T lymphocyte activation profiles in peripheral blood of long- versus short-term residents of Kuwait: comparison with asthmatics

<p><b>INTRODUCTION</b>During the Arabian Gulf Wars of 1991 and 2003, the resident population of Kuwait sustained heavy exposure to environmental toxicants introduced by military activities. No comprehensive studies have been conducted to assess how exposure to the wartime and postwar environment may have altered the fundamental patterns of immune reactivity among Kuwaitis in ways that affect pathogenesis of disease. This present study addresses this issue by characterising immunological features of asthma and allergies in a Kuwaiti population that is unique and possibly correlates with toxicant exposures.</p><p><b>MATERIALS AND METHODS</b>Twenty-fi ve long-term residents of Kuwait afflicted with bronchial asthma concurrent with rhinitis; and 2 healthy control groups: 18 long-term residents and 10 newcomers to Kuwait were evaluated by 2- and 3-colour fl ow cytometry for peripheral blood T cell subpopulation frequencies.</p><p><b>RESULTS</b>Relative to healthy, long-term residents, significantly elevated frequencies of all activated cell phenotypes were observed in the blood of the asthmatic group (P <0.05 to P <0.001), except for CD8+HLA-DR+ cells and a presumed T-regulatory (Treg) subpopulation: CD4+CD25(high). The asthmatic group was also observed to have larger populations of CD3+ (pan-T cells), CD4+ (T helper cells) and CD8+ (cytotoxic T cells), CD3+CD56 (NKT-like cells) and CD56+CD16+ (NK cells) compared to healthy long-term residents. Compared to healthy recent immigrants, the blood of long-term residents contained elevated levels of CD3+CD56+ (NK-like), CD4+CD45RA+/ CD45RO+ (Naive-to-Memory Transitional), but lower CD4+CD25+(high) (Treg) (P <0.05).</p><p><b>CONCLUSIONS</b>Elevated representation of natural killer (NKT)-like and memory phenotypes may predispose long-term residents towards enhanced susceptibility for airway disease; while at the same time, reducing representation of Treg cells which are protective against airway disease, and this may increase vulnerability to these syndromes among the residents of Kuwait. These results may provide insight into the features of immunopathogenesis of asthma and allergies in Kuwait that arise as a result of the special environment of the country.</p>

Are arrhythmias in rheumatic mitral regurgitation common as in mitral valve prolapse in children ?

Rheumatic fever is a common cause of acquired heart disease in children and young adult throughout the developing world and the pancarditis caused by rheumatic fever may manifest by palpitations. Ventricular arrhythmias are a common feature in patients with mitral valve prolapse [MVP] and several factors have been identified in those patients who progress to sudden death, including severe mitral regurgitation. So could arrhythmias in children with rheumatic mitral regurgitation [MR] be as common as in patients with mitral valve prolapse? This study included 30 patients [pts] with isolated rheumatic mitral regurgitation with different grades [mild, moderate and severe mitral regurgitation] diagnosed by echocardiography [group I] compared to group II [control group], which included 30 healthy children with a normal heart confirmed by echocardiography. All the study population was subjected to the following: Full medical history and physical examination, laboratory investigations, twelve leads ECG, chest X-ray, echocardiography and Ambulatory twenty four hours ECG monitoring [Holter]. The total prevalence of arrhythmias detected by Holter monitoring in the studied patients and control group were 40% [12 pts] and 16.6% [5 pts] respectively, p value = 0.04. As regard the type of arrhythmias; sinus tachycardia occurred in 10 pts [33.3%] and 4 pts [13.3%] in group I and II respectively [p value > 0.05]. Infrequent premature atrial contractions [PACs] occurred in 2 pts [6.7%] in group I and one patient [3.3%] in group II [p value > 0.05]. The incidence of arrhythmias detected by Holter recording was insignificant with mild MR compared to the control group [p value = 0.4]. Thereafter, the prevalence of arrhythmias increased proportionally to the degree of MR. The occurrence of arrhythmias in pts with moderate and severe rheumatic MR was significantly higher as compared to the control group [p value = 0.02 and 0.009 -respectively]. The incidence of arrhythmias was not significantly higher in cases of rheumatic MR with active rheumatic fever [4 pts had arrhythmias out of 5 pts with rheumatic activity] than those with rheumatic MR without rheumatic activity [p value = 0.07]. The prevalence of arrhythmias in the patients studied in relation to the echocardiographic findings revealed a significantly higher incidence of arrhythmias in rheumatic MR with left atrial enlargement; eleven out of thirteen pts had sinus tachycardia and PACs [p value = 0.0001]. We conclude from this study that rheumatic mitral regurgitation in the pediatric age group is associated with sinus tachycardia and uncommonly with premature atrial contractions; no other arrhythmias were detected even in association with cardiac enlargement or active carditis. The incidence of arrhythmias in MVP is much more common than in rheumatic MR. Ventricular arrhythmias occurs in MVP, while it did not occur with rheumatic MR in our study. The incidence of arrhythmias in rheumatic MR is significantly related to the severity of mitral regurgitation

