Advanced heart block in acute rheumatic fever

First degree heart block is considered a minor criterion for the diagnosis of this condition. The cases presented here demonstrate that higher degrees of heart block do occur in rheumatic fever. Children presenting with acquired heart block should be worked-up for rheumatic fever. Likewise, it is imperative to serially follow the electrocardiogram in patients already diagnosed with acute rheumatic fever, as the conduction abnormalities can change during the course of the disease

The Adverse Effects of Wealth on Cardiovascular Health: A Scientific Statement of the International College of Cardiology.

Background and Aims: Increase in economic status may be associated with increased consumption of Western type of foods and sedentary behaviour. In the present review, we discuss that increase in wealth may be associated with adverse effects on health behaviour Study Design and Methods: Internet search and discussion with colleagues. Results: Review of studies indicate that with increase in wealth, there is increased consumption of high fat, ready prepared foods and decrease in physical activity in most of the countries resulting in obesity and metabolic syndrome, leading to cardiovascular diseases (CVDs) and other chronic conditions. Many experts during the United Nations High Level Meeting in Sept 2011, misinterpreted the WHO estimates and proposed that, of total deaths, 22·4 million arise in the poorest countries, and 13.7 million in high-income and upper-middle-income countries and therefore poverty may be the major cause of deaths due to non-communicable diseases (NCDs). A recent study shows that 57.0 % of deaths in adults (aged 25-64 years) were due to CVDs and other chronic diseases, 25.5% due to communicable diseases and 15.9% due to injury and accidents. The deaths due to NCDs were highly prevalent among higher social classes compared to lower social classes who had greater deaths due to communicable diseases. It is interesting to know from new data from United States, that there is ‘Wealth’ without cardiovascular health in America. The whole world is likely to have the same scenario in the near future. Conclusions: Increase in wealth may be associated with altered health behaviour; greater consumption of unhealthy foods, tobacco consumption, mental load and sedentary behaviour resulting in increased risk of deaths due to CVDs and other chronic diseases which may change with knowledge about health education. Wealth may cause extension in life by buying of expensive drug therapy, intervention and surgery which are known to add income and employment in the west.

Efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients.

Helicobacter pylori is implicated in causation of peptic ulcers and gastric cancer and plays a pivotal role in gastric pathophysiology. In the present study we evaluated the relative efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients by ELISA. In the present study we evaluated the relative efficacy of sonicated and acid-extractable antigens in the serodiagnosis of H. pylori infection in peptic ulcer patients by ELISA. The two types of antigens mentioned above were prepared from H. pylori subcultures following appropriate procedures. Sera were collected from 13 subjects of whom eight were diagnosed to be suffering from duodenal ulcer (DU) and five from non-ulcer dyspepsia (NUD) and screened for the presence of anti H. pylori antibodies by ELISA. A case was considered seropositive, if the OD value was more than or equivalent to twice the mean OD value of blank. Analysis of our results showed that, with acid extractable antigen at a concentration of 2 mg/mL, 12 cases were seropositive. Contrastingly, with sonicated antigen, at a concentration of 2 mg/mL only eight cases were positive. It is concluded from this study, that the use of relatively purified antigens like acid extractable antigens enhances the sensitivity and specificity of this serodiagnostic test, indicative of its relatively higher efficacy over sonicated lysate containing multiple antigens.

Malondialdehyde as a sensitive marker of inflammation in patients with rheumatoid arthritis.

Malondialdehyde (MDA) levels in the serum were estimated by MDA-TBA (Thiobarbituric Acid) spectro colorimetric assay method in 23 rheumatoid arthritis (RA) patients and were compared with those in 18 healthy subjects. It was found that the mean levels of MDA (265.15 +/- 68.8 n moles/100 ml) in patients with RA were found to be significantly elevated when compared to the mean of that of controls (128.76 +/- 37.8 n moles/100 ml). This study reveals that MDA assessment appears to be a sensitive marker of inflammation in this chronic auto immune disorder and would help in understanding the nature of inflammatory damage at a cellular level.

Detection of antibodies to serum IgA and IgG in peptic ulcer cases by indirect haemagglutination test.

