AB0716 Characteristics of 4 cases of PL - 7 positive antisynthatase syndrome: interstitial lung disease being a more common feature then myositis

Background

Anti synthetase syndrome is a heterogeneous group of auto immune diseases characterised by antibodies against aminoacyl t RNA synthetase, associated with interstitial lung disease, myositis, arthritis and Raynaud’s phenomenon. Anti PL 7 antibody is rare, present in only 1-4% patients with anti synthetase syndrome.

Objectives

To describe clinical characteristics PL – 7 positive patients with antisynthatase syndrome.

Methods

In this retrospective study, cohort of patients with inflammatory myositis were screened for anti PL-7 antibody positivity and 4 cases were detected. Diagnosis was made based on either 2017 EULAR/ ACR classification criteria and/ or Bohan and Peter criteria. [1, 2] Clinical manifestations, investigations including antibody profile, treatment and treatment response were described.

Results

Of the 4 patients, 3 were female and age of onset varied from 36 to 69 years. Only 1 patient presented with proximal muscle weakness while three patients with dyspnoea. Joint involvement and Raynaud’s phenomenon was present in 2 patients. Two patients had scleroderma spectrum manifestations. Three patients had elevated CK during the disease course with maximum values being 228, 594 and 1200 with only one having muscle weakness. One patient had dermatomyositis and 2 patients had mechanic‘s hand.

HRCT patterns were usual interstitial pneumonia(UIP), nonspecific interstitial pneumonia(NSIP) and fibrosing NSIP with organising pneumonia. Three patients had anti Ro antibodies. All patients were treated with steroids, one each received Cyclophosphamide and Azathioprine initially however all the patients ended up with Mycophenolate mofetil—which controlled disease effectively without flare.

Table 1.Patient 1Patient 2Patient 3Patient 4Age at onset69 years52 years36 years55 yearsGenderMaleFemaleFemaleFemalePresentationShortness of breathShoulder weaknessArthritis and shortness of breathShortness of breathMuscleNo weaknessNo weaknessNo weaknessMaximum CK (U/L)2285941200105Raynaud’sPresentAbsentPresentJointArthritis - presentAbsentPresentAbsentSkinSkin tightnessScelrodactylyNail fold capillaries dilationAbsentSkin tightnessScelrodactylyNail fold capillaries dilationMechanic’s hands, facial pigmentationMechanic’s handLungPresentAbsentPresentPresentAntibodiesANA+Anti Ro+PL - 7 +ANA+, anti Ro & La +, anti Ro52+PL – 7+ANA negativeanti Ro52+PL – 7+ANA negativePL – 7 +HRCTUIPNo ILDNSIPFibrosing NSIP, COPLung functionFEV153%Not availableFEV136%FEV165%FVC47%FVC35%FVC82%FEV1/FVC113%FEV1/FVC103%FEV1/FVC83%DLCO34%DLCO49%DLCO50%EMGNot doneChronic myopathyNot doneNot doneMuscle biopsyNot doneNot availableNot doneNot doneTreatmentPrednisolone andIV cyclophosphamide initially (side effects)Later on Mycophenolate MofetilStable diseasePrednisoloneInitially AzathioprineLater MMF due to relapsing disease while of AZAMMF and Prednisolone—clinical responsePrednisolone and Mycophenolate-response with normalisation of PFTPulmonary hypertensionPresentAbsentPresentAbsent

Conclusion

In Anti PL – 7 positive patients, interstitial lung disease is much more common than myositis. Mechanic’s hands and scleroderma overlap appear to be a common association. Additionally, antibody positivity with Anti Ro/Ro52 was also noted. One patient had features of dermatomyositis including facial rash which is extremely rare for PL7. All of these patients responded very well to Mycophenolate.

