We report a previously undocumented drug interaction between cyclosporine A and quinine. A 39 year old Asian with a recent renal transplant was diagnosed to have a mild cerebral falciparum malaria. He was treated with seven days of oral quinine (600 mg, 8 hourly), followed by a stat dose of pyrimethamine (75 mg)--sulfadoxime (1200mg) because of a strong suspicion of chloroquine resistant falciparum malaria. Using a polyclonal radioimmunoassay method, we measured morning trough cyclosporine A level before, during and after the quinine treatment. Results showed a gradual decrease in the cyclosporine A level from a baseline value of 328 ng/ml to 107 ng/ml after seven days of oral quinine with a subsequent rise to pre-treatment level after discontinuation of quinine. There was no significant change in the dose of cyclosporine A administered during the period of quinine treatment (4.05 to 3.83 mg/kg body weight). Biochemical liver function tests, serum creatinine and hematological parameters were also essentially unchanged during this period. In vitro study showed no significant methodological interference in the cyclosporine assay by quinine dihydrochloride. These findings suggest an in vivo drug interaction between cyclosporine A and quinine. The mechanism of this interaction is not clear. Further studies are required to confirm the significance of this observation. Quinine and its stereoisomer, quinidine should be used with caution until further information is available.
Transmigration is the migration of a tooth across the midline of the jaw. This phenomenon is found only in relation to the permanent mandibular canines. Two cases are reported. In both, the cause of this deviation was an odontome found in the site normally occupied by the mandibular canine. The literature on transmigration is reviewed.
Fifty children aged 6 to 13 years and infected with Ascaris lumbricoides were selected for the study. The number of eggs laid daily by a female Ascaris increased with increase in its length, weight and diameter. Female worms became mature and started laying eggs when they reached a length of 118 mm. Adult female worms measuring 3.7 mm or more in diameter were found to be mature. The minimum weight of a worm producing eggs was 1.1 g. On average the number of eggs produced by the female decreased with increase in the worm load.
Eruption of a tooth into a nonoral environs is rare. Ectopic eruption of the tooth into the nasal cavity and chin has been reported before. This is a report of an ectopic third molar tooth in the roof of the maxillary sinus, which has not, to our knowledge, been reported before.
Three pyrethroids were evaluated in the laboratory against Aedes albopictus females by exposure to insecticide impregnated papers, and to 4th instar Ae. albopictus larvae as insecticide solutions. Lambda-cyhalothrin was found to be the most effective pyrethroid when tested against Aedes albopictus adult females and larvae compared with that of deltamethrin and permethrin.
Hematological changes were monitored in the leaf-monkey, Presbytis cristata, infected experimentally with 200 subperiodic Brugia malayi infective larvae. Prepatent periods were 54-86 days and peak microfilarial geometric mean counts (GMCs) were 1324 per ml blood. Total leukocyte and differential counts were measured at pre-infection, and then at weakly intervals before and during patency. Blood eosinophil level increased to about thrice the initial level at 3 weeks post-infection and this was maintained for the next 13 weeks before it started to rise again, increasing to more than 5 times the initial level at 20 weeks post-infection. The observed pattern of eosinophilia is probably related to the level of microfilaremia and the destruction of microfilariae in the spleen. There was no significant change in the total leukocyte counts during the period of observation.
Stool samples from 836 cases with diarrhea and acute gastroenteritis from the Pediatric ward, Penang General Hospital, were examined for Cryptosporidium oocysts. A dimethyl sulfoxide modified acid fast technique was used for the identification of the parasites. 36 samples or 4.3% were found to be positive for Cryptosporidium. The prevalence of infection was higher (2.39%) in children with diarrhea and vomiting than in children with acute gastroenteritis alone (0.8%). Stool examination and cultures from the Cryptosporidium positive samples revealed no other parasites, rotavirus or enteropathogenic bacteria. This suggests that Cryptosporidium may be an important agent in the causation of diarrhea in young children. A routine laboratory examination for the detection of Cryptosporidium in the search for causal agents of childhood diarrhea in our environment may, therefore, be significant.
The nutritional status of 641 children between the ages of 0 to 4 years old, from 835 households in 41 randomly selected rural villages with water supply in Sarawak were determined. Based on Waterlow's classification and the National Center for Health Statistics (NCHS) standards, 61% of the children were stunted and 44.1% were wasted. Based on Gomez's classification and the NCHS standards 81.9% of the children were malnourished. There was no sex difference in nutritional status. The percentage of malnourished children increased continuously with age while the percentage of children who were wasted increased from 6 to 36 months and then it leveled off. The percentage of stunted children also increased with age but the increase was sharpest in children who were 12 to 23 months old. It is noted that the Gomez classification overestimates the prevalence of undernutrition.
