Fungal contamination, aflatoxigenic fungi and levels of aflatoxin B1 in spices marketed in the West Bank of Palestine

Ninety-seven spices of seven different types were collected from different retailers in the West Bank of Palestine and were analysed for fungal contamination, specifically aflatoxigenic Aspergillus spp. and Aflatoxin B1 (AFB1) levels. Aspergillus was found in 89% samples analysed. Ground red chilli had the highest average number of fungal colonies. In decreasing order, mixed spices (57%), cardamom (53%), red chilli (52%), chicken spices (50%), sumac (47%) and pepper (38%), were contaminated with Aspergillus species. Aspergillus niger and A. flavus were dominating Aspergillus species in 37% and 23% of food samples analysed, respectively. Of the 11 tested isolates, 82% were identified as aflatoxin-producers. AFB1 was detected in 40.2% of the samples analysed with a mean value of 2.09 ± 3.20 μg/kg. Red chilli powder followed by chicken spices and cardamom recorded the highest levels (6.98, 3.55 and 1.48 μg/kg, respectively). Twenty-two of the spices (23%), were above the European Union's maximum limit of 5 μg/kg.

Nomenclature and definition of metabolic-associated fatty liver disease: a consensus from the Middle East and north Africa

With the increasing prevalence of obesity and type 2 diabetes, fatty liver disease associated with metabolic dysfunction is a global health problem, especially because it is one of the earliest consequences of obesity and it precedes diabetes development. Fatty liver disease associated with metabolic dysfunction is of particular concern in the Middle East and north Africa, where its prevalence is greater than that in the rest of the world. Despite the magnitude of the problem, no regional guidelines have been developed to address this disease. This Review describes suggestions of redefining fatty liver disease associated with metabolic dysfunction, including its terminology and criteria for diagnosis. Experts have raised serious concerns on the current nomenclature, which labels the disease as non-alcoholic fatty liver disease (NAFLD), and its diagnostic criteria. The panel reached a consensus that the disease should be renamed as metabolic-associated fatty liver disease (MAFLD) and that the disease should be diagnosed by positive criteria. The aim is now to work with authorities across the region to implement these proposed changes and reflect them in health-care policy and to improve health care for patients in this region.

Evidence of an Exponential Decay Pattern of the Hepatitis Delta Virus Evolution Rate and Fluctuations in Quasispecies Complexity in Long-Term Studies of Chronic Delta Infection

Chronic HDV infection can cause a severe form of viral hepatitis for which there is no specific treatment. Characterization of the hepatitis B or C viral quasispecies has provided insight into treatment failure and disease recurrence following liver transplantation, has proven useful to understand hepatitis B e antigen seroconversion, and has helped to predict whether hepatitis C infection will resolve or become chronic. It is likely that characterization of the hepatitis delta virus (HDV) quasispecies will ultimately have similar value for the management of this infection. This study sought to determine the RNA evolution rates in serum of chronic hepatitis delta (CHD) treatment-naïve patients, using next-generation sequencing methods. The region selected for study encompassed nucleotide positions 910 to 1270 of the genome and included the amber/W codon. Amber/W is a substrate of the editing process by the ADAR1 host enzyme and is essential for encoding the 2 delta antigens (HDAg). The amber codon encodes the small (unedited) HDAg form and the W codon the large (edited) HDAg form. The evolution rate was analyzed taking into account the time elapsed between samples, the percentage of unedited and edited genomes, and the complexity of the viral population. The longitudinal studies included 29 sequential samples from CHD patients followed up for a mean of 11.5 years. In total, 121,116 sequences were analyzed. The HDV evolution rate ranged from 9.5x10-3 to 1.2x10-3 substitutions/site/year and showed a negative correlation with the time elapsed between samples (p<0.05). An accumulation of transition-type changes was found to be responsible for higher evolution rates. The percentages of unedited and edited genomes and the quasispecies complexity showed no relationships with the evolution rate, but the fluctuations in the percentages of genomes and in complexity suggest continuous adaptation of HDV to the host conditions.

Antibiotic use and resistance in animal farming: a quantitative and qualitative study on knowledge and practices among farmers in Khartoum, Sudan

