Low back pain in the Bangladeshi adult population: a cross-sectional national survey

OBJECTIVE

Low back pain (LBP) is a common musculoskeletal disorder. This study aims to determine the residence-specific and sex-specific prevalence and the factors associated with LBP in Bangladesh.

METHODS

The study subjects (aged ≥18 years) were identified from 20 primary sampling units of the national census following a cross-sectional multistage stratified sampling design. We considered the mechanical type of LBP for this study. A Bangla version of the modified Community Oriented Programme for Control of Rheumatic Disorders questionnaire was used. A team of trained field workers, rheumatology residents and rheumatologists collected the data. Analysis was done using weighted data.

RESULTS

Two thousand subjects were approached, but 1843 could be screened. Among them, 561 had musculoskeletal disorders, and 343 were diagnosed with LBP. The weighted prevalence of LBP was 18.5% (95% CI: 11.8% to 25.2%) and age-standardised prevalence of LBP was 19.4% (95% CI: 14.0% to 24.8%), which was higher in women (27.2%, 19.3% to 35.1%) than men (14.0%, 8.7% to 19.3%). The prevalence persistently increased from age group 18-34 years (10.5%, 5.7 to 15.4) to ≥55 years (27.8%, 16.1% to 39.5%). People with no education had the highest prevalence (31.3%, 22.3% to 40.4%). The prevalence did not differ between urban and rural residential locations. Four factors were significantly associated with LBP: age (adjusted odds ratio: 2.4, 95% CI: 1.7 to 3.4), female sex (2.2, 1.5 to 3.3), absence of formal education (2.3, 1.6 to 3.3) and hypertension (1.7, 1.1 to 2.6).

CONCLUSION

LBP is a common problem in Bangladeshi adults. The factors identified are age, female sex, no formal education and hypertension. These should be addressed adequately to prevent and treat LBP.

Risk factors for non-communicable diseases in Bangladesh: findings of the population-based cross-sectional national survey 2018

OBJECTIVES

To determine the national prevalence of risk factors of non-communicable diseases (NCD) in the adult population of Bangladesh.

DESIGN

The study was a population-based national cross-sectional study.

SETTING

This study used 496 primary sampling units (PSUs) developed by the Bangladesh Bureau of Statistics. The PSUs were equally allocated to each division and urban and rural stratum within each division.

PARTICIPANTS

The participants were adults aged 18 to 69 years, who were usual residents of the households for at least 6 months and stayed the night before the survey. Out of 9900 participants, 8185 (82.7%) completed STEP-1 and STEP-2, and 7208 took part in STEP-3.

PRIMARY AND SECONDARY OUTCOME

The prevalence of behavioural, physical and biochemical risk factors of NCD. Data were weighted to generate national estimates.

RESULTS

Tobacco use was significantly (p<0.05) higher in the rural (45.2%) than the urban (38.8%) population. Inadequate fruit/vegetable intake was significantly (p<0.05) higher in the urban (92.1%) than in the rural (88.9%) population. The mean salt intake per day was higher in the rural (9.0 g) than urban (8.9 g) population. Among all, 3.0% had no, 70.9% had 1 to 2 and 26.2% had ≥3 NCD risk factors. The urban population was more likely to have insufficient physical activity (adjusted OR (AOR): 1.2, 95% CI: 1.2 to 1.2), obesity (AOR: 1.5, 95% CI: 1.5 to 1.5), hypertension (AOR: 1.3, 95% CI: 1.3 to 1.3), diabetes (AOR: 1.6, 95% CI: 1.6 to 1.6) and hyperglycaemia (AOR: 1.1, 95% CI: 1.1 to 1.1).

CONCLUSIONS

Considering the high prevalence of the behavioural, physical and biochemical risk factors, diverse population and high-risk group targeted interventions are essential to combat the rising burden of NCDs.

Salt Intake Behaviors among Type 2 Diabetic Patients of a Tertiary Level Hospital in Dhaka City

Hypertension and diabetes co-exist frequently. Therefore, salt intake behavior, a risk factor of hypertension, in diabetic patients plays an important role in determining their cardiovascular outcome. The purpose of this study was to assess the knowledge and behaviors of health risks associated with a salt intake in adults with type 2 diabetes. This cross-sectional study was conducted among the type 2 diabetic in-patients of Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh from October to December 2016. Data were collected from 131 respondents through interview using WHO STEPS module of salt with adaptation to local context like on amount of added salt while taking meal. Information on blood pressure, body mass index and relevant co-morbidities were also collected. About half of the respondents were women (56.5%). Mean age of the respondents was 54.3±14.4 years. More than six in 10 of them (62.6%) took added salt while taking meal; and 40.5% took processed foods with high salt. The mean amount of added salt intake among the users was 4.4±1.6gm per day having no significant difference between men and women. Though 47.3% of the respondents believed that lowering salt in meal is very important and 77.9% of them believed that excess salt or salty sauce can cause health problems. Salt intake behavior is poor in patients with type 2 diabetes even having regular contacts with doctors and other health professionals. Appropriate measures can be taken to increase awareness, change their attitude and behavior regarding salt consumption.

Use of a novel docosahexaenoic acid formulation vs control in a neonatal porcine model of short bowel syndrome leads to greater intestinal absorption and higher systemic levels of DHA

Infants with short bowel syndrome (SBS) are at high risk for malabsorption, malnutrition, and failure to thrive. The objective of this study was to evaluate in a porcine model of SBS, the systemic absorption of a novel enteral Docosahexaenoic acid (DHA) formulation that forms micelles independent of bile salts (DHA-ALT®). We hypothesized that enteral delivery of DHA-ALT® would result in higher blood levels of DHA compared to a control DHA preparation due to improved intestinal absorption. SBS was induced in term piglets through a 75% mid-jejunoileal resection and the piglets randomized to either DHA-ALT® or control DHA formulation (N=5 per group) for 4 postoperative days. The median±IQR difference in final vs starting weight was 696±425 g in the DHA-ALT® group compared to 132±278 g in the controls (P=.08). Within 12 hours, median±IQR DHA and eicosapentaenoic acid plasma levels (mol%) were significantly higher in the DHA-ALT® vs control group (4.1±0.3 vs 2.5±0.5, P=.009; 0.7±0.3 vs 0.2±0.005, P=.009, respectively). There were lower fecal losses of DHA and greater ileal tissue incorporation with DHA-ALT® vs the control. Morphometric analyses demonstrated an increase in proximal jejunum and distal ileum villus height in the DHA-ALT® group compared to controls (P=.01). In a neonatal porcine model of SBS, enteral administration of a novel DHA preparation that forms micelles independent of bile salts resulted in increased fatty acid absorption, increased ileal tissue incorporation, and increased systemic levels of DHA.

