The amino terminus of the salmonid alphavirus capsid protein determines subcellular localization and inhibits cellular proliferation

Salmonid alphavirus (SAV) is the most divergent member of the family Togaviridae and constitutes a threat to farming of salmonid fish in Europe. Here, we report cloning, expression and preliminary functional analysis of the capsid protein of SAV, confirming it to be expressed as an approximately 31-kDa protein in infected cells. The protein localizes strictly to the cytoplasm in Chinook salmon embryo cells, and either to the nucleus or cytoplasm in bluegill fry cells. An expression study of full-length and different truncated versions of the SAV capsid fused to the enhanced green fluorescent protein demonstrated that the localization is independent of other viral components in both cell lines, and controlled by the N-terminal 82 aa, which include a conserved, predicted helix and a downstream positively charged region. Thus, the results suggest that the SAV capsid possesses a cell-type-dependent potential for nuclear import and export. Moreover, the SAV capsid and its N-terminal 82 aa were shown to be associated with inhibition of cellular proliferation, a hallmark of the cytopathic effect caused by SAV. These results highlight that the SAV capsid is a multifunctional protein with possible importance for pathogenesis.     

Foreign body in tracheobronchial tree

Inhalation of foreign body into the tracheobronchial tree is a medical emergency sometimes resulting into sudden death. The current mortality rate due to foreign body inhalation ranges from 0% to 1.8%. Children with or without positive history of aspiration were examined and diagnosis was made on the basis of history, clinical findings, radiological evaluation and strong index of suspicion. A review of 30 cases of suspected foreign body aspiration revealed, children between 6 months were found to be very vulnerable to aspiration. Majority of children were boys. 80% of the patients had positive history of inhalation. Only 50% of the patients presented immediately i.e. within 24 hours after aspiration. Common symptoms were cough and respiratory distress. Decreased air entry was the significant clinical sign (50%). Obstructive emphysema and mediastinal shift were found in the majority of cases (50%). Rigid bronchoscopy under general anaesthesia and patient ventilating using a jet ventilator is a very safe and effective technique.     

Clinical epidemiology of acute myocardial infarction in Kuwait

OBJECTIVE: We studied the clinical epidemiological features of patients with AMI treated at a major hospital in Kuwait. The objectives of the study were to determine (i) personal and clinical characteristics of patients; (ii) prevalence of major risk factors among the patients; and (iii) factors associated with in-hospital morbidity and mortality. METHODS AND RESULTS: All patients (n = 126) who fulfilled the standard diagnostic criteria for AMI and treated at the CCU of the study hospital during the calendar year 1996 were included in the study. Patients were identified from the CCU register and information was extracted from the medical records. Multiple logistic regression was performed to study the factors independently associated with in-hospital morbidity and mortality. Of the 126 patients, 84.9% were men and 15.1% were women; and 40.5% were Kuwaiti nationals and 59.5% were expatriates. On average, male patients were younger than females (mean age = 52.4 +/- 10.4 years vs. 60.2 +/- 10.2 years), and male expatriates were the youngest sub-group in the study (mean age = 49.7 +/- 8.7 years). Overall, history of diabetes, hypertension, and CHD was recorded in 44.4%, 29.6%, and 16.8% of the patients, respectively. About 58% of the male patients were current smokers and the prevalence of smoking was significantly higher in expatriates compared with Kuwaiti patients (62% vs 36%, respectively). Kuwaiti nationals had a significantly high prevalence of diabetes compared with the expatriates (57% vs 36%, respectively). There was a significant trend in increasing prevalence of diabetes, hypertension and CHD with age whereas smoking was most prevalent (87%) in the youngest age group. As for the clinical features, 70.5% of the patients presented within 6 hours of the onset of symptoms, 73% presented with ST-segment elevation (40.5% with inferior, 32.5% with anterior ST-segment elevation), and fibrinolytic therapy was given to 63.6% of the patients. About half of the patients had an admission blood glucose level of > or = 10 mmol/l, and 70.6% had a fasting blood glucose level of > or = 6.1 mmol/l one day after admission. In the multiple logistic regression analysis, old age (> 60 years), anterior MI, and admission blood glucose level of > or = 10 mmol/l were found to be significantly associated with in-hospital cardiac morbidity. The in-hospital case fatality was about 6%. Old age and history of CHD were found to be the significant predictors of in-hospital mortality. CONCLUSION: Control of smoking and early diagnosis and appropriate treatment of diabetes may reduce the burden of AMI-related morbidity and mortality.     

