Role of D-dimer in determining coagulability status in pre-eclamptic and normotensive pregnant women.

A cross sectional study was carried out from January 2007 to December 2008 in the department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka in collaboration with Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Pregnant women with pre-eclampsia attending at Out-patient Department (OPD) and admitted in In-patient Department of Obstetrics and Gynaecology Dhaka Medical College Hospital, Dhaka were selected as cases. Healthy and uncomplicated pregnant women admitted in the same hospital were taken as controls. The study showed that 26-30 years and 21-25 years age category was higher in the case and control groups and the mean age was significantly higher in case group compared to control group (p=0.025). The study showed that 44% of case group had a significantly high level of plasma D-dimer (>0.5µg/ml) as opposed to control group (8%) (p<0.001). Estimation of odds ratio demonstrates that pre-eclamptic women (case) had 9 times (95% of CI = 2.8 - 28.9) more risk of having plasma D-dimer >0.5µg/ml than that of normal pregnant women (control). The mean systolic and diastolic blood pressures in patients with plasma D-dimer >0.5µg/ml were considerably higher than those who had plasma D-dimer ≤0.5µg/ml (p<0.001). The study showed that majority (81.8%) of pre-eclamptic women with plasma D-dimer >0.5µg/ml had systolic blood pressure ≥ 160 mm Hg compared to 46.4% of those who had plasma D-dimer ≤0.5µg/ml (p=0.010). And ninety percent of pre-eclamptic women with plasma D-dimer >0.5µg/ml had exhibited severe proteinuria as opposed to 53.6% of those who had plasma D-dimer ≤0.5µg/ml (p=0.017). The study concludes that plasma D-dimer level can easily be used in screening for the hypercoagulable state in pre-eclamptic patients which have preventive and therapeutic implications.

Socio-Economic and Health Status of Leprosy Affected Person: A Study in Jharkhand.

The study has been conducted in the Potka Block of East Singhbhum district of the state of Jharkhand. The district is mainly dominated by indigenous tribes, such as, Santhal, Munda, Ho, Bhumiz, Kharia, and Sabar. The unit of analysis of the study was an individual. The objectives were to: a) Understand the socio-economic and health status of LAP, b) Know the health seeking behavior and problems faced by the LAP, c) Assess the utilization of the programs related to Leprosy eradication in the study area and d), Suggest various measures for improving the socio-economic and health status of LAP. Fifty Leprosy affected persons (LAP) from the Potka block; comprising of 20% of LAP of that area have been selected as the study sample by using the method of Multi-Stage Random Sampling, with equal representation of men and women. The LAPs included leprosy patients, leprosy treated people and their family members. 39/50 (78%) of the respondents are illiterates and only 3/11 (6%) among the literate population have crossed matriculation and above. This seems to have resulted in the respondent's low level of awareness about the disease, resulting in delayed treatment. 14/25 (56%) percent of female and 13/25 (52%) of male respondents are considered untouchable by their natal families, thus forced to stay in congested leprosy colonies resulting in other social and health related issues. It was observed that leprosy cured children,and also children of LAP are being denied admission iany school, due to the social stigma attached to it. 27/50 (54%)of leprosy patients and leprosy cured people (mostly with visible deformities) were found to practice begging as their sole means of livelihood. Many LAPs are also engaged in cultivation and small scale business particularly among the rural population. An amount of gender disparity was also observed in the employment pattern among the LAPs. Among the, respondents 15/25 (60%) of the females are beggars as compared to 12/25 (48%) of the male respondents, 5/25 (25%) of males are each engaged in cultivation and small scale businesses in comparison to 1/25 (4%) of female and 6/25 (24%) of the female respondents are unemployed as compared to 2/25 (8%) of male respondents. It was observed that only 30% of the respondents were satisfied with the government treatment, 26% partially satisfied and rest were not satisfied with the government leprosy care system. Most of them wanted to seek treatment from the private health care providers. Overall this study reflects the poor socio-economic conditions of the LAPs. Though results of this exploratory study cannot be extrapolated to country or region or state without studying the situation in detail, it highlights the need for more in-depth studies and of government intervention in the form of encouraging awareness activities in the communities, engaging NGOs im case detection and after care service provision and rehabilitation of the LAPs.