Effects of Intensive versus Non-Intensive Physical Therapy on Children with Cerebral Palsy

Cerebral Palsy (CP) is one of the most common causes of all childhood disorders. There are tone, posture and movements difficulty due to non-progressive damage to the immature brain in CP. The hallmark of CP is a disability in the development of gross motor function (GMF). The influence of gross motor development on fine motor development is more important in early developmental period, specially under three years old and in children with CP. Various therapeutic interventions have been used in the management of GMF development. Among them physical therapy is the most common intervention in CP and is usually a component of mandated programs. Physical therapy means physical stimulations in the form of various therapeutic exercises, touch, massage, limbs and trunk movement, balancing and coordination training, gait and ambulation training, cognitive stimulation as well as speech, language and occupational therapy. Our study focused to see the effect by short term intensive versus non-intensive physical therapy on children GMF development by using gross motor function measure (GMFM) Score sheet, GMFM-88, version 1.0. Study provides the information that physical therapy intervention is effective in GMF development and intensive interventions are more effective in children with spastic CP than non-intensive one. Study also inform that the more early treatment the more effective result.

Late Enteral Feedings Are Associated with Intestinal Inflammation and Adverse Neonatal Outcomes

BACKGROUND

Morbidities of impaired immunity and dysregulated inflammation are common in preterm infants. Postnatal Intestinal development plays a critical role in the maturation of the immune system and is, in part, driven by exposure to an enteral diet.

OBJECTIVE

The aim of this study was to evaluate the influence of the timing of the first enteral feeding on intestinal inflammation and risk of disease.

METHODS

130 infants <33 weeks' gestation were studied. Maternal and infant data were abstracted from the medical record. Single and multiplex ELISA assays quantified cytokines from fecal and serum samples at two weeks postnatal age.

RESULTS

A delay in enteral feedings after the third postnatal day is associated with a 4.5 (95% CI 1.8-11.5, p=0.002) fold increase in chronic lung disease, 2.9 (1.1-7.8, p=0.03) fold increase in retinopathy of prematurity, and 3.4 (1.2-9.8, p=0.02) fold increase in multiple comorbidities compared to infants fed on or before the third day. Additionally, a delay in the initiation of feedings is associated with increased fecal IL-8 levels and a decreased IL-10:IL-8 ratio.

CONCLUSIONS

A delay in enteral feeding is associated with intestinal inflammation and increased risks of morbidities. To improve neonatal outcomes, early nutritional practices need to be reevaluated.

Dual use of tobacco among Bangladeshi men

INTRODUCTION

Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey.

METHODS

The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height.

RESULTS

The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of "smoking only," "smokeless only" and "dual use" of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets.

CONCLUSION

Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.

Resolvin D1 and lipoxin A4 improve alveolarization and normalize septal wall thickness in a neonatal murine model of hyperoxia-induced lung injury

Background

The critical fatty acids Docosahexaenoic Acid (DHA) and Arachidonic Acid (AA) decline in preterm infants within the first postnatal week and are associated with neonatal morbidities, including bronchopulmonary dysplasia (BPD). DHA and AA are precursors to downstream metabolites that terminate the inflammatory response. We hypothesized that treatment with Resolvin D1 and/or Lipoxin A₄ would prevent lung injury in a murine model of BPD.

Objective

To determine the effect of Resolvin D1 and/or Lipoxin A4 on hyperoxia-induced lung injury.

Methods

C57/BL6 pups were randomized at birth to Room Air, Hyperoxia (>90% oxygen), Hyperoxia + Resolvin D1, Hyperoxia + Lipoxin A₄, or Hyperoxia + Resolvin D1/Lipoxin A₄. Resolvin D1 and/or Lipoxin A₄ (2 ng/g) were given IP on days 0, 3, 6, and 9. On day 10, mice were sacrificed and lungs collected for morphometric analyses including Mean Linear Intercept (MLI), Radial Alveolar Count (RAC), and Septal Thickness (ST); RT-PCR analyses of biomarkers of lung development and inflammation; and ELISA for TGFβ₁ and TGFβ₂.

Result

The increased ST observed with hyperoxia exposure was normalized by both Resolvin D1 and Lipoxin A₄; while, hyperoxia-induced alveolar simplification was attenuated by Lipoxin A₄. Relative to hyperoxia, Resolvin D1 reduced the gene expression of CXCL2 (2.9 fold), TIMP1 (6.7 fold), and PPARγ (4.8 fold). Treatment with Lipoxin A₄ also led to a reduction of CXCL2 (2.4 fold) while selectively increasing TGFβ₂ (2.1 fold) and Smad3 (1.58 fold).

Conclusion

The histologic and biochemical changes seen in hyperoxia-induced lung injury in this murine model can be reversed by the addition of DHA and AA fatty acid downstream metabolites that terminate the inflammatory pathways and modulate growth factors. These fatty acids or their metabolites may be novel therapies to prevent or treat lung injury in preterm infants.

Predictors of tobacco smoking and smokeless tobacco use among adults in Bangladesh

INTRODUCTION

To examine predictors of current tobacco smoking and smokeless tobacco use among the adult population in Bangladesh.

MATERIALS AND METHODS

We used data from the 2009 Global Adult Tobacco Survey (GATS) in Bangladesh consisting of 9,629 adults aged ≥15 years. Differences in and predictors of prevalence for both smoking and smokeless tobacco use were analyzed using selected socioeconomic and demographic characteristics that included gender, age, place of residence, education, occupation, and an index of wealth.

RESULTS

The prevalence of smoking is high among males (44.7%, 95% confidence interval [CI]: 42.5-47.0) as compared to females (1.5%, 95% CI: 1.1-2.1), whereas the prevalence of smokeless tobacco is almost similar among both males (26.4%, 95% CI: 24.2-28.6) and females (27.9%, 95% CI: 25.9-30.0). Correlates of current smoking are male gender (odds ratio [OR] = 41.46, CI = 23.8-73.4), and adults in older age (ORs range from 1.99 in 24-35 years age to 5.49 in 55-64 years age), less education (ORs range from 1.47 in less than secondary to 3.25 in no formal education), and lower socioeconomic status (ORs range from 1.56 in high wealth index to 2.48 in lowest wealth index. Predictors of smokeless tobacco use are older age (ORs range from 2.54in 24-35 years age to 12.31 in 55-64 years age), less education (ORs range from 1.44 in less than secondary to 2.70 in no formal education), and the low (OR = 1.34, CI = 1.0-1.7) or lowest (OR = 1.43, CI = 1.1-1.9) socioeconomic status.

CONCLUSION

Implementation of tobacco control strategies needs to bring special attention on disadvantaged group and cover all types of tobacco product as outlined in the WHO Framework Convention on Tobacco Control (FCTC) and WHO MPOWER to protect people's health and prevent premature death.

CFTR dysfunction predisposes to fibrotic liver disease in a murine model

Cystic fibrosis liver disease (CFLD) is a rapidly progressive biliary fibrosis, resembling primary sclerosing cholangitis that develops in 5-10% of patients with cystic fibrosis. Further research and evaluation of therapies are hampered by the lack of a mouse model for CFLD. Although primary sclerosing cholangitis is linked to both ulcerative colitis and loss of cystic fibrosis transmembrane conductance regulator (CFTR) ion channel function, induction of colitis with dextran sodium sulfate (DSS) in cftr(-/-) mice causes bile duct injury but no fibrosis. Since profibrogenic modifier genes are linked to CFLD, we examined whether subthreshhold doses of the profibrogenic xenobiotic 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC), along with DSS-induced colitis, lead to bile duct injury and liver fibrosis in mice that harbor loss of CFTR function. Exon 10 heterozygous (cftr(+/-)) and homozygous (cftr(-/-)) mice treated with DDC demonstrated extensive mononuclear cell inflammation, bile duct proliferation, and periductular fibrosis. In contrast, wild-type (cftr(+/+)) littermates did not develop bile duct injury or fibrosis. Histological changes corresponded to increased levels of alkaline phosphatase, hydroxyproline, and expression of profibrogenic transcripts for transforming growth factor-β(1), transforming growth factor-β(2), procollagen α(1)(I), and tissue inhibitor of matrix metaloproteinase-1. Immunohistochemistry demonstrated fibrosis and activation of periductal fibrogenic cells based on positive staining for lysyl oxidase-like-2, α-smooth muscle actin, and collagen I. These data demonstrate that subthreshold doses of DDC, in conjunction with DSS-induced colitis, results in bile duct injury and periductal fibrosis in mice with partial or complete loss of CFTR function and may represent a useful model to study the pathogenic mechanisms by which CFTR dysfunction predisposes to fibrotic liver disease and potential therapies.