Epidemiology of smoking among Kuwaiti adults: prevalence, characteristics, and attitudes

INTRODUCTION: In 1996 we conducted a cross-sectional survey to study the epidemiology of smoking among Kuwaiti adults. METHODS: The 4000 participants were selected using a three-stage stratified cluster sampling design. Altogether 3859 participants (1798 males, 2061 females) returned a completed self-administered questionnaire. RESULTS: The prevalence of smoking was 34.4% (95% confidence interval (CI) = 32.2-36.6) among men and 1.9% (95% CI = 1.3-2.5) among women. Among men, the highest prevalence (56.5%; 95% CI = 36.2-76.8) was observed in the youngest age group (< or = 20 years). Among women the highest prevalence was observed in one of the older age groups (46-50 years) (7.1%; 95% CI = 3.1-11.1). Multiple logistic regression analysis showed that the following factors were independently associated with smoking: lower levels of education (odds ratio (OR) 3.5; 95% CI = 1.5-8.4), lower employment grade (OR = 4.1; 2.5-6.7), and being a separated, divorced, or widowed woman (OR = 4.9; 95% CI = 2.0-11.8). The majority of smokers (68%) began smoking when younger than 20 years; significantly more men (70%) than women (33%) began smoking at these ages (P < 0.0001). On average, men began smoking at an earlier age (18 years vs 21 years; P < 0.001) and therefore had smoked for a longer period (15 years vs 12 years; P < 0.05); men also consumed a higher number of cigarettes each day (26 vs 17; P < 0.05). A large proportion of smokers were ignorant about the health consequences of passive smoking: about 77% of those with children reported that they smoked in the presence of their children. Almost half (47%) of all smokers stated that they wanted to stop smoking, and about 56% had attempted to quit. The biggest perceived barrier to quitting was uncertainty about "how to quit". A total of 338 respondents (8.8%; 95% CI = 5.8-11.9) were classified as former smokers. About half of the former smokers had quit between the ages of 20 and 29 years; the average age of quitting was 28 years. Former smokers were more likely to have smoked fewer cigarettes per day and to have smoked for significantly less time than current smokers. DISCUSSION: Given the fact that free education is provided at all levels by the government, anti-tobacco education and awareness should be included as an integral part of the curriculum in schools and colleges.     

Health issues in ethnic minorities: awareness and action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.     

Corticosteroid-sparing effect of intravenous immunoglobulin therapy in patients with pemphigus vulgaris

BACKGROUND: Pemphigus vulgaris (PV) is a rare, potentially fatal autoimmune mucocutaneous blistering disease. The prolonged use of systemic corticosteroids, though clinically effective in high doses, can result in multiple debilitating adverse effects. Immunosuppressive agents, used as adjuvants and as corticosteroid-sparing agents, are not effective in all patients and are contraindicated in some. Therefore, alternative treatment modalities are needed to provide effective control of PV in such patients. OBJECTIVE: To demonstrate the corticosteroid-sparing effect of intravenous immunoglobulin (IVIg) therapy in patients with moderate to severe PV. DESIGN: A retrospective analysis in a cohort of 15 patients with moderate to severe PV who were treated with IVIg therapy. All 15 patients were corticosteroid dependent, and the use of other systemic conventional immunosuppressive agents was contraindicated. The patients were followed up over a mean period of 6.2 years. SETTING: Ambulatory tertiary medical care facility of a university-affiliated hospital. INTERVENTION: All 15 patients received an IVIg dose of 1 to 2 mg/kg per cycle. MAIN OUTCOME MEASURES: The following information was documented in each of the 15 patients before and after the initiation of IVIg therapy: total dosage and total duration of prednisone therapy and number of relapses. Also, the highest dosage and adverse effects of prednisone therapy, as well as the total duration of observation, were recorded. RESULTS: All 15 patients had a satisfactory clinical response to IVIg therapy. The use of systemic prednisone was gradually discontinued over a mean period of 4.3 months. A statistically significant difference was noted in the total dose of prednisone (P =.004), total duration of prednisone therapy (P =.003), and number of relapses (P<.001) before and after the initiation of IVIg therapy. CONCLUSIONS: Intravenous immunoglobulin therapy has a demonstrable corticosteroid-sparing effect. It is a safe and effective alternative treatment modality in patients with PV who are dependent on systemic corticosteroids or who develop significant adverse effects as a result of their use.     

Clinical audit of outcomes in Cochlear Implantation an Indian experience

This retrospective study is based on the assessment of outcomes of Cochlear Implantation taking into account various scoring systems like Category of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR). 100 candidates who were implanted between June 1997-June 2005 at Madras ENT Research Foundation (MERF), a tertiary referral center for cochlear implantation were included in the study. The results were analyzed using the above scoring systems to assess the performance levels of each implantee and to arrive at a cumulative result on the outcome of the implantation. Practical issues of concern to Cochlear Implantation in the Indian subcontinent were also analyzed.     

Three techniques for simpler, safer, and cost-effective rigid ureteroscopy

Postureteroscopy colic, accumulation of irrigant fluid in the bladder, and advancement of the ureteroscope through narrow ureters are some of the problems commonly encountered during ureteroscopy. Three methods to overcome these problems and to make ureteroscopy technically easy, safe and cost-effective are described.