Assessment of five live-cell characteristics in periphytic diatoms as a measure of copper stress

Metal pollution of fluvial systems remains a major problem and biomonitoring can be a useful tool for assessing the metal contamination. To assess their potential as new bioindicators of copper stress, we treated a field-collected live periphytic diatom community (dominated by Amphora, Navicula, and Nitzschia) with dissolved Cu under optimal growth conditions. We studied the effects of Cu on five live-cell attributes: motility, protoplasmic content, lipid body number and biovolume, and frustule morphology. In all three genera, motility and protoplasmic content decreased, whereas the LB number, biovolume and deformity increased when Cu and exposure time increased. The sensitivity to Cu was highest for % MF, % CPC and % BCLB in Navicula and the LB number and deformity in Nitzschia. Amphora appeared to be more tolerant to Cu in comparison with other genera. The five cell attributes were inter-related. A heatmap showed that a recommended indicator for rapid screening of Cu toxicity was % BCLB for Amphora and % MF for Navicula and Nitzschia. % MF might be the most common representative indicator that can be applied to all three genera to evaluate the lethal effects of Cu stress if only one of the five cell attributes must be selected.

Diatoms as indicators of environmental health on Korean islands

Diatoms are highly sensitive to perturbations in their environment and are thus useful as bioindicators for anthropogenic impacts such as pollution. However, there is no consensus about what aspects of diatom populations to measure (e.g., diversity, physiology, or morphology) and efficient and reliable survey protocols are lacking. Here, we evaluated the ecological status of diatom communities using both traditional and relatively novel methods on two islands (Deokjeok island and Daeijak island) affected by anthropogenic activities due to extensive agricultural practices and exploitation and that are under consideration for representative touristic sites in South Korea. Dissolved concentrations of metals and metalloid (As, Cu, Cr, Cd, Ni, Hg, Pb, and Zn) were below the ecological screening and toxicity reference values in water fractions but were above these values for sediment, particularly at one island, Deokjeok. The tested methods were generally consistent in finding little evidence for disruption of diatom communities, with dominance by Navicula and Gyrosigma, relatively high diversity, and typical abundance of lipid bodies and morphological deformities. However, analysis of lipid bodies and morphological deformities suggested greater potential anthropogenic disturbance at one site in Deokjeok. Future planning is required to ensure the maintenance of the near-pristine environments present on these islands.

Magnesium Aluminate Nanoparticles for Chemical Detoxification of Sarin and Soman

The solutions of Mg(NO₃)₂, Al(NO₃)₃, and (NH₄)₂CO₃ were mixed at pH 8 and then heated at 95 °C for 4 h, aged at room temperature for 16 h, and calcined at 650 °C for 4 h to obtain magnesium aluminate nanoparticles. The obtained materials exhibited spinel structure with the particle size being 6 to 26 nm. The nanoparticles demonstrated type IV nitrogen adsorption isotherm, typical of mesoporosity with a surface area of 325 m²/g. They were utilized for studies on chemical detoxification of deadly chemical warfare agents such as sarin and soman. Our results showed that the magnesium aluminate nanoparticles effectively decontaminated more than 99% of sarin and soman within 8-10 min when used at a ratio of 1:50-60% w/w.

Reappraisal of the toxicity test method using the green alga Ulva pertusa Kjellman (Chlorophyta)

This study was aimed to develop an objective way of quantifying the reproductive status of the green macroalga, Ulva pertusa using a vital stain and programmed automated analysis (by Image J program). The EC₅₀ values (with 95% CI), the concentrations of toxicants inducing a reduction of 50% in sporulation after 96 h exposure, from the newly developed method were similar to those obtained by the conventional method: 0.651 (0.598-0.705) mg l^-1 for Cd, 0.144 (0.110-0.162) mg l^-1 for Cu, 0.180 (0.165-0.195) mg l^-1 for atrazine, 0.076 (0.049-0.094) mg l^-1 for diuron and 30.6 (26.5-34.4) ml l^-1 for DMSO, respectively. When the EC₅₀ values from this study were compared to that those from literatures, the sensitivity for some toxicants was similar or higher than that of U. fasciata (1.930 mg l^-1 for germination for Cd), U. armoricana (0.250 mg l^-1 for Fv/Fm for Cu), U. reticulata (0.126-1.585 mg l^-1 for growth for Cu), and U. intestinalis (0.650 mg l^-1 for Fv/Fm for atrazine). The subjective views of the experimental performers can be eliminated using the newly developed method. The Ulva method gave consistent responses to Cu and Cd of internationally allowable ranges for effluents, implying that the method is a useful tool for monitoring industrial wastewaters containing these metals.

