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Biomedical subjects

M English

Publications and source records attributed to M English.

At least 55 records · Page 3Linked to original sources
PubMed1996

The pathogenesis of severe malaria in African children.

The pathogenesis of severe, Plasmodium falciparum malaria in African children is considered in the context of its two major clinical syndromes: malaria with respiratory distress; and malaria with neurological disturbance. Respiratory distress is an important prognostic marker in children with P. falciparum infections. In the majority of cases it reflects an underlying metabolic acidosis, usually associated with lactic acidaemia. Hypovolaemia and anaemia are important underlying factors. The syndrome of malaria with neurological impairment is not a homogenous condition. Four distinct groups of children fulfilling the WHO definition of cerebral malaria may be distinguished: (1) prolonged post-ictal state; (2) covert status epilepticus; (3) severe metabolic derangement (particularly hypoglycaemia and metabolic acidosis); and (4) children with a primary neurological syndrome. These distinctions are important from a therapeutic point of view, as well as for their implications for studies on underlying pathogenic factors. A simple framework is presented to summarize how three major processes, anaemia, the acute phase response and sequestration of infected cells, may interact to lead to reduced tissue oxygenation as a unifying process in the pathogenesis of both major clinical syndromes of severe malaria.

Acute Disease↗
PubMed1996

Deep breathing in children with severe malaria: indicator of metabolic acidosis and poor outcome.

Despite the frequent association of respiratory symptoms and signs with malarial morbidity and mortality in sub-Saharan Africa, the value of individual symptoms and signs has rarely been assessed. We have prospectively examined the association of individual clinical findings with the summary diagnosis of respiratory distress, outcome, and the presence of metabolic acidosis in children admitted with severe malaria to a Kenyan district hospital. Respiratory distress was present in 119 of the 350 children included in the study and in 23 of the 30 deaths (relative risk = 6.5, 95% confidence interval = 2.8-14.4). The features of a history of dyspnea, nasal flaring, and indrawing or deep breathing (Kussmaul's respiration) were individually most closely associated with the summary diagnosis of respiratory distress. Of these, deep breathing, which was sensitive (91%) and specific (83%) for the presence of severe metabolic acidosis (base excess < or = -12), is the best candidate sign to represent the prognostically important syndrome of malarial respiratory distress. Therefore, it warrants further prospective evaluation in different clinical settings and areas of different malaria endemicity.

Acidosis↗
PubMed1996

Transfusion for respiratory distress in life-threatening childhood malaria.

We have prospectively collected information during resuscitation in 24 children with life-threatening malaria. All had clinical respiratory distress and 16 were severely anemic (hemoglobin < or = 5 g/dL) on admission. Central venous pressure (CVP) measurements were normal (< or = 5 cm of water) prior to treatment but all had a metabolic acidosis. The geometric mean lactate level was significantly higher in children admitted with severe anemia than in those without severe anemia (11.2 mmol/l versus 4.2 mmol/l; P = 0.009). Hypovolemia (a CVP on admission < 0 cm of water) was associated, although not significantly, with a higher admission plasma creatinine concentration (94 mumol/l versus 64 mumol/l; P = 0.06) and probably contributed to the severely reduced creatinine clearances (0-39 ml/min/1.73 ml2) found in 12 of the 13 children in whom this was assessed in the first 24 hr. Treatment resulted in a rapid decrease in blood lactate in 16 of the 13 children in whom this was assessed in the first 24 hr. Treatment resulted in a rapid decrease in blood lactate in 16 of the 20 children transfused, which was most dramatic in severely anemic children, who were rapidly resuscitated. In nonanemic children, early and rapid administration of normal saline usually resulted in both metabolic and clinical improvement. However, in three children, two of whom died, acidosis persisted despite resuscitation. Metabolic acidosis often accounts for respiratory distress in life-threatening childhood malaria. Severe anemia and hypovolemia appear to play major roles in its pathogenesis, are readily treatable, and there appears to be little risk of congestive cardiac failure even with an aggressive approach to fluid replacement.

