Twenty-year survivors of kidney transplantation

There have been few studies of patients with renal allografts functioning for more than 20 years. We sought to identify clinical factors associated with ultra long-term (>20 year) renal allograft survival and to describe the clinical features of these patients. We performed a retrospective analysis of the Irish Renal Transplant Database and included 1174 transplants in 1002 patients. There were 255 (21.74%) patients with graft function for 20 years or more. Multivariate analysis identified recipient age (HR 1.01, CI 1.01-1.02), gender (male HR 1.25, CI 1.08-1.45), acute rejection (HR 1.26, CI 1.09-1.45) and transplant type (living related donor vs. deceased donor) (HR 0.52, CI 0.40-0.66) as significantly associated with long-term graft loss. Median serum creatinine was 115 μmol/L. The 5-year graft survival in 20-year survivors was 74.7%. The mean age at death was 62.7 years (±10.6). The most common causes of death were cardiovascular disease and malignancy. The two major causes of graft loss were death (with function) and interstitial fibrosis/tubular atrophy. Comorbidities included skin cancer (36.1%), coronary heart disease (17.3%) and other malignancies (14.5%). This study identifies factors associated with long-term allograft survival and a high rate of morbidity and early mortality in long-term transplant recipients.

Comparison of three cell fixation methods for high content analysis assays utilizing quantum dots

Semiconductor nanoparticles or quantum dots are being increasingly utilized as fluorescent probes in cell biology both in live and fixed cell assays. Quantum dots possess an immense potential for use in multiplexing assays that can be run on high content screening analysers. Depending on the nature of the biological target under investigation, experiments are frequently required on cells retaining an intact cell membrane or also on those that have been fixed and permeabilized to expose intracellular antigens. Fixation of cell lines before or after the addition of quantum dots may affect their localization, emission properties and stability. Using a high content analysis platform we perform a quantitative comparative analysis of three common fixation techniques in two different cell lines exposed to carboxylic acid stabilized CdTe quantum dots. Our study demonstrates that in prefixed and permeabilized cells, quantum dots are readily internalized regardless of cell type, and their intracellular location is primarily determined by the properties of the quantum dots themselves. However, if the fixation procedures are preformed on live cells previously incubated with quantum dots, other important factors have to be considered. The choice of the fixative significantly influences the fluorescent characteristics of the quantum dots. Fixatives, regardless of their chemical nature, negatively affected quantum dots fluorescence intensity. Comparative analysis of gluteraldehyde, methanol and paraformaldehyde demonstrated that 2% paraformaldehyde was the fixative of choice. The presence of protein in the media did not significantly alter the quantum dot fluorescence. This study indicates that multiplexing assays utilizing quantum dots, despite being a cutting edge tool for high content cell imaging, still require careful consideration of the basic steps in biological sample processing.

Yeast-derived sigma C protein-induced immunity against avian reovirus

Avian reoviruses (ARVs) can result in disease and economic losses in the poultry industry. Vaccines against ARV may not provide full protection and can cause adverse reactions. The coding sequence of the sigma C protein from strain S1133 of avian reovirus was expressed in Schizasaccharomyces pombe. Sigma C protein expression was demonstrated by Western blotting, and the protein was evaluated for its ability to protect specific-pathogen-free (SPF) chickens against challenge with the virulent S1133 strain. Serologic and challenge-infection data showed the efficacy of the recombinant vaccine administered orally each week for 3 consecutive wk. Sigma C protein induced antibody, as determined by enzyme-linked immunosorbent assay. Percentage (%) protection induced by the low dose (125 microg purified yeast-expressed sigma C protein/chicken) or the high dose (250 microg purified yeast-expressed sigma C protein/chicken) was 64 and 91, respectively. The commercial vaccine administered once or twice provided 82% protection. Results supported the feasibility of a plant-derived vaccine for use in poultry immunization schemes.

Deletion of chromosome arm 15q and hitherto unreported duplication of del(15q) in myeloid disorders

Deletion of the long arm of chromosome 15 has been described as a recurrent chromosomal abnormality in myeloid malignancies. We present here some additional case reports of deletion 15 including two cases with an extra copy of the deleted chromosome, a finding that has not previously been described. We compare our cases to those previously reported. Our findings show that, contrary to previous reports, this abnormality may not always be associated with an unfavorable prognosis. They also indicate that deletion 15q most frequently appears to be associated with myelomonocytic disease. Potential candidate genes on 15q that may be involved in the tumorigenesis of these cases are discussed.