References

[1]Lundberg IE, Tjärnlund A, Bottai M, et al. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups [published correction appears in Ann Rheum Dis. 2018 Sep;77(9):e64]. Ann Rheum Dis. 2017;76(12):1955-1964. doi:10.1136/annrheumdis-2017-211468

[2]Bohan A, Peter JB. Polymyositis and dermatomyositis (first of two parts). N Engl J Med. 1975;292(7):344-347. doi:10.1056/NEJM197502132920706

Disclosure of Interests

None declared

FRI0475 STEROID SPARING AGENTS IN POLYMYALGIA RHEUMATICA: A SYSTEMATIC REVIEW

Background:

Polymyalgia rheumatica (PMR) is the commonest chronic inflammatory musculoskeletal disease of the elderly. The mainstay of treatment for PMR is long term systemic glucocorticoid (GC), which is associated with significant systemic toxicity. There is a need for steroid sparing drugs in PMR to reduce GC cumulative dose and GC induced adverse effects.(1)

Objectives:

To evaluate the role of steroid sparing agents in PMR.

Primary outcomes:

Secondary outcomes:

Methods:

Electronic databases including Medline, Embase and Cochrane databases (CENTRAL) were searched since inception for prospective randomized control trials comparing disease modifying anti rheumatic drugs (DMARDs) and biologics with systemic GC in PMR, published in English with more than 20 patients and a minimum study duration of 24 weeks. As different classification criteria for PMR exist, studies were included if they used any accepted classification criteria for PMR. Case series, case reports, retrospective, non-randomized trials, abstracts, systematic reviews and non English language trials were not included. Patients with Giant cell arteritis (GCA) were excluded. Risk of bias and quality was assessed using the Cochrane tool.

The studies were assessed for cumulative GC dose, proportion of patients in remission, proportion of patients with relapse, reduction in inflammatory markers, adverse events and mortality.

Results:

5 studies were selected for final review-- 3 studies involving Methotrexate, one study on azathioprine, one on Infliximab. The study on Azathioprine had high risk of bias, small sample size and low quality (Level 2 evidence) with high attrition rate but it revealed reduction of daily prednisolone with Azathioprine. A high quality RCT (Level 1) did not confirm a steroid sparing effect with Infliximab vs placebo, and there was no significant difference between relapse or remission rate. Methotrexate studies showed conflicting results: one high quality RCT (Level 1) and one low quality RCT (Level 2) on Methotrexate revealed statistically significant steroid sparing effect, however the remaining study did not demonstrate between Methotrexate and placebo. Two methotrexate studies assessed the risk of relapse, with conflicting results (relapses 73% placebo vs 47% methotrexate; or no difference).

Methotrexate was not associated with increased adverse effects in any of the studies. Azathioprine was associated with significant adverse events resulting in high attrition.

A meta analysis was not performed for methotrexate as the studies were heterogenous.

Conclusion:

There is a lack of evidence regarding DMARDs and biologics in PMR. Methotrexate is an effective steroid sparing agent, and is not associated with increased adverse events. Azathioprine may be effective but is associated with significant adverse events. Infliximab is not an effective steroid sparing agent in PMR. More high quality RCTs are needed to study the efficacy of steroid sparing agents.

References:

[1]Bhaskar Dasgupta, Frances A. Borg, Nada Hassan, Kevin Barraclough, Brian Bourke, Joan Fulcher, Jane Hollywood, Andrew Hutchings, Valerie Kyle, Jennifer Nott, Michael Power, Ash Samanta, on behalf of the BSR and BHPR Standards, Guidelines and Audit Working Group, BSR and BHPR guidelines for the management of polymyalgia rheumatica,Rheumatology, Volume 49, Issue 1, January 2010, Pages 186–190

Disclosure of Interests:

None declared

FM2-3 Slave to the rhythm: seasonal differences in non-motor symptoms in parkinson’s

Objectives

To determine the effect of the change of season on non-motor symptoms in Parkinson’s disease (PD).

Design

Cross-sectional retrospective study.

Subjects

364 consecutive Parkinson’s patients in the London area taking part in the Non-motor Longitudinal International Study (NILS) study at King’s College Hospital London between November 2011 and April 2018.

Methods

Participants were divided into three groups based on their assessment date, using a simplified ecological seasonal model:

November until February;

March until 15 June;

16 June until October.

The primary outcome was a seasonal difference in non-motor symptom scale (NMSS) total scores and the secondary outcomes were NMSS subscores. Outcomes were adjusted for multiple testing using formal Bonferroni correction.

