Sequential Serum Cytokine Levels of TNF-Alpha, IL-4 and IL-12 are Associated with Prognosis in Plasmodium falciparum Malaria.

We investigated the prognostic role of TNF-alpha, IL-4 and IL-12 in a clinically well defined group of Plasmodium falciparum infected patients (n = 32) sequentially from Day 0 to Day 10 with a 2 day interval along with a control group of 16 healthy volunteers of same range of age and sex. Infection with malaria is often fatal because mitochondria are unable to generate enough ATP to maintain normal cellular function. ATP deficiency arises in malaria due to an inability of mitochondria through the effects of inflammatory cytokines on their function, to utilize available oxygen. In our study TNF-alpha and IL-12 levels were significantly elevated but IL-4 level showed persistent decline in Day 0, but subsequent measurement in Day 2, 4, 6, 8 and 10 showed persistent decline in levels of TNF-alpha and IL-12, an elevation in IL-4 levels which were associated with disease prognosis of the infected patients. These results again provide evidence that cytokines are very much a dominant partner in malaria pathogenesis with a specific prognostic role.

Pleural fluid MDA and serum-effusion albumin gradient in pleural effusion.

Pleural fluid malondialdehyde (PMDA) and serum effusion albumin gradient(SEAG) were estimated in 60 patients of pleural effusion of diverse etiologies. The results were compared with Light's criteria to distinguish between transudates and exudates. The mean PMDA level was 0.68±0.24nmol/ml and 1.17±0.25nmol/ml in transudates and exudates respectively showing a statistically significant (p<0.05) rise in exudates in comparison to transudates. SEAG registered a significant fall in exudates (P<0.001) when compared with transudates. PMDA revealed a positive correlation with pleural protein(r=+0.30) and a significant negative association with SEAG (r= -0.33).Sensitivity and specificity of PMDA were better than the parameters of Light's criteria. Whereas SEAG documented approximately equal sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with Light's criteria. Therefore PMDA and SEAG can be taken together in addition to Light's criteria to strengthen the discrimination between transudates and exudates in borderline cases of pleural effusion.

Evaluation of oxidative stress in pregnancy induced hypertension.

This work was undertaken to investigate correlation between oxidative stress and initiation of pathogenesis of pregnancy induced hypertension (PIH). Fifty primigravidae in age group of 20-35 years and gestational age 28-42 weeks with PIH were taken as cases. Twenty healthy primigravidae with no medical and surgical complications of pregnancy and with blood pressure ≤140/90 mm Hg served as controls. The cases were again subgrouped as severe preeclampsia (12 in number) and mild pre-eclampsia (38 in number). All of them were evaluated for serum malondialdehyde (MDA), Serum vitamin E and plasma vitamin C levels. The serum MDA levels were raised significantly in women with mild preeclampsia (P<0.01) and in women with severe preeclampsia (P<0.01) in comparison to normal primi gravida. The serum vitamin E levels were decreased in primi gravida with mild preeclampsia (p<0.1) and in primi with severe pre eclampsia (P<0.1) in comparison to normal primi gravida but the fall was not statistically significant. There was a significant fall (P<0.05) in the vitamin C levels in primi with mild preeclampsia than in the normal primi. The vitamin C levels in severe preeclamptic patients were lower than the normal primi but the fall was not statistically significant (P=0.10). The serum MDA and vitamin E showed a negative correlation in all the cases. The serum MDA and plasma vitamin C also showed a negative correlation in the control and study group. This observation suggests that in hypertensive disorders of pregnancy there is an imbalance between lipid peroxidation and antioxidant vitamin status because of oxidative stress. The decreased serum concentrations of the antioxidant vitamins supports the hypothesis that lipid peroxidation is an important causative factor in the pathogenesis of preeclampsia. The rise in antioxidants is probably to compensate the increased peroxide load in severe preeclampsia.

Cryoprotective Effect of Disaccharides on Cord Blood Stem Cells with Minimal Use of DMSO.