Autoantibodies to serum IgA and IgG were detected in 206 peptic ulcer patients (196 duodenal ulcer and 10 gastric ulcer) and 52 healthy age and sex-matched controls by indirect haemagglutination test. A significantly increased mean titre of autoantibodies to serum IgA was observed in the peptic ulcer patients. Forty-eight (24.61%) duodenal ulcer cases had autoantibody titre values above mean +/- 2 SD of controls. Titres of autoantibodies to serum IgG were significantly increased only in the gastric ulcer cases. The results suggest an immunologic abnormality in a sizeable fraction of these cases.

Detection and characterization of circulating immune complexes in peptic ulcer.

BACKGROUND. Immunological factors have been implicated in the pathogenesis of peptic ulcer following the demonstration of autoantibodies against IgA in patients with this disease. We investigated whether circulating immune complexes were present in this condition, and what type of immunoglobulins were involved. METHODS. The sera of 37 patients with duodenal ulcer and 8 with gastric ulcer were tested for the presence of circulating immune complexes using the polyethylene glycol (PEG) assay and the results compared with those in 79 controls. The precipitate was dissociated and the levels of IgA, IgG and IgM estimated using the single radial immunodiffusion technique. Simultaneous estimation of these immunoglobulins in the serum was also done. Autoantibodies against IgA in the serum were tested using the ELISA test. RESULTS. Eleven patients (6 with duodenal ulcer and 5 with gastric ulcer) were found to have circulating immune complexes. The mean protein content of the PEG precipitates was significantly higher in patients than in control subjects (p < 0.001). The mean values of all the immunoglobulin isotypes were higher in patients than in controls. The IgA content in the PEG precipitates of positive cases was higher than that in control subjects (p < 0.05). CONCLUSION. Patients with peptic ulcer have circulating immune complexes which may interfere with normal immunoregulation.

Role of pure and biologically active amoebal RNA in assessment of lymphokines: a report of 55 ALA cases.

Amoebic liver abscess cases (55) were assessed for release of lymphokines (LMIF) using pure and biologically active amoebal RNA of axenic Entamoeba histolytica (NIH: 200) obtained with cesium chloride centrifugation. Lymphokines released by T lymphocytes in response to both amoebal RNA and whole amoebic lysate (WAL) were tested by leukocyte migration inhibition test (LMIT) on blood samples from amoebic liver abscess cases. A significant increase was observed in the release of lymphokine and 100% positivity was observed with amoebal RNA compared to whole amoebic extract with a positivity of only 78%. The difference between means leukocyte migration inhibition of the above two with regards to release of lymphokine was highly significant (P less than 0.001). This shows that patients had high degree of leukocyte sensitization to amoebal RNA of E. histolytica compared to whole amoebic lysate. These findings suggest that the amoebal RNA plays an important role as a potent antigen in the elicitation of cell mediated immune responses in amoebic liver abscess cases.

Autoimmunity in amoebiasis.

Amoebic liver abscess (ALA) and symptomatic intestinal amoebiasis cases were assessed by indirect haemagglutination assay for auto-reactive IgG and IgA class of antibodies in response to healthy human serum IgG and IgA. The present results indicated the presence of autoreactive IgG and IgA class of antibodies in ALA and intestinal amoebiasis respectively.

Detection of autoreactive antibodies to serum IgG and IgA in amoebic liver abscess cases.

Assessment of autoreactive antibodies in response to healthy human serum IgA and IgG was performed by indirect haemagglutination assay on serum samples from 81 amoebic liver abscess cases for IgA and 70 for IgG. Appropriate controls were taken simultaneously. IgA, IgG were isolated and purified from a healthy human serum through Sephadex G-200 and protein A CL 4B sepharose chromatography. These immunoglobulins were used for the detection of its own antibodies in amoebic liver abscess cases. This revealed that 43.20% and 48.50% of the cases were positive for IgA and IgG respectively, where as only 19.35% and 28.30% of the controls were in positive category (IgA and IgG respectively). The mean titres with standard deviation of the autoreactive antibodies to serum IgA both in ALA cases and controls shows a highly significant difference between tests and controls (P less than 0.001). Similarly the mean titres with standard deviation both in ALA and controls for the serum IgG differed significantly (P less than 0.001). This suggests the presence of autoreactive antibodies against serum IgA and IgG in amoebic liver abscess cases.

