Serum levels of soluble urokinase plasminogen activator receptor is associated with parasitemia in children with acute Plasmodium falciparum malaria infection.

Serum levels of soluble urokinase plasminogen activator receptor (suPAR) are significantly elevated and of prognostic value in patients suffering from serious infectious diseases such as HIV and tuberculosis. Our objective was to investigate suPAR levels during symptomatic malaria infection and 7 days after treatment. Children younger than 6 years who presented with fever or other symptoms compatible with malaria were enrolled. Blood films and samples were collected on day 0 and day 7. Twenty-five children were allocated to each of three groups according to the amount of Plasmodium falciparum detected in their initial blood film. Children in group 1 had parasite densities in excess of 20 parasites per 200 leucocytes. The median plasma suPAR level was 6.49 ng/mL (interquartile range [IQR]: 4.90-7.61) and correlated to parasitemia (Spearman 0.43, P < 0.0001). Blood was obtained from 20 children in group 1 after 7 days of treatment. All became malaria negative in their blood slides and all decreased in suPAR level to median 3.48 ng/mL (IQR: 3.08-3.91) (P < 0.0001). Group 2 consisted of 25 children with 1-20 parasites in their blood slide. The suPAR level was median 2.91 ng/mL (IQR: 2.27-4.40) and decreased with median 0.5 ng/mL following treatment (P = 0.0002). Group 3 showed to be negative in their blood slides and most received antibiotic treatment. suPAR decreased from median 3.26 ng/mL (IQR: 2.77-4.46) to median 2.47 ng/mL (IQR: 2.01-3.75), on day 7 (P = 0.006). This study demonstrates an important association between suPAR and acute malaria infection in humans.

Holter monitoring in AL amyloidosis: prognostic implications.

The heart is involved in more than one third of patients with primary (AL) amyloidosis at diagnosis and it is by far the most common cause of death. Rhythm and conduction abnormalities generally represent the terminal event. The aims of this study were to determine the spectrum of Holter abnormalities found in AL amyloidosis and to assess their prognostic significance, particularly in relation to sudden death. Fifty-one patients with AL amyloidosis were included, and all of them had a complete history, physical examination, two-dimensional echocardiography, and 24-hour Holter monitoring. Fifty-five percent of these patients had echographic signs of heart involvement and 23% had heart failure. Complex ventricular arrhythmias were found in 57% of patients, couplets in 29%, and nonsustained ventricular tachycardia in 18%. Overall median survival was 23.4 months. Congestive heart failure, echocardiographic abnormalities, and Holter abnormalities adversely affected survival. The multivariate analysis demonstrated that interventricular septum thickness and couplets were independent predictors of survival. The presence of couplets correlated with sudden death. Holter monitoring may contribute to assessing the prognosis of patients with AL amyloidosis.

Effect of reconstruction of the anterior cruciate ligament on proprioception of the knee and the heel strike transient.

Abnormal proprioception of the knee joint has been documented after rupture of the anterior cruciate ligament (ACL) and may result in the loss of muscular reflexes. Excessive loading from the lack of muscular control may predispose the joint to osteoarthrosis. To investigate this problem, 10 patients were studied at an average of 31.6 months after ACL reconstruction. Three tests of joint proprioception and measurements of the vertical component of heel strike force during normal gait were used. A normal control group also was studied. For two of the proprioception tests (reproduction of passive motion and relative reproduction), there were no statistical differences among the uninjured (control) limbs, the normal contralateral limb of patients with a reconstructed ACL, and the extremity with a reconstructed ACL. In the third test (threshold of detection of motion), which previously has been shown to be adversely affected by ACL injury, the measurements for both extremities of patients with a reconstructed ACL were more accurate than those for the control group. The reconstructed extremity performed less accurately than the contralateral extremity (p < 0.05). The heel strike transient (vertical component of ground reaction force at heel strike) for uninjured and ACL-reconstructed limbs was not significantly different. In fact, the extremity with the reconstructed ACL had a lower transient than the uninjured extremity. Heel strike transients in patients with a reconstructed ACL were higher than those in the controls, but the differences were significant only when corrected for velocity of gait.(ABSTRACT TRUNCATED AT 250 WORDS)

Histamine and catecholamine values in allergic subjects under specific hyposensitization treatment.

It has been quite some time since a histamine/catecholamine balance was established. This balance was also observed at the moment of anaphylactic shock in dogs previously hypersensitized. Few findings have demonstrated that histamine is released in skin reaction produced by allergen injection. The hypothesis that the histamine release was positive in intradermal and subcutaneous reaction provoked through injecting both routes by allergen used for hyposensitization led us to carry out the present study in a group of allergic patients. We determined the quantity of histamine found in blood plasma prior to and 4 hours after hyposensitization, and observed if there was an increase in the histamine and catecholamine produced, that is to say if a histamine-catecholamine balance was established. However, no such balance was produced. Instead it was evident in this work that no histamine was released in the area of administration. We in part confirm the works of other authors which doubt the existence of such a release and incline towards the idea that what is released are vasoactive kinins.

The role of catecholamines in specific hyposensitization.

With the use of modern techniques for the evaluation of catecholamines, this work studies the behavior of catecholamines in the urine of a group of 33 allergic patients before and after injection of allergens as part of immunotherapy. In 24 of these patients the amount of adrenalin and norepinephrine had increased 24 hours after the injection of the allergens (p less than 0.001). This confirms the noradrenergic role of the allergen, apart from the release of histamine as a result of the immunologic mechanism. Histamine is released as a result of the increase of the norepinephrine and is evidence of a homeostatic mechanism, as had been established in a previous investigation by the authors.

The role of cyclic amp in the process of specific hyposensitization.

The parenteral administration of a specific allergen produces a local edema due to the liberation of histamine. We have investigated the plasmatic cyclic AMPO in this reaction. A group of allergic patients (36 in all) with asthma or rhinitis or both diseases and with a very positive prick skin test was studied. The level of cyclic AMP was investigated before and after injecting the patients with the specific hyposensitizing extract. The average levels of cyclic AMP in our patients before the injection of the specific extract were 2.6 pmol/ml and this corresponded to the normal levels found in the controls in our laboratory (13.8 pmol/ml). After the injection of the allergen these levels increased by an amount that varied between 0.1 pmol/ml and 33.4 pmol/ml in 61.1% of the cases (p > 0.05). The cyclic AMP decreased by an amount that varied between 0.1 pmol/ml and 16.0 pmol/ml in 38.8% of the patients (p > 0.05).