Results

102 patients were allocated to group 1, 105 patients to group 2 and 157 patients to group 3. Seasonal differences were present in NMSS total scores (p=0.042), especially between groups 1 and 3 (p=0.037). Differences were also present for NMSS domain 1 (cardiovascular and falls; p=0.004), 2 (sleep and fatigue; p=0.049), 4 (hallucinations; p=0.003) and 9 (miscellaneous; p=0.031). Within domain 9 there was only a significant difference for question 28 (smell; p=0.008).

Conclusions

These results indicate that non-motor symptoms in Parkinson’s fluctuate throughout the year with lowest scores in the summer months and highest in the winter months. These variations need to be taken into account to avoid inappropriate changes in medication regimes.

FM2-2 Exploratory analysis whether wearable sensor data can correlate with aspects of non-motor symptoms in parkinson’s: a real life study with the parkinson’s kinetigraphTM

Objectives

To determine the association between the range and nature of non-motor symptoms (NMS) in people with Parkinson’s (PwP) and validated Parkinson’s KinetigraphTM (PKG) outcome measures.

Design

Cross-sectional retrospective study of participants enrolled in the Non-motor Longitudinal International Study (NILS, UKCRN No: 10084) at King’s College Hospital, London.

Subjects

108 PwP with a PKG recording within 4 months of a NILS assessment were included in the analysis.

Methods

PKG is a validated accelerometery-based measure for motor function in PwP, reporting scores for global bradykinesia (BKS) and dyskinesia (DKS). NMS were assessed by the NMS scale (NMSS).

Results

Using multiple linear regression, BKS was predicted by NMSS domains 6 (gastrointestinal tract; p=0.006) and 8 (sexual function; p=0.003). DKS was predicted by domains 3 (mood/cognition; p=0.016), domain 4 (perceptual problems; p=0.025), domain 6 (gastrointestinal tract; p=0.029) and domain 9 (miscellaneous, p=0.003). In these domains, anxiety, delusions, dysphagia, hyposmia, weight change and hyperhidrosis significantly predicted DKS. In addition, carbidopa dose predicted NMSS total scores (p=0.037), but not total LEDD (p=0.91).

Conclusions

In PwP, measures of BK and DK were mainly associated with gastrointestinal problems, underpinning the importance of gastric absorption of oral medications and constipation and the related motor effects in PwP. Interestingly, carbidopa appears to have a role in non-motor symptoms in PwP, which deserves further investigation.

Preventing caries in young children of immigrant Bangladeshi families in New York: perspectives of mothers and paediatricians

OBJECTIVE

Childhood caries is common in South Asian immigrant families. Few children visit a dentist by 12 months, as recommended by current guidelines. The paediatric visit has important potential for linking children to preventive care. The aim of this study was to understand the barriers and facilitators to caries prevention for young children of immigrant Bangladeshi families in New York. Qualitative data were collected as a preliminary step in the development of an oral health counselling intervention for South Asian children.

BASIC DESIGN

Qualitative interviews on child feeding and oral health prevention were conducted with Bangladeshi mothers. Qualitative interviews were conducted with paediatricians regarding their experiences with providing care. The data were analysed using standard qualitative approaches.

SETTING

Paediatric practices serving low income Bangladeshi immigrants in New York City.

PARTICIPANTS

26 mothers of children aged 6-24 months receiving services in five paediatric settings and 15 paediatricians providing care in these settings.

RESULTS

Both mothers and their paediatricians described risky feeding practices, communication problems and a lack of compliance. Oral health for young children was a low priority for some mothers. Most, however, were concerned about childhood caries but lacked skills or resources to decrease caries risk.

CONCLUSIONS

Results support our plan to develop an empowerment-based counselling intervention to address caries risk in children. Paediatric dentists should be aware of the barriers to caries prevention in this group.

Anaphylactic shock in pregnancy: a case study and review of the literature

We describe a 22-year-old previously healthy primigravida who presented with spontaneous rupture of membranes at 40 weeks of gestation. Because of her history of inadequate prenatal care, a chemoprophylaxis regimen against group B streptococcal infection was prescribed upon admission. Within a few minutes after initiation of an i.v. infusion of penicillin G, the patient developed generalized erythema and severe hypotension, which was essentially unresponsive to intravenous boluses of ephedrine. Following stabilization of maternal blood pressure with incremental doses of epinephrine, emergency cesarean section was performed with delivery of a severely depressed neonate. Postoperative recovery of the mother was uneventful, although the baby was diagnosed to have suffered significant neurological damage. This unfortunate event highlights the therapeutic dilemma in anaphylaxis during pregnancy, a relatively rare but potentially life-threatening event. A critical review of the scientific literature reveals several etiological agents for anaphylaxis during the perioperative period, with penicillin as the leading cause of anaphylaxis-related mortality. Although epinephrine is the vasopressor of choice during hemodynamic resuscitation in the non-pregnant patient, during pregnancy it may pose a risk to the placental-fetal circulation. Additionally, upon review of the various published reports to date, timing and mode of delivery of the neonate in the face of anaphylactic shock remains controversial.

