Immunosuppression protocols for HLA identical renal transplant recipients.
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Acute Disease↗
Biomedical subjects
D See
Publications and source records attributed to D See.
Hypnotizability and the use of traditional dhami-jhankri healing in Nepal.
This study examined the role of hypnotic responsiveness in the practice of a dhami-jhankri, a traditional Nepali healer. The hypnotic capacity of 248 male patients was measured in an allopathic (Western) clinic, an Ayurvedic (ancient Hindu healing art) clinic, and a dhami-jhankri's practice. Hypnotizability was assessed using the Hypnotic Induction Profile (HIP). The Induction scores of the HIP were significantly higher among the dhami-jhankri's patients than among either the Ayurvedic or allopathic patients. Furthermore, patients who returned to the dhami-jhankri were more highly hypnotizable than first-time dhami-jhankri patients. In addition, treatment satisfaction as reported by dhami-jhankri patients was positively correlated with HIP scores. The authors conclude that hypnotic phenomena as measured in the West might be an important component of the dhami-jhankri's treatment in the East.
Demography↗
Electrophoretic detection of single-nucleotide polymorphisms.
Single-nucleotide polymorphisms (SNPs) represent the most prevalent class of genetic markers available for linkage disequilibrium or cladistic analyses. PCR primers may be labeled with fluorescent dyes and used to rapidly and accurately differentiate among alleles that are defined by a single-nucleotide differences. Here, we describe the primer-mediated detection of SNPs based on primer mismatch during allele-specific amplification of preamplified target sequences. Primers are labeled with different fluors at their 5' nucleotides, with their 3' termini at the transition mutation that defines allelic variation at the target locus. Each primer perfectly matches one of the two available alleles for each locus. Electrophoretic detection permits characterization of the product both by size and fluor. This report demonstrates some of the capabilities of this assay, including heterozygote determination and multiplexed analysis.
Alleles↗
Successful short-term suppression of clarithromycin-resistant Mycobacterium avium complex bacteremia in AIDS. California Collaborative Treatment Group.
During a randomized study of clarithromycin plus clofazimine with or without ethambutol in patients with AIDS and Mycobacterium avium complex (MAC) bacteremia, eight participants received additional antimycobacterial drugs following the detection of a clarithromycin-resistant isolate (MIC, > 8 micrograms/mL). A macrolide (seven received clarithromycin, one azithromycin) and clofazimine were continued; additional treatment included various combinations of ethambutol, ciprofloxacin, amikacin, and rifabutin. After the detection of a resistant isolate and before receipt of additional antimycobacterials, the median peak MAC colony count in blood was 105 cfu/mL (range, 8-81,500 cfu/mL). After additional antimycobacterials, the median nadir MAC colony count was 5 cfu/mL (range, 0-110 cfu/mL). Five (63%) of eight patients had a > or = 1 log10 decrease, including two who achieved negative blood cultures; all of these responses occurred in patients originally assigned to clarithromycin plus clofazimine. Treatment of clarithromycin-resistant MAC bacteremia that emerges during clarithromycin-based treatment can decrease levels of bacteremia and transiently sterilize blood cultures.
AIDS-Related Opportunistic Infections↗
Annotation: children's disengagement from medical homes--a neglected public health imperative.
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Child↗
The capacity of a combined liposomal hepatitis B and C vaccine to stimulate humoral and cellular responses in mice.
Combined hepatitis B surface antigen and hepatitis C antigen were encapsulated into 1, 2, and 5 microm discrete liposomes and then lyophilized. Groups of adolescent CD-1 mice were given a single 0.3 mL oral dose of these liposomes containing 50 microg/mL hepatitis B surface antigen and hepatitis C antigen, 50 microg/mL of the same antigens or liposomes alone. Animals in each group were sacrificed every 2 weeks for 10 weeks and the humoral response investigated by enzyme-linked immunosorbent assay (ELISA) and the cellular response by splenic lymphocyte proliferation to 10 microg of either antigen. Seroconversion to both antigens in the mice receiving liposomal antigens occurred in 87.5% of animals sacrificed at 4 weeks and later. One animal (12.5%) receiving antigen alone seroconverted to hepatitis B virus at 6 weeks, but all animals receiving liposomes alone remained negative. Proliferation indexes (PI) greater than 3 were observed in all animals receiving liposomal antigens, with the greatest response seen at 10 weeks. PI was less than 2 for all animals in the other two groups. Thus, a single oral dose of liposomes of three sizes containing both hepatitis B and C antigens given to mice resulted in rapid seroconversion and a progressive robust cellular immune response, whereas the antigens alone or liposomes without antigen did not.
Animals↗
Application of an expert system in the management of HIV-infected patients.
A rule-based expert system, Customized Treatment Strategies for HIV (CTSHIV), which encodes information from the literature on known drug-resistant mutations was developed. Additional rules include ranking and weighting based on antiviral activities, redundant mechanisms of action, overlapping toxicities, relative levels of drug-resistance, and proportion of drug-resistant clones in the HIV quasispecies. Plasma was obtained from HIV-infected patients and the RNA was extracted. Segments of the HIV pol gene encoding the entire protease, reverse transcriptase, and integrase proteins were amplified by reverse transcriptase-polymerase chain reaction (using a total of three primer pairs) and cloned. Sequencing was performed on five clones from each of two patients. When the patient's RNA sequencing data were entered into the expert program, and the information was downloaded directly into the CTSHIV program, the five most effective two, three, and four drug regimens coupled with an explanation for their choice were displayed for each patient. Thus, the CTSHIV system couples efficient genetic sequencing with an expert program that recommends regimens based on information in the current medical literature. It may serve as a useful tool in the design of clinical trials and in the management of HIV-infected patients.
