Sulphilimine cross-links in Goodpasture's disease.

The sulphilimine cross-link of the Goodpasture (GP) autoantigen is a novel molecular mechanism (structural constraint) for conferring immune privilege to a site which otherwise is susceptible to structural changes that induce an immunogenic and pathogenic conformation. Perturbation of the assembly or cleavage of the sulphilimine cross-links could be a key factor in the aetiology of Goodpasture's disease in susceptible individuals.

Peripheral group I metabotropic glutamate receptors modulate nociception in mice.

The metabotropic glutamate receptors (mGluRs) are found throughout the central nervous system, where they modulate neuronal excitability and synaptic transmission. Here we report the presence of phospholipase C-coupled group I mGluRs (mGluR1 and mGluR5) outside the central nervous system on peripheral unmyelinated sensory afferents. Given their localization on predominantly nociceptive afferents, we investigated whether these receptors modulate nociceptive signaling, and found that agonist-induced activation of peripheral group I mGluRs leads to increased sensitivity to noxious heat, a phenomenon termed thermal hyperalgesia. Furthermore, group I mGluR antagonists not only prevent, but also attenuate established formalin-induced pain. Taken together, these results suggest that peripheral mGluRs mediate a component of hyperalgesia and may be therapeutically targeted to prevent and treat inflammatory pain.

Assessment of enzyme linked immunosorbent assay based diagnostic kits (Toxokit-G and Toxokit-M) for the detection of IgG and IgM antibodies to Toxoplasma gondii in human serum.

An enzyme linked immunosorbent assay (ELISA) using penicillinase was developed in the form of diagnostic kits (Toxokit-G and Toxokit-M) for the detection of IgG and IgM antibodies to Toxoplasma gondii. The performance of both the kits was compared with commercially available diagnostic kits, i.e. Enzygnost-Toxoplasmosis/IgG (Behring Co., Germany), TOXOTEK-G (Flow Lab., U.K.) and Toxoplasma IgM Microassay (Diamedix Corp., U.S.A.) by testing toxoplasma-suspected human serum samples. The results indicate a good reliability between these diagnostic kits. Toxokit-G has 86.66 and 96.05% sensitivity and specificity respectively. The main advantage of Toxokit-G is that the end result can be assessed visually without using sophisticated instruments. Toxokit-M has 100% sensitivity and specificity and test results were not affected by the presence of antitoxoplasma IgG antibodies, rheumatoid factor or antinuclear antibodies.

Impact of an intervention on HIV, sexually transmitted diseases, and condom use among sex workers in Bombay, India.

OBJECTIVE: To develop and test an HIV intervention targeting sex workers and madams in the brothels of Bombay. SUBJECTS AND METHODS: In a controlled intervention trial, with measurements before and after the intervention, 334 sex workers and 20 madams were recruited from an intervention site, and 207 and 17, respectively, from a similar control site, both in red-light areas of Bombay. All sex workers were tested for antibodies to HIV and syphilis, and for hepatitis B surface antigen. Information on sexual practices, condom use and knowledge of HIV was collected by interviewer-administered questionnaire. All subjects in the intervention group underwent a 6-month program of educational videos, small group discussions and pictorial educational materials; free condoms were also distributed. The blood tests and the questionnaire were readministered to all subjects at both sites immediately after the intervention. Both groups were followed for approximately 1 year. RESULTS: The baseline level of knowledge about HIV and experience with condoms was extremely low among both sex workers and madams. The baseline prevalence of HIV antibodies was 47% in the intervention group and 41% in the control group (P = 0.17). The incidence densities for HIV and sexually transmitted diseases were significantly different in the two groups (all P < 0.005): 0.05 and 0.16 per person-year of follow-up for HIV, 0.08 and 0.22 per person-year for antibodies to syphilis, and 0.04 and 0.12 per person-year for hepatitis B surface antigen in the intervention and control women, respectively. Following the intervention, women reported increased levels of condom use, and some (41%) said they were willing to refuse clients who wouldn't use them. However, both the sex workers and the madams were concerned about losing business if condom use was insisted upon. CONCLUSIONS: Both HIV prevalence and incidence are alarmingly high among female sex workers in Bombay. Successful interventions can be developed for these women, and even a partial increase in condom use may decrease the transmission of HIV and sexually transmitted diseases. Intervention programs of longer duration that target madams and clients and make condoms easily available are urgently needed at multiple sites in red-light areas.

