Methotrexate hepatotoxic effects in children with juvenile rheumatoid arthritis.
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Biomedical subjects
Publications and source records attributed to A Martini.
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Ecoepidemiological analysis of a Moroccan focus of leishmaniasis caused by Leishmania tropica revealed considerable enzymatic diversity. Seven zymodemes belonging to the complex were identified in 149 strains isolated from humans, dogs, and the vector Phlebotomus sergenti. Three distinct subgroups were identifiable, two of which were in turn, composed of three "small variant" zymodemes. The diversity appears to be related to the age of the focus, which may have allowed colonization by zymodemes of different geographic origins. Diversification into "small variants" is apparently the result of recent mutation, possibly associated with genetic exchange.
In a Moroccan focus of cutaneous leishmaniasis caused by Leishmania tropica, 7,907 female sandflies captured with CDC traps were dissected from summer to autumn 1989. Among species of the genus Phlebotomus, only P. sergenti harbored promastigotes. Eighty-nine strains belonging to the complex L. tropica were isolated. The frequency of vector infection was zero in June, rose to 1.3% in August, and reached 9.9% in October, which indicates that the period of high risk is at the end of the hot season. Out of 89 strains isolated, 74 were completely typed and corresponded to the following four zymodemes: MON-102 (one strain), MON-107 (56 strains), MON-122 (two strains), and MON-123 (15 strains). Only the first two were observed in humans. The distribution of zymodemes MON-102 and MON-107 was very different in humans, dogs, and the vector. In one of the sites surveyed, which was strongly dominated by MON-107, the absence of human cases involving this zymodeme suggests the existence of a wild reservoir.
In an ecoepidemiological study in the Syrian foci of human visceral (VL) and cutaneous (CL) leishmaniasis, domestic dogs infected with Leishmania infantum MON-1 and L. tropica MON-76 were found for the first time. In Syria canine leishmaniasis caused by L. infantum, occurs in the humid and sub-humid western belt from the coastal zone to the nearby mountain ranges. Sporadis cases of human VL occur in this area. Canine CL, caused by L. tropica was found in the semi-arid zone in a village with a high human infection rate. The infection causes small papules or crusted ulcers on the nose or muzzle. These observations are relevant to control. In human VL foci it is recommended not to control the dog population, unless this is linked with other activities, such as rabies control. Control of dogs in the CL areas is not justified because of the small size of the lesions and the rarity of the parasites. Indeed the role of the dog as the "true" reservoir host is questionable. Human CL infection is best controlled by active case detection and specific treatment.
The measurement of auditory brainstem evoked responses and middle latency evoked responses may improve the evaluation of diabetic neuropathy. Twenty diabetic patients were studied (12 males, 8 females), aged 21 to 63 years with normal hearing, together with 20 age- and sex-matched normal subjects (10 males, 10 females). Auditory brainstem evoked responses were induced by rarefaction clicks of 0.1 ms at a repetition rate of 21.1 CPS and an intensity of 75 dB hearing level. Middle latency evoked responses were induced with clicks of 0.1 ms, a repetition rate of 7.7 CPS and an intensity of 75 dB hearing level. Diagnostic criteria were: a I-V interval latency shift greater than 2SD of the control group for the auditory brainstem evoked response test or the interval difference of wave V greater than 0.2 ms. Middle latency evoked response was diagnostic if the latency of the Pa component was greater than 2SD of normals. Twenty-five per cent of subjects had retrocochlear impairment (absence of I wave) even in the absence of symptoms. The combined technique of auditory brainstem evoked response and middle latency evoked response improved the detection rate of central nervous system dysfunction. Auditory brainstem response is important for detecting desynchronization of the auditory response, whereas middle latency evoked response detects abnormalities in the more rostral regions of the central nervous system. In conclusion, there is a role for auditory brainstem evoked response and middle latency evoked response in the global assessment of diabetic neuropathy.
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The prevalence of anticardiolipin antibodies was evaluated in 70 children with juvenile chronic arthritis (JCA), in 25 adult patients with rheumatoid arthritis, in 42 healthy children and in 40 adult controls. Thirty seven (53%) patients with JCA were positive for IgG or IgM anticardiolipin antibodies, or both, and 30 (43%) for IgG anticardiolipin antibodies. In contrast, only seven (28%) adult patients with rheumatoid arthritis presented anticardiolipin antibodies, which were of IgG class in four (16%) cases. IgG anticardiolipin antibodies were negative in all control subjects while IgM anticardiolipin antibodies were detected in two (5%) children and in four (10%) adult controls. No correlations were found in patients with JCA between the presence or titres of anticardiolipin antibodies and various clinical or laboratory variables. No patient with anticardiolipin antibodies showed any feature of the anticardiolipin syndrome.
The treatment of juvenile chronic arthritis requires the integration of various professionals (pediatrician, physiotherapist, orthopedic surgeon, ophthalmologist). The therapeutic program is targeted to control the inflammation with drugs and to preserve joint function with physiotherapy. Since juvenile chronic arthritis is clinically heterogeneous, the natural course and the possible complications which characterize each clinical form must be taken into account.