Quantitative study of As (V) and As (III) interaction with mangrove DNA by molecular fluorescence spectroscopy.

This study describes the in vitro study of (1:1) one step nucleophilic displacement ([Formula: see text]) of phosphate by heavier anion arsenate and arsenite in the DNA of arsenic ridden Sundarban mangroves. Mangrove DNA was found to give rise to a broad fluorescence and its integrated fluorescence intensity was enhanced on addition of As (V) and As (III), respectively. Analyses of the fluorescence parameter showed adequacy of 1:1 model to describe substitution of phosphate of mangrove DNA chain exiplex by arsenate and arsenite with equilibrium constant (log Kc) ranging between 4.19 and 4.32 for As (V), and between 3.77 and 3.89 for As (III) at pH 7 and 25°C. In the cases, the melting temperature (Tm) and reassociation rate constant of mangrove DNA was increased on treatment with As (V) and As (III). It is suggested that heavier ion arsenate and arsenite may substitute phosphate in natural DNA.

Implication of organic matter on arsenic and antimony sequestration in sediment: evidence from Sundarban mangrove forest, India.

This study reports the measurement of stability constants for the interaction of As (V and III) and Sb (V and III) with humic substances extracted from aquatic sediments of the Sundarban mangrove forest ecosystem. It was observed that As and Sb formed a slightly more stable association with fulvic acid (FA) than with its humic acid (HA) counterpart. Quenching of fluorescence at increasing As (III and V) or Sb (III and V): FA or HA ratios was obtained that ideally correspond to a 1:1 complexation model. Quite strong complexation of As and Sb by FA and HA occurs at neutral pH, indicating that HA and FA probably markedly affect the mobility of As and Sb in the mangrove environment.

Wood chemistry and density: an analog for response to the change of carbon sequestration in mangroves.

This study aimed to resolve the variations of physical and chemical properties of wood records measured in different mangroves with their annual carbon sequestration. The methods of investigation used were to examine growth rate by monitoring breast height diameter, wood chemistry and density, FTIR spectroscopy and thermogravimetry. Carbon sequestration rate showing an increase with density varied between 0.088 and 0.171 µg C kg(-1) AGB s(-1), and Avicennia marina showed the maximum value and Bruguiera gymnorrhiza, the minimum. The changes in FTIR bands at 4000-2500 cm(-1) and 1700-800 cm(-1) were correlated to the variations in cellulose in mangrove woods and lignin to cellulose ratio ranged between 0.21 and 1.75. Thermal analyses of mangrove wood suggested that the fuel value index (985-3922) exhibited an increase with the decrease in maximum decomposition temperature and density. The seasonal variation of temperature and CO2 were likely to affect chemical properties through changes in wood density.

Restoration of impaired free radical generation and proinflammatory cytokines by MCP-1 in mycobacterial pathogenesis.

Mycobacterium tuberculosis exerts its pathogenic effects mainly via its cell wall glycolipid called Mannosylated Lipoarabinomannan (Man-LAM), which subverts the cellular inflammatory responses by the suppression of superoxide anion generation in earlier hours, and nitric oxide (NO) generation at later hours of pathogenic invasion. In this paper, we have shown the prophylactic effect of C-C chemokines, both in vitro and in vivo. Exogenous administration of C-C chemokines, particularly monocyte chemoattractant protein (MCP)-1, led to the induction of superoxide anion generation via the restoration of impaired protein kinase C (PKC) signalling in Man-LAM-treated macrophages. Monocyte chemoattractant protein-1 could also potently induce NO generation by upregulation of the proinflammatory cytokines tumour necrosis factor-alpha and interleukin-12 from Man-LAM-treated macrophages accompanied by inhibition of anti-inflammatory responses. Our in vivo observations clearly exhibited effective restoration of impaired PKC signalling as well as proinflammatory cytokine expression by MCP-1 in Man-LAM treated as well as M. tuberculosis H37Rv-infected C57BL/6 mice. We also observed, as direct evidence, that MCP-1 induced a significant reduction of the number of viable tubercle bacilli in the lungs and spleen of infected mice. Collectively, our findings strongly suggest the effectiveness of MCP-1 as a potent immunoprophylactic tool for controlling the mycobacterial establishment within the host.

