Clinical manifestations of ocular toxocariasis - abstract

Fifteen symptomatic patients were seen at the Eye Clinic, General Hospital, Port-of-Spain from December, 1988 to October, 1989 and 12 cases were available for review. A complete eye examination was done, and serum IgG and IgM (to Toxocara) levels were measured by an ELISA method. There were 5 females and 7 males with ages ranging from 4 to 61 years. Toxocara titres ranged from 1:00 to 1:3, 200 with the most frequent value being 1:200. The commonest presenting complaint was a moderate to severe visual impairment (8/11 or 73 per cent). Two patients had sudden onset of visual loss due to lesions at the posterior poles with macular involvement. Other presenting features were pain and redness of the eye associated with anterior uveitis (2 patients) and 4-year old patient had a white reflex in the pupil (leucocoria) for which an important differential diagnosis is retinoblastoma. Overall, Toxocara granulomas were seen on 9 of 12 patients. Therapy consisted essentially of steroids, topical and systemic and a non-steroidal anti-inflammatory preparation (indomethacin). All patients available for follow-up (n = 11) showed significant improvement and none required surgery. These results emphasize that ocular Toxocariasis must be considered in cases of posterior uveitis in Trinidad (AU)

Immunological profiles in patients with chronic glomerulonephritis - abstract

The objectives of the study were to determine the humoral and cellular immunological profiles of 14 patients with chronic glomerulonephritis (CGN) who were about to be dialyzed. Fourteen healthy subjects matched for age, sex and ethnic origin served as controls. Serum IgG levels showed no significant difference in the two groups. However, serum IgA levels were elevated (p<0.01) but serum IgM levels were suppressed (p<0.001). Immune complexes (IC) were prepared by the polyethylene glycol 6,000 precipitation method and their immunoglobulin content measured. The IgG and IgM levels in IC were markedly depressed (p<0.001, p<0.001 respectively. IgG subclass determinations showed that IgG1 and IgG3 were essentially the same in patients and controls. The IgG2 level, however, was markedly elevated (p<0.02) in patients. Cellular immune responses to the rheumatogenic M41 and to the nephritogenic M55 cell membrane antigens at 3 concentrations (100, 10, 1 ug/ml) as well as to phytohaemagglutinin (PHA) a non-specific mitogen, were measured. In patients, there was depressed cellular sensitivity to the M55 antigen at all 3 concentrations (p<0.01; p§.05; p<0.05, respectively). This suppression was greatly exaggerated when cellular sensitivity to the M55 antigen at the same 3 concentrations was measured (p<0.001, p<0.001, p<0.001 respectively. Patients and controls showed no difference in their response to PHA. These results suggest that both the cellular and humoral immunological factors play a role in the pathogenesis of chronic renal disease (AU)

Variations of the prevalence of IgG and IgM antibodies to Toxocara in Trinidadian school children - abstract

Toxocara involvement in ocular lesions was suspected following the high frequency of IgG antibodies in serum samples of patients attending the Eye Clinic at the General Hospital, Port-of-Spain. Also, a high prevalence of IgG antibodies to Toxocara was found in 5-9 year-old children in certain Caribbean islands. Fifty children, aged 6-15 years with equal numbers of boys and girls, were randomly selected from 5 schools in rural South and Central Trinidad. A stool sample (examined for parasites) and a 5ml blood sample were obtained from each student. Serum from 17 patients with ocular symptoms and from 39 patients with other symptoms were also examined. Serum IgG and IgM antibodies (to Toxocara) were determined by ELISA method. Fifty children from one school were given a thorough eye examination. The prevalence of antibodies seemed to increase with age, from 54 per cent in 5-7 year olds to 87 per cent in 12-13 year olds for IgG, and from 56 per cent to 61-63 per cent for IgM antibodies. IgG antibodies to Toxocara were more prevalent in males than females, but there was no positive correlation with reported geophagia or association with domestic pets. There was a higher prevalence of IgGs (88 per cent) in sera from patients with ocular lesions than in those without such lesions (39 per cent, p<0.01). Results suggest the need for a comprehensive study of toxocariasis in childhood in Trinidad and Tobago (AU)

Monoclonal antibodies to herapin sulphate proteoglycan: development and application to the study of normal tissue and pathological human kidney biopsies - abstract