Antibiotic resistance is a major emerging global public health threat. Farmers in the Khartoum state are believed to misuse antibiotics in animal farming leading to daily exposure to resistant bacteria and antibiotic residues. Hence, farmers are at potential risk exposure to bacteria, zoonotic infection and toxicity. We hypothesized that farmers' misuse of antibiotics could be due to their ignorance of the importance of optimal use of antibiotics, the potential health hazards and the economical waste associated with antibiotic misuse practices. In the present study, we investigated knowledge and practices among farmers regarding antibiotic use and resistance. For this purpose, a cross-sectional study was conducted in Khartoum state where data were collected from 81 farmers using structured interviews. Data were analysed both quantitatively and qualitatively. Fifty-two per cent of farmers were uneducated or had studied for < 6 years. The majority reported antibiotic use for treatment and prevention while only 5% stated use for growth promotion. Antibiotic group treatment for both sick and healthy animals was commonly practiced among most farmers. The most commonly used group of antibiotics was the quinolones, which was reported by one-third. Only 30% of the farmers had heard of antibiotic resistance and provided their definition. Almost half were not aware of the commonly transferred zoonotic infections between humans and animals. The farmers consume 1-2 meals/day from their own farm products. A significant association between low education, poor knowledge of farmers on antibiotic use, antibiotic resistance and zoonotic infections was found. This association may play a vital role in the present practiced misuse of antibiotics. Our findings on farmers' practices could be used as baseline information in defining the gaps related to antibiotic use and resistance in animal farming in Sudan. It can thus serve as a foundation for future interventions.

Nonalcoholic fatty liver disease and cardiovascular disease: has the time come for cardiologists to be hepatologists?

Nonalcoholic fatty liver disease (NAFLD) is prevalent in people with the metabolic syndrome and type 2 diabetes and is present in up to one-third of the general population. Evidence is now accumulating that NAFLD is associated with obesity and diabetes and may serve as a predictor of cardiovascular disease (CVD). The possible mechanisms linking NAFLD and CVD include inflammation and oxidative stress, hyperlipidaemia, insulin resistance, and direct impact of NAFLD on coronary arteries and left ventricular dysfunction. In addition, several studies suggest that NAFLD is associated with high risk of CVD and atherosclerosis such as carotid artery wall thickness and lower endothelial flow-mediated vasodilation independently of classical risk factors and components of the metabolic syndrome. It is not yet clear how treatment of NAFLD will modulate the risk of CVD. Furthermore, studies are urgently needed to establish (i) the pathophysiology of CVD with NAFLD and (ii) the benefit of early diagnosis and treatment of CVD in patients with NAFLD. In the absence of biochemical markers, it is crucial that screening and surveillance strategies are adopted in clinical practice in the growing number of patients with NAFLD and at risk of developing CVD. Importantly, the current evidence suggest that statins are safe and effective treatment for CVD in individuals with NAFLD.

[Multidrug resistance in uveal melanoma]

In spite of important progress in the local treatment of uveal melanoma, the most frequent primitive intraocular tumor, 15%-30% of patients still die because of tumor metastasis. This tumor is characterized by constitutive chemoresistance, thwarting any attempt to control it using the usual chemotherapy protocols. The chemoresistance of uveal melanoma is mainly due to the typical multidrug resistance phenotype (MDR), which is linked to overexpression of membrane proteins that actively extrude anticancer drugs from the cell. Typical MDR is particularly complex in this tumor since several chemoresistance-related proteins are simultaneously produced. The negative prognostic significance of the overexpression of P-glycoprotein, the main representative among the typical MDR-related proteins, was shown in uveal melanoma. The atypical MDR phenotype, which refers to other chemoresistance mechanisms such as resistance to apoptosis also contributes to the chemoresistance of uveal melanoma. Thanks to the recent progress in molecular biology, the chemosensitization strategies of gene therapy approaches, which aim at weakening the pathological activity of MDR genes in cancer cells, are currently on the rise. This approach will disrupt current therapeutic strategies and necessarily improve and standardize the methods used to characterize the chemoresistance profile of this cancer. Indeed, we will have to know the genes to be targeted for each melanoma in order to induce cell chemosensitivity.

Données cytogénétiques actuelles : vers la monosomie du chromosme 3 comme principal facteur pronostique du mélanome uvéal

Uveal melanoma is the most frequent intraocular cancer. The recent development of new technologies such as microsatellite analysis and comparative genomic hybridization have elucidated both the cytogenetics and the natural history of this disease. Fifty to 60% of uveal melanomas are linked to monosomy 3, which appears as an early and determinant event in tumor progression. Tumors with this anomaly have a very poor prognosis. Recent work suggests that this category of uveal melanomas represents a distinct pathological entity from that associated with normal disomy 3. Chromosome 6 aberrations probably make up a second entry point into the process of carcinogenesis, while gains in 8q seem to appear later in the natural history of uveal melanoma because of their higher frequency in larger tumors. Progress in genome analysis has identified regions in chromosomes 3, 6, and 8 as those most probably involved in tumorigenesis. It is to be hoped that this will soon lead to the discovery of the genes responsible.

