Workshop 3 (synthesis): recycling and water utilities--shared characteristics of well performing and 'turnaround' utilities and the reform of poorly performing utilities

New approaches and technologies are required to deal with extremely unsatisfactory sanitation conditions, which give rise to serious health problems. Nutrient loads reaching recipients also pose threats to ecosystems.

Raised prorenin and renin concentrations in pre-eclamptic placentae when measured after acid activation

AIM

The aim of the study was to ascertain if there was any difference in the levels of prorenin and active renin between pre-eclamptic and normotensive feto-placental tissues.

METHODS

Supernatants of homogenates from fresh, vaginally delivered placentae from 15 normotensive and 15 pre-eclamptic women were measured for renin concentration (RC), prorenin concentration and renin activity (RA). RA and RC were measured in the absence and presence of nephrectomised sheep plasma, respectively. Prorenin was estimated as the difference between renin concentration in the sample before and after acid activation. All concentrations are expressed as rate of angiotensin generation (ng/ml/h). Angiotensin I was measured by radioimmunoassay. Statistical analysis was performed using Student's 't' test for unpaired samples. All results are presented as mean+/-SEM.

RESULTS

The concentrations of renin and prorenin were highest in the chorion laeve when compared to amnion and placenta (p < 0.01) in both the groups. Furthermore, the concentrations of renin and prorenin were significantly higher in all the tissues from women with pre-eclampsia (p < 0.01).

CONCLUSION

Renin and prorenin levels are raised in the placental tissues from women with pre-eclampsia. With recent evidence suggesting that both prorenin and renin may have cellular effects independent of angiotensin II generation, there is a need for further study into its role in placentation.

Autoantibodies, lupus and the science of sabotage

Anti-double-stranded DNA antibodies (anti-dsDNA) and antiphospholipid antibodies (APL) are important in the pathogenesis of systemic lupus erythematosus (SLE) and the antiphospholipid syndrome (APS) respectively. Not all anti-dsDNA or APL antibodies can cause clinical effects. Those that are particularly likely to cause tissue damage tend to be of IgG isotype and to possess particular binding properties. Rigorous statistical analysis of published sequences of human monoclonal anti-DNA and APL antibodies showed that IgG antibodies with binding properties characteristic of pathogenicity tend to have multiple somatic mutations in their variable regions. The distribution of these mutations suggests that they have been selected by antigen. This leads to accumulation of certain residues at the antigen-binding sites of these antibodies. Arginine residues are especially important. A computer-generated model of the pathogenic human monoclonal anti-DNA antibody B3 predicted that arginines in the heavy and light chain complementarity-determining regions (CDRs) would interact with dsDNA. We expressed cloned sequences encoding the B3 heavy and light chains in vitro to produce whole IgG. The cloned sequences of the heavy and light chains were manipulated to express a range of variant IgG antibodies. Binding assays on the expressed antibodies showed that altering specific arginine residues reduced binding to dsDNA in a way consistent with computer generated structural models. Changing the pattern of somatic mutations in the light chain altered binding to both dsDNA and histones, but in different ways. A single arginine-to-serine mutation in light-chain CDR1 of B3 reduced binding to both those antigens and may also have reduced the pathogenicity of the expressed antibodies in severe combined immunodeficiency (SCID) mice. Monoclonal human APL were expressed using the same system. Nineteen different heavy-light combinations were expressed. The ability to bind cardiolipin correlated well with the presence of exposed arginine residues in the heavy- and light-chain CDRs. The heavy chain of the pathogenic APL antibody IS4 contains four exposed arginines in CDR3. The results of mutagenesis studies suggested that two of these promote binding to cardiolipin whereas the other two have no such effect.

Effect of rainfall on the movement and persistence of metsulfuronmethyl and clopyralid applied to pasture

Metsulfuronmethyl and clopyralid are two herbicides frequently used in pasture The mobility and persistence of both have been previously reported and showed great variation between overseas and New Zealand results In a field trial the effect of simulated rain within the first 7 days of herbicide application on the persistence and movement of these chemicals was studied using bioassay methods Results show that 15 mm of simulated rain on either Day 1 3 or 7 after herbicide application had no apparent effect on the dissipation of metsulfuronmethyl but natural rainfall that occurred later in the experiment leached it to the 50100 mm soil layer Glasshouse bioassays of soil samples collected from the field showed that between 75 and 90 of the applied herbicide had degraded by Day 56 Clopyralid stayed in the top 50 mm of soil during the experiment but by Day 56 less than 10 of the applied herbicide remained

Risk of coronary heart disease and stroke in a large British cohort of patients with systemic lupus erythematosus

OBJECTIVES

Patients with systemic lupus erythematosus (SLE) are at increased risk of myocardial infarction and stroke. We sought to determine how much of this risk was dependent on recognized cardiovascular risk factors.