Anti-HIV Agents↗
A randomized evaluation of ethambutol for prevention of relapse and drug resistance during treatment of Mycobacterium avium complex bacteremia with clarithromycin-based combination therapy. California Collaborative Treatment Group.
Patients with AIDS and Mycobacterium avium complex (MAC) bacteremia are at high risk for relapse and emergence of resistant isolates during monotherapy with clarithromycin. Ninety-five AIDS patients with MAC bacteremia received clarithromycin plus clofazimine, with or without ethambutol, in a prospective, multicenter, randomized open-label trial. Of 80 patients with positive baseline cultures, sterilization or a 2 log10 reduction in colony-forming units of MAC in two consecutive blood cultures occurred in 69% of both groups. There were nine relapses in the two-drug arm and three in the three-drug arm. Kaplan-Meier estimates of risk of relapse at 36 weeks were 68% and 12%, respectively (P = .004). All relapse isolates were resistant to clarithromycin. Median time to clarithromycin resistance was 16 weeks with two drugs and 40 weeks with three drugs (P = .004). Ethambutol reduced relapses and emergence of clarithromycin resistance and should be considered an essential component of clarithromycin-based therapies for MAC bacteremia.
Adult↗
Liposomes modulate Kupffer cell endotoxin response.
OBJECTIVES: To test the hypothesis that pretreatment with liposomes enriched with the omega 3 fatty acid docosahexaenoic acid (22:6 omega 3) will alter the Kupffer's cell and systemic cytokine (tumor necrosis factor and interleukin-6) response to endotoxin challenge, and to demonstrate alterations in Kupffer's cell phospholipid fatty acid composition after in vivo liposome treatment. DESIGN: Nonrandomized controlled laboratory investigation in Wistar rats. INTERVENTIONS: Animals were assigned to three pretreatment groups: no liposomes; liposomes, 100 mg/kg; or liposomes, 400 mg/kg given by bolus intravenous injection with the animals under inhalation anesthesia. Eighteen hours after liposome treatment, each group was challenged with Escherichia coli lipopolysaccharide (3 mg/kg intraperitoneally in 10 mL of lactated Ringer's solution) or lactated Ringer's solution only. In a separate set of experiments, Kupffer's cells were obtained from animals pretreated with liposome, 400 mg/kg, or controls and challenged with lipopolysaccharide (1, 100, or 10(4) ng/mL) in vitro. OUTCOME MEASURES: Serum and Kupffer's cell supernatant tumor necrosis factor and interleukin-6 bioactivity, Kupffer's cell phospholipid fatty acid composition, survival, and liver histologic findings. RESULTS: In vivo liposome pretreatment (400 mg/kg) resulted in significant increases in serum tumor necrosis factor and interleukin-6 levels 90 minutes after intraperitoneal lipopolysaccharide challenge (P < .05 vs no liposomes). Kupffer's cells isolated from liposome-treated animals (400 mg/kg) compared with untreated controls release significantly more tumor necrosis factor and interleukin-6 after lipopolysaccharide stimulation in vitro in a dose-dependent response (P < .05). Liposome treatment increased total polyunsaturated fatty acid, total omega 3, and docosahexaenoic acid 22:6 omega 3 content in Kupffer's cell phospholipids compared with untreated controls. Survival 24 hours after lipopolysaccharide challenge was reduced by liposome (400 mg/kg) pretreatment (P < .05 by chi 2 test). Livers from each treatment group demonstrated focal areas of hepatocyte necrosis and inflammatory cells. CONCLUSION: Liposome pretreatment increases the circulating and Kupffer's cell cytokine response to endotoxemia, increases Kupffer's cell polyunsaturated fatty acid content, and is associated with reduced survival.
Animals↗
Toxicity of deltamethrin and cypermethrin to the larvae of the diamond-back moth, Plutella xylostella L.
Two photostable pyrethroids, deltamethrin and cypermethrin, were tested against fourth instar larvae of a susceptible (S) strain and a resistant (R) strain of Plutella xylostella L. by topical application. Both compounds were very effective against the S strain larvae (LD50 for deltamethrin = 0.0014 micrograms/larva, LD50 for cypermethrin = 0.0046 micrograms/larva, at 48 h). However, the R strain collected from the field was greater than 1600-fold resistant to deltamethrin and greater than 30 000-fold resistant to cypermethrin. Deltamethrin was poorly synergised with piperonyl butoxide in the S strain, but much stronger synergism was obtained in the R strain. The possible reasons for such high levels of resistance and the potential use of synergised pyrethroids in Plutella control programmes are discussed.
Animals↗
Cytokine production by adherent and non-adherent mononuclear cells in chronic fatigue syndrome.
It has been suggested that cytokines play a role in certain clinical manifestations of chronic fatigue syndrome (CFS). In this study adherent (monocytes) and non-adherent (lymphocytes) mononuclear cells were stimulated in the presence or absence of phytohemagglutinin (PHA) or lipopolysaccharide (LPS), respectively, and supernatants were assayed for IL-6, TNF-alpha, and IL-10 by ELISA. IL-6 was also measured at the mRNA level by polymerase chain reaction. The levels of spontaneously (unstimulated) produced TNF-alpha by non-adherent lymphocytes and spontaneously produced IL-6 by both adherent monocytes and non-adherent lymphocytes were significantly increased as compared to simultaneously studied matched controls. The abnormality of IL-6 was also observed at mRNA level. In contrast, spontaneously produced IL-10 by both adherent and non-adherent cells and by PHA-activated non-adherent cells were decreased. This preliminary study suggests that an aberrant production of cytokines in CFS may play a role in the pathogenesis and in some of the clinical manifestations of CFS.
Adult↗