Evaluation of erythropoiesis in protein energy malnutrition

This study evaluated erythropoiesis in 50 infants hospitalized with protein energy malnutrition and in 50 control infants. The red cell count, mean corpuscular haemoglobin and reticulocyte index were significantly lower, while the white blood cell count, median corpuscular fragility and red cell distribution width were significantly higher on admission than in controls. Total serum protein, albumin, fasting blood glucose, and serum folate were significantly lower on admission than in controls. Serum ferritin was significantly higher and total iron-binding capacity was significantly lower on discharge compared to controls. The serum erythropoietin was significantly higher on admission and discharge than in controls. The anaemia of protein energy malnutrition is due to mixed deficiencies resulting in ineffective erythropoiesis despite an increased level of erythropoietin.

Evaluation of erythropoiesis in protein energy malnutrition

This study evaluated erythropoiesis in 50 infants hospitalized with protein energy malnutrition and in 50 control infants. The red cell count, mean corpuscular haemoglobin and reticulocyte index were significantly lower, while the white blood cell count, median corpuscular fragility and red cell distribution width were significantly higher on admission than in controls. Total serum protein, albumin, fasting blood glucose, and serum folate were significantly lower on admission than in controls. Serum ferritin was significantly higher and total iron-binding capacity was significantly lower on discharge compared to controls. The serum erythropoietin was significantly higher on admission and discharge than in controls. The anaemia of protein energy malnutrition is due to mixed deficiencies resulting in ineffective erythropoiesis despite an increased level of erythropoietin.

[The imaging diagnosis of pericardial agenesis]

Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death. Therefore, surgical treatment has sometimes been indicated, even though in the cases were asymptomatic. We report the case of a 50 year-old woman with partial pericardial agenesis and herniation of left atrial appendage trough. The defect was discovered by a routine chest x-ray and treated in a conservative way. Current diagnostic and therapeutic techniques are reviewed.

A randomized trial of Lactobacillus acidophilus BG2FO4 to treat lactose intolerance

BACKGROUND

Lactose intolerance is the most common disorder of intestinal carbohydrate digestion. Lactobacillus acidophilus BG2FO4 is a strain of lactobacilli with properties of marked intestinal adherence and high beta-galactosidase activity.

OBJECTIVE

This study was designed to determine whether oral feeding of Lactobacillus acidophilus BG2FO4 leads to a lactose-tolerant state.

DESIGN

We studied 42 subjects with self-reported lactose intolerance and performed breath-hydrogen tests to determine whether they were lactose maldigesters. Subjects with established lactose maldigestion (n = 24) were invited to be randomly assigned to an omeprazole-treated (hypochlorhydric) group or a non-omeprazole-treated group, but 6 subjects chose not to participate. All randomly assigned subjects (n = 18) ingested Lactobacillus acidophilus BG2FO4 twice per day for 7 d and stool samples were collected. Breath-hydrogen tests were performed and symptom scores were recorded at baseline and after lactobacilli ingestion.

RESULTS

Lactose maldigestion was established in 24 of 42 subjects (57%) with self-reported lactose intolerance. In 18 lactose-maldigesting subjects, overall hydrogen production and symptom scores after ingestion of Lactobacillus acidophilus BG2FO4 were not significantly different from baseline values. Live Lactobacillus acidophilus BG2FO4 was recovered in stool samples from 7 subjects.

CONCLUSIONS

Lactose intolerance is overreported in subjects with gastrointestinal symptoms after lactose ingestion. Treatment of lactose-maldigesting subjects with and without hypochlorhydria with Lactobacillus acidophilus BG2FO4 for 7 d failed to change breath-hydrogen excretion significantly after lactose ingestion.

[Dehiscence of a composite aortic graft (Bono and Bentall technique) secondary to Acinetobacter endocarditis]

Acinetobacter sp. are gram-negative bacteria and usually resistant to multiple antibiotics. They are a customary cause of nosocomial infections, but are uncommon etiologic agents of endocarditis. We present a case of endocarditis caused by Acinetobacter iwoffi in a composite aortic graft with a St. Jude prosthetic valve, using the Bono and Bentall procedure, complicated with multiple graft dehiscenses causing first a peritube pseudoaneurysm and finally severe paraprosthetic valve regurgitation to the left ventricle which required emergency surgery.

[Diagnostic criteria of infective endocarditis: from Von Reyn to Duke. Transthoracic and transesophageal echocardiography]

The Von Reyn criteria determine only a small number of definitive diagnoses of infectious endocarditis, while it is mainly diagnosed by histopathological confirmation in surgery or autopsy. This necessitates carrying out a new diagnostic scheme with accurate sensitivity and specificity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional and transesophageal echocardiography, in the diagnosis of infectious endocarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. Often, tissue destruction causes regurgitation, which is responsible for hemodynamic impairment or allows the spread of the infectious process to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagnosis of this disease. Sensitivity of transesophageal technique to detect vegetations and complications is higher than that observed in conventional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infectious endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.