METHODS

Initially a software package 'Cardio-Risk-Manager', which utilizes Framingham data, was used to calculate a 10-yr risk of coronary heart disease (CHD) and stroke for 202 patients with SLE (Group 1) in comparison with hypothetical age- and sex-matched comparators. Subsequently 47 patients who had been followed since 1991 (Group 2) were studied to compare their predicted risks in 1991 with the actual number of cardiovascular events that occurred during the subsequent decade.

RESULTS

Patients in Group 1 had a higher predicted 10-yr risk of stroke (P<0.0001), but not of CHD, than their comparators. However, following age stratification, traditional risk factors predicted a higher risk of CHD (P<0.0001) and of stroke (P<0.0001) in patients under 40 with SLE compared with age-matched comparators. The predicted 10-yr risks of CHD and stroke for patients aged 40 and above were not significantly different from those of their comparators. Predicted risks, however, were lower than the true 10-yr event rate for CHD and stroke in patients in Group 2. In this group, during the 10 yr of follow-up four patients (8.5%) suffered a CHD event and five patients (10.6%) had a stroke, significantly more than were predicted by the presence of conventional risk factors (P<0.001 for CHD and P<0.001 for stroke, respectively).

CONCLUSIONS

Conventional risk factors predicted an increased risk of stroke and CHD in younger patients. They do not, however, fully explain the high risk of cardiovascular disease in patients with SLE. Although it is important to address the management of orthodox risk factors for cardiovascular disease in patients with SLE, other causes must be sought to explain the increased incidence of CHD and stroke, especially in those aged over 40.

Structure–function analysis and the molecular origins of anti-DNA antibodies in systemic lupus erythematosus

Patients with the autoimmune rheumatic disease systemic lupus erythematosus (SLE or ‘lupus’) develop a wide variety of clinical and serological manifestations including the presence of antibodies to double-stranded DNA (dsDNA), which are often diagnostic and potentially pathogenic. In this review, we have examined the links between the structure and function of anti-dsDNA antibodies, emphasising their clinical associations. We have also reviewed studies involving animal models, the analysis of human antibody sequences and studies of, and using, computer modelling and crystal structure.

Mothers' mental health and infant growth: a case-control study from Rawalpindi, Pakistan

BACKGROUND

Epidemiological studies in Pakistan show high rates of depression in women, while rates of malnutrition in children are also high. This study aimed to determine whether poor maternal mental health is associated with an increased risk of infant undernutrition.

METHODS

Clinic-based case-control study. A total of 172 consecutive infants and their mothers attending for 9-month measles immunization were recruited over a 3-month period. Eighty-two undernourished infants [weight for age below the National Centre for Health Statistics (NCHS)/World Health Organization (WHO) third centile] were matched to 90 controls (weight for age above 10th centile), and their mothers interviewed for mental distress using the Self-Reporting Questionnaire (WHO SRQ-20, a psychiatric screening instrument). Infants' exposure to maternal distress (score > or = 10 on SRQ-20) and other potential risk or protective biological, social, socio-economic and family factors were measured.

RESULTS

Mental distress determined by WHO SRQ-20 was associated with increased risk of undernutrition in infants (odds ratio 3.91, 95% confidence interval 1.95-7.86). This association remained significant after controlling for birthweight and social factors.

CONCLUSION

Exposure to maternal mental distress is associated with undernutrition in 9-month infants in urban Pakistan. These mothers may represent a group whose children are at higher risk of ill health, and potentially be a specific target for advice on infant care. Early recognition and treatment of mental health problems in mothers may help reduce morbidity and mortality rates in children.

Experimental results on the recognition of embryos in human assisted reproduction

The recognition of embryos suitable for transfer in human assisted reproduction is important, and there is evidence that the morphology of the cells may influence the results achievable. A procedure for this recognition problem has been formulated based on morphological attributes of the images of the embryos, and it is therefore useful to compare the recognition of experts with that of a machine programme. The aim of this paper is to compare the precision in the recognition of viable embryos by a group of experts to that of a machine recognition procedure, both for a basic set of embryos and a blind set. Experts were asked to classify the images of 249 embryos transferred to 73 patients, indicated as the training set and another set of 103 embryos transferred to 35 patients called the blind set. A machine programme was used for the same classification. For all the experts the results were statistically not significantly different from independence, which means that viable embryos are not recognized as such for both data sets. Instead, the machine algorithm recognizes in a statistically significant way, the membership class for the embryos submitted. Cell morphology is important for IVF, but differences do not appear to be discernable by the senses, clinical insight, experience and/or training, while classification by machine methods provides more accurate results, which could be improved by enlarging the training set.