MeSH terms: Age Factors; Body Height; Body Weight; Child, Preschool; Female; Humans; Infant; Infant Nutrition Disorders/epidemiology*; Infant, Newborn; Malaysia/epidemiology; Male; Nutritional Status*; Surveys and Questionnaires; Reference Standards; Child Nutrition Disorders/epidemiology*; Prevalence
Eighty-six clinical isolates of Aeromonas hydrophila were studied for their ability to produce four exotoxins: a haemolysin active against rabbit erythrocytes, cytotoxin and enterotoxin detectable with Vero cell cultures, and the cholera toxin-like factor detected by an enzyme-linked immunosorbent assay. At least one exotoxin was produced by 80% of enteric and 96% of non-enteric isolates. The exotoxin profiles of non-enteric isolates were more restricted than those of enteric isolates, with haemolysin and cytotoxin producers preponderant. Although haemolysin and cytotoxin were produced by isolates from all sources, the enterotoxin and cholera toxin-like factor were more common amongst enteric isolates. The production of haemolysin and cytotoxin were closely related but the association between the enterotoxin and the cholera toxin-like factor was not significant.
Three bacterial species of Clostridium (septicum, tertium and sporogenes) were identified to produce extracellular proteases cleaving IgA to Fab and Fc fragments, as demonstrated by SDS-PAGE and immunoelectrophoretic procedures. These enzymes acted on monometric IgA1 paraproteins and normal serum IgA1 but had no activity on IgA2 paraproteins and intact secretory IgA1 from human colostrum. Their action on polyclonal serum IgA1 suggested the absence of neutralizing anti-clostridial IgA protease activity. Although the enzymes were shown not to act on secretory IgA1, they were, however, able to digest free alpha-heavy chains of the dimeric IgA molecules. Susceptibility of the alpha-heavy chain to the proteases was more likely due to the change to a more accessible conformation than because of the absence of neutralizing anti-enzymic activity.
PIP:
Health workers in Malaysia randomly assigned either a low-dose triphasic or a low-dose monophasic oral contraceptive (Triquilar and Marvelon, respectively) to 198 women to examine discontinuation rates and reasons for discontinuation. 15.3% of Triquilar women and 9.1% of Marvelon women forgot to take 1 pill at some time during the study while 6.1% and 3% forgot to take at least 3 consecutive pills. There were more complaints and/or complications among Triquilar women than among Marvelon women. The most serious complication was severe headaches (only 1 woman from each group). 2 women in the Marvelon group complained of either generalized itchiness or digestion impairment. Complaints of women in the Triquilar group included localized and generalized itchiness, weight gain, digestion impairment, dryness of vagina, and numbness of extremities. Women in the Triquilar group were more likely to have menstrual complaints than those in the Marvelon group (14.3% vs. 9.1%). The leading menstrual complaint in both groups was spotting (6.1% vs. 4%). No Marvelon women reported menorrhagia, scanty menses, or intermenstrual pelvic pain or discomfort while at least 1 woman did from the Triquilar group. The percentage of women with changes in complaints since admission were the same for both groups. Total discontinuation rates which included lost to follow ups were 46.9% and 40%, respectively. The most common reason for discontinuation for both groups was desired method change (11.2% Triquilar and 14.1% Marvelon). Method unrelated reasons (unable to return to clinic, moving/travel, and not interested in the study) were the next most common reason for discontinuation. 3 women conceived while taking Triquilar. These pregnancies were attributed to method failure, perhaps due to incomplete pituitary suppression. There were no accidental pregnancies in the Marvelon group.
Monoclonal antibodies (MAbs) directed against different epitope regions on three sexual stage-specific gamete surface proteins of Plasmodium falciparum, Pfs 25, Pfs 230, and Pfs 48/45, were used to study the genetic diversity of these epitopes among fresh isolates of P. falciparum from Malaysia, using immunofluorescence microscopy (IFA). Among 45 Malaysian isolates, one epitope of Pfs 25, designated region I, showed evidence of variable reactivity with MAbs among different isolates; the Pfs 25 epitope, region II, was universally recognized by MAbs in all isolates. Two apparently distinct epitope regions of Pfs 230 were defined by MAbs, one of which was universally recognized by MAbs among the 45 isolates; the other was conserved in all but three isolates. The epitope regions of gamete-surface protein Pfs 48/45, designated regions I, IIa, IIb, IIc, III, and IV, were examined for reactivity by IFA in 33 isolates. Epitope regions I, IIb, III, and IV were conserved in all isolates; regions IIa and IIc existed in variant forms.
Uniformity of electric field intensity of microwaves within the microwave oven cavity is necessary to ensure even load-heating, and is particularly important in pathology procedures where small volume irradiation is carried out. A simple and rapid method for mapping electric field distribution, using reversible thermographic paint, is described. Spatial heating patterns for various positions, and the effects of introducing dummy loads to modify heating distributions, have been obtained for a dedicated microwave processor, and comparison made with a domestic microwave oven.
MeSH terms: Electricity; Hot Temperature; Microwaves*; Pathology/instrumentation; Thermography
Type IVa choledochal cysts with cylindrical dilatation of the intrahepatic ducts constitute a relatively less recognized variety of choledochal cysts, and differ from cystic dilatation of intrahepatic ducts in their clinical manifestations and response to treatment. Five patients with type IVa choledochal cysts and cylindrical dilatation of major intrahepatic ducts who underwent cyst excision and Roux-en-Y hepaticojejunostomy are reported. The duration of symptoms was less than 1 year in all patients. Palpable abdominal mass and abdominal pain were present in 3 patients. The traid of jaundice, abdominal pain and mass was present in only 1 patient. The intrahepatic dilatation regressed after excision of the extrahepatic cyst just below the hilum of the liver. The surgical technique is described and the need for excision of the cyst is emphasized.