Maize contains a Lon protease gene that can partially complement a yeast pim1-deletion mutant

We have identified a gene in maize that encodes a product belonging to the Lon protease family. In yeast and mammals, Lon-type proteases catalyze the ATP-dependent degradation of mitochondrial matrix proteins. The maize gene, which we have designated LON1, is predicted to encode a protein with a molecular mass of 97.7 kDa. Lon1p is more similar in sequence to bacterial Lon proteases than to the yeast and human mitochondrial Lon proteases. LON1 transcripts are present in shoots of 4-day-old etiolated maize seedlings, and transcript levels decrease when these seedlings are heat-shocked. LON1 transcripts are also present at comparable levels in leaves and roots of 2-week-old greenhouse-grown seedlings. In yeast, the mitochondrial Lon-type protease, Pim1p, has been implicated in mitochondrial protein turnover, the assembly of mitochondrial enzyme complexes, and mitochondrial DNA maintenance, and it is essential for respiratory function. We show that maize Lon1p can replace the Pim1p function in yeast for maintaining mitochondrial DNA integrity, but not in the assembly of cytochrome a x a3 complexes.

[Transesophageal echocardiography follow-up of patients operated on using the Bono-Bentall technique in aneurysms or dissection of the ascending aorta]

INTRODUCTION

Increasingly patients are surviving after reconstructive surgery of the ascending aorta. These patients require follow-up to detect postoperative prognostic markers, such as persistence of the flow in a false lumen, intimal rupture, or graft complications. We conducted a study with transthoracic and transesophageal echocardiography in order to detect residual abnormalities and establish the usefulness of this technique in a group of patients after Bono-Bentall surgery for ascending aorta pathology.

PATIENTS AND METHODS

Twelve patients were studied with transthoracic and transesophageal echocardiography, four after surgery for annulo-aortic ectasia with severe aortic insufficiency and eight for type A aortic dissection. The Bono-Bentall surgical procedure was used in all the patients with Cabrol's modification being added in three.

RESULTS

Seven of the eight (87%) patients with aortic dissection had residual abnormalities: five persistence of the distal dissection, one pseudo-aneurysm, and one peritubular haematoma. A residual lesion (pseudo-aneurysm) was found in just one of the four patients (25%) who underwent surgery for annulo-aortic ectasia. The ejection fraction was normal in those patients who had been operated on for aortic dissection and depressed in those who had annulo-aortic ectasia (60 +/- 9 vs 40 +/- 10; p = 0.005).

CONCLUSIONS

In patients undergoing surgery with the Bono-Bentall procedure there is a high incidence of residual aortic abnormalities, especially when the operation is for aortic dissection. Transesophageal echocardiography is an ideal diagnostic method for the detection and follow up of residual abnormalities after ascending aorta surgery. We believe this technique should be included in the periodic follow up of these patients.

[Prolapse surgery through the vagina with the help of Endo Stitch. Technical note and preliminary study]

OBJECTIVE

Vaginal cure of genitourinary prolapses is a reliable technique. We propose a technical simplification: the use of the laparoscopic suturing instrument Endo Stitch. Bladder neck suspension can be performed in this way without supra-pubic incision. Sacrospinous suspension is sometimes difficult with a risk of sciatic nerve, pudendal artery or rectum trauma. This is also performed more easily using Endo Stitch.

SUBJECTS AND METHODS

Twenty patients with genitourinary prolapse were treated by one surgeon using the Endo Stitch. The patients were followed for 6 to 18 months.

RESULTS

No per- or postoperative complications attributable to the use of Endo Stitch were encountered. With two recurrent genital prolapses and one persistent urinary stress incontinence, anatomic and functional results seem to be similar to reference series, but must be confirmed with more follow-up.

[Epidural spinal hematoma following thrombolytic therapy for an acute myocardial infarct]

We describe a case of spinal epidural hematoma in a 58 year old patient who suffered a myocardial infarction and was treated with recombinant tissue plasminogen activator. Computed tomographic and magnetic resonance imaging studies utilized, confirmed the presence of the hematoma. The main signs and symptoms in establishing the presumptive diagnosis and the essential contribution of magnetic resonance in confirming the diagnosis are mentioned. Finally, we review the bleeding complications due to thrombolytic agents and therapeutic prospects and prognosis in this pathology.

[Diastolic dysfunction, left ventricular hypertrophy, and microalbuminuria in mild to moderate essential arterial hypertension]

INTRODUCTION

It is known, that there is a high prevalence of left ventricular diastolic disfunction, which precedes left ventricular hypertrophy in hypertensive people, but there is little published in literature about the relationship between these findings and the presence of microalbuminuria.

OBJECTIVE

In our study, we pretend to evaluate prevalence and eventual relation among microalbuminuria, diastolic disfunction and left ventricular hypertrophy, in young mild to moderate hypertensive patients, non diabetic and without previous treatment.

