APOL1 null alleles from a rural village in India do not correlate with glomerulosclerosis.

BACKGROUND: Among African-Americans, genome wide association revealed a strong correlation between the G1 and G2 alleles of APOL1 (apolipoproteinL1, also called trypanolytic factor) and kidney diseases including focal and segmental glomerulosclerosis, HIV-associated nephropathy and hypertensive nephrosclerosis. In the prevailing hypothesis, heterozygous APOL1 G1 and G2 alleles increase resistance against Trypanosoma that cause African sleeping sickness, resulting in positive selection of these alleles, but when homozygous the G1 and G2 alleles predispose to glomerulosclerosis. While efforts are underway to screen patients for G1 and G2 alleles and to better understand "APOL1 glomerulopathy," no data prove that these APOL1 sequence variants cause glomerulosclerosis. G1 and G2 correlate best with glomerulosclerosis as recessive alleles, which suggests a loss of function mutation for which proof of causality is commonly tested with homozygous null alleles. This test cannot be performed in rodents as the APOL gene cluster evolved only in primates. However, there is a homozygous APOL1 null human being who lives in a village in rural India. This individual and his family offer a unique opportunity to test causality between APOL1 null alleles and glomerulosclerosis. METHODS AND FINDINGS: We obtained clinical data, blood and urine from this APOL1 null patient and 50 related villagers. Based on measurements of blood pressure, BUN, creatinine, albuminuria, genotyping and immunoblotting, this APOL1 null individual does not have glomerulosclerosis, nor do his relatives who carry APOL1 null alleles. CONCLUSIONS: This small study cannot provide definitive conclusions but the absence of glomerulosclerosis in this unique population is consistent with the possibility that African-American glomerulosclerosis is caused, not by loss of APOL1 function, but by other mechanisms including a subtle gain of function or by the "genetic hitchhiking" of deleterious mutations in a gene linked to APOL1 G1 and G2.

Economic impact of interventional study on rational use of antiseptics and disinfectants in Super Speciality Hospital of Nagpur.

OBJECTIVE: To measure the impact of interventions on rational use of antiseptics and disinfectants (A and D) for cost containment in Super Speciality Hospital (SSH) of Government Medical College, Nagpur (GMCN), India. MATERIALS AND METHODS: This study was conducted from October 2003 to March 2007 in SSH of GMCN. In the pre-interventional phase (Phase-I), purchase, stocking and distribution of A and D was studied to find problem areas. Based on this formative data an intervention was planned (Phase-II) during which rationing of the A and D was done. Rational quantities needed for different A and D procedures were calculated based on recommendations of National Aids Control Organization (NACO) with modifications to suit our hospital setup. Detailed information, education, communication and training about rational use of A and D were provided to the hospital staff. In the post-interventional phase (Phase-III), the use of A and D was rationalized at the distribution level and the efficacy of in-use A and D was tested at user sites. Data about medicine expenditure, patient record and A and D usage in various departments was obtained from hospital records. Savings on A and D as against total annual medicine expenditure was calculated taking the cost of A and D in the post-intervention period. RESULTS: The expenditure on A and D as a result of intervention decreased by 20.7%. Out of the total medicine expenditure, the expenditure on A and D which accounted for 6.2% before intervention, decreased to 1.95% after the intervention. CONCLUSION: The information, education and communication (IEC) interventions attempted by us resulted in significant decrease in the use and expenditure of A and D.

Short report: Human trypanosomiasis caused by Trypanosoma evansi in a village in India: preliminary serologic survey of the local population.

After discovery of the first recorded case of human infection with Trypanosoma evansi, serologic screening of 1,806 persons from the village of origin of the patient in India was performed using the card agglutination test for trypanosomiasis and T. evansi. A total of 410 (22.7%) people were positive by whole blood, but only 81 were confirmed positive by serum. However, no trypanosomes were detected in the blood of 60 people who were positive at a high serum dilution. The results probably indicate frequent exposure of the human population to T. evansi in the study area, which suggests frequent vector transmission of parasites to humans. Although T. evansi is not infective for humans, a follow-up of seropositive persons is required to observe the evolution of human infection with this parasite.

Seroprevalence of human immunodeficiency virus infection in pregnancy in a tertiary care hospital.

BACKGROUND: Human Immunodeficiency Virus (HIV) /Acquired Immunodeficiency Syndrome (AIDS) is increasing at an alarming rate globally. It has now become a major challenge & threat to public health. HIV infection in women occur primarily during their reproductive years, hence pregnancy provides a unique opportunity for implementing prevention strategies against HIV infection. If we estimate seroprevalence in pregnancy, the effective & timely intervention will reduce the transmission of infection to newborns. AIMS: To study the seroprevalence of HIV infection in pregnancy in a tertiary care hospital. SETTING: Antenatal Care Clinic of a Tertiary Care Hospital. DESIGN: A cross-sectional study. MATERIAL AND METHODS: Blood samples of all the pregnant women with written consent were collected and tested for HIV antibodies as per National AIDS Control Organization (NACO) guidelines over a period from September 2002 to August 2004. However only those who were HIV sero-reactive were included in this study. Spouses of sero-reactive pregnant women were also counselled and tested. Statistical analysis was done using Chi-square test. RESULTS: Out of the total 10683 blood samples from pregnant women tested, 147 (1.38%) were found to be HIV sero-reactive. Sero-reactive cases when compiled year-wise, showed increase in the seroprevalence from 1.24% in September 2002 -- August 2003 to 1.45% in September 2003 -- August 2004. Majority 69 (46.94%) sero-reactive pregnant women were in the age group of 19--24 years followed by 25--29 years age group (31.29%). Out of 88 spouses of HIV sero-reactive pregnant women, 85 (96.59%) were found to be HIV sero-reactive. CONCLUSION: In the present study, seroprevalence of HIV infection was found to be 1.38% amongst pregnant women.

Human trypanosomiasis caused by Trypanosoma evansi in India: the first case report.

We report an Indian farmer who had fluctuating trypanosome parasitemia associated with febrile episodes for five months. Morphologic examination of the parasites indicated the presence of large numbers of trypanosomes belonging to the species Trypanosoma evansi, which is normally a causative agent of animal trypanosomiasis known as surra. Basic clinical and biologic examinations are described, using several assays, including parasitologic, serologic, and molecular biologic tests, all of which confirmed the infecting species as T. evansi. Analysis of cerebrospinal fluid indicated no invasion of the central nervous system (CNS) by trypanosomes. Suramin, a drug used exclusively for treatment of early-stage human African trypanosomiasis with no CNS involvement, effected apparent cure in the patient. This is the first case reported of human infection due to Trypanosoma evansi, which was probably caused by transmission of blood from an infected animal.