicated cases of active lepromatous leprosy are compared with those of D.D.S. in a similar number of cases. Though clinical improvement was similar in both the groups, improvement in B.I. and M.I. appears to be better in the latter group. High price of Rifampicin is its greatest drawback at present.

Structures of gangliosides from bovine adrenal medulla

Five gangliosides, accounting for over 95% of the total ganglioside fraction, were isolated from bovine adrenal medulla by preparative thin-layer chromatography and the carbohydrate structures determined by a combination of periodate oxidation and permethylation techniques. Partially methylated alditol acetates were generated from the neutral sugars of the fully methylated glycolipids and identified by gas-liquid chromatography. Substitution on N-acetylgalactosamine was determined by methanolysis of the permethylated ganglioside, acetylation of the products, and identification of the resulting substituted methyl glycosides by GLC. Periodate oxidation followed by borohydride reduction confirmed some of the linkages and demonstrated the absence of (2-8) linkages between sialic acid units. Mass spectrometry of the permethylated gangliosides gave information on sugar sequence at the nonreducing end.