Presumed ocular toxoplasmosis presenting as papillitis

Unilateral papillitis is a rare manifestation of ocular toxoplasmosis. However, other causes of papillitis need to be ruled out before concluding the diagnosis.     

Blood sugar profile in diabetics receiving plain insulin

Blood sugar profile was studied by checking multiple plasma venous samples at 1/2 hr interval after porcine plain insulin. Mean blood sugar was the highest (198.8 +/- 24.6 mg%) at 1 1/2 hrs and the lowest (86.3 +/- 18.4) at 4 1/2 hrs after breakfast. 52% of the patients had hypoglycemias between 4 and 5 hrs. It is recommended that pre-lunch blood sugar be checked in those receiving plain insulin.     

Gentamicin dosing in neonatal patients

Objective: To compare trough and peak serum gentamicin concentrations in neonatal patients using two dosing regimens. Method: A retrospective audit of gentamicin serum concentrations obtained with the current neonatal gentamicindosing regimen (regimen 1) was conducted. Results were then compared with the introduction of a new regimen (regimen 2). Preliminary results necessitated a change to a further dosage schedule (regimen 3), where data was again collected. Results: For regimen 1,79% of patients achieved satisfactory trough concentrations, 30% achieved satisfactory peak concentrations, and 16% achieved a satisfactory combined trough and peak concentration.For regimen 2,80% of patients achieved satisfactory trough concentrations, 63% achieved satisfactory peak concentrations, and 48% achieved a satisfactory combined trough and peak concentration.For regimen 3,76% of patients achieved satisfactory trough concentrations, 56% achieved satisfactory peak concentrations, and 45% achieved a satisfactory combined trough and peak concentration. Conclusion: Regimen 3 shows a marked improvement in serum gentamicin concentrations. However neonates in the 3238 weeks postconceptional age group achieved higher trough and peak serum gentamicin levels than expected. Therefore the dosage interval in this group of neonates will be increased from 18 hourly to 24 hourly dosing, and regimen reaudited.     

Analysis of the interaction between the HIV-inactivating protein cyanovirin-N and soluble forms of the envelope glycoproteins gp120 and gp41

The novel virucidal protein cyanovirin-N (CV-N) binds with equally high affinity to soluble forms of either H9 cell-produced or recombinant glycosylated HIV-1 gp120 (sgp120) or gp160 (sgp160). Fluorescence polarization studies showed that CV-N is also capable of binding to the glycosylated ectodomain of the HIV-envelope protein gp41 (sgp41) (as well as SIV glycoprotein 32), albeit with considerably lower affinity than the sgp120/CV-N interaction. Pretreatment of CV-N with either sgp120 or sgp41 abrogated the neutralizing activity of CV-N against intact, infectious HIV-1 virions. Isothermal calorimetry and optical biosensor binding studies showed that CV-N bound to recombinant sgp120 with a K(d) value ranging from 2 to 45 nM and to sgp41 with a K(d) value of 606 nM; furthermore, they indicated an approximate 5:1 stoichiometry for CV-N binding to sgp120 and a 1:1 stoichiometry for CV-N binding to sgp41. Circular dichroism studies additionally illuminated the binding of CV-N with both sgp120 and sgp41, providing the first direct evidence that conformational changes are a consequence of CV-N interactions with both HIV-1 envelope glycoproteins.     

Prospective, Pilot, Open-Label, Short-Term Study of Conversion to Leflunomide Reverses Chronic Renal Allograft Dysfunction

Leflunomide (LEF) is a synthetic isoxazole derivative with anti-inflammatory and antiviral properties, which has been reported to prevent acute rejection and delay progression of chronic allograft nephropathy (CAN) in animal models. We performed a pilot, crossover trial in 22 renal transplant recipients who were converted from azathioprine (AZA) or mycophenolate mofetil (MMF) to LEF in an effort to slow progression of renal dysfunction [deteriorating renal function (n = 5), cyclosporine (CyA) nephrotoxicity (n = 4) or biopsy-proven CAN (n = 13)]. Baseline maintenance immunosuppression consisted of CyA, AZA or MMF and prednisone. Six-month postconversion patient and graft survival was 100% and 91%, respectively. Mean serum creatinine 6months preconversion was 2.2 +/- 0.6mg/dL, at initiation was 3.0 +/- 1.1 mg/dL, and 6 months postconversion was 2.8 +/- 1.3 mg/dL. The rate of change in serum creatinine was 35 +/- 39%/6 months preconversion and -5 +/- 21%/6 months postconversion to LEF (p = 0.003). Two patients discontinued LEF for diarrhea and myalgia. No readmissions, increase in liver function tests, infections or acute rejection episodes occurred. Mean CyA levels did not change, 146 +/- 72 ng/ mL pre-LEF vs. 132 +/- 51 ng/mL post-LEF, p = NS. Conversion to LEF reversed progression of chronic renal allograft dysfunction with minimal toxicity.     

Cross-linked protein crystals for vaccine delivery

The progress toward subunit vaccines has been limited by their poor immunogenicity and limited stability. To enhance the immune response, subunit vaccines universally require improved adjuvants and delivery vehicles. In the present paper, we propose the use of cross-linked protein crystals (CLPCs) as antigens. We compare the immunogenicity of CLPCs of human serum albumin with that of soluble protein and conclude that there are marked differences in the immune response to the different forms of human serum albumin. Relative to the soluble protein, crystalline forms induce and sustain over almost a 6-month study a 6- to 10-fold increase in antibody titer for highly cross-linked crystals and an approximately 30-fold increase for lightly cross-linked crystals. We hypothesize that the depot effect, the particulate structure of CLPCs, and highly repetitive nature of protein crystals may play roles in the enhanced production of circulating antibodies. Several features of CLPCs, such as their remarkable stability, purity, biodegradability, and ease of manufacturing, make them highly attractive for vaccine formulations. This work paves the way for a systematic study of protein crystallinity and cross-linking on enhancement of humoral and T cell responses.     

A prospective clinical review of ��multi model�� approach for treating ear keloids

This is a prospective clinical study of 46 ear keloids in 31 patients (with a mean follow-up of 18 months) treated from January 2006 to December 2006 at The Queen Elizabeth Public Hospital, Barbados, West Indies by a single surgeon. The mean age is 21.9 years (range 3-66 years). Seven out of 46 lesions were recurrent lesions following previous surgery. All the lesions were excised surgically (extralesional). Ten out of 31 patients were given postoperative, Intralesional Triamcinolone starting from the 1^st post operative visit on three visits at monthly intervals. Fourteen patients were given postoperative superficial X-ray therapy of 12 Gy in three equal fractions on three consecutive days starting from the 3^rd postoperative day. Seven recurrent keloids of this study were given a combination of both superficial X-ray therapy and intralesional triamcinolone. All patients were followed at monthly intervals for three visits from the time of surgery and every three months until the end of the 1^st year and then every six months thereafter. Five of 46 postoperative surgical wounds showed evidence of recurrence during the 1^st year but could be suppressed with Intralesional triamcinolone. This study confirms that surgical excision of keloids supplemented with radiotherapy and/Intralesional triamcinolone is a reliable method with few complications. In addition, the study concludes that the key in preventing recurrence is regular clinical follow-up to encounter early recurring lesion (clinical evidence of raised scars or palpable nodules if deep seated) which is 100% susceptible to Intralesional triamcinolone for 2-3 times at monthly intervals.