Assessment of metal contamination in water and sediments from major rivers in South Korea from 2008 to 2015

This study is the first report to evaluate (8 years data) the contamination degree and distribution characteristics of metals in the surface water and sediments of four Korean rivers (Nakdong, Yeongsan, Geum, and Han). Eight years of data were evaluated, and metal concentrations in the river water were found to be below permissible limits but high enough to cause detrimental effects (under chronic exposure) to aquatic organisms. The analysis of metals in the river sediments showed the following trend: Zn > Cu > Cd > Pb > Ni > As > Cr > Hg. The concentrations of metals in sediments (especially in the Geum and Han rivers) were above the permissible limits reported by international agencies. Concentrations of Cu, Ni, and Zn were high enough to pose risks to aquatic communities. In sediments, metals pollution was also evaluated using different indices, such as enrichment factor (EF), geoaccumulation index (I_geo), contamination factor (CF), degree of contamination (C_d), modified degree of contamination (mC_d), and pollution load index (PLI). The CF, EF, and I_geo indices demonstrated that most of the river sediment samples were moderately to heavily contaminated by Cd, Cu, Pb, and Zn. The PLI values were above one in the Geum and Han river sediments, which indicated polluted conditions. Similarly, C_d indicated a considerable to very high degree of contamination, while mC_d indicated a low to moderate degree of contamination in all four river sediments. Finally, it was found that the extent of metals pollution in the Korean rivers reached a critical condition, which could be detrimental to the biota of the rivers, as well as to humans in the long term.

Towards a multi-bioassay-based index for toxicity assessment of fluvial waters

Despite their proven reliability for revealing 'acceptable' degrees of toxicity in waste- and reclaimed waters, bioassays are rarely used to assess the toxicity of hazardous contaminants present in natural waters. In this study, we used organisms from different trophic levels to assess the toxicity of water samples collected from four different South Korean rivers. The main objective was to develop a multi-descriptor index of toxicity for undiluted river water. The responses of six test organisms (Aliivibrio fischeri, Pseudokirchneriella subcapitata, Heterocypris incongruens, Moina macrocopa, Danio rerio and Lemna minor) after laboratory exposure to water samples were considered for this index, as well as the frequency of teratologies in diatom assemblages. Each individual test was attributed a toxicity class and score (three levels; no toxicity = 0, low toxicity = 1, confirmed toxicity = 2) based on the organism's response after exposure and a total score was calculated. The proposed index also considers the number of test organisms that received the highest toxicity score (value = 2). An overall toxicity category was then attributed to the water sample based on those two metrics: A = no toxicity, B = slight toxicity, C = moderate toxicity; D = toxicity and E = high toxicity. The susceptibility of the test organisms varied greatly and the sensitivity of their response also differed among bioassays. The combined responses of organisms from different trophic levels and with different life strategies provided multi-level diagnostic information about the intensity and the nature of contamination.

Metal toxicity and recovery response of riverine periphytic algae

In the present study, in situ assessment of metal (Cu and Zn) toxicity followed by their recovery response was examined in periphyton dominated by diatoms. For doing so, metal diffusing substrates (MDS) were constructed and deployed in the river water for 6 weeks (3 weeks stress and 3 weeks recovery after replacing metal solution from the MDS). The use of MDS ensured that colonised periphyton on metal diffusing and control substrates were exposed to similar environmental conditions. The metal toxicity and recovery response of the community was examined in terms of traditional algal community parameters (biovolume, species richness, Shannon index, relative abundance) as well as with the newer non-taxonomical parameters (deformities and lipid bodies in diatoms). Both traditional and non-taxonomical parameters indicated complete recovery (from metal toxicity) of periphytic communities after 3 weeks following the withdrawal of Cu and Zn solution from the diffusing substrates. Newer non-taxonomical parameters, such as, deformities and lipid bodies, provide a new insight to understand metal toxicity and recovery response of diatom assemblages (the dominant autotrophs in the periphyton community) because these features are directly visible in live frustules, need no expertise in identification of diatoms and can be globally assessed with simple protocol. The experimental loss of metal pollutants and the constant immigration of algae (not previously exposed to high levels of metals) in fluvial systems aided periphyton recovery. Lastly, it is found that periphytic biofilms (dominated by diatoms) proved to be good bioindicators of metal toxicity and recovery in fluvial ecosystem.

Evaluating features of periphytic diatom communities as biomonitoring tools in fresh, brackish and marine waters

The aims of this study were to assess the biodiversity of periphytic diatom assemblages in fresh, brackish and marine waterbodies of Korea, and to assess the effect of environmental and anthropogenic factors on parameters such as the quantity and biovolume of lipid bodies and deformations of diatoms as early warning measures of anthropogenic impact. Diatom samples were collected from 31 sites (14 freshwater, 10 brackish and 7 marine), which included less impacted (upstream) and impacted (downstream) sites in each water type. Our results showed higher abundance and biodiversity of periphytic diatoms at the less impacted sites in terms of species richness, Shannon index, cell count and biovolume of the communities than at the impacted sites for freshwater and estuarine sites, but not for marine sites. 84 diatom species were noted in freshwater, 80 in brackish water and 40 in marine waters. In comparison to diatoms of the impacted sites, those of less impacted freshwater, brackish and marine sites had less lipid bodies (also less biovolume) and a lower percentage of teratological frustules, and showed more mobile forms in the community. Principal component analysis (PCA) also showed clear segregation of impacted from less impacted sites by the extent of the presence of lipid bodies (higher both in number and biovolume) and deformities in diatom frustules. Pearson correlation analysis revealed that lipid body induction and deformities were positively correlated with metals (Cd, Co, Cr, Cu, Fe, Pb and Zn) and nutrients (total phosphorus and total nitrogen), whereas they showed negative correlation with salinity, dissolved oxygen, suspended solutes and pH. Life-forms, lipid bodies and deformities in diatoms may be an effective biomonitoring tool for assessing biological effects of pollutants in non-marine aquatic ecosystems in Korea.