Acidosis↗
PubMed1995

Hybrid time-frequency adaptive filtering for the recovery of ventricular late potentials.

Ventricular late potentials are small ECG components that have significant diagnostic importance. Temporal averaging is used to recover these signals from high levels of background noise, but is not the optimum approach. A new form of hybrid time-frequency adaptive filtering is introduced that is based on signal division into a series of frequency bands. This technique is able to process the averaged data further and to reduce significantly the noise levels beyond that achieved by simple averaging. Examples of the processing are shown and its applicability is discussed.

Algorithms↗
PubMed1995

Interobserver variation in respiratory signs of severe malaria.

Respiratory abnormalities are common presentations of malaria and acute respiratory tract infection, both of which are major causes of childhood mortality and morbidity in sub-Saharan Africa. Appropriate management depends on accurate assessment of disease severity which for the majority of children must be based on clinical signs alone. Choosing which signs best serve this purpose remains a considerable problem particularly in malaria endemic areas. As part of a prospective study to define clinical signs indicative of life threatening malaria video recordings were used to examine the level of agreement between clinicians for potentially important respiratory signs in 51 children. Overall agreement was good for recession, severe recession, and nasal flaring (kappa = 0.57, 0.50, and 0.60 respectively) and substantial for deep breathing and the summary impression of respiratory distress (kappa = 0.70 and 0.69 respectively). However, within this substantial variation in interpretation was apparent between individual observers from slight to almost perfect agreement (kappa values 0.10-0.92). Video is a useful tool to demonstrate interobserver variation and it may also allow training in recognition of signs and a means of standardising clinical signs between centres.

Child↗
PubMed1995

The management of severe malaria in children: a review.

We have attempted to summarise an approach to management of severe malaria from our experience and that of others from published data in this review. This represents our current state of knowledge and practices which may change as research continues in this field. It also represents what we feel should be the minimum aim in treating severe malaria even at district hospital level. It focuses on practical issues encountered when admitting such patients: initial assessment, immediate supportive management, use of transfusion, appropriate anti-malarial treatment and ongoing management.

Child↗
PubMed1993

Chemical composition of baboon plant foods: implications for the interpretation of intra- and interspecific differences in diet.

Information on the chemical composition of baboon foods from the Laikipia Plateau, Kenya, is presented. Despite some differences in methods, results of analyses performed on the same foods at different sites were found to be extremely consistent, encouraging the view that meaningful intra- and interspecific comparisons of diet selection are feasible. Contrary to assumptions in the literature, no relationship between the abundance of food types and their chemical composition was found, nor was the foliage eaten by the baboons found to be a low-quality or high-fibre item in comparison with fruits and storage organs. Emphasis is placed on the need for caution in the use of simplistic dietary taxonomies which imply phytochemical and ecological homogeneity within broad food categories. Comparisons between three species revealed marked differences in the chemical composition of their diets; in particular, baboon diets were found to be higher in protein and lower in fibre than those of either lowland gorillas or Malaysian leaf monkeys, and differences in condensed tannin levels were also found. The relationship between these differences and the socio-ecology of the three species is discussed.

Alkaloids↗
PubMed1992

Effects of hypothermia on hemodynamic responses to dopamine and dobutamine.

Hemodynamic characteristics, arrhythmogenicity, and dose-related hemodynamic responses to intravenous dopamine (group I) and dobutamine (group II) were examined in 16 swine at three different core body temperatures (38.5 degrees C, 35 degrees C, and 30 degrees C). The animals were anesthetized with isoflurane and mechanically ventilated. Cooling and re-warming were accomplished by a femoral-jugular A-V shunt. The animals were cooled down to 30 degrees C and stabilized for 1 hour before intravenous infusion of dopamine (group I, n = 8) or dobutamine (group II, n = 8) was started at 2, 5, 10, 15, 20, and 30 micrograms/kg/min. Hemodynamic responses to the two inotropes were continuously monitored with a bedside monitor equipped with a PC mode for customized data collection and analysis. Computerized arrhythmia detection was performed. Our findings were: (1) profound hypothermia (30 degrees C) causes significant depression of hemodynamic functions; (2) IV infusion of dopamine and dobutamine can be used safely and effectively for inotropic support during profound hypothermia, and the optimal dosage for improving cardiac output is 10-20 micrograms/kg/min; (3) no risk of inducing arrhythmia was noted with IV infusion of both inotropes up to a maximum dosage of 30 micrograms/kg/min, even though significant sinus tachycardia was consistently seen at 30 micrograms/kg/min.

