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Biomedical subjects

H Shah

Publications and source records attributed to H Shah.

At least 19 recordsLinked to original sources

Self tolerance to T cell receptor V beta sequences.

T cell tolerance to self is achieved by deletion or inactivation of clones recognizing peptides of self proteins presented by major histocompatibility complex molecules. A considerable fraction of self proteins accessible to the immune system is contributed by the system itself, for example, the receptors used for antigen recognition (antibodies and T cell receptors [TCRs]). Thus far, it has remained unclear, whether antigen receptors are subject to self tolerance, or on contrary, engage into network interactions implying immunity rather than tolerance. In this study, we demonstrate self tolerance to synthetic peptides corresponding to the first hypervariable region of the V beta 8.1 and V beta 8.2 TCR proteins. We also show that the tolerogenic synthetic peptide corresponds to a fragment produced by processing of the V beta protein, and conversely, that a V beta peptide not produced by processing is also not subject to self tolerance. Thus, the rules of tolerance seem to apply to antigen receptors, at least to their germline-encoded portions, in a similar fashion as to other self proteins. This finding has important implications for studies of natural and artificially induced immune networks.

Amino Acid Sequence

Mycoses of the breast: diagnosis by fine-needle aspiration.

Fungal infections of the breast are unusual and may clinically mimic carcinoma. When studied by fine-needle aspiration (FNA), such masses may yield necrosis, granulomatous inflammation, reactive histiocytes, and atypical epithelial cells. Cohesive groups of atypical epithelial cells featured nuclear enlargement and overlapping, as well as prominent nucleoli. The organisms may be widely scattered, so that careful evaluation was required for their identification. In concert with provocative clinical findings, these features may lead to an erroneous diagnosis of malignancy. We describe three women with mycotic masses of the breast initially studied by FNA. The first patient presented at age 31 with a large, firm breast mass, chest wall extension, and radiographic evidence of vertebral bone involvement. FNA was requested to confirm the clinical diagnosis of advanced breast carcinoma. In addition to the atypia described above, the smears showed yeast forms indicative of blastomycosis surrounded by neutrophils. She remains well, following antifungal treatment. The second case of Blastomycosis was diagnosed by FNA of a breast mass in a 64-yr-old woman, who also responded to treatment. The third patient's preoperative needle aspiration showed granulomas, but no organisms were identified, even with special stains; silver stains of surgically excised tissue showed histoplasmosis.

Adult

A retrospective review of cases of anaerobic empyema and update of bacteriology.

We conducted a retrospective study to update the bacteriology of 46 cases of anaerobic empyema that were originally studied between 1976 and 1993 at the Wadsworth Anaerobic Bacteriology Clinical Research Laboratory (Los Angeles). Anaerobic bacteriologic studies were completed for all 46 pleural fluid specimens, and aerobic bacteriologic studies were completed for 41 of these specimens. Thirty-seven clinical charts were available for review. A total of 161 anaerobic isolates (3.5 per patient) representing 64 species or groups were recovered. The most common isolates were as follows: Fusobacterium nucleatum (19); Prevotella oris-buccae group (13, 9 of which were P. oris); Bacteroides fragilis group (11, 4 of which were B. fragilis); pigmented Prevotella species (17, 8 of which were in the Prevotella intermedia-nigrescens group); Peptostreptococcus species (17, 9 of which were Peptostreptococcus micros); Eubacterium species (7); Lactobacillus species (8); Actinomyces species (7); and Clostridium species (7). Nineteen if the cases were of purely anaerobic etiology; of these, eight were caused by a single organism: F. nucleatum (five cases); B. fragilis (two cases); and Prevotella mangus (one case). Of the 45 aerobic isolates (1.1 per patient), viridans streptococci were most common (21 isolates), followed by group D nonenterococcal streptococcus (four isolates). Only nine gram-negative rods (six enteric and three nonenteric organisms) and one Staphylococcus aureus isolate were recovered. The susceptibility to penicillin of 64 isolates was examined with the use of the spiral gradient method; 21 (33%) of these isolates were beta-lactamase positive (MICs ranged from 1.1 to > or = 54 micrograms/mL vs < or = 0.27 micrograms/mL for beta-lactamase-negative strains).