Decreased postnatal docosahexaenoic and arachidonic acid blood levels in premature infants are associated with neonatal morbidities

OBJECTIVE

To measure the changes in whole blood fatty acid levels in premature infants and evaluate associations between these changes and neonatal morbidities.

STUDY DESIGN

This was a retrospective cohort study of 88 infants born at <30 weeks' gestation. Serial fatty acid profiles during the first postnatal month and infant outcomes, including chronic lung disease (CLD), retinopathy of prematurity, and late-onset sepsis, were analyzed. Regression modeling was applied to determine the association between fatty acid levels and neonatal morbidities.

RESULTS

Docosahexaenoic acid (DHA) and arachidonic acid levels declined rapidly in the first postnatal week, with a concomitant increase in linoleic acid levels. Decreased DHA level was associated with an increased risk of CLD (OR, 2.5; 95% CI, 1.3-5.0). Decreased arachidonic acid level was associated with an increased risk of late-onset sepsis (hazard ratio, 1.4; 95% CI, 1.1-1.7). The balance of fatty acids was also a predictor of CLD and late-onset sepsis. An increased linoleic acid:DHA ratio was associated with an increased risk of CLD (OR, 8.6; 95% CI, 1.4-53.1) and late-onset sepsis (hazard ratio, 4.6; 95% CI, 1.5-14.1).

CONCLUSION

Altered postnatal fatty acid levels in premature infants are associated with an increased risk of CLD and late-onset sepsis.

Correlation between severity of coronary artery stenosis and perfusion defect assessed by SPECT myocardial perfusion imaging

Numerous non-invasive techniques are developed to assess the severity of coronary artery disease (CAD). Coronary angiography (CAG) is an established method for the diagnosis and to quantify the severity of coronary artery stenosis. Single photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) using Technetium-99m (Tc-99m) tetrofosmin is also a useful established technique for the assessment of severity of CAD. This prospective observational study was carried out in Bangabandhu Sheikh Mujib Medical University (BSMMU) to assess the severity of coronary artery stenosis using Tc-99m Single Photon Emission Computed Tomography myocardial perfusion imaging (SPECT-MPI) in comparison with CAG. Eighty two (82) consecutive patients with mean age 53.51(SD+/-7.08) years and Candian Cardiovascular Society (CCS) class I and II severity of chest pain, male: female ratio (4.8:1) was studied. Tc-99m SPECT-MPI was performed by one-day exercise stress and rest protocol. A total of two hundred and forty six coronary artery territories examined in this study. By CAG normal coronary arteries were found in seventy six, moderate stenosis in twenty four and severe stenosis in one hundred and forty-six coronary artery territories whereas SPECT-MPI found normal perfusion in twenty seven, mild perfusion abnormality in seventeen, moderate perfusion abnormality in thirty two and severe perfusion abnormality in one hundred and sixty five coronary artery territories. Sensitivity and specificity of SPECT-MPI using Tc-99m tetrofosmin in detecting coronary artery stenosis were 87.09% and 80.95% respectively. The positive predictive value, negative predictive value and accuracy of the test were 91.01%, 73.91% and 85.18% respectively. From this study it can be concluded that Tc-99m SPECT-MPI was a safe, effective and excellent non-invasive tool for the detection of severity of coronary artery lesion and can be used to predict severity of CAD.

Linoleic acid supplementation results in increased arachidonic acid and eicosanoid production in CF airway cells and in cftr-/- transgenic mice

Cystic fibrosis (CF) patients display a fatty acid imbalance characterized by low linoleic acid levels and variable changes in arachidonic acid. This led to the recommendation that CF patients consume a high-fat diet containing >6% linoleic acid. We hypothesized that increased conversion of linoleic acid to arachidonic acid in CF leads to increased levels of arachidonate-derived proinflammatory metabolites and that this process is exacerbated by increasing linoleic acid levels in the diet. To test this hypothesis, we determined the effect of linoleic acid supplementation on downstream proinflammatory biomarkers in two CF models: 1) in vitro cell culture model using 16HBE14o(-) sense [wild-type (WT)] and antisense (CF) human airway epithelial cells; and 2) in an in vivo model using cftr(-/-) transgenic mice. Fatty acids were analyzed by gas chromatography-mass spectrometry (GC/MS), and IL-8 and eicosanoids were measured by ELISA. Neutrophils were quantified in bronchoalveolar lavage fluid from knockout mice following linoleic acid supplementation and exposure to aerosolized Pseudomonas LPS. Linoleic acid supplementation increased arachidonic acid levels in CF but not WT cells. IL-8, PGE(2), and PGF(2α) secretion were increased in CF compared with WT cells, with a further increase following linoleic acid supplementation. cftr(-/-) Mice supplemented with 100 mg of linoleic acid had increased arachidonic acid levels in lung tissue associated with increased neutrophil infiltration into the airway compared with control mice. These findings support the hypothesis that increasing linoleic acid levels in the setting of loss of cystic fibrosis transmembrane conductance regulator (CFTR) function leads to increased arachidonic acid levels and proinflammatory mediators.

Smoking and smokeless tobacco consumption: possible risk factors for coronary heart disease among young patients attending a tertiary care cardiac hospital in Bangladesh

OBJECTIVES

To determine the risk of coronary heart disease (CHD) associated with various types of tobacco consumption among young patients aged 20-49 years attending a tertiary care cardiac hospital in Bangladesh.

STUDY DESIGN

Case-control study.

METHODS

The study was undertaken at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. The study population comprised 69 cases with CHD and 138 controls without CHD from the emergency department of NICVD. Quantitative interviews were performed.

RESULTS

Most of the cases (79.7%) were either current or past consumers of some form of tobacco, compared with less than half of the controls (46.4%). The increased risk of CHD was approximately four fold in ever smokers [adjusted odds ratio (OR) 4.0, 95% confidence interval (CI) 1.7-9.5] and cases who had ever used smokeless tobacco (adjusted OR 4.0, 95% CI 2.0-8.1). Smokeless tobacco consumption was strongly associated with CHD after adjustment for smoking and other confounders.

CONCLUSION

This study found evidence for an association between various types of tobacco consumption and CHD, particularly for bidi smoking and different types of smokeless tobacco consumption. Policies should be made and implemented to combat bidi smoking and smokeless tobacco consumption, as well as cigarette smoking.