Altitudinal distribution and abundance of microhylid frogs (Cophixalus and Austrochaperina) of north-eastern Australia: baseline data for detecting biological responses to future climate change

Extensive abundance surveys of microhylid frogs across altitudinal gradients within the Wet Tropics rainforests of north-eastern Australia were undertaken. Detailed patterns of abundance were resolved for nine microhylid species exhibiting differing associations within the altitudinal gradient. The position of altitudinal range boundaries was found to be largely consistent with previous accounts in the literature, providing confidence in established limits to species distributions. Microhylid frogs, in particular those species restricted to mountaintops, are considered among other endemic rainforest vertebrates within the region to be one of the groups most immediately threatened by climate change. The combined results establish important baseline data for assessing the impacts of climate change, including altitudinal shifts in distribution and localised declines in abundance, on microhylid frogs in the region.

Laboratory evaluation of two native fishes from tropical North Queensland as biological control agents of subterranean Aedes aegypti

The ability of 2 freshwater fishes, eastern rainbow fish Melanotaenia splendida splendida and fly-specked hardyhead Craterocephalus stercusmuscarum stercusmuscarum, native to North Queensland to prey on immature Aedes aegypti was evaluated under laboratory conditions. The predation efficiency of the 2 species was compared to the exotic guppy, Poecilia reticulata, which is commonly used as a biological control agent of mosquito larvae. Of the 3 fish species tested, M. s. splendida was shown to be the most promising agent for the biological control of Ae. aegypti that breed in wells. Melanotaenia s. splendida consumed significantly greater numbers of immature Ae. aegypti than P. reticulata, irrespective of developmental stage or light conditions. Unlike C s. stercusmuscarum, M. s. splendida could be handled, transported, and kept in captivity for extended periods with negligible mortality. However, M. s. splendida was also an efficient predator of Litoria caerulea tadpoles, a species of native frog found in wells during the dry season. This result may limit the usefulness of M. s. splendida as a biological control agent of well-breeding Ae. aegypti and suggests that predacious copepods, Mesocyclops spp., are more suitable. However, the use of M. s. splendida as a mosquito control agent in containers that are unlikely to support frog populations (e.g., aquaculture tanks and drinking troughs) should be given serious consideration.

Impaired IgG responses in a child with homozygous C2 deficiency and recurrent pneumococcal septicaemia

Homozygous deficiency of the second component of complement (C2) is the most common inherited deficiency of complement. Although C2 deficiency has been detected in asymptomatic individuals, patients usually present with either autoimmune disease or recurrent pyogenic infection, particularly due to encapsulated bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b and Neisseria meningitidis. Interestingly, infection is the most common mode of presentation of C2 deficiency in young children (1). An association between C2 deficiency and IgG subclass deficiency has also been previously described. We now report a female child with C2 deficiency that presented at the age of 3 mo with recurrent pneumococcal septicaemia. Although IgG subclass levels were normal, specific IgG responses to vaccination against S. pneumoniae and H. influenzae were significantly impaired.

Symptomatic and asymptomatic chlamydial non-gonococcal urethritis in Jamaica: the potential for HIV transmission

To determine the contribution of Chlamydia trachomatis to non-gonococcal urethritis (NGU) in men attending sexually transmitted disease (STD) clinics in Jamaica we studied men with NGU (n=339), and control groups including asymptomatic men who were STD contacts (n=61), asymptomatic men who were not STD contacts (n=32) and men with gonococcal urethritis (GU) (n=61). Urethral specimens were examined for C. trachomatis and Neisseria gonorrhoeae. Serological tests for syphilis (STS) and HIV-1 infection were also performed. C. trachomatis accounted for 63% of cases of NGU but high prevalences were also found in asymptomatic STD contacts (59%), asymptomatic STD non-contacts (78%) and men with GU (48%). The prevalence of C. trachomatis in men with GU differed significantly from that in men with NGU and asymptomatic STD non-contacts (P<0.05). C. trachomatis infection in men with NGU was associated with multiple sex partners (71% vs 58%; chi2=4.78; odds ratio (OR)=1.76; P<0.05) and previous history of gonococcal infection (83% vs 42%; chi2=59.8; OR=6.8; P<0.0001). Concomitant infection with HIV-1 occurred in 5.2% of cases of NGU and 50% and 90%, respectively, of the HIV-positive men had chlamydia or reactive STS. As a cost effective strategy in the control of STD and HIV we recommend presumptive treatment for C. trachomatis in men seeking STD treatment in Jamaica.