Adult

Benign tumors of the tracheobronchial tree. Endoscopic characteristics and role of laser resection.

We conducted a review of all the bronchoscopies performed at our institutions for benign tumors from 1980 to 1991 to determine the endoscopic characteristics of these lesions. We reviewed the charts, the endoscopic characteristics from our video records, and finally the pathologic findings of these cases. We tried to identify the effectiveness of laser resections in each group. Of a total of 3,937 patients, 185 (4.7%) were benign tumors. On these patients, 317 procedures were carried out. There were 3 myoblastomas, 53 papillomas, 1 adenoma, 8 chondromas, 4 fibromas, 45 hamartomas, 15 hamartochondromas, 6 lipomas, 19 angiomas, 5 leiomyomas, 4 schwannomas, 1 neurofibroma, and 21 amyloidomas. Results of laser resection were "very good" in 115 (62%) and "good" in 70 (38%). Complications were minimal: two mediastinal emphysemas, one pneumothorax, and one anesthesia-related cardiac arrest leading to the single death in this series. In general, benign tumors of the proximal endobronchial tree responded well to laser resection when their endoscopic appearance is recognized and prognosis known. Even when recurrent, repeated procedures can be performed easily with good results. This series is probably the largest in the world's literature about endoscopic recognition and the role of laser resection in patients presenting with benign endobronchial tumors.

Adult

Presentation of a viral T cell epitope expressed in the CDR3 region of a self immunoglobulin molecule.

Synthetic peptides corresponding to microbial epitopes stimulate T cell immunity but their immunogenicity is poor and their half-lives are short. A viral epitope inserted into the complementarity-determining region 3 (CDR3) loop of the heavy chain of a self immunoglobulin (Ig) molecule was generated from the Ig context and was presented by I-Ed class II molecules to virus-specific, CD4+ T cells. Chimeric Ig-peptide was presented 100 to 1000 times more efficiently than free synthetic peptide and was able to prime virus-specific T cells in vivo. These features suggest that antigenized Ig can provide an improved and safe vaccine for the presentation of microbial and other peptides.

Amino Acid Sequence

Cells expressing an H chain Ig gene carrying a viral T cell epitope are lysed by specific cytolytic T cells.

The epitope corresponding to amino acid residues 147-161 of the nucleoprotein (NP) of influenza A virus is recognized by CTL in association with H-2Kd class I Ag. Herein, we engineered an Ig molecule carrying this CTL epitope by replacing the diversity gene segment of the H chain V region of an anti-arsonate antibody with an oligonucleotide that encodes the CTL epitope. The chimeric H chain gene was expressed either alone or together with the parental L chain in the nonsecreting BALB/c myeloma B cell line, SP2/0. The Ig produced by cells transfected with both the chimeric H chain and parental L chains genes expressed the NP epitope but lost the original arsonate binding activity. In addition, SP2/0 cells expressing the chimeric H chain either alone or together with the parental L chain were lysed by class I restricted NP-epitope specific CTL. By contrast, SP2/0 cells pulsed with soluble chimeric Ig molecules were not lysed by the specific CTL. These observations indicate that: 1) this particular CTL epitope can be expressed on Ig molecules without altering the H and L chain pairing; 2) this CTL epitope can be generated from this chimeric Ig in which it is surrounded by flanking regions distinct from those of the viral NP; and 3) the generation of this CTL epitope from the Ig molecule requires the endogenous pathway as do viral proteins.

Amino Acid Sequence

Crossed renal ectopia. Correlative imaging.