A novel approach to regulate experimental visceral leishmaniasis in murine macrophages using CCR5 siRNA.

Early infection with Leishmania donovani during visceral leishmaniasis (VL) results in the enhanced expression of C-C chemokine receptor 5 (CCR5) in macrophages. CCR5 expression at different time points of infection revealed increased expression at protein and mRNA level from 3 to 24 h and beyond 24 h expression of CCR5 is downregulated. To better understand the functional role of CCR5 during leishmania infection, RNA interference strategy has been used to modulate macrophage function by targeting the expression of CCR5 gene. We found that silencing of CCR5 receptor expression by transfection of CCR5-specific small interfering RNA (siRNA) in murine peritoneal macrophages restricted the parasitic burden up to 70% during early hours of infection. In addition, gene silencing of CCR5 prior to L. donovani infection enhanced the pro-inflammatory response of the host macrophages in comparison with infection alone as shown by high nitric oxide generation and the TNF-alpha:IL-10 ratio. These findings suggest that CCR5 receptor plays a significant role in the entry and establishment of L. donovani in murine macrophages and CCR5 gene silencing would be a potent therapeutic approach to control VL by restricting parasite entry.

Induction of host protective Th1 immune response by chemokines in Leishmania donovani-infected BALB/c mice.

The resolution from leishmanial infection is dependent on the coordinated interactions between the components of the cell mediated immune system and the activation of T-cell population into appropriate cytokine production and the activation of macrophages. Earlier reports established that C-C chemokines particularly macrophage inflammatory protein (MIP)-1alpha and macrophage chemoattractant protein (MCP)-1 restrict the parasitic burden via the regulation of impaired protein kinase C (PKC) signalling and induction of free-radical generation in murine leishmaniasis. This study explored the role of MIP-1alpha and MCP-1 in the induction of T helper 1 (Th1) immune response and suppression of T helper 2 (Th2) response in Leishmania donovani-infected BALB/c mice. These chemokines induced the known pro-inflammatory cytokine interleukin (IL)-12 secretion and inhibited the secretion of anti-inflammatory cytokines IL-10 and transforming growth factor-beta in infected macrophages. Impaired antigen presentation capability of infected macrophages was also restored by the chemokine treatment. C-C chemokine treatment resulted in reduced levels of mRNA expression of IL-10, but increased levels of mRNA expression of IL-12p40, interferon (IFN)-gamma, tumour necrosis factor-alpha and inducible nitric oxide synthase in both liver mononuclear cells as well as in splenocytes, reflecting a switch of CD4+ differentiation from Th2 to Th1. Flow cytometric analysis of infected spleen cells suggested that C-C chemokine treatment enhances the CD4+ T cells to produce increased levels of IFN-gamma. These studies hypothesize a promising immuno-prophylactic effect of chemokines against leishmaniasis by induction of Th1 cytokine release imparting a long-term resistance.

A new genetic disorder in mitochondrial fatty acid beta-oxidation: ACAD9 deficiency.

