In vitro regulation by muramyl dipeptide of interferon production from peripheral blood mononuclear cells of healthy volunteers

We investigated the effect of N-acetyl-muramyl-L-alanyl-D-isoglutamine (MDP) on interferon (IFN)-alpha and -gamma production by peripheral blood mononuclear cells from healthy subjects. MDP, on its own, was found to lack the ability to induce IFN production. However, this synthetic adjuvant was able to modulate IFN production induced by other stimuli. In cultures from a considerable number of tested donors, MDP enhanced IFN-gamma levels induced by phytohaemagglutinin. This effect was further potentiated after depleting the PBMNC cultures of their adherent cells. In contrast, MDP significantly suppressed the Sendai virus-induced IFN-alpha and this effect was reversed following adherent cell depletion. Identical regulatory effects on IFN production were exerted by the adjuvant active analogue of MDP, namely murabutide. The adjuvant inactive stereoisomer, MDP (DD) exhibited a similar enhancing effect on IFN-gamma but had a significantly lower inhibitory activity on IFN-alpha production. The potential value of this generation of immunomodulators in the treatment of viral infections and in models for studying the regulation of IFN at the molecular level is discussed.     

Insulin binding substances,autoimmunity and type i diabetes in kuwaiti patients and their kindred

Summary Insulin autoantibodies (IAAs) are associated with type I diabetes mellitus (DM) and have been suggested as predictive markers of the disease. Using an ELISA assay, we have studied the prevalence of binding to human insulin in sera from an Arab type I DM population and compared it with the prevalence in the family members (FMs) of the probands, in type II DM patients from the same population, and in Arab control subjects. Significant levels of binding occurred in 11/16 (69%) of type I DM patients and in 21/34 (62%) of their FMs, but in only 5/31 (16%) of type II DM patients and in 1/25 (4%) of control subjects. Within families, there was homogeneity with regard to the level of insulin binding and the mean family levels correlated with those of the proband (r=0.68, df=7, p=0.05). HLA-DR3 or -DR4 antigens occurred in 55/63 (87%) of type I DM patients and in 95/118 (81%) of their FMs. This was significantly higher (p<0.001) than in either type II DM patients (39/75, 52%) or in control subjects (34/93, 37%). ICAs were present in significantly more (25/43, 58%) of type I DM patients than their FMs (3/82, 3%) (p<0.001). They did not occur in either type II DM patients or in the control group. In conclusion, insulin binding occurred in sera from both type I diabetic patients and their kindred, and hence did not appear to be specifically associated with the development of clinical diabetes.     

Counterimmunoelectrophoresis using an arc 5 antigen for the rapid diagnosis of hydatidosis and comparison with the indirect hemagglutination test

A modified counterimmunoelectrophoresis and a conventional indirect hemagglutination test were compared for routine diagnosis of human hydatid disease in an endemic area in the Middle East. Counterimmunoelectrophoresis was performed on a cellulose acetate membrane with dilutions of a commercially available antigen which interacts with sera of patients with confirmed hydatid disease to produce the arc 5 precipitin line. The test was performed with unconcentrated human sera and the lines stained in an aqueous solution of Ponceau red. Sensitivity (95.5% vs. 93.2%) and specificity (99.2% vs. 89.9%) were higher with counterimmunoelectrophoresis than with indirect hemagglutination. Cross-reactivity with sera of patients with other parasitic infections was noted with indirect hemagglutination but not with counterimmunoelectrophoresis. There was no cross-reactivity with sera of patients with autoimmune disorders by either test.     