Application and assessment of a robust elastic motion correction algorithm to dynamic MRI

The purpose of this study was to assess the performance of a new motion correction algorithm. Twenty-five dynamic MR mammography (MRM) data sets and 25 contrast-enhanced three-dimensional peripheral MR angiographic (MRA) data sets which were affected by patient motion of varying severeness were selected retrospectively from routine examinations. Anonymized data were registered by a new experimental elastic motion correction algorithm. The algorithm works by computing a similarity measure for the two volumes that takes into account expected signal changes due to the presence of a contrast agent while penalizing other signal changes caused by patient motion. A conjugate gradient method is used to find the best possible set of motion parameters that maximizes the similarity measures across the entire volume. Images before and after correction were visually evaluated and scored by experienced radiologists with respect to reduction of motion, improvement of image quality, disappearance of existing lesions or creation of artifactual lesions. It was found that the correction improves image quality (76% for MRM and 96% for MRA) and diagnosability (60% for MRM and 96% for MRA).

A novel wavelet neural network based pathological stage detection technique for an oral precancerous condition

AIM

To describe a novel neural network based oral precancer (oral submucous fibrosis; OSF) stage detection method.

METHOD

The wavelet coefficients of transmission electron microscopy images of collagen fibres from normal oral submucosa and OSF tissues were used to choose the feature vector which, in turn, was used to train the artificial neural network.

RESULTS

The trained network was able to classify normal and oral precancer stages (less advanced and advanced) after obtaining the image as an input.

CONCLUSIONS

The results obtained from this proposed technique were promising and suggest that with further optimisation this method could be used to detect and stage OSF, and could be adapted for other conditions.

Analysis of haemophilia B database and strategies for identification of common point mutations in the factor IX gene

Haemophilia B is an X-linked recessively inherited bleeding disorder caused by heterogeneous mutations spanning the entire factor IX gene. As spontaneous germ-line mutations are known to occur mostly at CpG dinucleotides in the FIX gene, control of the disease would require continuous carrier detection and mutation screening. Identification of point mutations, the most common type of mutation in FIX gene, is more challenging compared with deletion and insertion mutations. We examined the haemophilia B database to identify specific nucleotides in the FIX gene that are mutated in relatively large number of patients and the variability (if any) in the mutational hotspots at CpG dinucleotides. It was found that while mutations responsible to account for all 2348 haemophilia B patients covered 20% of the FIX cDNA, only 1% of the cDNA involving mostly CpG dinucleotides accounted for mutation in 42.41% of the patient pool. Thus, only 27 nucleotides need to be investigated to identify the common point mutations, among which 15 are predicted to undergo change in restriction sites on mutation. It is interesting to note that seven nucleotides occurring in CpG dinucleotides do not have any reported mutation despite each of those being predicted to harbour mutation as a result of transition and having mutations recorded in the database for the neighbouring nucleotides. Strikingly large number of mutation in codon 296 causing T to M change in catalytic domain originally proposed to be the result of the founder effect also contains largest number of haplotype suggesting recurrence of de novo mutation.

