Sequential respiratory, psychologic, and immunologic studies in relation to methyl isocyanate exposure over two years with model development.

Of 113 methyl isocyanate (MIC)-exposed subjects studied initially at Bhopal, India, 79, 56, 68, and 87 were followed with clinical, lung function, radiographic, and immunologic tests at 3, 6, 12, 18, and 24 months. Though our cohort consisted of subjects at all ages showing a varied severity of initial illness, fewer females and young subjects were seen. Initially all had eye problems, but dominant symptoms were exertional dyspnea, cough, chest pain, sputum, and muscle weakness. A large number showed persistent depression mixed with anxiety, with disturbances of personality parameters. The early radiographic changes were lung edema, overinflation, enlarged heart, pleural scars, and consolidation. The persistent changes seen were interstitial deposits. Lung functions showed mainly restrictive changes with small airway obstruction; there was impairment of oxygen exchange. Oxygen exchange improved at 3-6 months, and spirometry improved at 12 months, only to decline later. The expiratory flow rates pertaining to large and medium airway function improved, but those for small airways remained low. There were changes of alveolitis in bronchoalveolar lavage fluid on fiber optic bronchoscopy, and in 11 cases positive MIC-specific antibodies to IgM, IgG, and IgE were demonstrated. On follow up, only 48% of the subjects were clinically stable, while 50% showed fluctuations. Thirty-two percent of the subjects had lung function fluctuations. Detailed sequential behavior over 2-4 years was predicted for dyspnea, forced vital capacity, maximum expiratory flow rate (0.25-0.75), peak expiratory flow rate, VO2, and depression score. A model for clinical behavior explained a total variance of 52.4% by using the factors of cough, PCO2 and X-ray zones in addition to above five parameters. The behavior of the railway colony group (1640 patients) revealed a similar pattern of illness. When this observed pattern of changes was transferred to the affected Bhopal city sections (with an equitable age-sex distribution), our model results were again validated. Thus the picture of MIC-induced disease seems similar despite the differences for age-sex and initial severity of illness in our cohort and in the population of Bhopal city as predicted by our model.

Evaluation of apolipoproteins A1 and B in survivors of myocardial infarction.

Lipid profile of sixty survivors of myocardial infarction was studied and these results were compared with hundred age and sex matched controls. Seventy one percent had normal cholesterol (Ch). However, 80% of them had elevated serum Triglyceride (Tg) values. A decreased apolipoprotein A1 (apo A1) with an increased apolipoprotein B (apo B) values were observed in these patients. Ratio of apo A1 to apo B remained significantly low in survivors of myocardial infarction. It was seen that more abnormalities in patients were observed in apolipoprotein concentrations rather than lipoprotein or lipid concentration.

Impaired pancreatic bicarbonate secretion in chronic malnutrition.

Twenty three children with recurrent episodes of diarrhea and chronic malnutrition were studied for pancreatic duct function. Those children were subjected to pancreatic stimulation with pancreozymin and secretin. Grade I malnourished children, as per Gomez classification, formed the control group. The water output from pancreas increased in malnourished children (p < 0.05). It correlated significantly to cationic transport (p < 0.01). Sodium and potassium together accounted for significant proportion of water output in pancreatic fluid. Potassium transport increased with increasing severity of malnutrition and may be responsible for the hypokalemia observed in malnourished children. Pancreatic secretion of bicarbonate decreased in severe malnutrition inspite of increased flow rate of pancreatic secretion. This is probably due to defective bicarbonate secretion likely to be located at pancreatic duct epithelial cell membrane.

Preparation of lyophilised lipid rich quality control serum by isolating lipids using large scale chromatography technology.

The plasma fractionation is a technology to separate therapeutic plasma proteins. The fractionation is carried out either by solvent precipitation (ethanol) or recently by chromatography. During the process of chromatography lipids were found in waste fraction. A new lipid rich lyophilised quality control (Q.C.) sera was prepared inexpensively using this waste plasma fraction. This is probably the first attempt to prepare the Q.C. sera by large scale chromatographic method in India.

Activation of murine leukaemia virus under different physiological conditions.

The leukaemic lesions in intact and ovariectomized mice of strain ICRC, induced with 20-methylcholanthrene (20-MCA) in combination with or without hormones were investigated for the presence of mouse leukaemia virus (MuLV) by (i) bioassays and (ii) electron microscopy. The different experimental groups treated with 20-MCA were (i) intact females, (ii) ovariectomized females, (iii) ovariectomized females with pituitary graft, (iv) ovariectomized females with 10 mug oestradiol/day for 30 days and (v) ovariectomized females with 1 mug oestradiol together with 1 mg progesteron/day for 30 days. It was possible to transmit nearly all these experimentally induced leukaemias to syngeneic mice through acellular extracts, compared with very poor transmissibility of spontaneous leukaemias in the ICRC strain, indicating functional activation of viral agents on combined treatment with carcinogen and hormones. Potency of the acellular leukaemic extract from the mice of group (ii) without the ovarian hormones was much weaker than that from mice of the other experimental groups. The leukaemogenic activity of MuLV was enhanced on serial transmission in syngeneic hosts. Leukaemic lesions of ovariectomized mice treated with 20-MCA and oestradiol were also transmissible to the sucklings of allogeneic mice of strain C3H-MTV, C57-BL and Dba-MTV. The cell-free supernatant medium of the cultures of these leukaemic lesions induced leukaemias on back inoculation into syngeneic mice. Electron microscopic studies of lesions induced with carcinogen and oestradiol consistently showed abundant intracytoplasmic type A particles. Numerous intracytoplasmic type A particles as well as some type B particles were found in the leukaemic tissues of ovariectomized females treated with MCA and oestradiol combined with progesterone. Type C particles, characteristic of MuLV were seen in the leukaemic tissues of all other experimental groups. These findings indicate a significant influence of the physiological condition of the host, particularly the hormonal make up, on expression and activity of specific viral agents.

Dyslipoproteinemia in renal transplantation.

Twenty-seven live related donor renal allograft recipients were evaluated for dyslipoproteinemia. Twenty-two patients received dual immunosuppression with prednisolone and azathioprine. Five patients received cyclosporin as well. Total cholesterol (Tch), triglycerides (TG), HDL cholesterol (HDLch), LDL cholesterol (LDLch) and VLDL cholesterol (VLDLch) levels were estimated. Fifteen (56%) patients showed significant lipoprotein abnormalities. Renal allograft recipients showed significantly lower levels of Tch (p < 0.05) and LDLch (p < 0.05) and higher levels of TG (p < 0.005) and HDLch (p < 0.05). Diet and beta blockers did not influence lipoprotein levels. A significant negative correlation was noted between post-transplant duration and Tch, TG and VLDLch levels. Increased TG levels were associated with increase in weight and higher daily prednisolone dosage at the time of evaluation. The study confirms the existence of dyslipoproteinemia in renal allograft recipients.