Hepatic structure and function in Papua New Guineans with leprosy

Hepatic function, including plasma bromsulphthalein (BSP) clearance was studied in 20 Papua New Guineans with leprosy: 11 lepromatous (LL) (6 had erythema nodosum leprosum (ENL)) (group A), and 9 tuberculoid or borderline (BT or BB) (group B); 12 controls (group C) were also studied. Four of five with abnormal BSP results had significant complicating or additional factors (hepatic amyloidosis, pustular ENL, hepato-cellular carcinoma and a pyogenic abscess), compared with two of 15 with normal results (tuberculous osteitis and pyogenic osteomyelitis). In nine (five from group A, and four from group B) needle liver biopsy histology was assessed: foci of vacuolated phagocytes and histiocytes, and tuberculoid granulomata were the most frequent lesions; none had cirrhosis.Leprosy is not associated with impaired hepatocellular function unless a severe complication or coincident disease is concurrently present. In this limited study therapeutic agents were not associated with abnormal liver structure or function. When liver function is abnormal in leprosy, another cause (e.g. secondary amyloidosis, sepsis or malignancy) should be searched for.     

Frozen stored Leishmania tropica vaccine: the effects of dose,route of administration and storage on the evolution of the clinical lesion. Two field trials in the Israel Defense Forces

The first field trial of frozen vaccine against cutaneous leishmaniasis yielded a 100% take rate and a high ulceration rate at a dose of four million units. Two further trials were designed to investigate differences in response rates on the basis of duration of storage, sex of vaccinee, vaccination dose and method of administration.257 soliders (151 males and 106 females) were inoculated in 1978 with an isolate of Leishmania tropica major that had been stored at the temperature of liquid nitrogen for 11 months before use. Those inoculated with an intradermal jet injector and those receiving half a million units by conventional injection yielded very low take rates. For those receiving two million and one million units, no difference in response was demonstrated between males and females or between doses. The over-all take rate for these groups after six months of follow-up was 71·6% with an ulceration rate of only 23·7%.In a subsequent trial in 1979, 131 men were inoculated with one of two frozen isolates of L. tropica major that had been stored for 11 and 18 months, respectively, at doses of either two million or four million units. The take rate after 12 months of follow-up was 91% and 93% for the four and two million units dose, respectively. The corresponding ulceration rates were 39·5% and 25%. The lesions produced by the higher dose developed more rapidly than those produced by the lower dose. The ability of the parasites to produce lesions rapidly with high ulceration rates appears to decline during prolonged storage, even in the frozen state.     

Hepatitis B virus (HBV) markers among patients with chronic liver disease in Kuwait

The prevalence of hepatitis B surface antigen (HBsAg), antibody to the hepatitis B core (anti-HBc) and to surface antigen (anti-HBs), was investigated, using sensitive radioimmunoassay (RIA) systems, among patients with different clinical entities of chronic liver disease in Kuwait, and compared to a control blood donor population. 81% of patients and 44% of the controls had at least one HBV marker. 24% of patients, but none of the controls had both HBsAg and a high titre of anti-HBc in the absence of anti-HBs, suggesting a chronic infection. 31% of our patients with hepatosplenic schistosomiasis, 20% with cryptogenic cirrhosis and chronic active liver disease and 60% with hepatocellular carcinoma had these two markers. HBV antigenaemia was significantly more prevalent among male than among female patients and was particularly high among those less than 35 years old. The high prevalence of the various HBV markers among our patients suggests that HBV is a major factor in the development of chronic liver disease in our area. Furthermore, in view of the high prevalence of antigenaemia in patients with hepatosplenic schistosomiasis, HBV infection must play a concomitant role in the development of a more serious form of chronic liver disease among such patients.     

Epidemiological characteristics and clinical findings in patients with serologically proven toxocariasis.

The enzyme-linked immunosorbent assay (ELISA) using Toxocara canis larva-specific antigens was used to confirm a presumptive clinical diagnosis of visceral larva migrans in patients whose serum specimens were submitted to the Center for Disease Control. The clinical and epidemiological characteristics of patients with diagnostic ELISA titres (greater than or equal to log2 5) were compared with patients who had less or no detectable antibody. The typical patient with serologically confirmed toxocaral visceral larva migrans was about five years of age and resided in the southern half of the USA. Clinical findings were likely to include leucocytosis, eosinophilia, an increased anti-A or anti-B isohaemagglutinin titre, and an elevated serum IgG level. Pica, as ascertained by a physician questionnaire, was not a consistent finding and both sexes were nearly equally represented.     