Animals↗
PubMed1990

IL-4 directs the development of Th2-like helper effectors.

Our studies show that the presence of IL-4 during the response of naive Th cells causes precursors to develop into a population comprised largely of "Th2-like" effectors that secrete IL-4 and IL-5, but little IL-2 or IFN-gamma. We find that the levels of IL-4 and IL-2 determine both the level of effectors developed in response to mitogen or Ag and the patterns of lymphokines they secrete when restimulated. IL-2 is required for optimum generation of effectors, and increasing levels of IL-2, augments the expansion of effectors secreting both IL-4/IL-5 and IFN-gamma. In contrast, IL-4 is required for the development of IL-4/IL-5 secreting effectors but suppresses the development of IL-2 and at higher doses IFN-gamma-secreting effectors detected after 4 days. Also dramatic are the effects of the presence or absence of IL-4 evaluated after an additional 1 to 2 wk. When cultures with or without initial IL-4 are cultured in IL-2 alone from days 4 to 11, they retain their distinct patterns of lymphokine production. Those cells that developed in cultures without IL-4 progressively secrete more IL-2 and can be maintained and expanded in IL-2. They continue to produce IFN-gamma, though the levels decrease somewhat with time, but they do not acquire the ability to produce IL-4 or IL-5. These cells thus increasingly resemble Th1 cell lines. In contrast, those cells in cultures initially exposed to IL-4, generate effectors which secrete high levels of IL-4/IL-5 (plus variable levels of IFN-gamma) at days 4 to 5, but the populations of cells developed, are not maintained well on IL-2 alone. Those cells that do survive continue to secrete IL-4 and IL-5 but not IL-2. In addition, IFN-gamma production, if present, falls off with time. Thus the cells in these cultures take on an increasingly Th2-like phenotype. It appears that the effects of low levels of IL-4 in suppressing IL-2 production by day 4 effectors appear to be transient whereas the higher levels appear to drive the development along a distinct pathway which is irreversible. These studies support the concept that different subsets of helper cells, which correspond roughly to Th1 and Th2 subsets, can develop rapidly in short term culture with respectively low vs high levels of IL-4. They support the concept that such distinct phenotypes arise from alternate pathways of differentiation that can be expected to reflect pathways available for helper T cell differentiation in the animal.

Animals↗
PubMed1990

CD4+ T cell subsets. Lymphokine secretion of memory cells and of effector cells that develop from precursors in vitro.

We have studied the properties of several developmentally defined subpopulations of CD4+ T cells from normal animals which can be stimulated to secrete lymphokines. We find that the Th cells responsible for direct secretion of lymphokines after stimulation are from a resting, very long lived subpopulation of CD4+ T cells which persists for over 25 wk after adult thymectomy. These T cells are depleted by in vivo administration of antithymocyte serum and they are enriched among T cells which express high levels of Pgp-1. This phenotype suggests that the T cells responsible are most likely memory T cells which have resulted from antigen exposure in vivo. T cells in this subset secrete predominantly IL-2 with small quantities of IL-3, granulocyte/macrophage CSF, and IFN-gamma. In contrast, the CD4+ T cells which require in vitro culture and restimulation before they develop into an effector population with the ability to secrete lymphokines after restimulation, differ dramatically by most of these criteria. The precursors we study are resting Th cells which are considerably shorter lived after adult thymectomy (5 to 10 wk) and resistant to the same doses of antithymocyte serum which deplete the putative memory population. We hypothesize that this precursor population represents naive helper cells which have not yet encountered Ag. The effectors derived from such precursors can be stimulated to secrete high levels of both Th cell types 1 and 2 lymphokines (IFN-gamma, IL-4, IL-5, granulocyte/macrophage CSF, and IL-3). Generation of effectors requires proliferation and differentiation events which occur during a mandatory culture with lymphokines and antigen presenting cells for 3 to 4 days. We discuss the striking phenotypic and functional differences among these subpopulations of helper cells--the precursor population and the two types--memory and cultured effector Th which secrete lymphokines. We also discuss the relationship of these populations to CD4+ T cell subsets defined by other studies of patterns of lymphokine secretion and by cell surface phenotype.