MATERIAL AND METHODS

We studied prospectively 80 untreated hypertensive patients, with normal serum creatinine, and non diabetic (52.5% women and 47.5% men, mean age 41.4 +/- 9.6 years). We evaluated filling indexes by Doppler Echocardiography: Ratio of early to late diastolic peak filling velocity and early filling deceleration time. Left ventricular hypertrophy was defined by Devereux's criteria. Microalbuminuria in twenty four hours was measured by radioimmunoassay in hypertensive patients (microalbuminuria: 30-300 mg/24 hours).

RESULTS

Microalbuminuria occurred in 23.7%, left ventricular hypertrophy 40%, and diastolic disfunction 48.8%, no significant correlation existed between the same. Only 29.5% had no cardiac or renal disease. Statistically significant differences were found in ratio of early to late diastolic peak filling velocity and microalbuminuria, between the two study populations, but multiple regression analysis didn't prove such correlation. Ratio of early to late diastolic peak filling velocity was independently related to age and diastolic blood pressure.

CONCLUSIONS

There is a high prevalence of cardiac and/or renal disease in mild hypertensive patients, only 29.5% of these patients are free of disease. We don't find relation between lesions in these organs.

[Asymptomatic aortic dissection in a patient with aortic valve prosthesis]

The occurrence of iatrogenic aortic dissection after aortic valve replacement is uncommon, usually late, and exceptionally asymptomatic. We present here a case of dissecting aneurysm suspected by excessive mediastinal dilatation observed in the routine annual roentgenogram exam of a patient who has had an aortic valve prosthesis for thirteen years. The confirmation with other diagnostic methods and its successful surgical treatment are also described.

Short-term recombinant human growth hormone treatment increases growth rate in achondroplasia

To investigate the effect of recombinant hGH treatment on the growth rate and proportion of individuals with achondroplasia and hypochondroplasia, we studied 15 individuals with these common skeletal dysplasias. The study lasted 24 months and included 6 months of observation, 12 months of hGH therapy (0.04 mg/kg.day), and 6 months of posttreatment growth rate determination. In achondroplasia, the mean growth rate during the hGH treatment (5.3 +/- 1.6 cm) was significantly increased compared with that during the pretreatment (4.0 +/- 1.0 cm.yr, P < 0.01)) and posttreatment periods (3.1 +/- 1.3 cm; P < 0.001). In the 4 children with hypochondroplasia, the growth rate during hGH treatment was 7.0 +/- 2.4 cm/yr and 4.9 +/- 1.5 cm/yr during the pre- and posttreatment periods, respectively. In achondroplasia, there was a significant increase in growth rate of only the lower segment (from 1.1 +/- 1.6 cm/yr to 3 +/- 1.2 cm/yr, P < 0.02). There was no significant acceleration in the growth of the upper segment and of the scanogram measurements of the long bones. No untoward effects were noted. Recombinant hGH increases short-term growth velocity in children with achondroplasia/hypochondroplasia. Unexpectedly, this treatment does not seem to have a lesser effect on limbs than on trunk growth rate and, therefore, during 1 yr of treatment, does not increase body disproportion.

From relief to development: the long-term effects of 'temporary' accommodation on refugees and displaced persons in the Republic of Croatia

The increasing scale of international intervention in conflict is generating new pressures on the humanitarian community. Increased expenditure on emergency relief, static levels of overseas development aid and subsequent lack of funds for development are dictating that agencies design relief projects that positively effect developmental reconstruction. This paper examines the provision of shelter for refugees and displaced persons in the Republic of Croatia and identifies ways in which it has encouraged and discouraged sustainable reconstruction. It argues that to promote lasting reconstruction, programmes must focus on saving livelihoods as well as lives, thus minimising the long-term psychological and physical impacts of aid on refugees, displaced persons and host communities.

Researching under fire: issues for consideration when collecting data and information in war circumstances, with specific reference to relief and reconstruction projects

The post-Cold War era has witnessed an increased number of conflicts and higher levels of international intervention by the humanitarian community and the military. Those who undertake to research the actions of relief and development agencies acting in these wars must act within new parameters that require a flexible, innovative and reflective approach. Not much is known about data collection in war. The most relevant publications come from the field of development studies. This paper is a beginning in a much-needed discourse on researching under fire; it is offered not as a definitive work, but as a starting-point for discussion.