The use of diatoms in ecotoxicology and bioassessment: Insights, advances and challenges

Diatoms are regularly used for bioassessment and ecotoxicological studies in relation to environmental and anthropogenic disturbances. Traditional taxonomical diatom parameters (cell counts, biovolume estimates, species richness, diversity indices and metrics using sensitive and tolerant diatom species) are regularly used for these studies. In the same context, very less focus was given on new endpoints of diatoms (life-forms, nuclear anomalies, alteration in photosynthetic apparatus shape, motility, lipid bodies, size reduction and deformities), in spite of their numerous merits, such as, their easiness, quickness, cheapness, global acceptation and no especial training in diatom taxonomy. In this review we analyzed 202 articles (from lab and field studies), with the aim to investigate the bioassessment and ecotoxicological advancement taken place in diatom research especially in terms of exploring new endpoints along with the traditional taxonomical parameters in a perspective which can greatly enhance the evaluation of fluvial ecosystem quality for biomonitoring practices.

Changing picture of acute kidney injury in pregnancy: Study of 259 cases over a period of 33 years

The incidence of acute kidney injury (AKI) in pregnancy is declining in developing countries but still remains a major cause of maternal and fetal morbidity and mortality. The aim of the study was to analyze the changing trends in pregnancy related AKI (PR-AKI) over a period of thirty-three years. Clinical characteristics of PR-AKI with respect to incidence, etiology and fetal and maternal outcomes were compared in three study periods, namely 1982-1991,1992-2002 and 2003-2014. The incidence of PR-AKI decreased to 10.4% in 1992-2002, from 15.2% in 1982-1991, with declining trend continuing in 2003-2014 (4.68%).Postabortal AKI decreased to 1.49% in 2003-2014 from 9.4% in 1982-1991of total AKI cases. The AKI related to puerperal sepsis increased to 1.56% of all AKI cases in 2003-2014 from 1.4% in 1982-1991. Preeclampsia/eclampsia associated AKI decreased from 3.5% of total AKI cases in 1982-1991 to 0.54% in 2003-2014. Pregnancy associated – thrombotic microangiopathy and acute fatty liver of pregnancy were uncommon causes of AKI. Hyperemesis gravidarum associated AKI was not observed in our study. Incidence of renal cortical necrosis (RCN) decreased to 1.4% in 2003-2014 from 17% in 1982-1991.Maternal mortality reduced to 5.79% from initial high value 20% in 1982-1991. The progression of PR-AKI to ESRD decreased to1.4% in 2003-2014 from 6.15% in 1982-1991. The incidence of PR-AKI has decreased over last three decades, mainly due to decrease in incidence of postabortal AKI. Puerperal sepsis and obstetric hemorrhage were the major causes of PR-AKI followed by preeclampsia in late pregnancy. Maternal mortality and incidence and severity of RCN have significantly decreased in PR-AKI. The progression to CKD and ESRD has decreased in women with AKI in pregnancy in recent decade. However, the perinatal mortality did not change throughout study period.

Potential of cyanobacterial biofilms in phosphate removal and biomass production

Four cyanobacterial biofilms, raised from cyanobacterial mats and dominated by Phormidium and Oscillatoria spp., were successfully grown attached to polyester mesh discs, and were tested for their probable application in [Formula: see text] -P removal from domestic sewage and other nutrient enriched wastewaters. Biofilm # 2, dominated by Phormidium fragile, best removed [Formula: see text] -P; nevertheless, some of it also grew outside the substrate making harvesting difficult. Other biofilms also efficiently removed [Formula: see text] -P from the medium in the following order: Biofilm # 1 > Biofilm # 3 > Biofilm # 4. Their growths were restricted to discs and are therefore better candidates as they can be efficiently harvested after [Formula: see text] -P removal. [Formula: see text] -P removal was primarily due to its uptake during growth of the biofilm rather than because of precipitation as pH of the medium remained <8.5. [Formula: see text] -N concentration in the medium determined [Formula: see text] -P removal efficiency of the test biofilms and therefore optimum N:P ratio is necessary for optimizing [Formula: see text] -P removal. The test biofilms could also efficiently remove [Formula: see text] -N from the medium.

Exploring the status of motility, lipid bodies, deformities and size reduction in periphytic diatom community from chronically metal (Cu, Zn) polluted waterbodies as a biomonitoring tool

Taxonomic metrics of diatoms are regularly used for aquatic biomonitoring, including testing for heavy metal stress. In contrast, non-taxonomical parameters in diatoms are rarely assessed. In the present study, taxonomical features of diatoms, such as cell density, chlorophyll a, species richness, and the Shannon index, were reduced at severely polluted (Cu, Zn) sites compared with less polluted sites. Some non-taxonomic parameters, such as, lipid bodies (LBs) number and size, carotenoid/chlorophyll a ratios, and frustule deformities were elevated at the severely polluted sites in comparison to the less polluted sites in both the areas. Cell size diminished and motility changed from smooth to erratic with increasing Cu and Zn pollution. Some of these behavioral and physiological changes were easily assessed (e.g., motility and formation of LBs), while morphological alterations (cell wall deformities and changes in cell size) requires more time and human expertise in diatom taxonomy. These parameters were consistent across metal concentrations of sediments, in the water, and in cells. The results illustrate the usefulness of these non-taxonomic parameters in biomonitoring, especially as early warning tools for ecotoxicity assessment and testing for sublethal effects. Some of these parameters, such as cell size and cell wall deformities, can be easily incorporated into traditional protocols, although LBs and motility metrics will require more effort.