Evaluating a measure of everyday problem solving for use in African Americans

Results from previous research on everyday problem solving involving Caucasians suggests that it may be a useful concept in studying cognitive aging in African Americans. The purpose of this investigation was to examine: (1) the factor structure of an everyday problem solving in a sample of African Americans, (2) the internal consistency of everyday-problem solving in a sample of African Americans, and (3) the relationship of problem solving to demographic factors, physical functioning, and measures of fluid ability. The sample included subjects recruited from Baltimore, MD. The sample consisted of 249 community dwelling African-American adults with a mean age of 67.8 years (SD = 8.47). Variables included the Everyday Problem Solving Test (EPT), gender, age, education, physical functioning, and inductive reasoning. Everyday problem solving as a latent construct was confirmed and the split half reliability was high (.89). As in previous research, inductive reasoning and physical functioning were related to everyday problem solving abilities. We also found that certain domains of the EPT are more influenced by demographic factors than others. Our finding suggest that the Everyday Problems Test is appropriate for use with African American samples.

Is HIV/STD control in Jamaica making a difference?

OBJECTIVE

To assess the impact of the comprehensive HIV/STD Control Program established in Jamaica since the late 1980s on the HIV/AIDS epidemic.

METHODS

AIDS case reports, HIV testing of blood donors, antenatal clinic attenders (ANC), food service workers, sexually transmitted disease (STD) clinic attenders, female prostitutes, homosexuals and other groups were used to monitor the HIV/AIDS epidemic. Primary and secondary syphilis and cases of congenital syphilis were also monitored. National knowledge, attitude and practice (KAP) surveys were conducted in 1988, 1989, 1992, 1994 and 1996.

RESULTS

The annual AIDS incidence rate in Jamaica increased only marginally in the past three years from 18.5 per 100000 population to 21.4 in 1997. HIV prevalence in the general population groups tested has been about 1% or less. Among those at high risk, HIV prevalence rates have risen to 6.3% (95% confidence interval 5.0-8.0) in STD clinic attenders, around 10% and 21% in female prostitutes in Kingston and Montego Bay respectively and approximately 30% among homosexuals. Syphilis rates and congenital syphilis cases have declined. The proportion of men aged 15-49 years reporting sex with a non-regular partner declined from 35% in 1994 to 26% in 1996 (P< 0.001). Women ever having used condoms increased from 51% in 1988 to 62.5% in 1992 and 73% in 1994 and 1996 (P< 0.001), while condom use with a non-regular partner increased from 37% in 1992 to 73% in 1996 (P= 0.006). Condom use among men was high over the period: around 81% had ever used condoms and 77% used them with non-regular partners. Gay men, inner-city adults and adolescents aged 12-14 years all reported increases in condom use while condom sales and distribution increased from around 2 million in 1985 to 10 million in 1995.

CONCLUSION

HIV/STD control measures appear to have slowed the HIV/AIDS epidemic in Jamaica, however a significant minority of persons continue to have unprotected sex in high risk situations.

Correlation of platelet Fc gammaRIIA polymorphism in refractory idiopathic (immune) thrombocytopenic purpura

Fc gammaRIIA, a low affinity receptor for IgG, is a polymorphic molecule: Fc gammaRIIA-HH131, Fc gammaRIIA-HR131 and Fc gammaRIIA-RR131. This polymorphism influences the efficiency of the receptor to bind with IgG2. Recent reports on altered distribution amongst individuals with heparin-induced thrombocytopenia (HIT) prompted us to examine the Fc gammaRIIA polymorphism in a cohort of patients with refractory idiopathic (immune) thrombocytopenic purpura (ITP), in whom severe disease had required them to undergo splenectomy. 29 post splenectomy ITP individuals and 61 normal controls were investigated. Polymerase chain reaction (PCR) and a Southern blotting technique were used to determine the Fc gammaRII polymorphism. Although the distribution of the allotypes of Fc gammaRIIA in the control population was similar to that found in other European studies of Caucasian populations (15 (25%) HH131; 35 (57%) HR131; 11 (18%) RR131), the patient group was skewed towards the RR131 allotype which has least efficiency for IgG2 binding (3 (10%) HH131; 12 (42%) HR131; 14 (48%) RR131; P<0.005). These findings suggest that Fc gammaRIIA polymorphisms may be implicated in the pathophysiology of ITP or may be responsible for modulating the immune response in this heterogeneous autoimmune disease.