Haplotype structure of TP53 locus in Indian population and possible association with head and neck cancer

It has been proposed that a constellation of three TP53 polymorphisms (intron 3 16 bp duplication, codon 72 BstUI, and intron 6 Nci I RFLP at nt 13494) constitute a haplotype predictive of increased cancer risk. We have estimated the allele frequency of these polymorphisms in three endogamous Indian ethnic populations from three different geographic locations (viz. Iyer from south India, Brahmin from central India and Mahishya from eastern India), as well as in head and neck squamous cell carcinoma (HNSCC) patients, and in ethnically matched normal individuals from the eastern region of India. The genotype distributions and allele frequencies of the three polymorphisms in all but one population, as well as in patients, showed a good fit to Hardy-Weinberg equilibrium. Strong linkage disequilibria were observed between all loci in every population examined, except for the 16bp-Nci I haplotype in the Mahishya population. The Mahishya population differed significantly from the other two populations with respect to differences in allele frequency and haplotype frequency. Although there were no significant differences in genotypic frequency at any of the loci between HNSCC patients and the matched control population, the minor allele frequency of codon 72 and intron 3 16 bp polymorphisms showed significant variation. Variation in overall haplotype frequency between patients and normal individuals was significant (p = 0.036) when two rare haplotypes 2-1-2 and 1-2-1 were combined. The rare haplotype 2-1-2 was found to be modestly over represented in HNSCC patients as compared to normal individuals.

Comparison of global transcription responses allows identification of Vibrio cholerae genes differentially expressed following infection

Comparison of global transcription profiles of Vibrio cholerae grown in vitro and in vivo revealed that 20% of the genome was repressed and about 5% was induced under in vivo conditions. Hybridization with the cloned genes revealed that the virulence genes ctx, toxR, toxT and tcpA were induced under in vivo conditions. Dissection of two in vivo induced cosmids identified another set of three genes homologous to che Y1 involved in motility and chemotaxis, pnuC encoding the major component of the nicotinamide mononucleotide transport system and icmF belonging to a cassette involved in multiplication inside host cells. These results demonstrate that the global transcription profile approach might be a powerful method for identification of differentially expressed transcripts under in vivo conditions.

Use of RNA arbitrarily primed-PCR fingerprinting to identify Vibrio cholerae genes differentially expressed in the host following infection

Evidence suggests that a repertoire of Vibrio cholerae genes are differentially expressed in vivo, and regulation of virulence factors in vivo may follow a different pathway. Our work was aimed at characterization of in vivo-grown bacteria and identification of genes that are differentially expressed following infection by RNA arbitrarily primed (RAP)-PCR fingerprinting. The ligated rabbit ileal loop model was used. The motility of in vivo-grown bacteria increased by 350% over that of in vitro-grown bacteria. Also, the in vivo-grown cells were more resistant to killing by human serum. By using the RAP-PCR strategy, five differentially expressed transcripts were identified. Two in vitro-induced transcripts encoded polypeptides for the leucine tRNA synthatase and the 50S ribosomal protein, and the three in vivo-induced transcripts encoded the SucA and MurE proteins and a polypeptide of unknown function. MurE is a protein involved in the peptidoglycan biosynthetic pathway. The lytic profiles of in vivo- and in vitro-grown cells suspended in distilled water were compared; the former was found to be slightly less sensitive to lysis. Ultrathin sections of both cells observed under the transmission electron microscope revealed that in contrast to the usual wavy discontinuous membrane structure of the in vitro-grown cells, in vivo-grown cells had a more rigid, clearly visible double-layered structure. The V. cholerae murE gene was cloned and sequenced. The sequence contained an open reading frame of 1,488 nucleotides with its own ribosome-binding site. A plasmid containing the murE gene of V. cholerae was transformed into V. cholerae 569B, and a transformed strain, 569BME, containing the plasmid was obtained. Ultrathin sections of 569BME viewed under a transmission electron microscope revealed a slightly more rigid cell wall than that of wild-type 569B. When V. cholerae 569B and 569BME cells were injected separately into ligated rabbit ileal loops, the transformed cells had a preference for growth in the ileal loops versus laboratory conditions.

The anti-bacterial action of diclofenac shown by inhibition of DNA synthesis

Most strains of Gram-positive and Gram-negative bacteria were inhibited by 50-100 mg/l of the anti-inflammatory agent, diclofenac sodium (Dc). In vivo test using 30 or 50 microg Dc per 20 g mouse (Swiss Albino variety) significantly (P <0.001) protected the animals when challenged with 50 MLD of a virulent Salmonella typhimurium. The anti-bacterial action of Dc was found to be due to inhibition of DNA synthesis which was demonstrated using 2 micro Ci (3H) deoxythymidine uptake.