PIP: The objective was to develop and test an HIV intervention targeting sex workers and madams in the brothels of Bombay. In a controlled intervention trial, with measurements before and after the intervention, 334 sex workers and 20 madams were recruited from an intervention site, and 207 and 17, respectively, from a similar control site, both in red-light areas of Bombay. All sex workers were tested for antibodies to HIV and syphilis, and for hepatitis B surface antigen. Information on sexual practices, condom use, and knowledge of HIV was collected by questionnaires. All subjects in the intervention group underwent a 6-month program of educational videos, small group discussions and pictorial educational materials; free condoms were also distributed. The blood tests and the questionnaire were readministered to all subjects at both sites immediately after the intervention. Both groups were followed for approximately 1 year. The baseline prevalence of HIV antibodies was 47% in the intervention group and 41% in the control group (p = 0.17). The incidence densities for HIV and sexually transmitted diseases were significantly different in the 2 groups (all p 0.005): 0.05 and 0.16 per person-year of follow-up for HIV, 0.08 and 0.22 per person-year for antibodies to syphilis, and 0.04 and 0.12 per person-year for hepatitis B surface antigen in the intervention and control women, respectively. Following the intervention, there was a significant increase in knowledge of modes of HIV transmission in the intervention group (n = 334) compared to the control group (n = 190) (60% vs. 99% compared to 56% vs. 26%, p 0.001). In addition, women reported increased levels of condom use and some (41%) said they were willing to refuse clients who would not use them. However, both the sex workers and 100% of the madams were concerned about losing business if condom use was insisted upon. Intervention programs of longer duration that target madams and clients and make condoms easily available are urgently needed.

Comparative evaluation of coagglutination and latex agglutination test (Rotalex kit) for detection of rota virus.

Coagglutination test was compared with commercially available latex agglutination test (Rotalex kit) for detection of rota virus in faecal samples from clinically suspected cases of viral gastroenteritis. Out of 80 test samples 16 (20%) and 20 (25.3%) were positive for rota virus antigen by Rotalex kit and coagglutination test respectively. All the 40 controls were negative for viral antigen by Rotalex kit and only one gave positive result by coagglutination test. Coagglutination test was found to be economical, sensitive and specific for screening and rapid diagnosis of Rota virus diarrhoea.

Gastric colonization and pneumonia in intubated critically ill patients receiving stress ulcer prophylaxis: a randomized, controlled trial.

OBJECTIVE: To study the effects of pharmacologically increasing gastric pH on gastric colonization and the development of pneumonia in intubated critically ill patients. DESIGN: Randomized, controlled trial. SETTING: Medical ICU in a university hospital. PATIENTS: Thirty-four tracheotomized patients with tetanus. INTERVENTIONS: Sixteen patients received iv ranitidine to increase gastric pH greater than 4 (ranitidine group), while 18 patients received no prophylaxis for upper gastrointestinal bleeding (control group). MEASUREMENTS AND MAIN RESULTS: Mean gastric pH was higher in the ranitidine group (median 4.7, range 3.6 to 6.1) than in the control group (median 2.1, range 1.2 to 4.9; p less than .05). Gastric colonization occurred in 15 (94%) of 16 patients who received ranitidine, 2 days (median; range 1 to 5) after intubation; gastric colonization also occurred in all control patients (median 4 days, range 1 to 9; p less than .05). Pneumonia occurred in 13 (81%) of 16 patients who received ranitidine, 3 days (median, range 1 to 5) after intubation and in nine (50%) of 18 control patients (p less than .01) 5 days after tracheal intubation (median, range 3 to 14; p less than .01). Prior gastric colonization by the pathogen that caused pneumonia was demonstrable in nine (56%) of 16 patients who received ranitidine vs. eight (44%) of 18 control patients (p greater than .05). The risk for developing pneumonia in the ranitidine-treated group was highest in the first 4 days after tracheal intubation. There was no difference in the frequency of upper gastrointestinal hemorrhage in the two groups. CONCLUSIONS: Pharmacologically increasing gastric pH increases the risk for developing pneumonia in intubated critically ill patients. The pneumonia occurs earlier than in untreated control patients.

Detection of HSV-2 antigen in carcinoma cervix and premalignant conditions by immuno-cytochemistry.

One hundred and twelve cases of cervical pathology (58 paraffin sections and 54 cervical smears) were assessed by PAP technique and 30 cases by indirect immunofluorescent technique. Forty-two normal cervical smears from the age matched controls were stained by indirect immuno-fluorescent technique. HSV-2 antigen was detected by PAP method in 86 out of 112 cases (78.57%) i.e. 50/55 squamous cell carcinoma, 13/13 carcinoma in situ, 11/15 severe dysplasia, 3/4 moderate dysplasia and 9/16 mild dysplasia. The amount of antigen was maximum in squamous cell carcinoma and decreased in carcinoma in situ, severe, moderate and mild dysplasia in descending order. Three cases of adenocarcinoma cervix were negative. Only one case out of 42 controls was positive. HSV-2 antigen was detected by an indirect IF technique in 8/9 squamous cell carcinoma, 2/3 carcinoma in situ, 3/7 dysplasia, O/1 adenocarcinoma and 4/10 inflammatory cases. The above findings support the association between HSV-2 and squamous cell carcinoma cervix, as well as carcinoma in situ which is statistically significant.

Chronic bronchitis: IgA and C3 in acute exacerbations.