Cell culture models demonstrate that CFTR dysfunction leads to defective fatty acid composition and metabolism

Cystic fibrosis (CF) is associated with fatty acid alterations characterized by low linoleic and docosahexaenoic acid. It is not clear whether these fatty acid alterations are directly linked to cystic fibrosis transmembrane conductance regulator (CFTR) dysfunction or result from nutrient malabsorption. We hypothesized that if fatty acid alterations are a result of CFTR dysfunction, those alterations should be demonstrable in CF cell culture models. Two CF airway epithelial cell lines were used: 16HBE, sense and antisense CFTR cells, and C38/IB3-1 cells. Wild-type (WT) and CF cells were cultured in 10% fetal bovine serum (FBS) or 10% horse serum. Fatty acid levels were analyzed by GC-MS. Culture of both WT and CF cells in FBS resulted in very low linoleic acid levels. When cells were cultured in horse serum containing concentrations of linoleic acid matching those found in human plasma, physiological levels of linoleic acid were obtained and fatty acid alterations characteristic of CF tissues were then evident in CF compared with WT cells. Kinetic studies with radiolabeled linoleic acid demonstrated in CF cells increased conversion to longer and more-desaturated fatty acids such as arachidonic acid. In conclusion, these data demonstrate that CFTR dysfunction is associated with altered fatty acid metabolism in cultured airway epithelial cells.

Alterations in immune response and PPAR/LXR regulation in cystic fibrosis macrophages

BACKGROUND

Cystic fibrosis (CF) is characterized by an excessive inflammatory response in epithelial cells and macrophages. In CF mice, lung inflammation can be abrogated by oral treatment with docosahexaenoic acid (DHA). Since PPARs and LXRs are important regulators of inflammation and fatty acid metabolism in macrophages, we hypothesized that these pathways are dysregulated in CF macrophages and are corrected with DHA treatment.

METHODS

Peritoneal macrophages were obtained from wild type and cftr(-/-) mice. LPS induced cytokine secretion and NFkappaB activity were analyzed with and without oral DHA treatment. The expression and activity of PPARalpha,gamma, delta and LXRalpha were analyzed by RT-PCR and EMSA.

RESULTS

LPS induced TNFalpha and IL-6 secretion and NFkappaB p65 activity were increased in CF macrophages. This was associated with low basal PPARgamma expression and attenuated LPS induced induction of PPARdelta, LXRalpha and ABCA1. DHA pretreatment in vivo decreased TNFalpha secretion and p65 activity, and increased PPARalpha and gamma expression and function. The effects of DHA could be reproduced by PPAR agonists and blocked by a PPARalpha antagonist.

CONCLUSION

Impaired regulation of nuclear receptors may contribute to the abnormal LPS induced signaling in CF macrophages and is reversed by DHA.

Confocal light absorption and scattering spectroscopic microscopy monitors organelles in live cells with no exogenous labels

This article reports the development of an optical imaging technique, confocal light absorption and scattering spectroscopic (CLASS) microscopy, capable of noninvasively determining the dimensions and other physical properties of single subcellular organelles. CLASS microscopy combines the principles of light-scattering spectroscopy (LSS) with confocal microscopy. LSS is an optical technique that relates the spectroscopic properties of light elastically scattered by small particles to their size, refractive index, and shape. The multispectral nature of LSS enables it to measure internal cell structures much smaller than the diffraction limit without damaging the cell or requiring exogenous markers, which could affect cell function. Scanning the confocal volume across the sample creates an image. CLASS microscopy approaches the accuracy of electron microscopy but is nondestructive and does not require the contrast agents common to optical microscopy. It provides unique capabilities to study functions of viable cells, which are beyond the capabilities of other techniques.

Confocal light absorption and scattering spectroscopic microscopy

We have developed a novel optical method for observing submicrometer intracellular structures in living cells, which is called confocal light absorption and scattering spectroscopic (CLASS) microscopy. It combines confocal microscopy, a well-established high-resolution microscopic technique, with light-scattering spectroscopy. CLASS microscopy requires no exogenous labels and is capable of imaging and continuously monitoring individual viable cells, enabling the observation of cell and organelle functioning at scales of the order of 100 nm.

Thermostability of Cromobacterium viscosum lipase in AOT/isooctane reverse micelle

The thermostability of Cromobacterium viscosum lipase (EC 3.1.1.3) entrapped in AOT (sodium bis-[2-ethylhexyl] sulfosuccinate) reverse micelles was increased by the addition of short-chain polyethylene glycol (PEG 400). Two different approaches were considered: (1) the determination of half-life time and (2) the mechanistic analysis of deactivation kinetics. The half-life of lipase entrapped in AOT/isooctane reverse micelles with PEG 400 at 60 degrees C was 28 h, ninefold higher than that in reverse micelles without PEG 400. The lipase entrapped in both reverse micellar systems followed a series-type deactivation mechanism involving two first-order steps. The deactivation constant for the first step at 60 degrees C in PEG containing reverse micelles was 0.055 h!1, 11-fold lower than that in reverse micelles without PEG, whereas it remained almost constant for the second step. The inactivation energy of the lipase entrapped in reverse micelles with and without PEG 400 was 88.12 and 21.97 kJ/mol, respectively.

Ethanol administration to cystic fibrosis knockout mice results in increased fatty acid ethyl ester production

BACKGROUND

Fatty acid ethyl esters (FAEE) are nonoxidative ethanol metabolites shown to produce toxic effects in the liver and pancreas in vivo and in vitro. Because alcohol-induced chronic pancreatitis is associated with mutations in the gene responsible for cystic fibrosis (CFTR), we hypothesized that CFTR dysfunction leads to increased levels of these toxic nonoxidative ethanol metabolites following alcohol administration.

METHODS

Cystic fibrosis (CF) and wild-type (WT) mice were injected intraperitoneally with 1, 2, or 3 g/kg of 50% ethanol. Mice were sacrificed and the liver and pancreas removed for FAEE analysis.

RESULTS

The mean FAEE concentration (pmol/g) detected in the liver of cftr mice following injection with 2 g/kg of ethanol was significantly greater than the amount detected in WT (p < 0.005). A similar trend in FAEE concentration was seen in the pancreas, but the difference was not statistically different. In both the liver and pancreas, analysis of individual FAEE species demonstrated a selective increase in ethyl oleate.

CONCLUSION

These data show an association between CFTR dysfunction and qualitative and quantitative changes in FAEE in liver and pancreas upon ethanol exposure.

Evidence of increased flux to n-6 docosapentaenoic acid in phospholipids of pancreas from cftr-/- knockout mice

An association has been reported between alterations in fatty acid metabolism and cystic fibrosis (CF). We hypothesized that these alterations are specific for a particular lipid component(s) and are the result of a specific metabolic defect. The different lipid classes were examined for fatty acid changes by using pancreatic homogenates and primary cultures of pancreatic acini from cftr(-/-) (CF) and wild-type mice. Lipid classes and phospholipids were separated by aminopropyl column chromatography and high-performance liquid chromatography, and fatty acid methyl esters were analyzed. The results indicate that in CF mice (1) linoleate was decreased in phospholipids but not in neutral lipids; (2) there was an increase in dihomo-gamma-linolenate and in docosapentaenoate, the terminal fatty acid of the n-6 pathway, in total lipids and total phospholipids, but not in the neutral lipid class; and (3) the docosapentaenoate (n-6)/docosahexaenoate (n-3) ratio was significantly elevated in neutral phospholipids. This suggests an enhanced flux through the n-6 pathway beyond arachidonate. This study provides a more in-depth understanding of the fatty acid alterations found in CF, as reflected by the cftr(-/-) mouse model.