Survival of yogurt-containing organisms and Lactobacillus gasseri (ADH) and their effect on bacterial enzyme activity in the gastrointestinal tract of healthy and hypochlorhydric elderly subjects

The effect of the live bacterial yogurt cultures, namely Streptococcus thermophilus and Lactobacillus bulgaricus, and a mucosal adhering strain of Lactobacillus gasseri (ADH) on small intestinal and fecal bacterial characteristics was examined in 10 elderly subjects with atrophic gastritis and 23 elderly normal volunteers (11 received yogurt and 12 received ADH). Neither S thermophilus nor L bulgaricus was recovered from the stomach or small intestine of subjects fed yogurt or pasteurized yogurt. ADH was recovered from gastric or small intestinal aspirates in three of four subjects and in the stools of four of five subjects diagnosed with atrophic gastritis. In 11 of 12 normal subjects, ADH was isolated from stools. There was a significant reduction in fecal bacterial enzyme activity in both normal volunteers and subjects with atrophic gastritis after being fed with viable ADH. Adherent strains of bacteria such as ADH are likely to survive passage through the gastrointestinal tract and thus have greater metabolic effects.

Autoantibodies reacting with poly(ADP-ribose) and with a zinc-finger functional domain of poly(ADP-ribose) polymerase involved in the recognition of damaged DNA

Poly(ADP-Ribose) polymerase (PARP) is a chromatin-associated enzyme that specifically binds to DNA strand breaks in a zinc-dependent manner. We describe here the presence of IgG antibodies reacting with recombinant human PARP in the serum of patients with systemic lupus erythematosus (SLE) and primary and secondary Sjögren's syndrome (pSS and sSS). The reactivity of patients' sera was further studied in ELISA with a synthetic peptide of 44 residues corresponding to the second zinc finger (F2) present in the DNA-binding domain of PARP and which was shown to effectively bind 65Zn. Thirty-five percent of SLE sera (n = 97), 42% of pSS sera (n = 67), and 56% of sSS sera (n = 16) were found to contain raised levels of IgG antibodies reacting with peptide F2 which corresponds to the domain in PARP that is directly involved in the specific recognition of single and double strand breaks in DNA. Antibodies reacting with the whole enzyme and/or peptide F2 occurred independently from antibodies reacting with poly(ADP-ribose) which is rapidly synthesized in vivo by PARP from NAD and then degraded in response to DNA strand breaks.

Tofu and soy drinks contain phytoestrogens

OBJECTIVE

As the intakes of soy foods rise in the American diet, the weak estrogenic activity of plant phytoestrogens may reach biologically effective levels. We determined the content of phytoestrogens (plant compounds with weak estrogenic activity in human beings) in tofu, a commercially produced soy drink, and three soy-based formulas.

DESIGN

A modified isotope dilution gas chromatography-mass spectrometry method was used to analyze samples obtained from supermarkets or manufacturers.

SAMPLES

Two or three lots of duplicate samples of four brands of tofu, one commercially produced soy drink, and three soy-based specialty formulas were analyzed. Means and standard deviations were calculated for the isoflavones daidzein, Biochanin A, genistein, coumestrol, and formononetin.

RESULTS

Tofu soy products were highest in isoflavone content; means of brands ranged from 73.0 to 97.5 micrograms/g daidzein per g wet weight and 187.4 to 215.9 micrograms genistein per g wet weight. The commercial soy drink followed with 7.0 micrograms daidzein per g wet weight and 21.0 micrograms genistein per g wet weight; the soy-based formulas were nearly devoid of these two isoflavones. Mean levels of Biochanin A, formononetin, and coumestrol were very low or nil (eg, 0 to 1.0 microgram/g) in all products.

CONCLUSIONS

Tofu contained the highest amounts of isoflavones among the products tested, and there was some variability from brand to brand. The soy drink contained lesser amounts, and soy-based formulas were devoid of isoflavones.

Autoantibodies typical of non-organ-specific autoimmune diseases in HIV-seropositive patients

OBJECTIVE

To analyse serological aspects of systemic autoimmunity in HIV-1-seropositive patients and in individuals at risk for AIDS.

DESIGN AND METHODS

The reactivity of antibodies in the serum of 100 HIV-1-seropositive patients was investigated by enzyme-linked immunosorbent assay (ELISA) using a series of antigens known to be recognized by antibodies from patients with multisystemic autoimmune diseases, such as systemic lupus erythematosus, mixed-connective tissue disease and Sjögren's syndrome.

RESULTS

High levels of immunoglobulin G (IgG) antibodies reacting with double-stranded DNA (dsDNA), synthetic peptides of ubiquitinated histone H2A, Sm-D antigen, U1-A RNP antigen and 60 kD SSA/Ro antigen were found in 44-95% of HIV-infected patients. Among histone antibodies, the most frequent reactions were towards the carboxy-terminal region of histone H1 and to histone H2B and its amino-terminal domain 1-25. Eight HIV-1-seropositive patients at different stages of disease according to the Centers for Disease Control classification were also studied. In most cases, no obvious fluctuations were observed over several years. Antibodies were found early, and their specificity and apparent level of activity remained relatively constant. There was no evidence of such an autoimmune response in the serum of high-risk homosexual seronegative men.