Working with parents to promote health

A cleft lip, with or without cleft palate, is the most common craniofacial malformation. The issue of whether health can be attained if the person has a physical defect is discussed. Health education can be considered as a means whereby individuals learn to maintain, restore and promote health. Consideration is given to health promotion and the prevention of ill health in relation to infant feeding. Skill teaching, if successfully completed, may be regarded as a fundamental cornerstone to health promotion.

Folate assays: serum or red cell?

Tests for folate and vitamin B12 deficiency are frequently requested by clinicians in many different specialties. An audit of folate assay methodology was undertaken to establish the number of tests and types of assay performed in different centres, and to analyse the indications for these investigations, with a view to advising on the most appropriate assay for use in the laboratory. A questionnaire was sent to 30 centres, 24 (80%) of which participated in the audit. The types of folate assay performed, number of requests, reference range and method of analysis differed between centres. The major specialty users of the service were general practitioners, general physicians and geriatricians. A detailed analysis of 1,259 consecutive requests for folate assays from a single representative laboratory showed a significant correlation between serum and red cell folate levels (r = 0.49, p < 0.001). However, in patients with low serum folate, there was no correlation with red cell folate in the absence of macrocytosis. The major indication for folate analysis was for haematological abnormalities but 36% of cases were for nonspecific indications. A haematologist with an interest in folate metabolism was invited to moderate the results at an audit meeting of haematologists. The consensus was that the most appropriate screening test for folate deficiency is the serum assay, which can be combined easily with vitamin B12 assay.

Management of vaginal discharge in women treated at a Jamaican sexually transmitted disease clinic: use of diagnostic algorithms versus laboratory testing

The management of cervical infections is difficult in developing countries because laboratory facilities for diagnosing these infections are seldom available; therefore, syndrome-based management has been recommended by the World Health Organization (WHO). However, such alternative approaches need to be evaluated in real field settings. We used algorithms (flowcharts) for syndromic management of abnormal vaginal discharge to treat 752 women who presented at a Jamaican sexually transmitted disease (STD) clinic. Laboratory testing revealed cervical infection (gonococcal and/or chlamydial) in 34% of these women; trichomoniasis was documented for 25%; and at least one STD was documented for 54% of the women. Use of a clinical algorithm for diagnosing cervical infection was 73% sensitive (95% CI, 67-78) and 55% specific (95% CI, 49-62) when compared with laboratory testing. The risk-assessment-inclusive flowchart developed by WHO was 84% sensitive (95% CI, 80-89) and 40% specific (95% CI, 34-46) for diagnosing cervical infection. Positive predictive values for diagnosing cervical infection with use of the algorithms ranged from 42% to 43%, and negative predictive values ranged from 78% to 81%. The sensitivity of the algorithms for diagnosing trichomoniasis ranged from 85% to 88%. To treat as many infected women as possible, the most sensitive algorithm was selected for routine use in Jamaican STD clinics.

Tetanus immunity in elderly people

The aims of this study were to document the level of tetanus immunity in elderly people; to assess the value of immunization history in predicting tetanus immune status and to determine the response to tetanus immunization in elderly people compared with younger subjects. One-hundred day-hospital attenders (group 1), 100 long-term-care residents (group 2) and 50 young subjects (group 3) were recruited. Protective titres of tetanus antitoxin antibodies were detected in 20% of group 1, 45% of group 2 and 80% of group 3. Tetanus immunization history was a poor predictor of immune status in older people with a positive predictive value of 50% and a negative predictive value of 76%. The response to tetanus immunization was slower and of lower magnitude in older people. However, 36 of 37 older subjects developed protective levels of tetanus antitoxin antibodies on completion of a primary immunization programme.