Decreased peroxisome proliferator activated receptor alpha is associated with bile duct injury in cystic fibrosis transmembrane conductance regulator-/- mice

BACKGROUND

Primary sclerosing cholangitis (PSC) is associated with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. As proof of concept that CFTR dysfunction plays a role in PSC, induction of colitis in cftr mice results in bile duct injury that can be prevented by pretreatment with docosahexaenoic acid (DHA).

OBJECTIVES

Determine whether 1) CFTR dysfunction in cftr mice through a reduction in peroxisome proliferator activated receptor (PPAR)alpha or gamma leads to bile duct injury and 2) whether DHA prevents bile duct injury through an increase in PPAR.

METHODS

Cftr and wild-type (WT) mice were treated with dextran sodium sulfate (DSS) to induce colitis with or without pretreatment with oral DHA. PPARalpha and gamma as well as tumor necrosis factor (TNF)alpha were analyzed in liver tissue. PPARalpha mice were also treated with DSS and histology examined.

RESULTS

PPARgamma mRNA levels were low, with DSS suppressing mRNA levels equally in WT and cftr mice. PPARalpha levels were no different between cftr and WT litter mates by reverse-transcription polymerase chain reaction. After DSS, WT mice showed a 9.3-fold increase in PPARalpha mRNA levels and increased nuclear localization compared with no DSS (P < 0.05), with no increase seen in cftr mice. This was not caused by changes in TNFalpha. DHA treatment led to 7.0-fold increase in PPARalpha mRNA levels in cftr mice (P < 0.01). PPARalpha mice treated with DSS did not develop bile duct injury, indicating that PPARalpha alone is not sufficient to cause bile duct inflammation.

CONCLUSION

DSS induced bile duct injury in cftr mice is associated with a defect in PPARalpha expression, which is reversed by DHA.

Interleukin 8 secretion from monocytes of subjects heterozygous for the deltaF508 cystic fibrosis transmembrane conductance regulator gene mutation is altered

Patients with cystic fibrosis (CF) exhibit an excessive host inflammatory response. The aim of this study was to determine (i) whether interleukin 8 (IL-8) secretion is increased from monocytes from subjects heterozygous as well as homozygous for cystic fibrosis transmembrane conductance regulator (CFTR) mutations and (ii) whether this is due to increased cell surface lipopolysaccharide (LPS) receptors or, alternatively, increased activation of mitogen-activated protein kinases (MAPK). The basal level of IL-8 secretion was higher from monocytes from CF patients than from monocytes from healthy controls (P = 0.02) and obligate heterozygotes (parents of the CF patients). The 50% effective concentrations for LPS-induced IL-8 production for monocytes from both CF patients and obligate heterozygotes were 100-fold lower than those for monocytes from healthy controls (P < 0.05). No differences in the levels of IL-1beta production were seen between these groups. Expression of the LPS surface receptors CD14 and Toll-like receptor 4 were not different between CF patients and healthy controls. In contrast, phosphorylation of the MAPKs p38 and ERK occurred at lower doses of LPS in monocytes from patients heterozygous and homozygous for CFTR mutations. These results indicate that a single allelic CFTR mutation is sufficient to augment IL-8 secretion in response to LPS. This is not a result of increased LPS receptor expression but, rather, is associated with alterations in MAPK signaling.

Decreased expression of peroxisome proliferator activated receptor gamma in cftr-/- mice

Some of the pathological manifestations of cystic fibrosis are in accordance with an impaired expression and/or activity of PPARgamma. We hypothesized that PPARgamma expression is altered in tissues lacking the normal cystic fibrosis transmembrane regulator protein (CFTR). PPARgamma mRNA levels were measured in colonic mucosa, ileal mucosa, adipose tissue, lung, and liver from wild-type and cftr-/- mice by quantitative RT-PCR. PPARgamma expression was decreased twofold in CFTR-regulated tissues (colon, ileum, and lung) from cftr-/- mice compared to wild-type littermates. In contrast, no differences were found in fat and liver. Immunohistochemical analysis of PPARgamma in ileum and colon revealed a predominantly nuclear localization in wild-type mucosal epithelial cells while tissues from cftr-/- mice showed a more diffuse, lower intensity labeling. A significant decrease in PPARgamma expression was confirmed in nuclear extracts of colon mucosa by Western blot analysis. In addition, binding of the PPARgamma/RXR heterodimer to an oligonucletotide containing a peroxisome proliferator responsive element (PPRE) was also decreased in colonic mucosa extracts from cftr-/- mice. Treatment of cftr-/- mice with the PPARgamma ligand rosiglitazone restored both the nuclear localization and binding to DNA, but did not increase RNA levels. We conclude that PPARgamma expression in cftr-/- mice is downregulated at the RNA and protein levels and its function diminished. These changes may be related to the loss of function of CFTR and may be relevant to the pathogenesis of metabolic abnormalities associated with cystic fibrosis in humans.

Induction of colitis in cftr-/- mice results in bile duct injury

It is unknown why some patients with inflammatory bowel disease develop primary sclerosing cholangitis. We have recently shown that patients with primary sclerosing cholangitis have an increased prevalence of mutations in the gene responsible for cystic fibrosis (CFTR) compared with individuals with inflammatory bowel disease alone. Our aim was to examine whether induction of colitis by oral dextran leads to bile duct injury in mice heterozygous or homozygous for mutations in CFTR. The effect of oral administration of docosahexaenoic acid to correct a fatty acid imbalance associated with cystic fibrosis was also examined to determine whether this would prevent bile duct inflammation. Wild-type mice and mice heterozygous and homozygous for CFTR mutations were given dextran orally for 14 days to induce colitis. Bile duct injury was quantitated by blinded histological scoring and measurement of serum alkaline phosphatase activity. The effect of pretreatment with docosahexaenoic acid for 7 days was examined. Treatment of mice with 100 mg dextran/day for 9 days followed by 85 mg/day for 5 days resulted in a significant increase in bile duct injury as determined by histological scoring in homozygous cystic fibrosis mice compared with wild-type mice (P = 0.005). The bile duct injury seen in cystic fibrosis mice was reflected in a threefold increase in serum alkaline phosphatase (P = 0.0006). Pretreatment with oral docosahexaenoic acid decreased both histological evidence of bile duct injury and serum alkaline phosphatase levels. In the setting of colitis, loss of CFTR function leads to bile duct injury.

Association of cystic fibrosis with abnormalities in fatty acid metabolism

BACKGROUND

Patients with cystic fibrosis have altered levels of plasma fatty acids. We previously demonstrated that arachidonic acid levels are increased and docosahexaenoic acid levels are decreased in affected tissues from cystic fibrosis-knockout mice. In this study we determined whether humans with mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene have a similar fatty acid defect in tissues expressing CFTR.