In response to an epidemic of oriental sore around Damascus, an ecological and epidemiological survey was carried out in the village of Dmeir, 40 km NE of Damascus. Parasites isolated from six cases from Dmeir, and two other cases from Syria were identified as Leishmania major, zymodeme MON-26. This zymodeme is known as the agent of zoonotic cutaneous leishmaniasis from the Sub-Saharian Sahel to the Near and Middle East. This is the first report of L. major in Syria. In a group of 234 school children aged 5-11 years, the leishmanin skin test was positive in 37%, indicating a high transmission rate. The epidemic seems to be the result of agricultural and industrial development projects in the area: numbers of both the gerbil reservoir host and sandfly vector appear to be increased by the land improvement.
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The paper describes a case of spontaneous biliodigestive fistula in a cholecystectomized patient. Following a review of other published reports, the etiopathogenetic, clinical and therapeutic aspects of the case are discussed.
The binding of antinuclear antibody-positive juvenile arthritis (JA) sera to bovine thymus histones H1, H2A, H2B, H3, and H4 was studied by an enzyme-linked immunosorbent assay. Seventy-five percent of the JA patients tested positive for at least 1 antibody specificity. Antihistone antibodies were predominantly IgM, while IgG antibodies were less common and were restricted to histones H1 or H3. In the group of patients with JA of pauciarticular onset, antihistone antibodies were significantly more elevated in patients with past or present uveitis than in patients without a history of uveitis. Anti-H1 antibodies in JA patients were found to react mostly with determinants located in the carboxyl-terminal domain of the H1 molecule. Sera were also reactive with human histone H1(0) or chicken histone H5, which are H1 variants found only in nondividing cells.
Diffuse connective tissue diseases (DCTD) represent an heterogeneous group of disorders characterized by systemic inflammatory reactions that are currently classified on clinical grounds. Their aetiopathogenesis is largely unknown and appears to be very complex, associating exogenous factors with an immunogenetic predisposition. In the last decade, studies on human leukocyte antigen (HLA)-disease associations and antinuclear antibodies have provided some useful clues for the diagnosis and clinical management of DCTD.
Usher syndrome is characterized by congenital hearing loss, progressive visual impairment due to retinitis pigmentosa, and variable vestibular problems. The two subtypes of Usher syndrome, types I and II, can be distinguished by the degree of hearing loss and by the presence or absence of vestibular dysfunction. Type I is characterized by a profound hearing loss and totally absent vestibular responses, while type II has a milder hearing loss and normal vestibular function. Fifty-five members of eight type II Usher syndrome families were typed for three DNA markers in the distal region of chromosome 1q: D1S65 (pEKH7.4), REN (pHRnES1.9), and D1S81 (pTHH33). Statistically significant linkage was observed for Usher syndrome type II with a maximum multipoint lod score of 6.37 at the position of the marker THH33, thus localizing the Usher type II (USH2) gene to 1q. Nine families with type I Usher syndrome failed to show linkage to the same three markers. The statistical test for heterogeneity of linkage between Usher syndrome types I and II was highly significant, thus demonstrating that they are due to mutations at different genetic loci.
Thirty-eight Salmonella typhimurium strains isolated from December 1987 to March 1988 in Isernia, Central Italy, were characterized on the basis of their phage type, resistance to antimicrobials and plasmid profiles. According to their phage types, the isolates could be assigned to one of six groups, the prevalent one being PT 195 which accounted for 73.6% of isolates. On the basis of their plasmid content, the isolates could be assigned to one of ten groups. The prevalent plasmid profile (60.0; 6.0; 4.3; 4.0; 3.2 megadaltons) was found in 60.4% of isolates. All the isolates from a particular food (salsicce), and as most of isolates from humans who had consumed this food belonged to phage type 195 and were of the same plasmid profile. The combined use of phage typing and DNA plasmid analysis proved to be a useful tool in identifying epidemiologically related isolates in this investigation.
The basal fibrinolytic activity in 17 children with active juvenile chronic arthritis (JCA) was investigated. It was found that patients with JCA, and particularly those with the systemic form, show decreased plasma fibrinolytic activity and a marked increase in plasminogen activator inhibitor. Additionally, it was found that patients with systemic JCA, but not those with the polyarticular or pauciarticular form, have increased circulating levels of tissue-type plasminogen activator, and endothelial cell protein, suggesting possible endothelial cell participation in systemic JCA.
The influence of age on evoked auditory brainstem responses (ABRs) is still a matter of controversy. It is well known that in the elderly the ABRs show a progressive latency shift of the principal components. While many authors have reported a I-V internal latency shift, others claim that there is not a delay in the central conduction time (CCT) with ageing. Middle latency auditory evoked responses (MLRs) are also reported to be impaired in the elderly, but the few results published need further investigations. This study investigates some of the controversial aspects of electrophysiological assessment of the auditory system in the elderly. 36 healthy subjects (18 males and 18 females), mean age 67.2 years +/- 5.8, underwent ABRs, MLRs and SVRs and SVRs brain mapping evaluation. All the data were compared with our normative data for young adults. Our results confirm previous reports of a latency shift of all principal components of ABR, but do not demonstrate a significant CCT impairment in the elderly. The MLRs, SVRs and brain mapping analysis also support this conclusion.