Clinical features of renal diseases in South-East Asia

Summary: The renal diseases in South-East Asia are similar to other parts of the world (i.e. glomerulonephritis, diabetes mellitus, HT, obstructive uropathy, adult-onset polycystic kidney disease, nephrolithiasis and tubulointerstitial diseases). IgA nephropathy with haematuria is most common in Singapore, while IgM nephropathy with nephrotic syndrome is common in Thailand. Lupus nephritis is the most common cause of secondary glomerulonephritis and a major cause of rapidly progressive glomerulonephritis. Acute renal failure from specific infection (malaria, leptospirosis, melioidosis), from toxin exposure (snake bite, wasp sting), from exertional heat stroke, and from drugs is frequently found. Nephrolithiasis, distal renal tubular acidosis and hypokalaemia are endemic in NE Thailand. In conclusion, the broad clinical features of renal diseases in South-East Asia are similar to other regions, with additional specific causes from infections, toxic, metabolic and environmental derangements associated with these tropical locations.     

Antigenic cross-reactivity between Necator americanus and Ascaris lumbricoides in a community in Papua New Guinea infected predominantly with hookworm.

Sero-epidemiological data are presented in which antigenic cross-reactivity between Necator americanus and Ascaris lumbricoides has been investigated in a community in Papua New Guinea infected predominantly with N. americanus. It is our contention that the antigenic cross-reactivity which undoubtedly exists between these species accounted for (i) a peak in antibody levels against N. americanus in 10-13 years old children (driven by infection with A. lumbricoides), and (ii) the maintenance of apparent antibody levels against A. lumbricoides in older age groups (driven by infection with N. americanus in the absence of overt infection with A. lumbricoides). Cross-reactivity was analysed further, and apparently N. americanus-specific epitopes identified, by immunoblotting. These observations could have considerable bearing on the interpretation of data from sero-epidemiological studies which failed to take account of concurrent infection with these parasites.     

Trial of isotretinoin and calcitriol monitored by CA 125 in patients with ovarian cancer.

Twenty-two asymptomatic women with rising CA 125 levels after chemotherapy for ovarian cancer were entered into a trial of isotretinoin combined with calcitriol. Tumours were evaluated according to precise criteria based on serial CA 125 levels and by comparing regression slopes of CA 125 before and during therapy. There was no evidence based on CA 125 of any responses or significant change in tumour growth rate.     

Quality of life in surgically palliated complex congenital heart disease

The outcome of surgical palliation was evaluated in 26 children with complex cyanotic congenital heart disease. Outcome was examined in terms of ongoing symptoms, exercise tolerance, and the ability to participate in normal childhood activities. An activity score was calculated and each child performed graded treadmill exercise testing. Breathlessness (24 (92%) children), respiratory infections (nine (35%) children), and leg cramps (eight 31%) children) were the most common physical disorders. Although formal exercise testing showed a clear reduction in exercise tolerance compared with age and sex matched controls, palliation had allowed 23 (89%) to function with moderate exercise limitation, three (11%) having severely limited activity. Parents underestimated the child's exercise tolerance in 80% of cases. Sixteen (62%) patients attended school full time, eight (31%) attended part time, and two (8%) received only home tuition. Palliative surgery can give children with a single functional ventricle a level of activity which allows them to take part in most childhood activities. Subjective estimates of exercise tolerance are inaccurate in this group of children, and formal exercise testing can contribute useful information to decision making about further surgical intervention.     

不稳定型心绞痛病人β-血小板球蛋白浓度的检测

目的检测不稳定型心绞痛（UA）病人在标准药物治疗前后β-血小板球蛋白（β—TG）浓度、血小板计数（PLT）、血小板平均体积（MPV）和巨大血小板（LPLT）数量。方法UA病人（UA组）66例被分为两组：A组42例有过心绞痛病史；B组24例为初发性心绞痛。以22例健康人为对照。β—TG及其他活化标志物分别在治疗前测量（A组和B组）以及治疗8～10d后测量（B组）。结果A组及B组（治疗前后）血浆β—TG浓度比对照组明显升高，具有统计学意义（F=34．17，q=9．837～13．457，P〈0．05）。UA组LPLT数量比对照组显著升高（F=21．49，q=9．468～10．619，P〈0．05），而治疗对于PLT和MPV无影响（P〉0．05）。结论UA病人的β—TG和LPLT浓度由于血小板活化而升高，正规的临床治疗未能明显引起β-TG和其他活化标志物量的变化。