Anatomic variants of the kidneys are often noted during renal scintigraphy and other imaging studies. These conditions have a variable effect on overall renal function and can cause confusion, both clinically and on initial imaging. The authors describe a case of unfused, crossed renal ectopia in an elderly woman that appeared to be an abdominal mass and was subsequently evaluated by computed tomography, ultrasound, and scintigraphy.

Aged

An unusual complication of paracentesis.

Paracentesis is an important and commonly performed procedure in patients with ascites. It is a safe procedure when carried out in the midline below the umbilicus, with a complication rate of less than 1%. We report an instance in which a large midline varix was entered during paracentesis. The utility of different imaging techniques in detecting such anomalies in the portal hypertensive patient with portal hypertension and ascites is discussed. The approach and management of this complication are outlined.

Abdominal Muscles

Bone tuberculosis in Abbottabad.

Eighty patients of bone and joint tuberculosis were diagnosed and treated at DHQ Teaching Hospital, Abbottabad from August, 1987 to December, 1990. Majority of them were children and young adults. There were more females (57.5%) than males (42.5%). A major fraction of the cases were Afghan refugees. Most of the patients were malnourished and belonged to low socioeconomic class.

Adolescent

Induction of antibodies to the envelope protein of the human immunodeficiency virus by immunization with monoclonal anti-idiotypes.

Anti-idiotypes that possess the internal image of antigen can induce protective humoral immunity toward microbes. Herein we demonstrate antigen mimicry by monoclonal anti-idiotypes of a distinct epitope of the human immunodeficiency virus (HIV) envelope protein that is defined by a synthetic peptide. This peptide, corresponding to amino acid residues 503-535 (peptide 503-535) of HIV-1 IIIB gp160, induced antibodies in three mammalian species that interacted with HIV-1 gp120 and inhibited in vitro syncytium formation caused by HIV-1, IIIB and MN isolates. Three monoclonal anti-idiotypes were generated against rabbit anti-gp120 antibodies specific for peptide 503-535. These anti-idiotypes recognize an interspecies cross-reactive idiotype expressed on mouse, chimpanzee, baboon, rabbit, and human anti-gp120 antibodies specific for peptide 503-535. The interaction with the cross-reactive idiotype is inhibited by synthetic peptide and HIV-1 gp160. Furthermore, rabbits immunized with the monoclonal anti-idiotypes produced antibodies that also bind HIV-1 gp120 and gp160 and recognized the epitope defined by peptide 503-535.

Amino Acid Sequence

Cloning and expression of a Porphyromonas (Bacteroides) gingivalis protease gene in Escherichia coli.

A genomic library of Bacteroides gingivalis W83 chromosomal DNA was constructed in the Escherichia coli lambda (lambda) vector EMBL 4. Three recombinant lambda phages expressing a cloned protease were identified in the library. All three lambda phages contained cloned overlapping DNA fragments from the same region of the chromosome and encoded the same cloned protease. The cloned protease was expressed poorly using its own promoter in E. coli.

Bacteroides

Ciliary motility in two patients with yellow nail syndrome and recurrent sinopulmonary infections.

The yellow nail syndrome (YNS) is described as a combination of yellow nails, chronic lymphedema, pleural effusions, and recurrent sinopulmonary infections, but all these features need not be present for the diagnosis. The mechanism that renders patients with this syndrome susceptible to respiratory infections is not known. To determine whether abnormal ciliary motility is a predisposing factor, in vitro ciliary beat frequency (CBF) was measured in two patients with YNS and recurrent respiratory infections. In each case, the CBF was within normal limits (12 Hz). These data suggest that abnormal ciliary motility is not a pathophysiologic mechanism of recurrent sinopulmonary infections in YNS.

Adult

Surface properties and ultrastructure of Porphyromonas gingivalis W50 and pleiotropic mutants.

