A possible association of Pro12Ala polymorphism in peroxisome proliferator-activated receptor gamma2 gene with obesity in native Javanese in Indonesia.

BACKGROUND: Peroxisome proliferators-activated receptor gamma (PPAR gamma) is a nuclear hormone receptor that serves as a master regulator of adipocytes-specific genes contributing to adipocytes differentiation, susceptibility to obesity, and insulin sensitivity. The substitution of proline to alanine at codon 12 of the PPAR gamma2 gene (Pro12Ala polymorphism) is most frequently identified and the associations with diabetes, obesity, and other clinical parameters have been reported and discussed in several ethnic groups. Among native Javanese ethnicity, however, there is no report about this polymorphism. AIMS AND METHODS: Aims of this study were to estimate the allele frequency of the Pro12Ala polymorphism of PPAR gamma2 gene among native Javanese in Indonesia and to investigate the relationship between this polymorphism and obesity or diabetes. This study included 540 native Javanese subjects consisting of 337 diabetic patients and 203 normal glucose tolerance subjects. Both groups included totally 160 obese subjects (body mass index > or = 25 kg/m(2)). PCR-restriction fragment length polymorphism was used for the genotype determination. RESULTS: The allele frequency of Pro12Ala polymorphism in PPAR gamma2 gene among native Javanese is lower than that in other ethnic groups. No association is seen between the Pro12Ala and diabetes (0.01 vs 0.017%, p = 0.404), a trend of the higher BMI was observed in Pro12Ala carriers in nondiabetic subjects, although this association is limited by small numbers. CONCLUSION: In this study, no association is seen between the Pro12Ala polymorphism in PPAR gamma2 gene and diabetes; a weak association with obesity is seen.

Allergic and immunologic profile of symptomatic Persian Gulf War veterans.

BACKGROUND: Persian Gulf War veterans have been enrolled in the Veterans Administration Persian Gulf Health Registry for evaluation of unexplained symptoms and illnesses. The allergy and immunology division at the West Los Angeles Veterans Administration Medical Center evaluated 20 consecutive symptomatic Persian Gulf War veterans. OBJECTIVE: The purpose of this study was to examine the immunologic profiles of symptomatic Persian Gulf War Veterans. METHODS: A detailed history was obtained that included duties/responsibilities, length of time in the Persian Gulf, location, and exposures during the Gulf War. A complete physical examination was performed, with extensive laboratory testing and immediate and delayed hypersensitivity skin testing. Data from these Persian Gulf War Veterans were compared with a control population consisting of 44 non-Persian Gulf War veterans enrolled in our allergy and immunology clinic. Presenting allergic symptoms, presence of atopy, and total serum IgE levels were compared. RESULTS: Persian Gulf study patients and registry patients had a broad spectrum of nonspecific symptoms as compared with allergy clinic control patients who had dermatologic and respiratory symptoms. Persian Gulf study patients with allergy symptoms had a higher mean IgE level (88.7 IU/mL) than Persian Gulf study patients without allergy symptoms (47.5 IU/mL). Persian Gulf study patients with positive skin tests had a higher mean IgE level (161.5 IU/mL) than Persian Gulf study patients with negative skin tests (22.3 IU/mL). Laboratory data showed no significant immune abnormalities. CONCLUSION: Our study showed that 20 Persian Gulf veterans with a multitude of nonspecific symptoms had no immune abnormality. Mean IgE levels and eosinophil counts correlated with atopic state and reported allergy symptoms.

Asthma: analysis of intubated patients over a one-year period.

Mortality rates for asthma have increased significantly since 1980. During a 12-month period [1990] at the West Los Angeles VA Medical Center, six asthma patients required intubation. Contributing factors to intubation were steroid dependence, atopy, beta-agonist overuse, infection, non-compliance, adverse drug reaction, and undertreatment with steroids.

IgG subclass deficiency associated with corticosteroids in obstructive lung disease.

IgG subclass levels were measured in three groups of adult patients with obstructive airways disease to discern the relationships among depressed IgG subclass levels, chronic corticosteroid use, and recurrent sinopulmonary infections. Group 1 consisted of patients with corticosteroid-dependent bronchial asthma, group 2 patients had corticosteroid-dependent chronic bronchitis/emphysema, and group 3 was comprised of asthma patients not requiring oral corticosteroids but associated with recurrent sinopulmonary infections. One or more IgG subclass deficiencies were noted in 66.7 percent of group 1, 46.7 percent of group 2, and 6.7 percent of group 3. Significant differences were noted between groups 1 and 3 (p = .0008) and between groups 2 and 3 (p = .018), but not between groups 1 and 2 (p = .5). IgG1 deficiency was the most common subclass deficiency found; 14 (77.8 percent) of 18 patients with detectable subclass deficiency demonstrated IgG1 deficiency. In this study population, IgG subclass level deficiencies appeared to be secondary to long-term low-dose corticosteroid therapy.

Enalapril induced angioedema.

A report of three patients who developed angiodema while receiving enalapril. Patient 1 came in with an 8-hour history of facial swelling after enalapril had been started 2 days earlier. The second patient came in with severe angiodema of the tongue, larynx, and glottis requiring emergency tracheostomy, hydroxyzine, and steroids. He had been treated with enalapril for 1 year. The third patient developed facial swelling within a few hours of the first dose of enalapril. Angiodema with enalapril can occur early or late in the course of therapy. A possible mechanism for this drug reaction is the potentiation of bradykinin with resultant kinin system activation.

Predictive value of monitoring expiratory peak flow rates in hospitalized adult asthma patients.

This prospective single-blind study monitored the progress and outcome of 18 hospitalized asthmatic patients on intravenous corticosteroids by daily peak expiratory flow rate (PEFR) measurements to determine whether daily flow monitoring was useful as a guide for predicting response to therapy over the short- and long-term course posthospitalization. Daily monitoring of PEFR was helpful in demonstrating the response to therapy during hospitalization and at follow-up visit (1 to 2 weeks) posthospitalization. This change in PEFR during acute hospitalization and at initial follow-up visit did not correlate well with relapse or repeat hospitalization during the 5- to 17-month follow-up period.

Absence of tachyphylaxis to inhaled atropine in patients with chronic obstructive pulmonary disease.

A multicenter, 14-wk, double-blind, randomized, parallel group study of 60 patients with obstructive lung disease was performed to assess tachyphylaxis with inhaled atropine sulfate versus placebo. Forty patients completed the study; twenty-one were treated with placebo and nineteen were treated with atropine sulfate. Atropine and placebo groups were compared before and after inhaled atropine by spirometry at Weeks zero, 6, and 14. Medication side effects, other medication usage, and symptoms were recorded daily. Comparison of FEV1 response to atropine sulfate from baseline at Weeks zero, 6, and 14 did not show a statistically significant decrease. Inhaled atropine sulfate continued to be an effective bronchodilator in both placebo groups and atropine sulfate groups. There was no evidence of significant tachyphylaxis with atropine. Significant side effects in the atropine group when compared with placebo included dry mouth, dry skin, rapid heart rate, and nausea.