Spectrum of VP1 region genetic variants in the foot-and-mouth disease virus serotype O populations derived from infected cattle tongue epithelium

RNA virus population exists as a complex distribution of non-identical but closely related sequences known as viral quasispecies. Variant strains are selected from this quasispecies population in response to changing environment. The quasispecies dynamics of a virus existing within an infected host differs from that in a cell culture-adapted population. This study was carried out to explore the genetic variations present in the VP1 coding region of the foot-and-mouth disease (FMD) virus serotype O derived directly from infected cattle tongue epithelium. Molecular clonal populations of two serotype O strains belonging to lineages Ind2001 (IND 30/2011) and PanAsia2 (IND 5/2011) were sequenced at VP1 coding region. For IND 30/2011, 19 clones were sequenced and analysis showed variations at 12 nucleotide positions (nt) resulting in 8 amino acid (aa) replacements. Similarly, for IND 5/2011 virus, 18 clones were sequenced, of which six showed nt variations leading to 3 aa replacements. Most of the variable positions mapped to the surface-exposed loops and some of them were found in the neutralizing antigenic sites (position 81, 149, 169, 186 and 202 of IND 30/2011 and 141 of IND 5/2011), which potentially could be beneficial in rapid adaptive evolution of the virus by giving rise to antigenic variants to overcome neutralizing antibodies. These findings encourage further research into the landscape of the viral quasispecies population in vivo and its implication for viral ecology.

The Role of p53 Gene in Cervical Carcinogenesis

AIM

To investigate the role of p53 gene in cervical carcinogenesis.

MATERIALS AND METHODS

A total 50 cases and controls were taken after setting exclusion criteria. Venous blood (3 ml) samples were collected in sterile EDTA sterile vials. Both punch biopsy of cervical growth in cases and biopsy from cervix after hysterectomy in controls were performed. Genomic DNA was extracted from tissue and blood using standard protocol of Miller et al. 1994 using chloroform-phenol method. Gene was amplified using specific forward and reverse primers and p53 gene expressions were studied. The present study of p53 gene regulation analyzed the expression of 279-bp bands on 1.5 agarose gel.

OBSERVATIONS

Out of the total 50 samples of cases and controls, we were able to isolate DNA from 38 cases and 28 controls in blood and in 22 cases and 22 controls in tissue. In cases of carcinoma cervix, p53 expression is either downregulated or absent in 71.06 % of cases compared to 50 % of controls in blood and 72.73 % of cases compared to 59.09 % of controls in tissue, but these figures were not statistically significant (p = 0.67 and p = 0.167, respectively). p53 positivity rate was only in 27.78 % of squamous cell cancer and 50 % of adenocarcinoma. Three out of nine patients (33.3 %) with L.N. positive status have p53 gene positivity, whereas 23 % (3 out of 13) with L.N. negative status have p53 gene positivity, which is not significantly associated. In our study, p53 overexpression increases with the various stages of cervical cancer.

CONCLUSION

In our study, we found that there is the increased frequency of upregulation or overexpression of p53 gene in control in both blood (50 %) and tissue (40.9 %), but this association is statistically nonsignificant. In the present study, there is a lack of relationship between p53 overexpression and prognosis in the cervical cancer patients. However, our study lacked larger sample size which otherwise would have been able to lend support to truly significant findings through much larger combined and comparative datasets.

Response of a phytoplanktonic assemblage to copper and zinc enrichment in microcosm

The response of a laboratory-raised phytoplankton assemblage to copper and zinc enrichment was studied. Higher intracellular accumulation of both the test metals caused disappearance of metal sensitive species, loss of diversity and species richness, reduced growth rate, Chl a and biovolume; however, the community could recover after 14 days of incubation. Cyanobacteria showed marked sensitivity to both the test metals besides some diatoms, such as, Cyclotella meneghiniana and Melosira granulata. Metal enrichment enhanced the relative abundance of species like Scenedesmus quadricauda, Oocystis borgei, Achnanthes exigua, Fragilaria capucina and Nitzschia amphibia, and these were apparently metal tolerant. Cu and Zn stress induces formation of lipid bodies (bigger in size as well as in number) and morphological abnormalities in diatoms. Among these two metals, Cu impact was higher than Zn despite the fact that the intracellular accumulation of Zn was higher than Cu. Deformed raphe and mixed deformities in diatoms were exclusively found under heavy metal stress which was well supported by regression analysis. Finally the present study gives new insight for using diatoms as an effective tool for biomonitoring and biofuel production.

In human alleles specific variation of MTHFR C677T and A1298C associated "risk factor" for the development of ovarian cancer

Etiopathology of tumor biology is highly complex and ovarian cancer is one of the important gynaecological neoplasia associated with high risk of mortality rate. Methlenetetrahydrofolate reductase (MTHFR) mutation are commonly linked to folate metabolism with increased risk factor for the development of neural tube defects, recurrent pregnancy loss and development of several type of cancer but genetic interaction between two alleles of MTHFR has been poorly defined in ovarian cancer in India. Hence, present study becomes imperative with the aim to assess the alleles frequency of MTHFR (C677T & A1298C) gene polymorphism using PCR based RFLP analysis. The O.R at 95% confidence interval (C.I.) was computed between cases and their respective controls to determine "risk factor". Interestingly, our findings reveals highly significant (p < 0.001) difference in heterozygous (CT) condition of C677T allele by computing odd ratio (0.12 at 95% C.I, 0.021-0.0428; P for trend = 0.001) in controls and (0.34 at 95% C.I, 0.074-1.530; P for trend = 0.198) cases, suggesting that three time increase the "risk factor" for genetic susceptibility of MTHFR "T" allele for the development of ovarian carcinoma.