METHODS

Fatty acids from nasal- and rectal-biopsy specimens, nasal epithelial scrapings, and plasma were analyzed from 38 subjects with cystic fibrosis and compared with results in 13 obligate heterozygotes, 24 healthy controls, 11 subjects with inflammatory bowel disease, 9 subjects with upper respiratory tract infection, and 16 subjects with asthma.

RESULTS

The ratio of arachidonic to docosahexaenoic acid was increased in mucosal and submucosal nasal-biopsy specimens (P<0.001) and rectal-biopsy specimens (P=0.009) from subjects with cystic fibrosis and pancreatic sufficiency and subjects with cystic fibrosis and pancreatic insufficiency, as compared with values in healthy control subjects. In nasal tissue, this change reflected an increase in arachidonic acid levels and a decrease in docosahexaenoic acid levels. In cells from nasal mucosa, the ratio of arachidonic to docosahexaenoic acid was increased in subjects with cystic fibrosis (P<0.001), as compared with healthy controls, with values in obligate heterozygotes intermediate between these two groups (P<0.001). The ratio was not increased in subjects with inflammatory bowel disease. Subjects with asthma and those with upper respiratory tract infection had values intermediate between those in subjects with cystic fibrosis and those in healthy control subjects.

CONCLUSIONS

These data indicate that alterations in fatty acids similar to those in cystic fibrosis-knockout mice are present in CFTR-expressing tissue from subjects with cystic fibrosis.

Identification of serogroups of beta hemolytic streptococci in children with tonsillo-pharyngitis

Rheumatic fever and post streptococcal glomerulonephritis are common sequelae of beta hemolytic streptococci among Bangladeshi children. The occurrence of these serious complications of beta hemolytic streptococcal throat infections are related to the epidemiology of group A beta hemolytic streptococci. Little is known about the epidemiology of beta hemolytic streptococci in Bangladesh. We have studied 6890 school boys and girls of Narayangonj to find out the prevalence of beta hemolytic streptococcal infections of throat. From them we selected 2175 children, who were suffering from tonsillo-pharyngitis. This cross sectional study was conducted during March-December 1999. All statistical analysis was done by using statistical package SPSS windows version 8. The mean (SD) age of the children was 11.1 (3.3) years. Four hundred and twenty eight isolates of beta hemolytic streptococci were recovered from tonsillo-pharyngeal swab cultures obtained from 428 children. Among the isolated beta hemolytic streptococci, 92 (21.5%) belonged to group A, 5 (1.2%) to group B, 14 (3.3%) to group C and 317 (74.0%) to group G. These findings demonstrated the predominance of group G followed by A infection among school children. Therefore special attention should be paid not only to group A but also to group G. Further studies to determine prevalence of M serotypes are necessary.

Antioxidant vitamins improves hemoglobin level in children with group a beta hemolytic streptococcal infection

A study was done on school children infected with group A beta hemolytic streptococci to examine whether antioxidant vitamins play a role in improving the hemoglobin level. A total of 606 primary school children aged 5 to 15 years were randomly divided into two intervention groups. Group 1 (n=299) was treated with pehnoxymethyl penicillin V and group 2 (n=307) was treated with phenoxymethyl penicillin V plus antioxidant vitamins for eight weeks. From each group two blood samples were drawn in acute and convalescent (after eight weeks) states. Before treatment, mean hemoglobin values were 11.0 and 10.8 mg/dL in groups 1 and 2 respectively. After treatment hemoglobin values were 10.5 and 11.6 mg/dL respectively. Values were significantly decreased in group 1 (P=0.0001), whereas increased in group 2 (P=0.001). Adjustment for age and sex by ANCOVA confirmed the difference in hemoglobin levels between group (LS means-0.5 vs 0.8 in groups 1 and 2 respectively (P=0.0001). Hemoglobin level increases after antioxidant vitamin supplementation in children suffering from group A beta hemolytic streptococcal infection.

Intra-familial transmission of life-threatening group A streptococcal infection

Invasive group A streptococcal (GAS) infections have been of increasing concern worldwide during the past 15 years. Spread of group A streptococci to contacts with resulting invasive infection has been reported in families, in residential nursing homes, and even from patients to health care workers. We report an instance of temporally related life-threatening group A streptococcal infection in a husband and 2 weeks later in his wife. This example further emphasizes the need for careful observation among family members and other close contacts of patients with invasive group A streptococcal infection. Although at present there are no universal recommendations for monitoring or for antibiotic prophylaxis of close contacts of persons with invasive GAS infection, when added to existing literature, this report suggests additional consideration is required.

Streptococcal antibodies among rural school children in Bangladesh

The upper limit of normal values of group A streptococcal antibodies should be known for a population concerned because it is influenced by many local conditions. As yet the reference value of the these antibodies has not been determined by using a quantitative method among Bangladeshi children. We determined the reference value of anti-streptolysin O and anti-deoxyribonuclease B among 361 apparently healthy rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.2 years). Anti-streptolysin O was measured by an auto-analyzer and antideoxyribonuclease B was measured by microtitre method. The geometric mean titres for the entire group was 241 IU/ml and 222 IU/ml for anti-streptolysin O and anti-deoxyribonuclease B respectively. The upper limit of normal values (80th percentile) was 390 and 340 for anti-streptolysin O and anti-deoxyribonuclease B, respectively. These limits should be of value to physicians, epidemiologists and clinical laboratory personnel as well.

Dissecting the contradictory findings of angiotensin converting enzyme genetic polymorphism with blood pressure and hypertension

The studies on the association of deletion/insertion (D/I) polymorphism of angiotensin converting enzyme (ACE) gene with blood pressure and hypertension reported contradictory results. We review the articles that considered blood pressure or hypertension as the main outcome measure to have an overview of the situation. There is heterogeneity of allele frequencies of ACE locus among ethnic groups. In descending order of D allele frequencies, ethnic groups are: Gulf Bedouin (0.657), Black (0.597), White (0.577), Chinese (0.400), Japanese (0.377), Bangladeshi (0.374) and Indian Sikh (0.373). Multiple studies were available for the Caucasians and Japanese with relatively large sample sizes. Three out of five studies in the Caucasians found association either in males or in females with blood pressure or hypertension. None of the three Japanese studies observed an association. So, ACE locus may be considered a marker for blood pressure or hypertension in the Caucasians but not in the Japanese. This racial difference is not surprising, because heterogenecity of ACE activity according to ACE genotypes has been reported among ethnic groups, and important differences in environmental factors persist. Studies in other populations were either small or sampling procedures were not adequately described. Given that the studies varied in designs, settings, sample size, and adjustment for confounding variables, adequately powered large-scale multicentre, multi-ethnic population-based studies using same method are required to resolve this contradiction.

Reference value of immunoglobulins in healthy school children of Bangladesh

The reference value of immunoglobulins (Igs) should be known for a population concerned because it is influenced by many clinical and local conditions. As yet the reference value of the Igs have not been determined in Bangladeshi children. This study determined the reference value of Igs in apparently healthy 261 rural Bangladeshi primary school children (aged 5 to 14 years, mean 9.3 years). IgG, IgM and IgA were determined by an auto-analyzer. The mean (standard deviation) value of IgG was 1728 (344) mg/dl. The corresponding values for IgM and IgA were 200 (88) and 163 (63) mg/dl, respectively. The 95% reference value calculation in all subjects showed that the range for IgG was 1103 to 2524, IgM was 92 to 390, and IgA was 72 to 325 mg/dl. These values could be used to evaluate Ig status in children with a variety of clinical conditions.