Animals↗
PubMed1990

Distinct regulation of lymphokine production is found in fresh versus in vitro primed murine helper T cells.

The kinetics of lymphokine RNA induction and secretion of biologically active lymphokine from CD4-enriched splenic T cell populations was investigated. Cells stimulated immediately after isolation from murine spleen ("fresh" T cells) and cells restimulated after 4 days of in vitro culture ("primed" T cells) were compared. Northern blot analysis and bioassays were used to analyze and quantitate production of eight lymphokines and the IL-2R. Fresh T cells produced high levels of IL-2 and low to moderate levels of IL-3, granulocyte/macrophage-CSF, and IFN-gamma. In vitro primed T cells produced IL-2, IL-3, IL-4, IL-5, IL-6, granulocyte/macrophage-CSF, IFN-gamma, and high levels of IL-2R RNA. Comparison of RNA levels and bioassays of supernatants from these populations indicated that primed T cells produced at least 10-fold more of six of the lymphokines than fresh T cells. Only IL-2 was produced in near equal amounts by fresh and primed T cells. There were also marked differences in the kinetics of lymphokine production by fresh and primed CD4+ T cells. After restimulation with Con A and PMA, primed cells produced a short burst of lymphokine RNA that peaked between 7.5 and 13 h and declined after 18 h. Fresh T cells lagged in the initial production of lymphokine RNA, with levels peaking 18 to 44 h after mitogenic stimulation. Depletion of CD4+ cells indicated that cells of helper phenotype were responsible for the majority of lymphokine production from the primed cells. Thus different subpopulations of Th cells defined by their respective ability to respond either directly (fresh T cells) or only after culture and restimulation (primed T cells) show different patterns of lymphokine gene regulation. Other studies suggest that the activity of "fresh" Th cells is due to a population with a "memory" phenotype, while the cells which require culture have a "precursor" phenotype. These distinct patterns of lymphokine gene regulation in the two populations of Th cells may account in part for differences seen in the kinetics and magnitude of the naive and memory immune responses which are regulated by Th cells.

Animals↗
PubMed1988

Role of antigen in the B cell response. Specific antigen and the lymphokine IL-5 synergize to drive B cell lymphoma proliferation and differentiation to Ig secretion.

CH12 tumor B cells specific for SRBC require SRBC as Ag and the lymphokine IL-5 (formerly known as BCGFII) for optimal proliferation and differentiation to Ig-secreting cells. Lysed SRBC and IL-5 purified to homogeneity synergize markedly, especially at low B cell densities. A sizable proportion of CH12 cells differentiate into Ig-secreting plaque-forming cells when low numbers of the B lymphoma cells (100 to 3000) are cultured with Ag and IL-5. IL-2 or IL-4 have no effects. Intact SRBC or lysed SRBC are equally effective as sources of Ag. Even in the presence of the mitogens LPS and dextran sulfate, there is a striking requirement for Ag for both proliferation and differentiation at low B cell density. Because of the low cell numbers used, the results strongly suggest that the effects of Ag and lymphokine are directly on the B cell. The cell surface phenotype of the CH12 lymphoma and the kinetics of their response suggest that CH12 B cells have the characteristics of activated B cells. Thus, it appears that Ag binding to surface Ig gives a direct signal to at least some B cells that is critical in the later phases of the B cell response after initial activation during which proliferation and differentiation to Ig secretion occur and that the lymphokine IL-5 costimulates with Ag to mediate this phase of the response.

Adjuvants, Immunologic↗
PubMed1987

Endogenous excitotoxic agents.

