Severity of asthma: the role of CD25+, CD30+, NF-kappaB, and apoptotic markers.

OBJECTIVES: We studied the role of the regulatory T cells CD4+CD25+ (Treg) and activated CD4+CD30+ cells in the pathogenesis of asthma and their association with apoptosis and NF-kappaB in patients with mild intermittent asthma (MA), severe persistent asthma (SA), and healthy volunteers (HV). METHODS: Peripheral blood lymphocytes (PBL) were extracted from asthmatic patients during exacerbations, and CD4+ cells were separated using Dynal beads. Immunostaining of whole PBL for NF-kappaB, Bax, and Bcl-2, and immunostaining of CD4+ cells for CD25+ and CD30+ cells were performed using immunocytochemistry. RESULTS: Treg cells were expressed at higher levels in MA than in HV and SA (P < .05), while CD30+ T cells were expressed at higher levels in both SA and MA than in HV (P < .05), although there was no remarkable difference between SA and MA (P>.05). Levels of NF-kappaB, Bcl-2, and Bcl-2/Bax increased, whereas those of Bax decreased, progressively, from MA to SA (P < .05). NF-kappaB levels correlated directly with the Bcl-2/Bax ratio and with CD4+CD30+ cells in SA and MA, whereas CD4+CD30+ cells correlated inversely with the Bcl-2/Bax ratio. CONCLUSIONS: Unregulated Treg cells probably return inflammatory responses to normal values during exacerbations in MA; however, expression of Treg cells was extensively diminished in SA, leading to probable loss of suppressive control over underlying immune reactions. CD4+CD30+ cells were associated with the pathogenesis of asthma but not with severity. NF-kappaB seems to be the central inflammatory factor in SA, with a remarkable loss of PBL apoptosis, diminished Treg levels, and high CD30+ cell levels that probably induce NF-kappaB, which in turn blocks the proapoptotic potential of CD30 induction itself.

Thermal Behavior of Selected Starches in Presence of Other Food Ingredients Studied by Differential Scanning Calorimetery (DSC)-Review.

This review article highlights the thermal behaviors of selected starches that were studied using differential scanning calorimetery (DSC) with data shown in various research publications. The starches of sago, potato, sweet potato, cassava, yam, and corn are included in this overview. Our examinations indicate that thermal properties are highly affected by the type of starch, its amylose/amylopectin content, and the presence of other food ingredients such as sugar, sodium chloride, water, milk, hydrocolloids, and meat. When the heating temperatures of the starches were increased, the DSC measurements also showed an increase in the temperatures of the gelatinization (onset [To ], peak [Tp ], and conclusion [Tc ]). This may be attributed to the differences in the degree of crystallinity of the starch, which provides structural stability and makes the granule more resistant to gelatinization.

The distinctive profile of risk factors of nasopharyngeal carcinoma in comparison with other head and neck cancer types.

BACKGROUND: Nasopharyngeal carcinoma (NPC) and other head and neck cancer (HNCA) types show a great epidemiological variation in different regions of the world. NPC has multifactorial etiology and many interacting risk factors are involved in NPC development mainly Epstein Barr virus (EBV). There is a need to scrutinize the complicated network of risk factors affecting NPC and how far they are different from that of other HNCA types. METHODS: 122 HNCA patients and 100 control subjects were studied in the region of the Middle East. Three types of HNCA were involved in our study, NPC, carcinoma of larynx (CL), and hypopharyngeal carcinoma (HPC). The risk factors studied were the level of EBV serum IgG and IgA antibodies measured by ELISA, age, sex, smoking, alcohol intake, histology, and family history of the disease. RESULTS: EBV serum level of IgG and IgA antibodies was higher in NPC than CL, HPC, and control groups (p < 0.01). NPC was associated with lymphoepithelioma (LE) tumors, males, regular alcohol intake, and regular smoking while CL and HPC were not (p < 0.05). CL and HPC were associated with SCC tumors (p < 0.05). Furthermore, NPC, unlike CL and HPC groups, was not affected by the positive family history of HNCA (p > 0.05). The serum levels of EBV IgG and IgA antibodies were higher in LE tumors, regular smokers, younger patients, and negative family history groups of NPC patients than SCC tumors, non-regular smokers, older patients and positive family history groups respectively (p < 0.05) while this was not found in the regular alcoholics (p > 0.05). CONCLUSION: It was concluded that risk factors of NPC deviate much from that of other HNCA. EBV, smoking, alcohol intake, LE tumors, male patient, and age > 54 years were hot risk factors of NPC while SCC and positive family history of the disease were not. Earlier incidence, smoking, LE tumors, and negative family history of the disease in NPC patients were associated much clearly with EBV. It is proposed that determining the correct risk factors of NPC is vital in assigning the correct risk groups of NPC which helps the early detection and screening of NPC.