CONCLUSIONS

Although the aetiology of AIDS is known, in general the aetiology of multisystemic autoimmune diseases remains to be determined, and the sequence of events taking place remains obscure in both cases. It is possible that the large spectrum of antibodies found in HIV-infected patients reflects a specific stimulation of B-cells by nuclear antigens released by apoptosis during an early stage of disease.

IgG antibodies from patients with primary Sjögren's syndrome and systemic lupus erythematosus recognize different epitopes in 60-kD SSA/Ro protein

Five synthetic peptides corresponding to the N-, the C- and a central domain in 60-kD SSA/Ro protein were prepared and tested with sera from 112 patients with systemic lupus erythematosus (SLE), 55 with primary Sjögren's syndrome (pSS) and 29 with rheumatoid arthritis. Among these five fragments, one representing residues 21-41, was recognized by antibodies in 57% of pSS patients. Interestingly, this peptide was recognized by only a few (less than or equal to 7%) of SLE sera, while 63% of pSS sera and 46% of SLE sera tested in parallel possessed antibodies reacting in ELISA with purified 60-kD SSA protein. The ELISA results were compared with the pattern of reactivity obtained in immunodiffusion and immunoblotting. The results indicate that the sensitivity of ELISA using peptide 21-41 and pSS sera was in the same range as immunoblotting and higher than immunodiffusion. Thus the peptide 21-41 proved useful for the detection of anti-SSA antibodies in the sera of patients with pSS. Furthermore, a positive ELISA using peptide 21-41 could be of potential use to discriminate pSS with systemic features from SLE. The fact that peptide 21-41 is recognized by antibodies in pSS but only by very few SLE sera implies that different mechanisms are involved in the anti-SSA immune response in these two autoimmune diseases.

Antigen-binding diversity of human hybridoma autoantibodies derived from splenocytes of patients with SLE

The antigen-binding specificity of human hybridoma-derived monoclonal autoantibodies (mAb) was analysed with mAbs derived from the spleens of two patients with active systemic lupus erythematosus (SLE). From one patient 72 mAbs (RSP clones) and from the other 173 mAbs (RT clones) were obtained. The binding specificity of these mAbs was analysed by solid- and fluid-phase ELISA against the autoantigens ssDNA, dsDNA, cardiolipin, SmRNP, histones, Sm-D and SS-B (La) synthetic peptides, and foreign antigens including bacterial polysaccharides. In addition, antinuclear antibody activity and anti-dsDNA binding were confirmed by fluorescence staining methods. Reflecting the patient's serological profile, none of the antibodies from the RSP clones reacted with ssDNA or dsDNA but 12 reacted with cardiolipin. In addition, three mAbs reacted with H4, five with U1 RNP, two with Sm-D peptides and 12 with SS-B peptides. In contrast, from the RT fusion, nine mAbs reacted with ssDNA, HI and SS-B peptides, seven with cardiolipin, four with dsDNA, two with Sm-D peptides and one each with H2A, H3 and H4. In many cases one mAb showed reactivity with more than one antigen: for example, mAb RT 72 binds to ssDNA, dsDNA, cardiolipin, H1, H4 and an Sm-D peptide; RT 6 binds to H1, SmRNP and ubiquitinated histone H2A. However, none of the antibodies showed 'across the board' polyreactivity; indeed, the selectivity of the reactions was notable and marked variation in antibody affinity was recorded. Eight of the mAbs bound to Salmonella typhimurium and two to the Klebsiella polysaccharide K-30.(ABSTRACT TRUNCATED AT 250 WORDS)

Survival of Lactobacillus species (strain GG) in human gastrointestinal tract

A newly isolated strain of a species of Lactobacillus of human origin, designated GG (Lactobacillus GG), has been studied to determine its ability to survive in the human gastrointestinal tract. When fed to 76 volunteers as a frozen concentrate or as a fermented preparation in milk or whey, Lactobacillus GG was recovered in the feces of all subjects receiving the fermented milk or whey and in 86% receiving the frozen concentrate when a single fecal specimen was cultured. The organism was also present in the feces of subjects concurrently receiving ampicillin. After terminating feeding of the organism, Lactobacillus GG persisted in the feces of 87% of volunteers four days later and in 33% of subjects seven days later. Lactobacillus GG lowered fecal bacterial beta-glucuronidase activity by approximately 80% in volunteers given the organism for four weeks. These studies demonstrate that Lactobacillus GG can survive and temporarily colonize the human gastrointestinal tract and can affect the metabolic activity of the resident microflora.