Rickets among children of a coastal area of Bangladesh

Many children with rachitic deformities have been reported in southern coastal area of Bangladesh but the actual rate of prevalence was not known. A survey was conducted to determine the magnitude of rachitic problem among the children of Chakaria thana of Cox's Bazar district of Bangladesh. Nine hundred children between 1-15 years selected randomly from 30 villages of total 340 villages. Face to face interview of the parents was taken and the children were examined for evidences of rickets. Serum calcium, phosphorus, alkaline phosphatase (ALP) were estimated and radiology of limbs were done in all clinically suspected cases and in a control of every eighth child. Seventy eight children (8.7%) had physical features suggestive of rickets. Fifty eight (6.4%) children had 'clinical rickekts' (positive physical feature(s) but normal ALP and negative radiology), 12 (1.3%) children had 'biochemical rickets' (positive physical features and raised ALP but negative radiology) and 8 (0.9%) children had 'confirmed rickets' (positive physical features, raised ALP and positive radiology). Out of 78 children with rachitic feature(s), Pectus carinatum was found as the most common clinical feature in 26 (33.3%) children followed by genu valgum in 23 (29.4%) cases. Twenty two normal children (2.2%) had raised level of ALP (>300U/L). The prevalence of rickets is high in children of Chakaria and further study is needed to find out the exact aetiology of rickets in children there.

Acute left ventricular failure after large volume pericardiocentesis

This paper reports on two cases of large volume pericardiocentesis followed by transient severe acute left ventricular (LV) systolic failure in the absence of any prior history of LV dysfunction. Acute LV volume overload due to interventricular volume mismatch is believed by most authors to be the cause for this phenomenon. Another plausible physiopathologic explanation is the acute increase in "wall stress" (Laplace's law) due to acute distention of the cardiac chambers secondary to a sudden increase in venous return at high filling pressures, combined with a "vacuum" effect of the evacuated pericardial space.

Suicidal feelings run high among mothers in refugee camps: a cross-sectional survey

OBJECTIVE

To study levels of mental distress in a sample of Afghan mothers caring for children in two refugee camps in North West Frontier Province (NWFP) of Pakistan.

METHOD

Cross-sectional survey of 297 consecutive mothers with young children, attending primary care centres, using a psychiatric screening instrument, the Self-Reporting Questionnaire (SRQ-20).

RESULTS

One hundred and six (36%) of women in the sample screened positive for a common mental disorder. Ninety-six (91%) of those screening positive had had suicidal thoughts in the previous month, and nine (8%) rated suicidal feeling as their topmost concern.

CONCLUSION

There is a high prevalence and severity of mental distress in Afghan mothers caring for young children in refugee camps. This may have serious long-term effects on the psychological and physical development of their children.

Blood lead levels during pregnancy and pregnancy outcome in Karachi women

OBJECTIVE

To evaluate association of blood lead levels with pregnancy outcome in the obstetrics and gynaecology unit.

METHODS

Blood lead levels were measured in 73 pregnant women at the time of delivery and assessed its association with pregnancy outcome.

RESULTS

Mean maternal lead level was 9.91+/-4.44 mg/dL (range 2.28-36.35 mg/dL). Mothers of boys had significantly higher (p=0.013, one-tailed t test) blood lead levels (11.05+/-5.19) when compared to mothers of girls (8.74+/-3.18 mg/dL.

CONCLUSION

Maternal lead levels at the time of delivery showed no association with gestational age, birth weight, recumbent length, or head circumference.

Environmental monitoring of asbestos products manufacturing units--a case study

Air borne asbestos dust concentration and occupational health environment of workers in a asbestos products manufacturing unit was monitored, and compared with the standards. Study reveals that overall airborne asbestos concentration in the unit is well within the limit, but the workers, which were exposed to air borne asbestos dust, showed a marked increase in deterioration of lung function as compared to the control population, which was not exposed to this dust. Further more, the population which was exposed to airborne asbestos dust along with other predisposing factors like cigarette smoking, showed a marked deterioration of lung function as compared to the population exposed only to air borne asbestos dust.

Life events, social support and depression in childbirth: perspectives from a rural community in the developing world

BACKGROUND

High rates of depression associated with childbirth have been reported in many parts of the developing world. However, the prevalence and associations of antenatal and post-natal depression in the rural population remain unknown. Disability associated with depression and its impact on infant health and development could have important public health implications for many developing countries where large proportions of the population are rural.

METHOD

All women living in southern Kahuta, Pakistan, in their third trimester of pregnancy were interviewed at 6 weeks before delivery (N = 632) and again at 10-12 weeks after delivery (N = 541), using WHO Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Personal Information Questionnaire (PIQ) and Brief Disability Questionnaire (BDQ).

RESULTS

The point prevalence of ICD-10 depressive disorder was 25% in the antenatal period and 28 % in the post-natal period. Depressed mothers were significantly more disabled, had more threatening life events, and poorer social and family support than non-depressed mothers. Vulnerable mothers were more likely to be depressed during pregnancy, rather than have an onset in the post-natal period.

CONCLUSION

Over one-quarter of mothers in a rural sub-district of Pakistan suffer from depression shortly before and after childbirth. Rapidly changing traditional family structures and practices may be increasing the risk of depression in many women. Recognizing and treating depression should be initiated during the antenatal, rather than post-natal period.