Expression of c-myc oncogene in coeliac disease.

A monoclonal antibody, produced by peptide immunisation was used to detect the distribution of p62c/myc by immunohistology in normal and coeliac small intestinal mucosa. The effect of gluten in four treated coeliac patients was investigated by taking serial jejunal biopsy specimens for six hours after a 10 g oral gluten challenge. There was a progressive increase in p62c/myc staining intensity in the villus enterocytes extending to the crypts, which accompanied the classical morphological changes occurring in the mucosa.     

Effects of the obese (ob/ob) genotype on spleen cell immune function.

Spleen cells from mice homozygous for the obese (ob) mutation killed DBA/2 mastocytoma target cells less well than spleen cells from lean littermates or unrelated age-and sex-matched controls of the same strain. Killing was impaired only when the attacker cells were primed in vivo, not following in vitro priming. Hence the effect of the ob/ob genotype is not to produce an irreversible functional change in the lymphocyte, but rather to produce an environment in which lymphocytes are less able to react to priming antigen. Not only were the spleen cells of in vivo primed obese mice less active than those of lean controls, but also their number per spleen was significantly decreased. Such a quantitive difference was no longer found in adrenalectomised animals, but the qualitative difference in spleen cell cytotoxic activity still occurred. This suggests that adrenocortical hyperfunction may affect immune function in obese mice, without necessarily being the only factor in the in vivo environment of obese mouse spleen cells capable of depressing cellular immune reactivity.     

Tuberculosis infection and disease in South African adolescents with perinatally acquired HIV on antiretroviral therapy: a cohort study

IntroductionThere are limited data on Tuberculosis (TB) in adolescents with perinatally acquired HIV (APHIV). We examined the incidence and determinants of TB infection and disease in the Cape Town Adolescent Antiretroviral Cohort (CTAAC).MethodsYouth between nine and fourteen years on antiretroviral therapy (ART) for more than six months in public sector care, and age‐matched HIV‐negative adolescents, were enrolled between July 2013 through March 2015 and followed six‐monthly. Data were censored on 31 October 2018. Symptom screening, chest radiograph, viral load, CD4 count, QuantiFERON (QFT) and sputum for Xpert MTB/RIF, microscopy, culture and sensitivity were performed annually. TB infection was defined by a QFT of >0.35 IU/mL. TB diagnosis was defined as confirmed (culture or Xpert MTB/RIF positive) or unconfirmed (clinical diagnosis and started on TB treatment). Analyses examined the incidence and determinants of TB infection and disease.ResultsOverall 496 HIV+ and 103 HIV‐negative participants (median age at enrolment 12 years (interquartile range, IQR 10.6 to 13.3) were followed for a median of 3.1 years (IQR 3.0 to 3.4); 50% (298/599) were male. APHIV initiated ART at median age 4.4 years (IQR 2.1 to 7.6). At enrolment, 376/496 (76%) had HIV viral load <40 copies/mL, median CD4 count was 713 cells/mm³ and 179/559 (32%) were QFT+, with no difference by HIV status (APHIV 154/468, 33%; HIV negative 25/91, 27%; p = 0.31). The cumulative QFT+ prevalence was similar (APHIV 225/492, 46%; 95%CI 41% to 50%; HIV negative 44/98, 45%; 95% CI 35% to 55%; p = 0.88). APHIV had a higher incidence of all TB disease than HIV‐negative adolescents (2.2/100PY, 95% CI 1.6 to 3.1 vs. 0.3/100PY, 95% CI 0.04 to 2.2; IRR 7.36, 95% CI 1.01 to 53.55). The rate of bacteriologically confirmed TB in APHIV was 1.3/100 PY compared to 0.3/100PY for HIV‐negative adolescents, suggesting a fourfold increased risk of developing TB disease in APHIV despite access to ART. In addition, a positive QFT at enrolment was not predictive of TB in this population.ConclusionsHigh incidence rates of TB disease occur in APHIV despite similar QFT conversion rates to HIV‐negative adolescents. Strategies to prevent TB in this vulnerable group must be strengthened.     

Acute myocardial infarction in the young

In space of 2 years our CCU admitted 38 patients under 40 years and the trend seems to be on the increase. The high prevalence of risk factors, the low frequency of arrhythmias and the low mortality rate were notable features. The role of psychological and physical stress in the pathogenesis of cor H. D. deserve more attention. The fact remains that the only road to a substantial reduction in premature death from CHD must be in its prevention.     