Umbilical cord blood (UCB) is an extremely attractive source of stem cells for the treatment of various benign and malignant hematological and non-hematological disorders. To facilitate the preservation of these stem cells, 10 % dimethylsulfoxide (DMSO) is widely used as cryoprotectant in cord blood banks. But it is found to be toxic at this concentration with the result of serious side effects in recipients after infusion of DMSO-cryopreserved cells. Evaluation of viability and functionality of cryopreserved hematopoietic stem cells is needed with either inclusion of nontoxic additives alone or with reduced DMSO concentration. We assessed the post thawing viability of UCB stem cells in the freezing medium containing disaccharides (sucrose or trehalose) alone and in combination with reduced amount i.e. 2 % DMSO by trypan blue staining. The functionally active progenitor cells content of the optimized media was then evaluated and compared with 5% DMSO by a colony forming unit assay using methylcellulose based media. The freezing solution containing 0.2 M trehalose with 2 % DMSO came out to be superior in the evaluation of viability and generation of hematopoietic colonies of erythroid and myeloid lineage than 5 % DMSO alone. While the percentage of viability was lower than 2 % DMSO, as observed in the medium containing 0.2 M trehalose or sucrose alone, with poor outcome of generation of myeloid lineage based colonies. Our study results suggest that trehalose (0.2M) with the inclusion of reduced concentration of DMSO(2%) can better replace 5%DMSO rather than complete removal of DMSO from the freezing medium.

Evaluating role of oxidative stress in determining the pathogenesis of falciparum malaria induced acute renal failure.

Serum malondialdehyde was measured in sixty-one falciparum malaria cases, which include thirty uncomplicated, and thirty-one complicated with acute renal failure. Twenty-six healthy individuals were also studied as controls. Serum malondialdehyde level was found to be significantly elevated in falciparum malaria induced acute renal failure cases when compared with uncomplicated falciparum malaria (p<0.001) and healthy controls (p<0.001). A positive correlation with the raised urea, creatinine and bilirubin levels were significant (r=0.62, p<0.025; r=0.65, p<0.05 and r=0.72, p<0.001 respectively) indicating the severity of complication with rise of lipid peroxides in falciparum malaria induced acute renal failure cases.

Serum IL-4, IL-12 and TNF-alpha in malaria: a comparative study associating cytokine responses with severity of disease from the Coastal Districts of Odisha.

We investigated the role of IL-4, IL-12 and TNF-alpha in clinically well-defined groups of Plasmodium falciparum and vivax (Pf & Pv) infected patients belonging to Group I (++), Group II (+++) and Group III (++++). On the basis of hematological parameters, hyperparasitaemia, and evidence of neurological involvement, three different levels of severity were selected attributing a score from Group I (++) to Group III (++++). In each group 16 patients each of P. falciparum and P. vivax malaria were studied. As a control group for cytokine determination 30 healthy volunteers were included in the study. Serum samples were analyzed for IL-12, IL-4 and TNF-alpha using (ELISA) obtained commercially (Ray Biotech). Hb levels of Pf and Pv patients were 8 ± 1.94, 7.6 ± 1.64 g/dl and 3.6 ± 1.23 and 10.1 ± 1.21, 9.4 ± 1.43 and 7.1 ± 0.98 g/dl. Serum iron levels of Pf and Pv patients were 85.86 ± 0.86, 81.10 ± 0.70 and 70.1 ± 0.73 and 99.47 ± 0.85, 96.67 ± 1.13 and 91.7 ± 2.65 mg/dl. TNF-alpha levels of Pf and Pv patients were 155 ± 23.66, 307.5 ± 111.87 and 955 ± 261.32 and 72 ± 9.93, 140.88 ± 23.11 and 469.37 ± 416.99 pg/ml. IL-12 levels of Pf and Pv patients were 117.5 ± 8.16, 160.63 ± 20.81 and 293.13 ± 94.64 and 75.7 ± 9.25, 112.9 ± 12.05 and 200 ± 53.78 pg/ml. IL-4 levels of Pf and Pv patients were 3.7 ± 0.11, 3.2 ± 0.13 and 2.3 ± 0.63 and 5.33 ± 1.08, 4.8 ± 0.16 and 3.9 ± 0.48 pg/ml. In the control group the values of TNF-alpha, IL-12 and IL-4 were 42.9 ± 13.5, 49.8 ± 11.59 and 6.06 ± 1.32 pg/ml respectively. Cytokines and poor oxygen delivery should not be viewed as alternative theories of malarial disease pathophysiology instead poor oxygen delivery is one of the consequences of excessive release of inflammatory cytokines which is further augmented by the present work.