The acyl-CoA dehydrogenases are a family of multimeric flavoenzymes that catalyze the alpha,beta -dehydrogenation of acyl-CoA esters in fatty acid beta -oxidation and amino acid catabolism. Genetic defects have been identified in most of the acyl-CoA dehydrogenases in humans. Acyl-CoA dehydrogenase 9 (ACAD9) is a recently identified acyl-CoA dehydrogenase that demonstrates maximum activity with unsaturated long-chain acyl-CoAs. We now report three cases of ACAD9 deficiency. Patient 1 was a 14-year-old, previously healthy boy who died of a Reye-like episode and cerebellar stroke triggered by a mild viral illness and ingestion of aspirin. Patient 2 was a 10-year-old girl who first presented at age 4 mo with recurrent episodes of acute liver dysfunction and hypoglycemia, with otherwise minor illnesses. Patient 3 was a 4.5-year-old girl who died of cardiomyopathy and whose sibling also died of cardiomyopathy at age 21 mo. Mild chronic neurologic dysfunction was reported in all three patients. Defects in ACAD9 mRNA were identified in the first two patients, and all patients manifested marked defects in ACAD9 protein. Despite a significant overlap of substrate specificity, it appears that ACAD9 and very-long-chain acyl-CoA dehydrogenase are unable to compensate for each other in patients with either deficiency. Studies of the tissue distribution and gene regulation of ACAD9 and very-long-chain acyl-CoA dehydrogenase identify the presence of two independently regulated functional pathways for long-chain fat metabolism, indicating that these two enzymes are likely to be involved in different physiological functions.

Immunomodulatory role of arabinosylated lipoarabinomannan on Leishmania donovani infected murine macrophages.

Arabinosylated lipoarabinomannan (Ara-LAM), a surface glycolipid antigen isolated from avirulent Mycobacterium smegmatis is involved in modulation of host cell signaling. In this study, we investigated Ara-LAM-mediated modulation of impaired immune responses during visceral leishmaniasis caused by protozoan parasite Leishmania donovani. Ara-LAM treatment at dose of 3 microg/ml in L. donovani infected murine peritoneal macrophages as well as J774A.1 macrophage cell line exhibited a distinct up-regulation of pro-inflammatory cytokines like TNF-alpha and IL-12 both at the protein and transcriptional level. In addition, generation of nitric oxide and iNOS expression were also observed. The present study showed that Ara-LAM was significantly effective in elimination of L. donovani parasites from both peritoneal as well as J774A.1 macrophages. Thus, it could be utilized as an immunomodulatory agent in prevention of leishmanial pathogenesis.

'Survival gene' Bcl-xl potentiates DNA-raised antitumor immunity.

T-cell priming is strongly affected by the longevity of antigen-bearing dendritic cells (DCs), which are typically short-lived in lymphoid tissues. 'Survival gene' Bcl-xl is critical for the lifespan of DCs in vivo. Here, we showed that in vivo coadministration of Bcl-xl under control of the DC-specific promoter (CD11c-Bcl-xl) and TRP2hsp70 DNA prolonged T-cell stimulation by DCs and augmented TRP2-specific-IFN-gamma-producing CD8+ T-cell responses. Consistent with these findings, enhanced protection and significant therapeutic immunity to B16 melanoma was generated by this coimmunization strategy, which also augmented therapeutic immunity to GL-26 tumor. In this B16 melanoma model, results from animal experiments with depletion of immune cells indicate that CD8+ T cells and NK cells are important in the antitumor immunity induced by this coimmunization strategy. These observations suggest that 'survival gene' Bcl-xl potentiates the magnitude of antigen-specific-CD8+ T-cell responses and the efficacy of antitumor immunity induced by DNA vaccine, and is relevant for the design of in vivo targeted DC-based vaccine strategies to improve immunity against cancer.

Rhinosporidiosis in Pondicherry.

One hundred and thirty-nine cases of rhinosporidiosis diagnosed histopathologically over a period of 4 years were analysed. Nasal rhinosporidiosis is common among males who bathe in stagnant ponds while ocular rhinosporidiosis is common among urban females. There is a seasonal variation in the incidence of nasal and ocular rhinosporidiosis.

Hamartoma of nasopharynx.

The extreme rarity of nasal and nasopharyngeal hamartoma, and its possible confusion in early diagnosis, prompted us to undertake a brief review of hamartomatous masses in E.N.T. practice along with this case report.