Lack of sensitivity of the latex agglutination test to detect bacterial antigen in the cerebrospinal fluid of patients with culture-negative meningitis

For culture-negative meningitis, use of the latex agglutination test for detection of bacterial antigen in the CSF has a sensitivity of only 7%. Routine use of the latex agglutination test may not contribute to the management of suspected acute bacterial meningitis, since patients are treated on the basis of their clinical presentations and CSF findings.

Apolipoprotein E genetic polymorphism and stroke subtypes in a Bangladeshi hospital-based study

The association between apolipoprotein E (apoE) genetic polymorphism and stroke has not been concordant in different racial populations. We investigated the association between apoE genotypes and stroke subtypes by a case-control study in Bangladesh for the first time among south Asian countries. First-ever-stroke patients (n=227; cerebral infarction, n=147, cerebral hemorrhage, n=80) and 190 controls were recruited from a hospital in Dhaka, Bangladesh. The diagnosis of stroke was based on CT and clinical findings. Cerebral infarction was classified anatomically into cortical and penetrating region. Infarction in the cortical region was further categorized etiologically into thrombosis and embolism. Cerebral hemorrhage was considered as a whole in all analyses. ApoE genotypes were determined by restriction fragment length polymorphism. In the multivariate conditional logistic regression analysis adjusted for potential confounders both the epsilon3/epsilon4 genotype and epsilon4 carrier conferred an approximately 3-fold increased risk for cerebral thrombosis in the cortical artery region (OR 3.5, 95% CI 1.2 to 10.4 and OR 3.1, 95% Cl 1.1 to 9.0, respectively) compared with epsilon3/epsilon3 genotype. However, when the analysis was restricted to the elderly (>60 years), epsilon 2 carrier was associated with a risk of hemorrhagic stroke (OR 19.2, 95% CI 1.3 to 295.2). Our study suggested that both apoE epsilon3/epsilon4 genotype and epsilon4 carriers were risk factors for cerebral thrombosis in cortical artery region, whereas epsilon 2 carrier was a risk factor for hemorrhagic stroke in the elderly.

Cardiovascular risk factors: distribution and prevalence in a rural population of Bangladesh

BACKGROUND

Little is known about the cardiovascular risk factors in the Bangladeshi population. We examined 'classic' risk factors, including central obesity, in a rural population.

METHODS

Non-biochemical variables were examined in 238 men and 272 women aged 18 years or more (mean +/- standard deviation 38.1 +/- 10.7 years in men and 36.0 +/- 9.8 in women). Fasting blood glucose and total cholesterol concentrations were determined in a sub-sample of 106 men and 135 women.

RESULTS

Men and women had a similar body mass index (20.4 +/- 3.1 vs 20.8 +/- 3.4 kg/m2), waist circumference (72.8 +/- 7.6 vs 71.4 +/- 8.7 cm), systolic blood pressure (118.4 +/- 13.7 vs 119.5 +/- 17.7 mmHg), diastolic blood pressure (75.9 +/- 9.9 vs 74.6 +/- 11.5 mmHg), total cholesterol (155.7 +/- 36.0 vs 162.0 +/- 35.2 mg/dl) and blood glucose level (89.0 +/- 14.9 vs 86.2 +/- 9.6 mg/dl. After categorization of these variables, the prevalence of thinness (body mass index < 18.5; 30.0 vs 30.3%), obesity (body mass index > or = 30; 0.8 vs 1.1%), hypertension (systolic blood pressure > or = 140 and/or diastolic blood pressure > or = 90 or medication; 9.8 vs 15.6%), hypercholesterolemia (total cholesterol > or = 240; 2.8 vs 3.0%) and diabetes mellitus (blood glucose > or = 126; 2.9 vs 0.7%) remained similar between the sexes. However, central obesity (waist circumference > or = 94 cm in men and > or = 80 cm in women) was less frequent (2.9 vs 16.8%; P = 0.001) in men. Overall, tobacco consumption (57.1 vs 23.2%; P = 0.001) and smoking (50.3% vs 2.9%; P = 0.001) were more frequent in men, but chewing tobacco consumption was similar (16.3 vs 21.4%; P = 0.095).

CONCLUSIONS

Our sample size is small, and larger studies are necessary for a more accurate description of the risk factors.

Angiotensin converting enzyme genetic polymorphism is not associated with hypertension in a cross-sectional sample of a Japanese population: the Shibata Study

BACKGROUND

The studies on the association of deletion/ insertion (D/I) polymorphism of angiotensin converting enzyme (ACE) gene with blood pressure and hypertension reported contradictory results. Because there was no population-based study in Japan, we examine the hypothesized association in a cross-sectional sample of a Japanese cohort.

METHODS AND RESULTS

The blood pressure of 464 men and 876 women aged 40-80 years was measured, and their DNA was analyzed for ACE D/I genotypes. The prevalence of the D allele was 38.7 and 39.2% in men and women, respectively (overall 39%). There was a tendency for higher covariate (age, body mass index, albuminuria, hematocrit, alcohol consumption, smoking, diabetes mellitus, ischemic heart disease and antihypertensive medication) adjusted mean levels of diastolic blood pressure for the DD genotype in men but not in women. However, this tendency disappeared after dichotomization of blood pressure into diagnostic categories (normotension and hypertension). Results did not differ when the subjects were divided into two age groups (< or = 59 and > or = 60 years). Covariate-adjusted odds ratios for hypertension for presence of the D allele were close to the null value of one. ACE genetic variation accounted for only 0.1 and 0.7% of the inter-individual variation in systolic and diastolic blood pressure in men. These estimates were 0.2 and 0.1%, respectively, in women.

CONCLUSION

Although there is a tendency of higher diastolic blood pressure in men with DD genotypes, there is no convincing evidence that ACE genotypes are associated with hypertension in this Japanese population.

Characteristics of HIV-1-infected patients with CD4:CD8 lymphocyte ratio normalization on antiretroviral therapy

Antiretroviral therapy for human immunodeficiency virus (HIV)-infection results in normalization of CD4:CD8 T-lymphocyte ratio in about 6% of cases. The T-cell ratio normalization on therapy was associated with a baseline CD4 of over 350 cells per microliter and a T-cell ratio of over 0.5 (for each, p < 0.01), but not with the current level of viral load suppression or compliance with clinic appointments (for each, p > 0.05). The patients with T-cell ratio normalization had a baseline median CD4 count of 428 cells per microliter (range, 353-883 cells per microliter) and a median T-cell ratio of 0.75 (range, 0.54-0.87). We could not address the effect of baseline viral load on T-cell ratio normalization, but there was no association with age, gender, race, HIV risk factor, or the length of antiretroviral therapy.