Repair of oral mucosal defects with cryopreserved human amniotic membrane grafts: prospective clinical study.

The aim of this study was to evaluate the clinical outcome of the surgical repair of oral mucosal defects using cryopreserved human amniotic membrane (HAM) as a graft material. Thirty-four patients with precancerous lesions such as leukoplakia, erythroplakia, and verrucous hyperplasia were included. Fresh amniotic membrane was obtained from women undergoing elective caesarean section; the membrane was cleaned, prepared in antibiotic solutions, and preserved at -80°C. Results suggested that HAM promotes healing and epithelialization without specific complications. Thus we conclude that the use of HAM gives promising results in the repair of post-surgical oral mucosal defects.

Influence of oxidants and anti-oxidants on semen parameters in infertile males.

The deleterious effect of free radicals on spermatozoa was assessed by estimating malondialdehyde and vitamins E and C in seminal plasma and their relation with different sperm parameters. Twenty-two fertile controls with 74 primary infertile males were analysed in the department of biochemistry, SCB Medical College, Cuttack. Seminal malondialdehyde level was observed to be raised in all infertile groups except azoospermic cases in comparison to control. Levels of vitamins E and C were significantly low in the infertile cases (p < 0.001) in relation to control. Significant positive correlation between malondialdehyde with total sperm count and leucocyte count (p < 0.01) indicates their dual contribution towards free radical generation. The negative association of semen malondialdehyde with normal sperm motility and morphology suggests damaging effect of free radicals on sperm membrane integrity. Marked negative correlation of seminal malondialdehyde with both the vitamins signifies their protective utilisation during oxidative phenomenon. In conclusion, understanding the physiologic and pathologic effects of free radicals on sperm function will help in designing new and effective treatment strategies in male infertility.

How can we improve socio-economic condition of women?

PIP: Aspects of discrimination against women in India are summarized, a case study of a rural district in Orissa is presented, and the article follows with a suggested 3-part strategy of education, employment and appropriate technology. The economic role played by women is difficult to quantitate because of their lifestyle that combines domestic work and unpaid family or low-paid outside farm or cottage industry labor. Besides these tasks, women usually care for dairy animals, and carry water and firewood. Discrimination against women in this system is evident, however, from some available statistics. 46% of women, as opposed to 20% of men, work as agricultural laborers. Women are denied education because they are not expected to do responsible work, then they are denied employment because they are not educated. Their work is counted as worth only half that of men, and based on this assumption, they are paid less then men. The male heads of 124 households in 7 villages in the Orissa area were interviewed to study labor participation of household members. 89% of the people worked in agriculture, 94% in rice paddy and 6% in oilseed or pulses for cash crops. The average farm size was 2.29 acres. Female literacy had risen to 14.3% from 1% 10 years before. Women usually worked in transplantation, weeding, harvesting and threshing, but also in heavier farm labor, construction of roads and buildings, quarrying and forestry. In this poor, hilly region, the custom of purdah was not practiced to the extent of keeping women from doing day labor outside the home. The authors' suggested strategy for women's development included appropriate technology such as the Gobar methane gas plant, provision of credit for women's industries, retention of girls in school and literacy programs for girls and women, and higher wages for women.^ieng