Detergent dissection of membrane proteins of Entamoeba histolytica and its effect on lymphokine release in in vitro.

Fifty-two amoebic liver abscess cases were assessed for the release of lymphokines (LMIF) using detergent dissected membrane proteins (DDMP) of axenic Entamoeba histolytica (NIH:200) obtained with sodium deoxycholate treatment. Lymphokines release by T lymphocytes in response to both DDMP and whole amoebic lysate (WAL) was tested by leukocyte migration inhibition test on blood samples from amoebic liver abscess cases. A significant increase was noted in the release of LMIF and 100% positivity was observed with DDMP compared to whole amoebic extract with a positivity of 73%. The difference between means of the above two with regards to release of LMIF was found to be highly significant (P less than 0.005). This shows the patients had high degree of leukocyte sensitization to surface antigens of E. histolytica compared to the whole amoebic lysate. These findings suggest that the antigens shed might have important role as a potent antigen in elicitation of CMI response in amoebic liver abscess cases.

Immunogenicity of detergent membrane proteins of Entamoeba histolytica.

The lymphokine release and antibody production were assessed in the peripheral blood of 52 and 48 cases of amoebic liver abscess respectively, by employing detergent dissected membrane proteins (DDMP) of axenic Entamoeba histolytica (NIH:200). Lymphokine release by T lymphocytes in response to both DDMP and whole amoebic lysate (WAL) was performed by leukocyte migration inhibition test. A highly increased release of LMIF and 100 per cent positivity was observed with DDMP where as the same for whole amoebic extract, was only 73 per cent. The difference between the means of the above two values with regards to release of LMIF, was found to be highly significant (P less than 0.005). Antibodies production in response to both DDMP and whole amoebic lysate was performed by indirect haemagglutination assay on blood samples from amoebic liver abscess cases. A 53 folds increased titres of IHA and cent percent positivity was observed with DDMP compared to WAL. The difference between mean titres of the above two with regards to detection of antibodies, was found to be highly significant (P less than 0.001). This shows that the patients, had high degree of leukocyte sensitization and production of antibodies which will not be assessed simply with WAL. These findings suggest that the shed material might have important role as a potent antigen in elicitation cell mediated and humoral immune response in amoebic liver abscess cases.

Alpha-1-antitrypsin activity in duodenal ulcer.

Alpha-1-antitrypsin activity was estimated in thirty-one duodenal ulcer patients and twenty-five age and sex matched controls. Statistically significant (P less than 0.05) decrease was noted in the mean alpha-1-antitrypsin activity in the patients sera. These observations indicate that alpha-1-antitrypsin deficiency may be one of the important factors in the aetiopathogenesis of duodenal ulcer in a considerable proportion of patients.

Studies on precipitating and hemagglutinating antibodies in systemic lupus erythematosus.

We studied the precipitating and hemagglutinating autoantibodies in the sera of patients with various connective tissue diseases in general and lupus in particular. Saline soluble extract of goat thymus had adequate antigenic materials as compared to other organs. Twenty per cent of patients with systemic lupus erythematosus were positive for precipitating autoantibodies by immunodiffusion and 44% by counterimmunoelectrophoresis. Normal human subjects, nonrheumatic disease patients and patients with rheumatoid arthritis and progressive systemic sclerosis were all negative. Forty seven per cent of positive systemic lupus erythematosus sera showed two precipitin systems. Enzyme sensitivities were used as the basis of identification of most of the antigenic specificities. Passive hemagglutination was carried out to identify antibodies to non-histone nuclear protein and nuclear ribonucleoprotein antigens. Thirty eight % of systemic lupus erythematosus patients were positive by this technique. Passive hemagglutination although a highly sensitive technique could not detect antibodies against antigenic systems other than non-histone nuclear protein and nuclear ribonucleoprotein.