Use of mid-arm and head circumference to estimate gestational age and nutritional status of newborns]

1110 neonates, from 30 to 42 of estimated gestational age (EGA) were measured on the 1st day of life to estimate upper mid-arm circumference (MAC) and head circumference (HC). Individual MAC/HC ratio was calculated. MAC/HC ratio was used to estimate gestational age and nutritional status of the newborns. We proved that MAC/HC ratio increased linearly between 30 and 38 week of pregnancy and it stabilized between 38-42 week. We compared MAC/HC ratio with birth weight, skin fold score, and ponderal index. We concluded that this ratio may be very useful to estimate gestational age and to include the neonates to "the group of risk".     

Analysis of the change in work patterns following installation of an inpatient pharmacy computer system

An experiment was designed to determine if the installation of a pharmacy computer produced a significant change in the distribution of routine inpatient dispensing activities for pharmacy personnel. Data were obtained using time lapse motion picture photography and work sampling procedures. Cameras were placed in three different locations for 6 days over a 2-week period before and after installation of the computer. A sample of approximately 2000 observations was reduced to machine readable format and analyzed using nonparametric statistical procedures. Results indicated a shift in work patterns of pharmacy personnel. It was concluded that the installation of a pharmacy computer had a significant effect on the distribution of routine inpatient dispensing activities. Pharmacy management should consider this information in anticipating efficient use of personnel and proper placement of computer hardware.     

Adjuvant chemo-radiotherapy in ampullary cancers.

PURPOSE: Patterns of failure following surgical treatment of ampullary cancers indicate that up to 45% of patients develop loco-regional recurrence. The effect of adjuvant chemo-radiotherapy on survival and loco-regional control is not yet established in this malignancy. PATIENTS AND METHODS: From January 1989 to December 2000, 113 patients underwent pancreatico-duodenectomy for ampullary cancer. One hundred and four patients who survived the operation were available for analysis to study the effect of adjuvant chemo-radiotherapy on survival and loco-regional control. Forty-nine patients received adjuvant chemo-radiotherapy (median dose 50.4 Gy with concurrent 5-Flurouracil) and long-term outcome in these patients was compared with those 55 who did not receive adjuvant therapy. RESULTS: The overall median survival was 30.1 (range 1.6-140.0) months with actuarial 1, 3 and 5-year survival rates of 79, 43 and 33%, respectively. No significant difference in median survival (34.6 vs 24.5 months; P=0.3) and actuarial 5-year survival rates (38 vs 28%) was seen between those who received and those who did not receive adjuvant therapy. Adjuvant chemo-radiotherapy did not influence the survival in high-risk patients (P=0.84), in various T and N stages and had no impact on loco-regional recurrence (P=0.6). CONCLUSIONS: Adjuvant chemo-radiotherapy did not improve the long-term survival or decrease recurrence rates in patients with ampullary cancers who had undergone pancreatico-duodenectomy.     

Perception and practice of sublingual immunotherapy among practicing allergists in the United States: a follow-up survey

BackgroundLimited information regarding current trends of sublingual immunotherapy (SLIT) use, perception, and prescribing patterns among allergists in the United States is available.ObjectiveTo obtain information about current allergist perception and practice of SLIT compared with 2007.MethodsOn behalf of the American College of Allergy, Asthma and Immunology (ACAAI) Immunotherapy and Diagnostics Committee, an electronic survey was sent to all practicing allergists of the ACAAI in August 2011.ResultsFifty-nine of 519 US respondents (11.4%) reported experience using SLIT compared with 45 of 766 (5.9%) in 2007 (P < .001). Lack of Food and Drug Administration (FDA) approval was the primary barrier in using SLIT in the United States among 469 of 520 respondents (90.2%), which was increased from 471 of 763 (61.7%) in 2007 (P < .001). Among US respondents, 344 of 516 (66.7%) believed that SLIT was safer than subcutaneous immunotherapy (SCIT) compared with 554 of 755 (73.4%) in 2007 (P < .01). In total, 22 of 51 SLIT users (43.1%) reported SLIT efficacy equal to or even greater than SCIT, which was similar to 21 of 38 (55.3%) reported in 2007 (P < .36).ConclusionRates of SLIT use reported by US respondents have nearly doubled in the last 4 years, with 11.4% of US respondents reporting SLIT use. Because the greatest barrier to SLIT use in the United States is the lack of FDA approval, it is anticipated that once an FDA-approved product is available, there will be widespread use of SLIT in the United States. Practice guidelines, which include effective dosages and schedules, will be critical to the broad implementation of SLIT in the United States.