Casual blood pressure: Its relationship to several cardiovascular risk factors in middle-aged men

The relationship between casual blood pressure and other cardiovascular risk factors in presumably healthy middle-aged men (in the age range of 50–60 years) was investigated in a cross-sectional study. It was found that people with high casual blood pressure (> 160 and/or > 95 mmHg) and who have no history of previous cardiovascular disease were older, heavier, had higher heart rates and blood glucose, smoked more and had more evidence of L.V.H. on E.C.G. than a control group who had normal or borderline casual blood pressure. It was concluded that even casually found hypertension in seemingly healthy individuals is associated with higher prevalence and degree of certain behavioral, physical and biochemical parameters frequently seen in people with ischaemic heart disease.     

First report of septicaemic melioidosis in Hong Kong

Septicaemia due to Pseudomonas pseudomallei was found in five patients; it complicated pneumonia in three. Four patients were old and had diabetes mellitus; the fifth patient, though young, was immunocompromised by steroid therapy. The clinical features were indistinguishable from those of other Gram-negative septicaemia. Four of the patients died. This was the first report of septicaemic melioidosis in Hong Kong where the disease might be endemic. Soil sampling and serological survey gave further supporting evidence. Early treatment using a bactericidal anti-Pseudomonal cephalosporin, such as ceftazidime, was suggested for this life-threatening infection.     

The control of gonorrhea by obstetricians and gynecologists

A questionnaire was mailed to all specialists practicing obstetrics-gynecology in two geographically remote metropolitan areas of comparable size. In one city routine culture for gonorrhea was performed by less than one-fifth of respondents, over one-fourth of diagnosed cases were unreported to the health department, and two-thirds of diagnosed patients had symptomatic infection. In the second city, where the Public Health Department had instituted a program of free culture media and microbiologic identification, half of responding physicians routinely cultured for gonorrhea, 93% of identified cases were reported, and half of diagnosed patients had asymptomatic infection. In both cities inappropriate therapy was given by nearly half of the respondents, and epidemiologic treatment was routinely used by less than half of the respondents. Data support the use of public health programs for diagnosis, and indicate that further physician education regarding appropriate individual and epidemiologic management are needed.     

Modifying the snack food consumption patterns of inner city high school students: the Great Sensations Study

The Great Sensations Program is a nutrition-education project developed for high school students. It was designed to (a) decrease students' consumption of salty snacks and (b) increase students' consumption of fresh fruit snacks. The overall programs were designed following principles of social learning: informative instruction, participatory classroom activities, personal goal setting, feedback, and reinforcement. The program was delivered in six lessons during regular health-education classes. A parental involvement program consisted of mailers and telephone calls to parents to teach them to encourage changes in student snacking habits. A schoolwide program was designed to provide out-of-class peer support for student modifications in salty snack foods. The program was evaluated in one high school using a 2 X 2 design. A second high school served as a no-treatment control. Program assessments were made at both schools before and after the classes, at the end of the school year, and the following fall the next school year following summer vacation. The schoolwide media program was effective in decreasing consumption of salty snack foods and in increasing consumption of target snack foods. However, only those students receiving classroom instruction maintained those changes until the end of the school year. No changes were maintained across summer vacation. These outcomes suggest that school programs developed using principles of social learning may be effective in facilitating important behavior changes at home and at school.     

Catechol estrogens and thrombosis: lack of a direct effect of 2-hydroxyestradiol on platelets

Women who use the oral contraceptive pill are at risk for a variety of thromboembolic complications, but the precise mechanism is unclear. Since 2-hydroxyestradiol is a major metabolite of estradiol and possesses some of the structural and functional properties of catecholamines, we examined whether this compound might influence thrombogenesis, in particular whether it would exert an epinephrine-like effect on the platelet. In vitro, 2-hydroxyestradiol does not cause or potentiate aggregation or thromboxane release, nor does it prevent the rise in cyclic AMP caused by anti-aggregatory prostaglandins. While 2-hydroxyestradiol does not exert a direct effect on the platelet in vitro, it may play a role in thrombosis in women who take oral contraceptives through another mechanism.     

Social bonds in a healthy elderly sample: characteristics and associated variables

Social bonds were examined in 256 healthy, independent-living elderly men and women using the Interview Schedule for Social Interaction (ISSI). Multivariate techniques were used to test for relationships between six dimensions of social bonds, as measured by the ISSI, and demographic characteristics as well as scores from the Kellner-Sheffield Symptom Questionnaire, the Jacobs Cognitive Screening Exam, the Halstead Category Test and the Wechsler Memory Scale. The study participants reported involvement in a range of satisfying, supportive, interpersonal relationships. Significant associations were found between social bonds and income, marital status, work status and health status. Emotional status, cognitive functioning, and memory were found to be independent of social bonds in our statistical model.     