Genetic diversity of stem cells and their functional impact on the development of neural tube defects in Eastern population of India

Anencephaly and myelomeningocele are the 2 most common forms of neural tube defects (NTDs). During embryogenesis large numbers of extrinsic and intrinsic factors are responsible for the closing of the neural tube. "Stem cells" maintain the pluripotency during differentiation of 3 germ layers, including the neural ectoderm. We examined the role of Oct4, Nanog3, and Sox2 genes in the etiopathology of NTDs in an eastern Indian population using PCR-based DNA analysis. The highest frequency (16%) of complete loss of the Sox2 gene was found in NTDs. The highest frequency (48%) of overexpression (upregulation) was found for Nanog3, while 40% was observed for Oct4 and Sox2. The odds ratio for cases versus controls was from 0.132 at 95% confidence interval = 0.005-1.298 for Nanog3 to 2.316 (0.424-13.812) for Oct4. The highest frequency (77%) of overexpression for Nanog3 and Sox2 was observed in encephalocele and anencephalic patients, while in the comparison of regional variation, i.e., cephalic to caudal regions of NTDs, the highest frequency of downregulation (regression) of Nanog3 and Sox2 was found in lumbosacral myelomeningocele patients. However, cervical myelomeningocele patients had the highest frequency of overexpression in all 3 genes, suggesting that the mutational spectra of stem cells influence the cells of the neural crest in NTDs.

Prevalence of cystathionine beta synthase gene mutation 852Ins68 as a possible risk for neural tube defects in eastern India

Cystathionine beta synthase gene (CβS) catalyzes the condensation of homocysteine with serine, forming cystathionine by the transsulfuration pathway. Disruption of CβS enzyme activity due to defective folic acid metabolism increases the risk factor for neural tube defects. We evaluated the CβS gene mutation in 25 children with neural tube defects (NTDs), including lumbosacral and thoracic myelomeningocele and open NTDs and mothers of cases, along with 25 healthy children and their mothers, serving as controls. Genomic DNA was isolated to assess the polymorphism of 852Ins68 in the CβS gene using PCR-RFLP analysis and nucleotide sequencing techniques. The 68-bp insertion was observed in one of the 25 NTD cases (lumbosacral myelomeningocele), and in two of the mothers of NTD cases. Statistical analysis was carried out using the Fischer exact probability test, which showed a lack of significance (P > 0.05), but the odds ratio of 2.08 with 95% confidence interval of 0.17-24.6 in NTDs mother was quite high because of the small sample size. However, the study was further extended to find out the involvement of specific nucleotide sequences, which again confirmed the 852Ins68 insertion and replacement of nucleotides (TCCAT to GGGG) in lumbosacral myelomeningocele (due to other category of NTDs), suggesting that it could be an independent risk factor for birth defects, including NTDs.

Spectrum of kidney diseases in patients with preeclampsia-eclampsia

AIM

The aim of this study was to analyse the clinical spectrum of renal manifestation of preeclampsia in pregnant women.

METHOD

Diagnosis of preeclampsia was made using two cardinal feature of the disease after 20th weeks of gestation in previously normotensive and nonproteinuric women: (1) Blood pressure > 140/90 mm Hg and (2) urinary protein excretion of > 300 mg/24 hour. The patients with renal manifestations were followed up to 12 weeks postpartum or till death whichever was earlier.

RESULT

Of 1805 pregnant women, preeclampsia was diagnosed in 106 (5.87%) patients. Primiparity constitutes 53.77% of total patients. Hypertension and proteinuria were observed in all patients. Hyperuricemia was observed in 93.65% of cases. Acute renal failure occurred in 22 patients. Dialysis support was needed in only four cases of ARF with complete recovery of renal function in 82% of cases. HELLP syndrome was seen in 16 (preeclampsia 5; eclampsia 11) patients. Sixty six patients (Death 13 and lost to follow up 27) were followed for 12 weeks. The renal parameters (Hypertension, Proteinuria and renal function) returned to normal in all except in two patients. Renal biopsy in these two cases revealed FSGS and MPGN in one each.

CONCLUSION

The incidence of preeclampsia was 5.87%. Nephrotic syndrome was observed in 11.32% of patients. Acute renal failure occurred in 20.8% of patients. Hypertension, proteinuria and renal function resolved to normal over a average period of 35.8 days in all survivors. The overall mortality was 12%. Neurological complication, pulmonary edema and multiple organ failure were the causes of death.

Loss of the AZFc region due to a human Y-chromosome microdeletion in infertile male patients

Infertility is a major reproductive health threat; the frequency of male infertility due to Y-chromosome microdeletions is 13-18% in the human population; these microdeletions involve recurrent loss of three non-overlapping regions designated as AZFa, AZFb and AZFc, associated with spermatogenic failure. Several contradictory reports have been published regarding deletion frequency based on sequence-tagged site markers and genotype-phenotype correlation. We examined the prevalence of Yq- deletion in 64 clinically diagnosed infertile male patients. We found a 3% frequency of microdeletion of the AZFc region; hormone profiles (FSH, LH and testosterone) showed significantly (P < 0.001) elevated levels compared to controls. No mutations were observed in the AZFa and AZFb regions, perhaps due to the selective use of sequence-tagged site markers.

Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India

BACKGROUND

Renal cortical necrosis (RCN) accounts for 2% of all cases of acute renal failure (ARF) in adults and 15-20% of ARF during the third trimester of pregnancy in developed nations. However, RCN incidence is higher in developing countries ranging from 6-7% of all cases of acute renal failure. The present study describes changing trends in the clinical spectrum of RCN in patients with ARF in Eastern India.

METHODS

Patients with ARF suspected to have RCN on clinical grounds underwent percutaneous renal biopsy. Patients showing cortical necrosis on histology were included in the present study. Diffuse and patchy cortical necrosis was classified based on standard histological criteria. The patients with cortical necrosis were studied over a period of 22 years; from July 1984 to December 2005. The results of our observation were compared with respect to etiology, incidence, prognosis and outcome of renal cortical necrosis in two study periods; namely, 1984-1994 and 1995-2005.

RESULTS

The incidence of RCN was 3.12% of all cases of ARF of diverse etiology. RCN was observed in 57 patients; obstetric 32 (56.2%); non-obstetric 25 (43.8%). Diffuse cortical necrosis was the dominant lesion in 41 (71.9%) patients and the remaining 16 (28%) patients had patchy cortical necrosis. The overall incidence of RCN in obstetric ARF was 15.2%; the incidence being higher (11.9%) in the post-abortal group in comparison to 3.3% in late pregnancy. RCN had occurred complicating abruptio placentae, puerperal sepsis and postpartum haemorrhage (PPH) in late pregnancy, while septic abortion was the sole cause of RCN in early pregnancy. Haemolytic uraemic syndrome (HUS) was the major (31.5%) cause of RCN in the non-obstetric group and miscellaneous factors were responsible in seven (12.3%) patients. Partial recovery of renal function was observed in 11 (19.2%), and 16 (28%) patients had progressed to ESRD. The incidence of RCN decreased from 6.7% in 1984-1994 to 1.6% in 1995-2005 of total ARF cases. RCN following obstetrical complication decreased significantly; 4.7% in the 1990s to 0.5% of the total ARF cases, in the 2000s. The mortality decreased to 19% in 1995-2005 from the initial high mortality of 72% in 1984-1994. The renal prognosis improved as a result of the decreased mortality of patients.

CONCLUSION

We observed a decreasing trend in the incidence of RCN in patients with ARF in recent years, which is associated with increased patient survival and better renal prognosis. This improvement was mainly due to declining incidence and severity of RCN in obstetrical ARF.

Acute renal failure in pregnancy in a developing country: twenty years of experience

Acute renal failure (ARF) has become a rare complication of pregnancy in developed countries. The aim of this study was to describe changing trends in pregnancy-related acute renal failure (PR-ARF) in two successive periods; 1982-1991 and 1992-2002. From July 1982 to December 2002, 190 cases of PR-ARF were observed in Eastern India (11.6% of total number of ARF needing dialysis). Obstetrical complications were causative factors for ARF in 15% (65/426) and 10% (125/1201) of patients in the two periods, respectively. The incidence of PR-ARF fell from 15% in 1982-1991 to 10% in 1992-2002, with respect to the total number of acute renal failure cases. Post-abortal ARF showed a declining trend, 9% in the 1980s to 7% in the 2000s, of the total number of ARF cases. Preeclampsia-eclampsia was the cause of obstetrical ARF in 23% (1982-1991) and 14.4% (1992-2002) of cases in these two periods. The percentage of total ARF due to eclampsia declined from 3.5% during the period 1982-1991 to 1.4% in 1992-2002. Puerperal sepsis contributed to 0.8% of total ARF in recent years, compared to 2.4% in the earlier period. The incidence of cortical necrosis decreased significantly (p < 0.001) from 17% in 1982-1991 to 2.4% in the 2000s. The maternal mortality reduced to 6.4% in 1992-2002 from initial high mortality of 20% in the period of 1982-1991.

CONCLUSION

PR-ARF which remained high in the initial period has decreased in recent years. This is associated with a declining trend in

Hypertension in pregnancy: hospital based study

Eighteen hundred two pregnant women consisting of 750 primigravida and 1,052 multigravida were screened for hypertension between July 2000 to June 2002. Hypertension was noted in 97 (5.38%) patients. Twenty five patients were lost to follow up and only 72 patients were included in the final study. The age of the patients ranged between 19 to 32 (mean +/- SD = 24.75 +/- 3.36) years. The majority of patients 41 (57%) were primigravida and 31 (43%) were multigravida. Of 31 multigravida, vast majority (84%) of patients were found to be hypertensive in the third trimester. Only 5 (16%) patient had hypertension in the first trimester. Stage I, II and III hypertension were noted in 18%, 50% and 32% of patients respectively as per JNC-VI criteria. Preeclampsia (PE) was seen in 44.44% (n=32), eclampsia in 40.28% (n=29), HELLP syndrome in 6.94% (n=5), chronic hypertension (HTN) with superimposed PE in 6.94% (n=5) and chronic HTN in 1.38% (n=1). Of the 6 patients with chronic hypertension 50% (3) had essential HTN. Acute renal failure (S. creat > 3 mg/dl) was seen in 7 patients and 4 required dialytic support. Maternal mortality was 5.55% (4) and perinatal death occurred in 37.5% (27) of deliveries. Low birth weight was seen in 66.66% (48) of births. Hypertension complicated 5.38% of all pregnancies in our study. Preeclampsia-eclampsia and its variants remain the major cause of hypertension in pregnant women. Hypertension during pregnancy is responsible for high fetal mortality and low birth weight.

