Diffuse Infiltrative Lymphocytosis Syndrome (DILS)

Diffuse infiltrative lymphocytosis syndrome (DILS) is characterised by a persistent CD8+ lymphocytosis and lymphocytic infiltration of various organs. The reported prevalence varies between 0.85 – 3%, and appears to be more common in Africans. Patients with DILS tend to have higher CD4+ cell counts and survive longer than those patients without DILS. Most patients present with bilateral parotid gland enlargement and features of the Sicca syndrome. Extraglandular involvement is common with the lungs being the most common site, followed by peripheral neuropathy and liver involvement. DILS is a benign presentation in most patients with few complications. Therapeutic trials are lacking although there are isolated reports of good response to antiretroviral and steroid therapy. With the high incidence of HIV in our population it is likely that DILS is under diagnosed probably due to our ignorance of this disease. Awareness of its various presentations may bring to light undiscovered patients with DILS. South African Family Practice Vol. 50 (2) 2008: pp. 42-4

Dyschromonychia: clinical significance in a South African population

Background The purpose of this study was to determine disease associations with dyschromonychia (DCO) in an outand inpatient population attending Kalafong Hospital. Methods This prospective and observational study included in- and out-patients attending the Immunology Clinic at Kalafong Hospital, Pretoria, Gauteng. The study was divided into three phases, the first of which was to evaluate the kappa values and prevalence of DCO. The second was to determine the disease associations of in-patients, and the third phase consisted of nail evaluation in an out-patient HIV-positive population.Results The kappa value was 0.72, as obtained by three investigators. DCO was found to have a 66% sensitivity, 92% specificity, 66% positive predictive value, 92% negative predictive value, a positive likelihood ratio of 8.2 and a negative likelihood ratio of 0.4 for HIV (inpatients). Patients with DCO were found to have a significantly higher rate of infections (predominantly involving the lung), significantly lower lymphocyte counts and CD4 cell counts, and significantly lower CD4:CD8 ratios and albumin levels (p = 0.0001). The best discriminatory CD4 for DCO was 216.6 x 10 6/l (sensitivity = 89%; specificity = 63%), while a CD4 value of 134.3 x 10 6/l yielded a sensitivity of 75% and a specificity of 73%. Conclusions This study demonstrates a close association between HIV and DCO, especially in the case of lower CD4 cell counts. The absence of DCO is a poor predictor for the presence of HIV, although its presence has a high sensitivity for HIV seropositivity. The clinical finding of DCO is a simple, quick and efficient sign for the evaluation of the immune status of our population with reasonable sensitivity and specificity for low CD4 cell counts.Keywords: dyschromonychia, human immunodeficiency virus, pneumonia, CD4 cell countFor full text, click here:SA Fam Pract 2005;47(9):54-5

Cattle Mammary Bioreactor Generated by a Novel Procedure of Transgenic Cloning for Large-Scale Production of Functional Human Lactoferrin

Large-scale production of biopharmaceuticals by current bioreactor techniques is limited by low transgenic efficiency and low expression of foreign proteins. In general, a bacterial artificial chromosome (BAC) harboring most regulatory elements is capable of overcoming the limitations, but transferring BAC into donor cells is difficult. We describe here the use of cattle mammary bioreactor to produce functional recombinant human lactoferrin (rhLF) by a novel procedure of transgenic cloning, which employs microinjection to generate transgenic somatic cells as donor cells. Bovine fibroblast cells were co-microinjected for the first time with a 150-kb BAC carrying the human lactoferrin gene and a marker gene. The resulting transfection efficiency of up to 15.79×10−2 percent was notably higher than that of electroporation and lipofection. Following somatic cell nuclear transfer, we obtained two transgenic cows that secreted rhLF at high levels, 2.5 g/l and 3.4 g/l, respectively. The rhLF had a similar pattern of glycosylation and proteolytic susceptibility as the natural human counterpart. Biochemical analysis revealed that the iron-binding and releasing properties of rhLF were identical to that of native hLF. Importantly, an antibacterial experiment further demonstrated that rhLF was functional. Our results indicate that co-microinjection with a BAC and a marker gene into donor cells for somatic cell cloning indeed improves transgenic efficiency. Moreover, the cattle mammary bioreactors generated with this novel procedure produce functional rhLF on an industrial scale