Association of major histocompatibility complex with psoriasis vulgaris in adult Kuwaitis

The association of the major histocompatibility complex [MHC] with psoriasis vulgaris has been reported in different ethnic groups. However, an identification of human leukocyte antigen [HLA] genes that determine susceptibility to the disease has not been reported previously among the Arabs of the Arabian Peninsula. This study was conducted with the objective of establishing any correlation between psoriasis and the expression of HLA class I and class II in a Kuwaiti population. Expression frequencies of the MHC were measured in 26 Kuwaiti patients with psoriasis, and 60 control individuals were matched for age, sex and ethnic background. Tissue typing for class I and class II antigens was carried out by lymphocytotoxicity assays. HLA-CW6, DQ2 and DQ7 were significantly increased in patients compared to controls [p = 0.0002, 0.0044 and 0.0004, respectively], while HLA-B7, DR5 and DR52 were significantly decreased [p = 0.002, 0.0004, 0.019, respectively]. These findings suggest that psoriasis is associated with HLA-CW6, DQ2 and DQ7 in the Kuwaiti population. Further studies to investigate the association of distinct HLA with psoriasis vulgaris based on the RNA levels are under way

Role of coxsackie B viruses in acute myocarditis in Egyptian children

This study comprised 40 children, aged 1-15 years, suffering from acute myocarditis and admitted to the New Children's Hospital, Cairo University. In addition to clinical and radiological assessment, laboratory tests including ASOT, detection of C-reactive protein and ESR were performed. This confirmed the diagnosis of 28 cases as acute rheumatic myocarditis. Paired sera from the remaining 12 cases, preliminarily diagnosed as viral myocarditis, were assessed for rising titre of complement-fixing antibodies against Coxsackie [B] virus. Two cases had a four-fold increase. Thus 16.6% of suspected viral cases [5% of total acute myocarditis cases] were diagnosed as due to Coxsackie [B] virus infection. This points to a possible role for this virus in acute myocarditis when a rheumatic aetiology has been excluded

Perinatal diagnosis of structural defects in high risk pregnancy

New and advanced methods for perinatal diagnosis of congenital anomalies have emerged aiming at reducing to the minimum the incidence of infant mortality and morbidity. Our study was carried on a group of high risk pregnancies including diabetics, those with history of congenital anomalies and still births, those with collagen diseases, with congenital heart diseases, a group exposed to teratogens in early pregnancy and a control group. All our cases were examined by ultrasound starting from the 16th week of gestation and onwards. Our results showed that the overall incidence of congenital anomalies was 15.33 percent in the high risk group compared to 5 percent in the control group. The highest incidence was 30 percent in those with history of congenital malformations, 25 percent in those exposed to teratogens, 20 percent in those with history of still births, 16.66 percent in those with collagen diseases, 11.95 percent in diabetics and 10 percent in those with congenital heart diseases. 16.66 percent of anomalies were detected prenatally by sonography, while the remaining 4.66 percent were diagnosed by postnatal assessment. The missed anomalies in the antenatal examination were all of the minor class, beyond the resolution of the equipment. The variable incidence in our study that was not in accordance with the worldwide figures is due to variable environmental, socio-economic, racial and ethnic factors. As prevention is better than cure, the upgrading of the level of education of the community and the stress on preconceptual and conceptual investigations and management by the newest technology will have a vital role in lowering our high incidence in the near future