MTHFR C677T and A1298C polymorphisms are risk factors for Down's syndrome in Indian mothers

Down's syndrome (DS), a chromosomal disorder due to trisomy 21, results mostly from nondisjunction in maternal meiosis. The present case-control study examined the association of genetic polymorphisms with predisposition to nondisjunction. Two common polymorphisms (SNPs), C677T and A1298C, in the 5,10-methylenetetrahydrofolate reductase (MTHFR) gene involved in folate metabolism, are known to lower the activity of this enzyme. Three hundred and fourteen mothers (with DS children and controls), mostly from the eastern states of India, were genotyped for the two above-mentioned SNPs. Significant association with both of these SNPs were detected, more specifically, in the mothers of DS children homozygous for the polymorphic alleles 677 T and 1298 C. The relative risk of T (C677T) and C (A1298C) homozygosity in mothers for DS-affected pregnancy was 7 (OR 7.67, 95% CI 1.67-35.08, P=0.003) and 4 (OR 4.40, 95% CI 1.45-13.26, P=0.008), respectively. Moreover, all 677TT mothers studied were less than 31 years of age, whereas no correlation with maternal age was observed for A1298C genotypes. Interestingly, all of the young 677TT mothers had either a first- or secondborn child with DS. Thus, this study reports that young Indian mothers with TT genotypes are genetically predisposed to nondisjunction due to abnormal folate metabolism.

Effects of metformin treatment on luteal phase progesterone concentration in polycystic ovary syndrome

The causes of luteal phase progesterone deficiency in polycystic ovary syndrome (PCOS) are not known. To determine the possible involvement of hyperinsulinemia in luteal phase progesterone deficiency in women with PCOS, we examined the relationship between progesterone, luteinizing hormone (LH) and insulin during the luteal phase and studied the effect of metformin on luteal progesterone levels in PCOS. Patients with PCOS (19 women aged 18-35 years) were treated with metformin (500 mg three times daily) for 4 weeks prior to the test cycle and throughout the study period, and submitted to ovulation induction with clomiphene citrate. Blood samples were collected from control (N = 5, same age range as PCOS women) and PCOS women during the late follicular (one sample) and luteal (3 samples) phases and LH, insulin and progesterone concentrations were determined. Results were analyzed by one-way analysis of variance (ANOVA), Duncan's test and Karl Pearson's coefficient of correlation (r). The endocrine study showed low progesterone level (4.9 ng/ml) during luteal phase in the PCOS women as compared with control (21.6 ng/ml). A significant negative correlation was observed between insulin and progesterone (r = -0.60; P < 0.01) and between progesterone and LH (r = -0.56; P < 0.05) concentrations, and a positive correlation (r = 0.83; P < 0.001) was observed between LH and insulin. The study further demonstrated a significant enhancement in luteal progesterone concentration (16.97 ng/ml) in PCOS women treated with metformin. The results suggest that hyperinsulinemia/insulin resistance may be responsible for low progesterone levels during the luteal phase in PCOS. The luteal progesterone level may be enhanced in PCOS by decreasing insulin secretion with metformin.

Antiovarian antibody in premature ovarian failure

Premature ovarian failure is a syndrome consisting of primary or secondary amenorrhoea, hypergonodotropiremia and hypoestrogenemia in women under the age of 40. An autoimmune mechanism was suggested as possible etiology when Vallolton and Forbes in 1966-67 found antibodies to the cytoplasm of rabbit ova in 29 of 232 tested sera. Immune mechanism in the pathogenesis of premature ovarian failure (POF) is suggested by association of autoimmune phenomenon with POF in some cases and demonstration of circulating antibodies to ovary in serum samples from women with POF. The incidence of presence of antiovarian antibody of POF patients has been reported earlier. Evidence of autoimmunity is present in 18-92% of patients with POF. In the present study we have studied 18 cases of POF without any overt manifestation of autoimmune disorder but the antiovarian antibody was detected, with the idea that this autoantibody might be the cause of ovarian dysfunction which is evident in POF. Presence of antiovarian antibody in 16.67% cases with POF in our study that ovarian antibodies may play a role in or reflect an autoimmune process responsible for the development of POF.

Renal cortical necrosis in pregnancy-related acute renal failure

Of 63 patients of obstetrical acute renal failure, 15 cases (23.8%) had biopsy proven bilateral renal cortical necrosis. Remaining 48 patients (76.2%) had acute tubular necrosis. Eight of 39 cases in early pregnancy had cortical necrosis (postabortum) and 7 of 24 patients in late pregnancy revealed cortical necrosis. Diffuse and patchy cortical necroses were seen in 12 and 3 patients respectively. The incidence of cortical necrosis was almost equal in both early as well as late pregnancies. The high incidence (20.5%) of cortical necrosis following septic abortion remains the interesting feature of the present study in contrast to very low incidence (1.5%) of cortical necrosis in postabortum group in developed countries. The death occurred in most patients (14 ie, 93.3%) of cortical necrosis because of uraemic complications and sepsis.