Mapping of epitopes on U1 snRNP polypeptide A with synthetic peptides and autoimmune sera

The ability of synthetic peptides encompassing almost the entire sequence of snRNP U1A polypeptide to be recognized in ELISA by sera of autoimmune patients was investigated. Sera from 18 patients with mixed connective tissue disease (MCTD), 145 with systemic lupus erythematosus (SLE) and 120 with other rheumatic autoimmune diseases were tested with 13 overlapping peptides. Among them, peptide 257-282 and, to a lower extent, peptide 1-11 were recognized by MCTD, SLE and Sjögren's syndrome sera. In contrast, peptide 35-58 was recognized by 94% of MCTD and only 19% of SLE sera. It did not react with any of the other patient sera. The ELISA results were compared with the pattern of reactivity observed in immunoblotting. The results indicate that peptide 35-58 probably contains a major epitope recognized by MCTD autoantibodies. It is noteworthy that in snRNP particles, this region of U1A interacts with RNA and presents only limited homology with the corresponding sequence 32-50 of U2B''.

Longitudinal analysis of antibodies to histones, Sm-D peptides and ubiquitin in the serum of patients with systemic lupus erythematosus, rheumatoid arthritis and tuberculosis

A longitudinal analysis of 12 lupus patients has been undertaken to assess their autoantibody reactivity by ELISA with histones, Sm-D peptides, ubiquitin and DNA. As controls patients with rheumatoid arthritis and tuberculosis were studied. Whereas the control groups showed little evidence of autoantibody reactivity 25% or more of the lupus patients had raised levels of autoantibodies against eight of the nine antigens tested. Of particular note was the fact that approximately 70% of the blood tested possessed antibodies reacting with Sm-D peptide 1-20. In contrast only one patient had anti-Sm antibodies by counter immunoelectrophoresis. In general the levels of antibodies to core histones reflected disease activity unlike the levels of anti-H1 antibodies. High levels of antibodies to ubiquitin often seemed to correlate inversely with active lupus and DNA antibody levels.

Recognition of synthetic peptides of Sm-D autoantigen by lupus sera

The reactivity of autoantibodies present in the serum of patients with systemic lupus erythematosus (SLE) was investigated by ELISA using seven overlapping synthetic peptides representing the entire sequence of the polypeptide D component of 'Sm antigen'. Of the 165 SLE sera tested, 59% were found to contain IgG antibodies able to bind to peptide 1-20, while 37% of the sera reacted with peptide 44-67. All sera reacting with peptide 44-67 also reacted with peptide 1-20. These two peptides were only seldom recognized by the sera of 187 patients with other rheumatic autoimmune diseases or by 53 sera of normal individuals. In a parallel study using sera that reacted with the D band in immunoblotting, most of the sera recognized peptides 44-67 (89%) and 1-20 (67%), while 33% of them reacted with peptide 97-119. The use of these synthetic peptides in ELISA may be of considerable help for detecting anti Sm autoantibodies.

Reversible shrinkage of a growth hormone-secreting pituitary adenoma by a long-acting somatostatin analogue, octreotide

Octreotide acetate (SMS-201-995), a somatostatin analogue, was used to treat an acromegalic patient harboring a growth hormone-secreting pituitary macroadenoma. Intermittent subcutaneous administration of octreotide suppressed growth hormone and insulin-like growth factor-I (IGF-I) levels and ameliorated clinical symptoms. Magnetic resonance imaging performed after 16 weeks revealed a 70% shrinkage of the pituitary mass, with a resultant partially empty sella turcica. To document that this shrinkage occurred as a result of octreotide treatment and not spontaneous tumor infarction, the medication was withdrawn for 4 weeks. A second magnetic resonance image disclosed regrowth of the tumor accompanied by rebound of growth hormone and IGF-I secretion. Subsequent biochemical remission has been sustained with preservation of anterior pituitary function since the drug was reinitiated. These findings suggest that intermittent subcutaneous administration of octreotide may provide potent medical ablation of growth hormone-secreting macroadenomas.

Is it normal for terminally ill patients to desire death?

Among 44 terminally ill patients, the majority (N = 34) had never wished death to come early. Of the remainder, three were or had been suicidal and seven more had desired early death. All 10 patients who had desired death were found to be suffering from clinical depressive illness. The methodologic difficulties encountered by the authors were the lack of a brief, efficient interview schedule suitable for debilitated patients and criteria for depressive disorder that do not depend on suicidal thoughts or on symptoms that can also be caused by physical disease.

Personality diagnosis and illness diagnosis

This case presented with features of affective disorder with psychosis and also of borderline, avoidant and schizotypal personality disorders. During the course of subsequent treatment there was a marked reduction not only in psychotic and depressive features, but also in criteria for personality disorder, especially borderline. Relevant literature is reviewed and the importance of treatable illness as a possible cause of apparent personality disorder is discussed.