Cell surface ultrastructure and other surface properties of Porphyromonas gingivalis strain W50 and pleiotropic mutants W50/BP1 (brown), and W50/BE1 (beige) were studied. The percentage hydrophobicity of strains W50, W50/BP1, W50/BR1, and W50/BE1 gradually decreased from 24 to 9. Ruthenium red stained cells studied by transmission electron microscopy revealed a layer of extracellular polymeric material of varying thickness depending on the strain. The layer was thickest in W50/BP1 (15-20 nm), strains W50 and W50/BR1 both had a layer of 12-15 nm, while strain W50/BE1 completely lacked this layer. The results clearly showed that the hydrophobicity of P. gingivalis was related not only to the thickness of the layer but also to other factors like the composition of the capsular material, such that only strain W50/BE1, for example, showed no haemagglutinating activity. The surface properties of the pleiotropic mutants appeared to be stable characteristics as cells grown on either solid or in liquid media gave comparable results. The loss of virulence of the beige strain (W50/BE1) is probably partly due to the alteration of these surface properties. Both virulent and avirulent strains, however, possessed extracellular vesicles.

Bacteroides

Biochemical and structural characterization of an unusual group of gram-negative, anaerobic rods from human periapical osteitis.

The biochemical and chemotaxonomic properties of three previously undescribed strains from human dental root canal infections are presented. The strains were obligately anaerobic Gram-negative rods with fimbriae and a thick capsule-like structure. Carbohydrates were not fermented and agglutination tests were negative. The presence of alpha-galactosidase, alpha- and beta-glucosidase, beta-N-acetylglucosaminidase and beta-galactosidase was confirmed. The strains produced acetic and succinic acids as metabolic end products. They contained a peptidoglycan structure based upon meso-diaminopimelic acid (Al gamma) and lacked respiratory quinones. The cellular fatty acids were mainly straight-chain saturated and methyl-branched molecules. High interstrain DNA homology was observed and the DNA base compositions were between 56 and 59 mol % G + C. These three strains appear to comprise the nucleus of a new genus of anaerobic, Gram-negative rods from odontogenic infections.

Adult

Black-pigmented Bacteroides spp. in human apical periodontitis.

The incidence of black-pigmented (BP) Bacteroides spp. in 62 human dental root canal infections (35 acute and 27 clinically asymptomatic cases of apical periodontitis) in 57 adults was studied. Altogether 37 strains of BP Bacteroides were found in 31 infections, always in mixed anaerobic infections. Two different BP Bacteroides species were present in six infections. B. intermedius was most frequently isolated (15 of 62 canals; 24%) followed by B. denticola which was present in 12 cases. Asaccharolytic BP Bacteroides species, B. gingivalis and B. endodontalis, were found in eight cases. BP Bacteroides species were found both from symptomatic and asymptomatic infections, but there were also several symptomatic cases from which BP Bacteroides species were not isolated. B. gingivalis and B. endodontalis were present only in acute infections, B. intermedius was found both in symptomatic and asymptomatic infections, and B. denticola occurred mostly in asymptomatic infections. BP Bacteroides species were isolated initially from 9 of the 11 teeth with symptoms at 1 week, but only from 22 of the 51 teeth that were symptomless at 1 week. Two strains of B. denticola were resistant to penicillin G at a concentration of 2.4 micrograms/ml, but the MIC of penicillin G for all other strains was 0.6 micrograms/ml or lower. Forty-two randomly selected patients received penicillin V (oral administration, 650 mg, three times daily) during the first week of endodontic therapy. Penicillin had no effect on the occurrence of symptoms after 1 week compared with the control group (20 patients).

Adult

Bremsstrahlung imaging after 32P treatment for residual suprasellar cyst.

A patient with residual suprasellar cystic neoplasm was treated by direct instillation of the 32P colloid. The incidental bremsstrahlung images on a conventional gamma camera helped to localize the pharmaceutical within and outside of the lesion. Advantages of bremsstrahlung imaging and the dosimetry results of phantom studies carried out are described.

Craniopharyngioma