Spectrum of renal cortical necrosis in acute renal failure in eastern India

Renal cortical necrosis is an uncommon cause of acute renal failure. We report 23 cases of biopsy-proven renal cortical necrosis which constituted 6.3% (23/363) of all cases of acute renal failure studied over a period of seven years (1985-92). The patients were divided into two groups: obstetric and non-obstetric. Obstetric complications were responsible for renal cortical necrosis in 15 (65.2%) patients while non-obstetric conditions accounted for the remaining eight (34.8%) cases. The overall incidence of cortical necrosis in obstetric acute renal failure was 15/63 (23.8%) patients, the incidence being nearly equal in early (20.5%) and late (29%) pregnancy. Post-abortum renal failure was the sole cause of cortical necrosis in early pregnancy in the obstetric group. Haemolytic uraemic syndrome (three patients) and septicaemia (two patients) were the main cause of necrosis in the non-obstetric group. The cortical necrosis was diffuse and patchy in 17 and six patients, respectively. The disease had a fatal prognosis in 20 (87%) patients; mortality was due to uraemic complications and infections in the majority of patients. The high frequency of post-abortum renal cortical necrosis in our patients is similar to the experience of other Indian workers.

Birthweight: its relationship with maternal and newborn skinfold thickness

Two hundred and forty seven pregnant women at term and their offsprings were studied. Maternal skinfold thickness was measured from ten different sites and newborn skinfold thickness was measured from four different sites in each set of cases. Maternal skinfold thickness was positively correlated with the birthweight and skinfold thickness of the offspring. The birthweight was also positively correlated with the skinfold thickness of offspring. The maternal axillary sites and offspring's subscapular site had higher inter correlation as well as with the birthweight of offspring.

Cellular immunity status in anaemia in pregnancy

Fifty pregnant women (25 anaemic and 25 non-anaemic) and 20 non pregnant women (10 anaemic and 10 non-anaemic) were studied. All pregnant women delivered full term (37-41 wk) singleton babies. Maternal blood lymphocyte stimulation indices (SI) at 0 and 24 h were lower in anaemic and non-anaemic pregnant women, compared to anaemic and non-anaemic non-pregnant women. This difference was more marked in anaemic pregnant women, as compared to non pregnant anaemic women at 0 and 24 h respectively. The SI of maternal and cord blood lymphocytes were significantly lower in severely anaemic mothers both at 0 and 24 h and in those with maternal serum iron levels below 50 micrograms/dl or maternal per cent transferrin saturation was below 15 per cent. The anaemic mothers and their offspring were found to have significantly lower blastogenic response to PHA added at 24 h indicating depression of T-suppressor cell function.

Non-specific vaginitis vis-a-vis Gardnerella vaginalis

One hundred patients of vaginitis along with 50 age matched control women were studied. Non-specific vaginitis (NSV) was diagnosed on the basis of the presence of at least any three of the four parameters which included presence of thin gray homogeneous discharge, pH of the discharge greater than or equal to 4.5, liberation of fishy odour from the discharge after adding 10 per cent KOH and presence of clue cells Using these criteria, NSV was diagnosed in 22 of the 100 patients and in 4 of 50 control women. Gardnerella vaginalis was cultured from 23 of the 26 women with NSV and 19 women without NSV (8 patients and 11 normal women). Women with NSV showed statistically significant difference in the presence of clue cells, amine test positivity and concentration of G. vaginalis as compared to women without NSV.

Prevalence of common infective agents of vaginitis

A total of 100 women with vaginitis and 50 age matched healthy women were studied for common infective agents of vaginitis. The vaginal secretions collected from these women were examined for Trichomonas vaginalis, G. vaginalis, and Candida species. The prevalence of infective agents in the patients was T. vaginalis 11 per cent. Candida species 30 per cent and Gardnerella vaginalis 31 per cent. In contrast, in the control group the prevalence was Candida species 14 per cent and G. vaginalis 22 per cent. T. vaginalis was not isolated from any of the control women. Mixed infections with G. vaginalis and Candida species were seen in four cases and T. vaginalis and Candida species in one case only. Mixed infection with T. vaginalis ahd G. vaginalis was not observed in any of the patients studied.

Primary hepatic pregnancy

A case of a 28 weeks primary hepatic pregnancy in a 25 year old female is reported. A live male fetus weighing 1300 g was delivered after laparotomy and the placenta was left intact. The uterus was of 8 weeks size with patent tubes. The patient made an uneventful recovery.

Blood coagulations studies in pregnant patients with infective hepatitis

Coagulation studies were made on 22 pregnant women with acute infective hepatitis and on 15 normal control pregnant women in third trimester. Fourteen hapatitis patients had clinical evidence of liver failure and all of them had a haemorrhagic diathesis; none of the patients without liver failure showed clinical evidence of haemostatic defects. Coagulopathy was present in most patients, its severity being greater in those with hepatic failure. Significant alterations were observed in bleeding time, whole blood clotting time, prothrombin time, thrombin time, plasma fibrinogen and serum levels of fibrinogen degradation products. The last three disturbances were most frequent in patients with liver failure. Increased fibrinolysis and disseminated intravascular coagulation also appeared to play a contributory role, particularly in patients with hepatic failure.