Studies on the genotoxicity of endosulfan in bacterial systems

Endosulfan, an organochlorine pesticide, was subjected to the differential sensitivity assay in repair-deficient and repair-proficient strains of Escherichia coli K12, prophage lambda induction assay in WP2s (lambda) and mutation induction in E. coli K12. The induction of umu gene expression with endosulfan was studied also in Salmonella typhimurium TA1535/pSK1002 cells. The differential sensitivity assay revealed that the recA 13 strain was the most sensitive. Endosulfan induced prophage lambda in E. coli and umu gene expression in S. typhimurium cells; however, the extent of the effects were low. Endosulfan also induced a dose-dependent increase in forward mutations in E. coli K12 cells from ampicillin sensitivity to ampicillin resistance. Our studies indicate the genotoxic potential of endosulfan and the role of the recA gene in the repair of endosulfan-induced DNA damage.

Ultrastructural and trace metal studies on radiographers' hair and nails

Scalp hair and fingernail samples of 42 medical radiographers and 42 nonradiographers (control) with matching age groups and food habits were collected for this study. Trace metal estimation by atomic absorption spectrometry (AAS) has indicated a significant increase (P < 0.001) in Zn, Cu, and Cd contents in the radiographers' hair and nails. Scanning electron microscopy (SEM) revealed structural changes in the hair and nails of radiographers. Significant alterations in the Zn and Cd contents along with extensive structural damage in the hair and nails probably indicate that low-dose X-radiation imposes stress on these radiation workers.

A trace metal (zinc and iron) study on low dose x-radiation response in rat skin

There is no reliable bio-dosimeter regarding low dose radiation effects in mammalian systems. In this study, chronic low dose (< 1 cGy) whole body x-irradiated rat skin have shown altered trace metal (zinc and iron) content which clearly indicated the redistribution of these metals in the integumentary system. The decreased zinc to iron ratios suggested enhanced oxidative stress of the tissue. Changes in trace metal content in irradiated rat skin, as a biological response to low dose radiation, were non-linear. Moreover, the lowered zinc content of E2, E3, E4 and E5 dose groups suggested a different steady state, compared to the control. The Zn: Fe ratio decreased with increasing radiation dose.

Hepatotoxicity of diazepam. Structural and trace metal studies in rat

Studies of effects of diazepam on liver parenchyma are very scanty. In this study, adult albino rats were treated with diazepam in two different doses (0.25 mg and 0.30 mg/kg body wt) daily for 30 and 60 d. Through light microscopy and electron microscopy, prenecrotic and necrotic changes were noted in the high-dose group. Trace metal analysis indicated that zinc (Zn) was reduced by 30 and 60 day under both the doses, whereas iron (Fe) and copper (Cu) were reduced significantly in these groups only after 60 d of treatment. This reduction in metal contents may have some correlations with necrotic changes in liver parenchyma.

Porins of Vibrio cholerae: purification and characterization of OmpU

Three outer membrane proteins with molecular masses of 40, 38, and 27 kDa of the hypertoxinogenic strain 569B of Vibrio cholerae have been purified to homogeneity. The synthesis of all the three proteins is regulated by the osmolarity of the growth medium. The pore-forming ability of the 40-kDa protein, OmpT, and the 38-kDa protein, OmpU, has been demonstrated by using liposomes, in which these proteins were embedded. The 27-kDa protein, OmpX, though osmoregulated, is not a porin. OmpU constitutes 30% of the total outer membrane protein when grown in the presence of 1.0% NaCl in the growth medium and 60% in the absence of NaCl. OmpU is an acidic protein and is a homotrimer of 38-kDa monomeric units. Its secondary structure contains predominantly a beta-sheet, and three to four Ca2+ ions are associated with each monomeric unit. Removal of Ca2+ irreversibly disrupts the structure and pore-forming ability of the protein. The pore size of OmpU is 1.6 nm, and the specific activity of the OmpU channel is two- to threefold higher than that of Escherichia coli porin OmpF, synthesis of which resembles that of OmpU with respect to the osmolarity of the growth medium. The pore size of OmpT, which is analogous to OmpC of E. coli, is smaller than that of OmpU. Southern blot hybridization of V. cholerae genomic DNA digested with several restriction endonucleases with nick-translated E. coli ompF as the probe revealed no nucleotide sequence homology between the ompU and ompF genes. OmpU is also not antigenically related to OmpF. Anti-OmpF antiserum, however, cross-reacted with the 45-kDa V. cholerae outer membrane protein, OmpS, the synthesis of which is regulated by the presence of maltose in the growth medium. OmpU hemagglutinated with rabbit and human blood. This toxR-regulated protein is one of the possible virulence determinants in V. cholerae (V. L. Miller and J. J. Mekalanos, J. Bacteriol. 170:2575-2583, 1988).