Partial characterization of a malaria mitogen.

Supernatants from 24-hour cultures of Plasmodium falciparum-infected human red blood cells stimulated lymphocytes from both malaria immune and malaria non-immune donors. Both T and B lymphocytes responded. Amalaria parasite-derived mitogen may play some part in the pathogenesis of the hypergammaglobulinaemia characteristic of malaria.     

Strategies for prevention using allied health professionals.

Preventive services which are directed at groups and individuals who are at high risk of some unfavorable outcome should be incorporated into the fabric of medical care practice. Allied health professionals have the required skills to provide preventive services with a greater sense of job satisfaction than do physicians. Experiences to date attest to the usefulness of allied health professionals in meeting the gaps in health care which are largely preventive in nature.     

A review of the carcinogenicities of nickel,chromium and arsenic compounds in man and animals

Increased incidences of cancers of the respiratory tract have been reported among (a) workers in nickel refineries; (b) industrial workers who have been engaged in production of chromates or in processing of chrome pigments; and (c) workers who have had diverse occupational exposures to arsenic compounds (metallurgical, chemical and agricultural workers). Human subjects who have developed clinical manifestations of arsenicalism as a result of environmental, occupational or iatrogenic exposures have been reported to have increased incidences of cancers of the skin and possibly of internal organs. Certain nickel and chromium compounds (e.g., nickel subsulfide and calcium chromate) that have been administered to rodents by parenteral or respiratory routes have induced cancers at the sites of deposition. Experimental induction of cancers in animals has not been reported as a consequence of administration of arsenic compounds.     

Use of low-dosage oral cyproterone acetate as a male contraceptive

To ascertain the effects of low-dosage cyproterone acetate (CPA) on the reproductive and endocrine functions of normal men, 25 volunteers were given CPA 0, 5 or 10 mg daily over 16 weeks, preceded by 12 weeks pretreatment observation and followed by 24 weeks posttreatment follow-up. CPA caused a decrease in sperm concentration, percentage motility, proportion of normal sperm and ability of the sperm to penetrate a column of cervical mucus in most patients. In addition, circulating testosterone, estradiol, LH and FSH levels were significantly reduced during treatment. All these changes reverted to the pretreatment level upon drug withdrawal. These findings suggest that firstly, although low dosage CPA was able to induce changes in seminal analyses, azoospermia was present in only one out of 15 subjects exposed to the drug. Secondly, the marked decrease in androgen levels associated with CPA treatment renders CPA unsuitable as a single entity agent for long-term male contraception.     

Endotoxaemia in Vibrio El Tor cholera

Endotoxaemia and endotoxin-induced changes were sought in Nigerian patients presenting with cholera/diarrhoea. The organism was Vibrio cholerae, bio-type El Tor, serotype Hikojima. The limulus amoebocyte lysate gelation test was used qualitatively by the clot method, whilst a spectrophotometric method was used quantitatively to measure endotoxin levels. 25 acutely ill patients tested had detectable endotoxaemia by the Escherichia coli endotoxin standard. The highest endotoxin level was found in a patient with sub-conjunctival haemorrhage. Changes in platelet counts, the detection of complement breakdown product C3d in plasma, the elevation of fibrin degradation products, the finding of elevated, normal or depressed C3 levels and the absence of circulating immune complexes, suggest a pathogenic role for endotoxin in Vibrio cholerae El Tor diarrhoea.     

A hypertension treatment program at the workplace to complement community care

A worksite hypertension control program was established for employees of the state of Maryland. Employees were screened for hypertension, and individuals identified as hypertensive were encouraged to seek care from community physicians. For those choosing not to seek such community care, a treatment program was initiated at the worksite. Of the 417 hypertensives identified, 54 (13%) elected to have their blood pressure treated at the worksite. Comparisons between the group choosing worksite care and the group choosing community care revealed that the worksite group was generally a higher risk group by virtue of having less awareness of their hypertension, being less likely to be on antihypertensive treatment, and being less likely to have their hypertension controlled by medication. This group made relatively little use of community physicians. Increases in hypertension treatment and control were greater in the worksite group after a 2-year follow-up examination. The project suggests an important role for worksite treatment programs for hypertension as a complement to existing community care.