GP2, a GPI-anchored protein in the apical plasma membrane of the pancreatic acinar cell, co-immunoprecipitates with src kinases and caveolin

We previously showed that endocytosis at the apical plasma membrane (APM) of the pancreatic acinar cell is activated by the cleavage of GP2, a GPI-linked protein, from the apical cell surface. This endocytic process, as measured by horseradish peroxidase uptake into pancreatic acinar cells, is blocked by the tyrosine kinase inhibitors genistein and tyrphostin B42 as well as by disruption of actin filaments with cytochalasin. This suggests that the cleavage of GP2 from the cell membrane may activate endocytosis through a tyrosine kinase-regulated pathway. However, the mechanism by which GP2 and tyrosine kinases act together to activate endocytosis at the APM remains unknown. In this study, we demonstrate that pp60, p62yes, caveolin, and annexin, which have previously been implicated in endocytosis in other cell lines, were present in high abundance in GPI-enriched membranes by Western blot analysis. pp60, p62yes, and caveolin all co-immunoprecipitated with GP2 except annexin. An 85-kDa protein whose tyrosine-dependent phosphorylation is correlated with the activation of endocytosis in intact acinar cells also was present in these immunoprecipitates. This suggests that in pancreatic acini, GP2 may exist in a complex with src kinases, caveolin, and an 85-kDa phosphorylated substrate to regulate endocytosis at the APM.

Bacteremia and possible endocarditis caused by Moraxella phenylpyruvica

Moraxella phenylpyruvica, a gram-negative coccobacillus, is usually considered a nonpathogenic bacterium. Only a few cases of invasive disease caused by this organism were reported in the 1970s. We report a well-documented case of bacteremia and possible endocarditis due to M phenylpyruvica in a previously healthy man.

Population attributable fraction of stroke incidence in middle-aged and elderly people: contributions of hypertension, smoking and atrial fibrillation

We determined the population attributable fraction (PAF) of stroke due to hypertension (HT), atrial fibrillation (Af) and smoking in a Japanese community. Residents of Shibata (n = 2,302) who were surveyed initially in 1977 were followed until 1997. Two hundred and thirteen first strokes occurred. Among those 40-64 years of age, the risk ratio (RR) of Af was 11.24, followed by untreated HT (3.61), uncontrolled HT (3.69) and smoking (1.84). The PAFs, however, were 14.9% for smoking, 13.5% for untreated HT, 8.6% for uncontrolled HT and 3.6% for Af. Among those over 65 years, only Af was significant (RR 3.89) and the PAF was 6.0%. Determination of PAFs is also essential for designing effective stroke prevention programs in communities.

Erythrocyte sedimentation rate in healthy school children of Bangladesh

The reference value of erythrocyte sedimentation rate (ESR) should be established for a population concerned because it is influenced by many local conditions. It has not yet been determined in healthy children of Bangladesh. This study was done to determine the reference value of ESR in Bangladeshi children. ESR was determined in a sample of 413 'healthy' primary school students (259 boys and 154 girls, mean age 8.7 years). Ninety-five percent of them had ESR < or = 30 mm (Westergren 1 h). Our findings suggest that ESR value > 30 mm (Westergren 1 h) should be considered high in Bangladeshi primary school children.

Humoral immune response in a sample of Bangladeshi children with rheumatic fever

Several researchers have investigated cellular response, and antibody response to different antigens of group A beta-haemolytic streptococci, cardiac tissues and B cell alloantigen in rheumatic fever (RF). However, immunoglobulins (Ig) which may indicate general immune status did not receive attention. This study was done in the outpatient clinic of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, to compare Ig levels in subjects with and without RF who have had recent group A beta-haemolytic streptococcal infections. We have recruited 44 RF cases aged 5 to 20 years, and 44 subjects without RF were randomly matched for age and sex as controls. Convalescent blood samples were used to measure antistreptolysin O and IgG, IgM, and IgA levels. The cases, as compared with the controls, had significantly higher levels of antistreptolysin O (mean 399 versus 321 IU/ml), IgG (mean 2386 versus 1885 mg/dl), IgM (mean 286 versus 222 mg/dl) and IgA (mean 258 versus 184 mg/dl). It is not clearly known why the immune response is higher in the RF cases. We have to elucidate factors responsible for higher immune response in children with RF.

Association of angiotensin converting enzyme (ACE) gene polymorphism with hypertension in a Bangladeshi population

The association of angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism with hypertension has not been confirmed. Inconsistencies may be due to the differences of background population characteristics. Till date, there has been no report in Bangladeshi population. This study was to examine the association of ACE (I/D) polymorphism with hypertension. Fifty-one primary hypertensives and fifty-two normotensives were recruited from a hospital in Dhaka city. Height, weight and blood pressure were measured. ACE (I/D) genotypes was established using polymerase chain reaction protocol. The genotype and allele frequencies did not differ significantly (P > 0.05) between the groups. In logistic regression analysis, adjusted for age, sex and body mass index, the genotypes were not associated with hypertension (DD vs II: Adds ratio = 2.6, P = 0.34; ID vs II: 0.4, 0.23; ID + DD vs II: 0.8, 0.69). In this hospital-based sample of Bangladeshi people, significant association of ACE I/D genotype with hypertension was not observed.

Does rheumatic fever occur usually between the ages of 5 and 15 years?

It has long been considered that rheumatic fever usually occurs in children between the ages of 5 and 15 years. However, supporting data from the developing countries are insufficient. It is important to know the age of occurrence of rheumatic fever for clinical and public health purposes. To describe the age distribution of Bangladeshi subjects, we have reviewed the records of all patients who attended with acute rheumatic fever in the outpatient department of the National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, during June 1990 through November 1995. During this period 630 subjects were diagnosed to have acute rheumatic fever defined by the revised Jones criteria. Of them, 535 (84.9%) presented with first attack. Their age ranged from 3 to 30 years, and a skewness to the right of the age distribution was observed. Thus, we used percentile distribution to determine reference range of age. The 2.5 and 97.5 percentiles were 5 and 22 years, respectively. Their mean (standard deviation) and median age were 12.7 (4.4) and 12 years, respectively. Slightly more than 22% of subjects were older than 15 while less than 1% were younger than 5 years. This finding was supported by multiethnic data from other developing countries. The current analysis warrants reevaluation of the prevailing conviction for age of occurrence of rheumatic fever. In conclusion, the age reference range for occurrence of rheumatic fever in Bangladesh should be considered to be 5 to 22 years but not 5 to 15 years.

Descriptive epidemiology of body mass index in Japanese adults in a representative sample from the National Nutrition Survey 1990-1994

OBJECTIVE

To determine the prevalence of obesity and reference percentile curves of body mass index (BMI; kg/m2) in Japanese adults.

DESIGN

Cross-sectional nationwide surveys (The National Nutrition Survey, Japan) carried out in 1990-1994. A sample of 23,556 males and 28,751 females aged 15-84 y was used for this analysis.

RESULTS

The prevalence of grades 1 (BMI: 25.0-29.9), 2 (30.0-39.9) and 3 (> or = 40.0) overweight, was estimated to be 24.3%, 1.84% and 0.019% in males, respectively, and 20.2%, 2.87% and 0.032% in females, respectively, subjects aged 35-64 y after standardization to the age-distribution of the standard world population (WHO, 1993). The age-standardized prevalence of obesity (for BMI > or = 26.4, a criterion of the Japan Society for the Study of Obesity; and > or = 30.0 was 13.6% and 1.86% in males, respectively, and 13.5% and 2.90% in females, respectively, subjects aged 35-64 y.

CONCLUSIONS

The standardized prevalence of obesity (BMI > or = 30.0) in Japanese adults was quite low compared with the data in western populations.