Competitive elution of protein A fusion proteins allows specific recovery under mild conditions

A novel system is described for mild elution of fusion proteins by competitive elution. The approach is based on displacement of immobilized fusions containing a monovalent IgG-binding staphylococcal protein A fragment (Z) from an IgG-affinity matrix by a divalent fragment fused to a serum-albumin-binding region derived from streptococcal protein G. Using real-time interaction analysis, the binding (K(aff)) to polyclonal human IgG was found to be 3.3 (+/- 0.4) x 10(8) M-1 for divalent ZZ and 2.0 (+/- 0.1) x 10(7) M-1 for monovalent Z. This more than tenfold difference in binding strength ensures a high efficiency in the elution step. The competitor protein can specifically be removed and recovered from the elution mixture by subsequent passage through a human serum albumin(HSA)-affinity column, leaving only the target fusion protein in the flow-through fraction. Here, we show that a recombinant Klenow fragment of DNA polymerase I expressed in Escherichia coli can be recovered with high yield, and retained activity, from a crude bacterial lysate by IgG-affinity chromatography using mild conditions during both binding and elution.

Kaposis sarcoma report of a case with exclusive oral involvement

A case of Kaposis sarcoma presenting exclusively in the oral cavity is reported. Exclusive oral presentation of Kaposis sarcoma is considered extremely rare. At the U.C.H. Ibadan, a total of one hundred and two cases of Kaposis sarcoma were seen in the last 24 years. None of these presented exclusively or concomitantly in the oral cavity, until this case under review. The clinical and histological difficulties that were encountered in diagnosing this exclusive oral presentation are discussed. Literature review on possible pathogenesis is highlighted.

Five year follow-up of patients with cancer of the bladder--the Northern Alberta experience

A prospective study of 549 cases of bladder cancer diagnosed in Northern Alberta from 1977 to 1980 shows that after 5 years, 51 patients (9.3%) were lost to follow-up, 318 (57.9%) were alive, and 180 (32.8%) were deceased, of which 98 had died of bladder cancer and 82 of other causes. Of the patients followed for 5 years, 386 had superficial disease at diagnosis. When comparing their survival rates to the expected rates for age/sex matched population, their relative survival rate at 5 years is 84.8% for females and 74.2% for males. For the 112 patients presenting with advanced disease the relative survival rate at 5 years was 32.2% for females and 19.3% for males. Five year recurrence-free interval in patients with superficial lesions was 57.3% when the original lesion was unifocal and 33.5% for patients with multifocal lesions. Survival was affected by stage, age, and sex in patients presenting with invasive disease and also by tumor type and recurrence rate in patients with superficial disease.

Effect of lithium therapy on inflammatory response

Chemiluminescence produced by normal cells was reduced in response to zymosan which was opsonized with serum from patients on prophylactic lithium therapy, compared to control serum from normal subjects (68 +/- 3.1 vs. 93 +/- 3.4 mV/5 X 10(5) cells). Preincubation of normal cells with serum from patients also resulted in reduced chemiluminescence activity when the cells were stimulated with autologous serum-coated zymosan (47 +/- 4.5 vs. 64 +/- 6.3 mV/5 X 10(5) cells). Spontaneous complement conversion was increased in the serum of patients on lithium therapy (46.3 +/- 3.8 vs. 25.3 +/- 2.5% conversion). These studies demonstrated that lithium, at safe therapeutic levels (0.4-0.9 mmol/liter), significantly altered complement conversion and had a marked affect on chemiluminescence activity by normal cells.

Karyotypic conversion in Ph1-positive chronic myeloid leukaemia with combination chemotherapy

Twelve previously untreated patients with Ph1-positive chronic myeloid leukaemia received combination chemotherapy soon after diagnosis. There was karyotypic conversion in five: in four, the percentage of Ph1-positive cells fell to 10 or less. In two other patients, who had mosaic karyotypes at presentation, the percentage fell to 5% and zero.

Prognostic value of peripheral lymphocyte count in hormone therapy of advanced breast cancer

Peripheral lymphocyte counts were performed on 41 patients with advanced breast cancer, before starting treatment with oestrogens or androgens. Patients were seen at monthly intervals, and the response to treatment was independently assessed, using the criteria of the British Breast Group. In the patients treated with oestrogens and androgens, the successful responders were found to have significantly higher pre-treatment peripheral lymphocyte counts than the intermediate responders and failures. It is suggested that pre-treatment peripheral lymphocyte counts may have a prognostic value in assessing potential response to hormone therapy in patients with breast cancer.