Serum IgA, secretory IgA and serum C3 were estimated in 22 patients of chronic bronchitis with acute exacerbation. These were compared with 22 normal controls. There was no significant difference in the parameters studied. However, all patients showed a significant change in the above parameters when divided into mild, moderate and severe categories depending on the chronicity of the disease. An inverse relationship between serum C3 and secretory IgA was observed.

Counterimmunoelectrophoresis in the immunodiagnosis of amoebiasis.

Counterimmunoelectrophoresis (CIE) detection of antiamoebic antibodies in the patients' sera, has been carried out and correlated with the routine diagnostic microscopic examination of stool and pus samples. The clinically suspected amoebiasis cases were divided into two main groups, (i) proved positive for Entamoeba histolytica as detected by microscopic examination of samples, and (ii) negative for the parasite. A total 153 cases of intestinal amoebiasis were studied. CIE was positive in 27 of the 84 proved cases, and in 12 out of 69 unproved cases showing negative microscopy. A total of 59 cases of amoebic liver abscess (ALA) were studied, of which CIE was positive in 20 of the 30 proved cases of ALA and in 4 of the 29 unproved cases. Sera from patients with non-amoebic illness (n = 48) gave negative results with CIE. Similarly sera from normal healthy controls (NHC) (n = 100) and asymptomatic cyst passers (n = 75) were negative by CIE.

An outbreak of meningitis caused by Neisseria meningitidis Group A.

During a period of six months from September, 1985 to March, 1986, there were twenty seven cases of pyogenic meningitis due to Neisseria meningitidis Group A. Maximum number of cases could be diagnosed by antigen detection by latex agglutination test. The organism was sensitive to all commonly used antibiotics. The patients affected were mostly young adults. The mortality rate was eleven per cent.

Immunoprofile of pulmonary tuberculosis-comparison with normal healthy controls.

The immunoprofile of 60 adult patients of pulmonary tuberculosis was studied and compared with 22 normal controls. The immunological parameters studied were serum protein electrophoresis, serum immunoglobulins (IgG, IgA and IgM), delayed hypersensitivity by Mantoux test, and T-cell % estimation. The mean total serum proteins and serum albumin were significantly lower, whereas mean beta and gamma globulins were elevated. Mean serum IgG and serum IgA showed a significant rise, whereas the T-cell % was significantly reduced when compared to controls. The significance of these findings is discussed.

Chronic bronchitis. IV--Antibody titres to bacterial antigens during acute exacerbations.

In 49 patients of chronic bronchitis with acute exacerbation, serum antibody titres were estimated against the respective pathogen isolated and cultured from sputum of individual patients. Antibody titres to Klebsiella and Staphylococcus coagulase positive organisms were found in 28 and 25 patients respectively. Paired serum samples from 21 patients showed rising antibody titres in 17 of them, whereas the antibody titres fell in the remaining 4 patients. Notably, only 2 patients demonstrated a four fold rise or fall in the antibody titres. The significance of these findings is discussed.

Actinomyces in cervical smears of women using intrauterine contraceptive devices.

Cervical smears from 1,784 women who attended the family planning clinics of the Institute for Research in Reproduction were examined for the presence of Actinomyces-like organisms. Among 815 intrauterine contraceptive device (IUD) users, the repeat smears from 57 women were positive for Actinomyces-like organisms, giving a prevalence rate of 6.99%. Immunofluorescent staining using specific antisera confirmed the presence of A. israelii in all 57 women. Forty IUD users whose smears were positive for Actinomyces-like organisms underwent bacteriologic culture studies; A. israelii was isolated in 23 of these cases. The clinical findings at the time of smear collection in the 57 IUD users were within normal limits. The initial cervical smears of all IUD users and both the initial and repeat smears of all nonusers were negative for Actinomyces-like organisms. The data indicate that prolonged use (greater than 2 years) of an inert or copper intrauterine device promotes the overgrowth of Actinomyces in the vagina and that this can be detected by routine cervical cytology.

PIP: Cervical smears from 1784 women who attended a family planning clinic in India were examined for the presence of Actinomyces-like organisms. There were 57 (7%) positive smears among the 815 IUD users in this group. Bacteriologic culture studies were carried out in 40 of these women and Actinomyces israelii was isolated in 23 cases. The initial cervical smears of all IUD users and both the initial and repeat smears of all nonusers were negative for Actinomyces. None of the positive smears involved women with less than 1 year of IUD use and only 4 cases were positive with 1-2 years of IUD use. There was no association between the presence of Actinomyces-like organisms and type of IUD, however. The cervical and pelvic examination findings in the 57 women with positive Actinomyces smears were within normal limits at the time of smear collection. These findings suggest that longterm IUD use promotes the outgrowth of Actinomyces in the vagina. Routine cervical cytology and clinical observation are recommended for the early detection of possible pelvic inflammatory disease in these women.