Changing survival, memory cell compartment, and T-helper balance of lymphocytes between severe and mild asthma.

BACKGROUND: Asthma is a complicated network of inflammatory reactions. It is classified into mild, moderate, and severe persistent asthma. The success of asthma therapy relies much on understanding the underlying mechanisms of inflammation at each stage of asthma severity. The aim of this study was to explore the differences in apoptotic potential, CD4/CD8 ratio, memory compartment, and T- helper (Th) 1 and 2 profile of peripheral blood lymphocytes (PBL) in patients with mild intermittent asthma and severe persistent asthma during exacerbation periods. RESULTS: Four research lines were investigated and compared among mild asthmatics, severe asthmatics, and healthy groups by applying immunocytochemical staining of PBL. Antiapoptotic and proapoptotic proteins with Bcl-2/Bax ratio, CD4, CD8 markers with CD4+/CD8+ ratio, CD45RO+, CD45RA+ markers with memory/naive ratio (CD45RO+/CD45RA+). Th2/Th1 cytokines balance represented by IL-4/IFN-gamma ratio was measured by enzyme-linked immunosorbent assay (ELISA) for in vitro PBL cytokine synthesis. It was found that Bcl-2/Bax ratio was higher in severe than in mild asthmatics which in turn was higher than in healthy group. And memory/naive ratio of PBL was higher in severe than in mild asthmatics. Moreover, memory cells, CD45RO+ and CD45RO+/CD45RA+ ratio were correlated directly with Bcl-2/Bax, in severe and mild asthma patients. In contrast, CD4+/CD8+ ratio was not changed significantly among healthy group, mild and severe asthmatics. However, CD8+ cells were correlated directly with memory cells, CD45RO+, in severe asthmatics only. Interestingly, the dominant profile of cytokines appeared to change from T helper 2 (Th2) in mild asthmatics to T helper 1 (Th1) in severe asthmatics where the lowest in vitro IL-4/IFN-gamma ratio and highest IFN-gamma were found. CONCLUSION: It was concluded that the underlying mechanisms of inflammation might vary greatly with asthma stage of severity. Mild intermittent asthma is mainly Th2 allergen-oriented reaction during exacerbations with good level of apoptosis making the inflammation as self-limiting, while in severe persistent asthma, the inflammatory reaction mediated mainly by Th1 cytokines with progressive loss of apoptosis leading to longer exacerbations, largely expanded memory cells, CD45RO+, leading to persistent baseline inflammation.

Therapeutic re-appraisal of multiple drug resistant Salmonella typhi (MDRST) in Pakistani children.

BACKGROUND: The emergence of multi drug-resistant Salmonella typhi (MDRST) in many developing countries including Pakistan, has led to a search for suitable alternatives to conventional therapy. Quinolones have been found to be an effective alternative for the treatment of MDRST, in adults as well as in children. METHODS: The efficacy of various therapeutic regimens currently used for the treatment of Typhoid was analysed. Children 1 month to 12 years of age admitted to the Children's Hospital from 1990 to 1993 with fever and Salmonella typhi isolated from blood cultures were included in this retrospective analysis. RESULTS: The cumulative prevalence of Multiple Drug Resistant Salmonella typhi (MDRST) was 67.2%. Only 32.8% of isolated Salmonella typhi were susceptible to chloramphenicol and amoxicillin. The cumulative cure rate with conventional therapy (chloramphenicol or amoxicillin) was 47.4% and 53.6% children needed a change of therapy. The average hospital stay for the non-responders to conventional therapy was 9.2 days as compared to 7.7 days for the responders. The average hospital stay of the patients treated with a third generation cephalosporin was 12.7 days. Patients treated with ofloxacin, a flouroquinolone drug, did not need a change of therapy. The average hospital stay of the patients treated with flouroquinolones was 6.2 days. CONCLUSION: There was a high prevalence of multiple drug resistant typhoid fever in hospitalized children, leading to a high failure rate with conventional therapy. This resulted in frequent change of therapy, delayed defervesence and prolonged hospital stay. The flouroquinolones were found to be the most effective drug against MDRST.

Fat absorption in persistent diarrhoea using 13C-labelled trioctanoin breath test.