Imported malaria in Kuwait

The number of imported malaria cases in Kuwait rose from 87 in 1980 to 504 in 1983, an increase of 579%. The continued resurgence of malaria in endemic zones, improved diagnostic techniques and a heightened awareness of imported malaria have contributed to the increase in the number of microscopically proved cases. Thick blood films fixed in acetone and stained in Giemsa proved a rapid method of diagnosis; species identification on the basis of a thin film on the same slide was performed with ease. Malaria was acquired in 38 countries. Most patients were young male adults. Most of the cases were due to Plasmodium vivax originating from India, although an increasing number of P. falciparum cases are also now being diagnosed from there. P. falciparum infections were evenly distributed throughout the year and most cases presented within 14 days of their arrival in the country. The highest number of P. vivax cases were diagnosed between May and October, when heat stress might have been a factor in precipitating a clinical attack of an infection previously acquired in the endemic zone. Attention is drawn to the importance of delayed attacks of P. vivax and, in semi-immunes, of P. falciparum. The time interval involved in establishing a history of "recent" travel in clinically suspected cases of malaria needs to be more clearly defined in each geographical area. Cases of induced malaria due to transfusion, accidental and congenital infections were identified. The fatality rate due to P. falciparum infections was low. In terms of the risk of renewed transmission, Kuwait may be considered a vulnerable area.     

Proficiency of Pediatricians in the Use of Inhaled Medication Delivery Systems for the Management of Asthma

Objective: To evaluate the proficiency of pediatricians in the demonstration of the proper use of metered-dose inhalers (MDIs) and to assess their theoretical knowledge of inhalation devices used in the management of asthma. Design: Prospective cross-sectional survey. Setting: Two university-affiliated hospitals. Participants: Seventy-one pediatricians and pediatric house staff. Intervention: Each pediatrician's technique was graded by two trained observers using a checklist of six essential steps recommended by national guidelines. Theoretical knowledge of asthma devices was evaluated by a written questionnaire. Results: Twenty (35.2%) pediatricians performed at least five steps correctly, 28 (39.4%) performed three or four steps correctly, and 18 (25.4%) performed two steps or less correctly. The most common errors were failure to start inhalation from functional residual capacity, failure to inhale slowly, and failure to wait at least 20 seconds before the next puff. Senior pediatricians were more skillful in the practical use of MDIs than were pediatric house staff (p = 0.03). The most common deficiencies in theoretical knowledge were related to estimation of the amount of medication in the canister (8.5% correct) and how valved holding chambers (VHCs) improve drug delivery to the lung (15.5% correct). Conclusion: Pediatricians in Kuwait have significant deficiencies regarding the practical and theoretical aspects of MDIs and other inhalation devices.     

Ultrasonographic diagnosis in abdominal tuberculosis

Sonographic findings were retrospectively analysed in 39 patients with proven abdominal tuberculosis (TB). The patients were treated over 15 years at a major teaching hospital, Mubarak Al-Kabber Hospital, in Kuwait. The findings included clear or complex ascites with fine strands, loculations and debris. The other findings were lymphadenopathy, bowel wall thickening, omental mass, focal lesions in the liver and spleen and psoas abscess. The sonographic findings in abdominal TB are not specific but may give valuable information to prevent unnecessary laparotomy.     

Effect of bonding systems on post-operative sensitivity from posterior composites

PURPOSE: To compare post-operative sensitivity from posterior composites lined with bonding systems that utilize either a self-etching primer or phosphoric acid conditioner. METHODS: Occlusal cavities on homologous contralateral posterior teeth in 28 selected subjects were lined with either One-Step Plus (a bonding system that utilizes phosphoric acid conditioner) or Clearfil SE Bond with a self-etching primer, and then restored with a hybrid resin composite. Post-operative sensitivity was assessed subjectively by asking the patient to classify pain from the restored tooth into none, mild or severe; and objectively by measuring the time it took for the patient to feel cold sensation when standardized ice stick was placed against the mid-buccal surface of the tooth. RESULTS: Subjective assessment showed that post-operative sensitivity was mild with either of the bonding systems; and marginal homogeneity test showed no statistically significant difference in the prevalence of post-operative sensitivity (P> 0.05), although there was a trend towards decreasing sensitivity with Clearfil SE Bond as post-operative period increased (P= 0.027). In the objective assessment, repeated measures of ANOVA showed that cold response measurements increased significantly with postoperative period only in the teeth lined with Clearfil SE Bond (P< 0.05), indicating decreasing post-operative sensitivity. However, paired t-test showed no significant difference between the cold response measurements obtained for the two bonding systems (P> 0.05).     