In an attempt to quantify the immuno-histochemical properties of the glomerular basement membrane (GBM), monoclonal antibodies (mAbs) were prepared against heparin sulphate Proteoglycan (HSPG). The HSPG was isolated from bovine glomerulae. Enzyme-linked immuno-sorbent assays (ELISA) and immunoblotting demonstrated that the mAbs reacted with HSPG. Indirect immuno-fluorescence showed that the mAbs stained renal basement membranes (BMs) and BMs in other organs of normal bovine and human tissues in patterns typical of HSPG. Immuno-inhibition studies, and immuno-blotting of heparin lyase digested HSPG, indicated that the mAbs recognizes HSPG core protein. Human kidney biopsies revealed interesting patterns of staining for HSPG. For instance, in kidney biopsies from patients with acute post-streptococcal glomerulonephritis, intact linear staining for HSPG was noted despite abnormal pathological processes shown by widened capillary loops. On the other hand, in membranous and in diffuse proliferative lupus glomerulonephritis, loss of HSPG staining was demonstrated at sites of immuno-deposition of IgG or C3; whereas, increased staining for HSPG was seen in areas of newly formed GBM. Extensive loss of HSPG was seen in areas of glomerular sclerosis and necrosis. In biopsies from patients with minimal change glomerulonephritis and mesangio-proliferative lupus glomerulonephritis, a normal linear GBM distribution of HSPG was noted. The study demonstrates that immunological injury to the HSPG component of the GBM of the kidneys plays an aetiological role in the pathogenesis of proteinuria in man (AU)

The clinical and pathological spectrum of paraquat toxicity - abstract

Over the last few years there has been an increasing incidence of admissions of Paraquat toxicity to the San Fernando General Hospital. We have done a detailed clinical and pathological study on thirteen (13) patients, ages 16 - 58, who died as a result of Paraquat toxicity. One patient was occupationally exposed to the Paraquat with percutaneous absorption of an unknown quantity. The remaining twelve (12) patients ingested the Paraquat for suicidal purposes. Vomiting occurred soon after the ingestion of Paraquat and was severe in eight patients. It was accompanied by weakness, lethargy, and semi stupor in four cases. Oral ulcers developed in all patients within two to three days following ingestion of the drug. Two patients developed respiratory distress within one to three days following ingestion. Four patients developed jaundice. Anuria was a complicating factor in two patients. The patient with tropical exposure developed skin ulcers at the site of exposure. This was followed by cough, repiratory difficulty and jaundice. The amounts of the chemical ingested range from 10 - 500 ml of the 40 percent solution. There was no direct correlation between the amount ingested and the length of survival. On histological examination, the pulmonary, hepatic and renal changes appeared to be progressive and related to survival time. On the first day, the predominant histological lesions in the lungs consisted of oedema; whereas, on the second day, oedema was associated with pulmonary haemorrhage. On subsequent days, and up to the seventieth day, the main changes were highlighted by progressive intersitial fibrosis. The main changes in the liver involved the bile excretory pathways and consisted mainly of cholestasis, usually localized in the centrilobular zone; and cholangiocellular injury involving the small and medium sized bile ducts in the portal areas. The sequence of hepatic lesions would suggest that Paraquat injury to the liver is biphasic. Ot is initially hepatocellular and becomes cholangiocellular after the first two days. The early renal changes were highlighted by interstitial oedema; whereas, after the second day, there was gradual progression from hydrophic degeneration of tubular cells to tubular necrosis. Renal biopsies done several days after ingestion in patients who survived, demonstrated findings consistent with interstitial nephritis. Our studies indicate that Paraquat is a highly toxic chemical agent and that ingestion of even small quantities of it is usually lethal. This study reveals that Paraquat causes significant pathological lesions in the lungs, liver, kidney, and upper gastrointestinal tract. The intensity of the pulmonary lesions appears to be the major pathological determinant in prognosis (AU)

Diuretic and clinical effects of low-dose furosemide in congestive heart failure patients.

A dose of 20 mg furosemide in congestive heart failure patients produces a significant diuretic and natriuretic effect. The peak effect was observed within 60-120 minutes in most patients. Twenty-four congestive heart failure patients were hospitalized for evaluation and management. Two withdrew from the study, and in three there was a prolonged (several months) remission of manifestations of congestive heart failure. The remaining 19 patients were treated with 40 mg furosemide per day for a four-week period. Six required 80 to 120 mg furosemide per day, and 13 were controlled on 40 mg per day. On 20 mg twice per day, one of the 13 patients dropped out voluntarily, two required a higher dose of furosemide, and 10 were controlled on this regimen for a four-week period. When dosage was reduced to 20 mg per day, five of the ten patients were controlled for an additional four weeks or longer, and five required higher doses of furosemide. Results of this study suggest that in congestive heart failure patients, 20 mg furosemide per day has significant diuretic and natriuretic properties. It also demonstrates that a number of patients with cardiac decompensation can be controlled on a relatively low dosage of furosemide and that periodic reevaluation of clinical status and diuretic requirements for maintenance therapy is of critical importance in management of patients with congestive heart failure.