A study was undertaken to investigate intestinal fat absorption in young children suffering from persistent diarrhoea in comparison with normal children of similar age. Absorption studies were performed using the breath test technique. Following oral administration of labelled triglyceride ([13C]trioctanoin), interval breath sampling was done for 6 h. The time course of excretion of 13CO2 in the breath was determined by isotope ratio mass spectrometric analysis of the gas samples. Excretion curves were constructed from the mean values of 13CO2 dose (per cent) excreted at each time point in breath samples and areas under the curve were determined for diarrhoea cases as well as for normal subjects. The time course of 13CO2 excretions and areas under the curve thus obtained were compared with each other and also with a reference study in which data from known malabsorption cases were available. The time of peak 13CO2 excretion in diarrhoea cases ranged from 60 to 240 min (average 150 min) compared with 120 to 270 min (average 195 min) for normal subjects, the level of peak of 13CO2 excreted/h was 4.8 +/- 1.2 per cent in diarrhoea cases and 5.3 +/- 2.3 per cent in normal children (NS). Mean areas under the curve for the two groups were 18.9 +/- 3.4 per cent for normal and 17.6 +/- 4.1 per cent dose 13CO2 excreted/6 h for diarrhoea cases (NS). These results indicate that intestinal absorption of medium chain triglycerides was not impaired significantly in the cases of persistent diarrhoea studied.

Dexamethasone and bacterial meningitis in Pakistan.

The objective of this study was to assess, in a developing country setting, the effect of dexamethasone therapy on bacterial meningitis outcomes. A prospective double blind placebo controlled trial was conducted in 89 children aged from 2 months to 12 years suffering from bacterial meningitis. Neurological, developmental, and hearing assessments were conducted at one, four, and 12 months after discharge. Forty eight patients received dexamethasone and 41 placebo. Initial antimicrobial drugs used were ampicillin and chloramphenicol. For all patients at the time of admission the mean duration of illness was 5.7 days; 47% had had seizures and 56% had impaired consciousness. Seventeen of 89 (19%) patients died. The mortality for the dexamethasone group was 25% as compared with 12% in the group receiving placebo. Presentation to the hospital after four days of symptoms and with impaired conscious state were independent predictors of death. Of the dexamethasone group survivors, 26.5% had neurological sequelae and 42.3% had hearing impairment, whereas in the placebo group it was 24% and 30% respectively. Altered state of consciousness was a predictor of neurological sequelae. The presence of neurological sequelae and high cerebrospinal fluid protein independently predicted hearing loss. No beneficial effect of dexamethasone was observed on morbidity or mortality of this group of patients with bacterial meningitis. Dexamethasone is therefore not useful in developing countries as adjunctive treatment in patients seriously ill with bacterial meningitis, who present late for treatment and have been partially treated.

Counselling in a hospital setting. Breastfeeding.

PIP: In 1990, a lactation management clinic was established at Children's Hospital in Islamabad, Pakistan, with the goal of promoting exclusive breast feeding for 4-6 months. Mothers who are experiencing problems breast feeding are referred to this specialized service from other units of the hospital. The clinic is staffed by two public health nurses. At intake, both mother and infant are examined and the attempt to breast feed is observed. Where appropriate, guidance is provided about how to position the infant during breast feeding. In addition, a social history that seeks information on the attitudes toward breast feeding on the part of the husband and extended family is taken to detect any psychosocial obstacles to a successful nursing experience. In some cases, breast feeding is prematurely terminated due to women's concerns that their breast milk is of poor quality or the insistence of significant others that the infant is not gaining enough weight. To date, the clinic has counseled over 4000 mothers. A follow-up survey of 273 of these women indicated that 67% had resolved their breast feeding problem. Three months after the initial consultation, 61% of these mothers were still exclusively breast feeding, 25% were providing both breast milk and supplemental fluids, and only 9% had weaned their infant.^ieng

Clinical profile of acute rheumatic fever in children.

A prospective study was done to determine the clinical profile of acute rheumatic fever in the first attacks and in recurrences separately. The data were compared with those from other countries. Eighty children were in their first attack while 46 had recurrences. Arthritis, the most common manifestations, was seen in 61 per cent of patients with first attack followed by carditis in 41 per cent, chorea in 28 per cent and subcutaneous nodules in 3 per cent. However, in the recurrences, arthritis was present in 52 per cent, carditis in 81 per cent, chorea in 11 per cent, and nodules in 4 per cent of cases. In both the groups, no case with erythema marginatum was seen. The results show that in the first attack the clinical picture broadly resembles that in European and North American countries. The presenting symptoms and signs are different during recurrence.