Although glutamate and aspartate are among the most likely compounds to function as central neurotransmitters, and both can produce cell death in neonatal animals, the efficient uptake systems for these amino acids mean that exceptionally high concentrations are required for toxicity in adults. A better candidate for an endogenous neurotoxin is quinolinic acid, which produces cell death via activation of the N-methyl-aspartate receptors. Several differences of detail between the activity of quinolinate and N-methyl-aspartate may indicate the existence of subpopulations of the N-methyl-aspartate receptor. Another compound in the same 'kynurenine' pathway as quinolinate, kynurenic acid, is an antagonist of the excitatory and neurotoxic actions of quinolinate, and the overall excitability of the central nervous system and the occurrence of cell death may therefore result from a balance between the concentrations of quinolinate and kynurenate.

Animals↗
PubMed1985

Effect of intravenous infusion of insulin in diabetics with acute myocardial infarction.

Diabetes mellitus is associated with a high mortality after myocardial infarction. To see whether this may be decreased by improved diabetic control the effect of an insulin infusion regimen was studied in patients with acute myocardial infarction. From April 1982 to April 1983, 33 diabetics were admitted with acute myocardial infarction. Those being treated with diet alone or oral hypoglycaemic drugs continued with this unless control was poor, when they were changed to a "sliding scale" regimen of subcutaneous insulin injections thrice daily. Those already receiving insulin were maintained on thrice daily subcutaneous injections. From April 1983 to April 1984, 29 diabetics had acute myocardial infarction. Those receiving treatment with oral hypoglycaemic drugs or insulin were changed to continuous intravenous infusion of insulin, the aim being to maintain the blood glucose concentration at 4-7 mmol/I (72-126 mg/100 ml). Those being treated with diet alone continued with this if blood glucose concentrations were acceptable. Total mortality fell from 42% in the first year to 17% in the second (p less than 0.05). Over the same period mortality among non-diabetic patients with myocardial infarction did not change significantly. There was a significant fall in cardiac arrhythmias (expressed as the percentage of patients in whom arrhythmias were recorded) from 42% to 17% (p less than 0.05). The most significant fall in the incidence of complications occurred in those who had been receiving oral hypoglycaemic drugs on entry to the study (87% to 50%, p less than 0.05).

Aged↗
PubMed1985

Lipid in the human gallbladder mucosa. A histochemical study by light and electron microscopy.

The distribution of lipids in the epithelium of 70 gallbladders removed for cholecystitis was investigated histochemically. Lipid was demonstrated in 68 gallbladders--cholesterol and its esters, triglycerides, free fatty acids and phospholipids. Neutral lipid was found at the bases of epithelial cells in 90 per cent and at the apex in 10 per cent of the gallbladders. Phospholipid was shown at the apex of epithelial cells in 64 per cent of the gallbladders. Electron microscopy in 12 specimens revealed cholesterol in and between the epithelial cells and in the underlying connective tissue.

Adolescent↗
PubMed1984

Monoclonal antibody to L3T4 blocks the function of T cells specific for class 2 major histocompatibility complex antigens.

The ability of antibody to Lyt-2 and to the newly described L3T4 antigen to block the functions of helper T cells with specificity for allogeneic class 1 or class 2 MHC subregion antigens was determined. Anti-Lyt-2 blocked both allohelp delivered by unprimed T cells and IL 2 production by primed T cells when the response was directed to class 1 MHC antigens, but had no effect when the response was directed to class 2 MHC or Mls antigens. Anti-L3T4 had reciprocal activity. A control reagent, anti-LFA-1, blocked all responses tested regardless of specificity. This and other reports provide strong evidence that L3T4 is the murine equivalent of the human T cell markers Leu 3/OKT4. The ability of antibodies directed against Lyt-2 and L3T4 to block T cell function in a fashion determined by the class of MHC antigen recognized by the T cell further supports the hypotheses that Lyt-2 and L3T4 molecule in the mouse and Leu-2 and Leu-3 molecules in the human are involved in the interaction of the T cell with class-specific determinants on MHC molecules.

Animals↗