Septic arthritis of the shoulder after mastectomy and radiotherapy for breast carcinoma

We report five patients who developed septic arthritis of the shoulder after cancer of the ipsilateral breast had been treated by surgery and radiotherapy. Lymphoedema was present in all cases. The infections were not obvious, having subacute onsets, and delays in diagnosis led to destruction of the joint in all but one patient.

Cell surface characteristics of environmental and clinical isolates of Vibrio cholerae non-O1

The cell surfaces of several toxigenic and nontoxigenic environmental and clinical isolates of Vibrio cholerae non-O1 have been examined. The environmental strains, irrespective of toxigenicity, are significantly more resistant to antibiotics and detergents than are V. cholerae O1 strains. The clinical isolates of non-O1 vibrios are as sensitive to a wide variety of chemicals as the O1 vibrios. The environmental non-O1 strains are also less susceptible to lysis when treated with protein denaturants or neutral and anionic detergents than are O1 vibrios and the clinical non-O1 strains. In contrast to O1 vibrios, the environmental non-O1 vibrios do not have exposed phospholipids in their outer membranes. These features of the cell surfaces of environmental non-O1 vibrios might have a role in the better survival of these organisms under environmental fluctuations.

Tuberculous infection in a rural population of south India: 23-year trend

A survey was conducted in Bangalore district of south India between February 1984 and January 1986 to study the tuberculosis infection rate. The data from this survey, along with the information derived from the earlier ones in the same area conducted between 1961-1968, have been used in the report to study the trend of tuberculosis. Tuberculin test results in 0- to 14-year-old unvaccinated children from each survey were distributed, and based on the antimode, infected persons were identified. The standardized prevalence rates in population from the surveys were converted into risk rates by using the TSRU methodology and compared. The average annual risk of infection of 1.1% observed in 1961 declined to 0.61% in 1985, representing a decline of approximately 37% in nearly 23 years. This amounted to an average decline of 3.2% per annum over the period. The trend probably represented a natural dynamics. Whether organized intervention played some role could not be commented upon. Similar studies in other parts of the country are recommended in order to have information on the trend in the country as a whole.

Haematological manifestations of primary Sjögren's syndrome: a clinicopathological study

Clinically significant cytopenias are thought to be uncommon in primary Sjögren's syndrome: only a few cases have been reported in the literature. Over a 3-year period we identified haematological abnormalities in 11 of 27 patients with Sjögren's syndrome. Six patients had a positive direct antiglobulin test, including one patient with all the features of autoimmune haemolytic anaemia and two others with some features of this condition. Four patients had immune thrombocytopenia and two patients had myelodysplastic syndrome. Neutropenia was noted in two patients, one patient had aplastic anaemia and one had pure red cell aplasia. Haematological disorders were found to be common in patients with Sjögren's syndrome (40 per cent). Accordingly, we suggest that patients with immune cytopenia(s) should be screened for Sjögren's syndrome using sensitive assays for anti-SS.A and anti-SS.B antibodies, and that patients with Sjögren's syndrome should be periodically monitored, with a full blood count to rule out any haematological abnormality.

Presence of exposed phospholipids in the outer membrane of Vibrio cholerae

Vibrio cholerae 569B was found to be highly sensitive to a wide range of chemicals, particularly hydrophobic compounds and neutral and anionic detergents. The phospholipid profile of the outer membrane was similar to that reported for other Gram-negative bacteria. The lipopolysaccharide (LPS) contained O-antigenic sugars and exhibited heterogeneity. In addition, the LPS moiety was characterized by a relatively low negative charge. Analysis by topological probes revealed the presence of a significant amount of exposed phospholipids in the outer membrane. The reduced negative charge of LPS molecules and the exposed phospholipids present in the outer membrane could be important in the increased permeation of exogenous compounds in V. cholerae.