Intraoperative bile duct visualization using near-infrared hyperspectral video imaging

BACKGROUND: Current methodologies for imaging the biliary system during cholecystectomy are cumbersome and do not eliminate the risk of bile duct injury. We describe an approach to intraoperative biliary imaging that will enable surgeons to see through the hepatoduodenal ligament and visualize the anteriorly placed biliary system. METHODS: A laparoscopic-capable, near-infrared, hyperspectral imaging system was built. Reflected light passes through a liquid crystal filter that is continuously tunable in the near-infrared spectrum (650-1,100 nm). Spectroscopic image data are collected from laparoscopic surgery images onto array detectors formatted into a 3-dimensional hyperspectral data cube having spatially resolved images in the x-y plane and wavelength data in the z plane. Deconvoluting and color-coding the spatial and spectral information provides an image representative of inherent chemical properties to the imaged tissue. RESULTS: Images of porcine biliary structures were obtained. The common duct-reflected spectra displayed a characteristic lipid shoulder at 930 nm and a strong water peak at 970 nm. Venous structures had absorption peaks at 760 nm (deoxyhemoglobin), 800 nm (oxyhemoglobin), and 970 nm (water). Arterial vessels had absorption peaks at 800 nm and 970 nm that would be expected for oxyhemoglobin and water. CONCLUSIONS: We have designed and constructed a device to significantly enhance intraoperative biliary imaging. This system should enable surgeons to see through the hepatoduodenal ligament and image the anteriorly placed biliary system without the need for dissection of the cystic duct, as is needed with intraoperative cholangiography. Because the biliary system can be seen before any dissection is performed, this dimensional imaging technology has the potential for eradicating bile duct injury.     

Orthodromic synaptic activation of rat olfactory bulb mitral cells in isolated slices

Axons of olfactory receptor neurons terminate in the glomerular layer of the olfactory bulb, where they synapse with the apical dendrites of mitral cells. Although the mitral cell and its excitation by the olfactory nerve have been the subject of numerous experimental investigations, in vitro studies of these neurons have primarily used nonmammalian preparations. We have recorded the responses of rat olfactory bulb mitral cells to stimulation of the olfactory nerve layer in vitro using extracellular and whole cell patch techniques. Olfactory bulbs were cut into 400-μm thick slices in approximately horizontal section and submerged in a recording chamber. Patch clamp electrodes were guided into the mitral cell layer, which was visible under a dissecting microscope. A stimulating electrode was placed onto the olfactory nerve layer (ONL) rostral to the recording electrode. In extracellular recordings, mitral cells typically responded to ONL stimulation with a prolonged excitation lasting 1 s or longer. With whole cell patch recordings, membrane resistances (mean 272 MΩ) were substantially higher than those reported in previous intracellular studies that used sharp electrodes. Small spontaneous excitatory potentials were present in some mitral cells. ONL stimulation caused a prolonged depolarization comparable to the duration of the period of excitation observed in extracellular recordings. At membrane potentials near −55 mV, ONL stimulation evoked a train of spikes. All but the first of these spikes were blocked by hyperpolarization of the membrane to −65 mV.     

Tubulolobular carcinoma of the breast with grooved and cerebriform nuclei: failure to identify this specific subtype in a case during routine fine needle aspiration cytology and histopathological diagnosis

Tubulolobular carcinoma (TLC) is a rare tumor of the breast in which histologic features of both tubular and lobular carcinoma are combined. We report a case of TLC, in which the specific subtype was missed at routine cytologic and histopathological examination. A 69-year-old woman presented with a right breast lump. Imaging studies indicated a malignant lesion in right upper quadrant. Routine fine needle aspiration (FNA) cytology diagnosis was a duct cell carcinoma (small cell type). In a setting of cystic thyroid lesions, presence of excessive nuclear grooves, and rare intranuclear cytoplasmic inclusion, metastatic papillary thyroid carcinoma was also considered. However, both these possibilities were not supported by immunocytochemical findings (estrogen receptor+, thyroglobulin-, and chromogranin-). The histopathology diagnosis was invasive duct cell carcinoma. Review of FNA smears and paraffin sections led to the diagnosis of TLC, which was supported by positive immunohistochemical stainings for markers like e-cadherin and β-catein.