Interaction of Vibrio cholerae cells with beta-lactam antibiotics: emergence of resistant cells at a high frequency

Unlike other gram-negative enteric bacteria, Vibrio cholerae cells were equally susceptible to penicillin and ampicillin and in general more susceptible than Escherichia coli to most of the beta-lactam antibiotics. The turbidity of penicillin-treated cultures contained to increase exponentially for about 3 h, although the cell viability declined rapidly within 30 min of penicillin addition. Prolonged treatment with beta-lactam antibiotics produced cells resistant to these antibiotics. A fluctuation test indicated that this resistance might be due to adaptive mutation. Cells resistant to a beta-lactam exhibited broad cross-resistance to other beta-lactam antibiotics. A new 12,000-Da outer membrane protein was detected both in beta-lactam-resistant cells and in wild-type cells growing in medium containing beta-lactam antibiotics. While the penicillin-resistant cells had all of the penicillin-binding proteins (PBPs) present in the parental cells, significant differences in the relative proportion of low-molecular-weight PBPs were seen. The low-molecular-weight PBPs from resistant cells seemed to form more stable complexes with penicillin than those from the parental strain.

HIV antibody screening of commercially available blood products in India

In a screening of 182 vials of various commercially available blood products in the Indian market, 32 (17%) were found to contain HIV-1 antibodies. The contamination with HIV-1 antibodies was detected in all types of blood products including immunoglobulin preparations, cryoprecipitates as well as albumin. Interestingly, the contamination was seen almost exclusively in the products manufactured in the Bombay-Pune area (32 of 92, 34%). It was very low in products manufactured near Delhi (1 of 90). A single vial of imported Factor VIII concentrate tested negative.

Prenatal diagnosis of autosomal dominant microcephaly and postnatal evaluation with magnetic resonance imaging

A case of fetal autosomal dominant microcephaly was prenatally diagnosed with ultrasonography in a woman with previously undiagnosed microcephaly. At the time of initial ultrasonographic assessment, the mother was identified to have a markedly small cranium, consistent with maternal microcephaly. The ultrasonographic examination showed the fetal head size to be four standard deviations below the mean for gestational age. Gestational dating from the other biometric parameters and from the last menstrual period was consistent with 31 weeks' gestation. Neurosonographic evaluation of the fetus revealed no obvious structural abnormalities. Serial ultrasonographic examinations at 35 and 38 weeks' gestation showed no changes in the fetal head size. A 2.64 kg male fetus was delivered at term. Neonatal assessment showed the fetal head circumference to be less than the second percentile for gestational age. Neurologic assessment of the neonate with magnetic resonance imaging showed abnormal development of the brain, with small cerebellar and cerebral hemispheres, and pachygyria. These images are compared with the magnetic resonance images of the mother. Our findings of maternal and fetal microcephaly are consistent with autosomal dominant microcephaly. To our knowledge, this is the first report of the prenatal diagnosis of autosomal dominant microcephaly.

Bioeconomic dynamics of a fishery modeled as an S-system

A bioeconomic model of a single species fishery is developed by using a realistic catch-rate function and assuming that a regulatory agency controls exploitation of the fishery by imposing a suitable tax on the catch. The existence of a nontrivial steady state and its stability are examined. The optimal harvesting policy is discussed from the viewpoints of variational calculus and control theory. The fishery is then modeled as an S-system by following the recasting techniques of Savageau and Voit. Numerical examples of the optimal control curves and the yield-effort curves are obtained by executing the ESSYNS algorithm.

Morphological study of the combined effect of purpurin derivatives and light on transplantable rat bladder tumors

Purpurin derivatives, a group of synthetic photosensitizers, were tested for their photodynamic activity against transplantable N-[4-(5-nitro-2-furyl)-2-thiazolyl]formamide-induced urothelial tumors growing in male Fischer 344 rats. Histological examination of tumors in animals treated with the purpurin derivatives and red light (greater than 590 nm, 360 joules/cm2) revealed tumor cell necrosis 24 h after completion of therapy. Control tumors showed no histological change. Purpurins have a major absorption peak in the red region (greater than 650 nm) of the visible spectrum, a region with good tissue penetration, and purpurins can be synthesized with a high degree of purity. This study demonstrates the potential of purpurin derivatives as photosensitizers for photodynamic cancer therapy.