Capsicum chinense Jacq.-derived glutaredoxin (CcGRXS12) alters redox status of the cells to confer resistance against pepper mild mottle virus (PMMoV-I).

KEY MESSAGE: The CcGRXS12 gene protects plants from cellular oxidative damage that are caused by both biotic and abiotic stresses. The protein possesses GSH-disulphide oxidoreductase property but lacks Fe-S cluster assembly mechanism. Glutaredoxins (Grxs) are small, ubiquitous and multi-functional proteins. They are present in different compartments of plant cells. A chloroplast targeted Class I GRX (CcGRXS12) gene was isolated from Capsicum chinense during the pepper mild mottle virus (PMMoV) infection. Functional characterization of the gene was performed in Nicotiana benthamiana transgenic plants transformed with native C. chinense GRX (Nb:GRX), GRX-fused with GFP (Nb:GRX-GFP) and GRX-truncated for chloroplast sequences fused with GFP (Nb:Δ2MGRX-GFP). Overexpression of CcGRXS12 inhibited the PMMoV-I accumulation at the later stage of infection, accompanied with the activation of salicylic acid (SA) pathway pathogenesis-related (PR) transcripts and suppression of JA/ET pathway transcripts. Further, the reduced accumulation of auxin-induced Glutathione-S-Transferase (pCNT103) in CcGRXS12 overexpressing lines indicated that the protein could protect the plants from the oxidative stress caused by the virus. PMMoV-I infection increased the accumulation of pyridine nucleotides (PNs) mainly due to the reduced form of PNs (NAD(P)H), and it was high in Nb:GRX-GFP lines compared to other transgenic lines. Apart from biotic stress, CcGRXS12 protects the plants from abiotic stress conditions caused by H2O2 and herbicide paraquat. CcGRXS12 exhibited GSH-disulphide oxidoreductase activity in vitro; however, it was devoid of complementary Fe-S cluster assembly mechanism found in yeast. Overall, this study proves that CcGRXS12 plays a crucial role during biotic and abiotic stress in plants.

Review of Cocos nucifera L. testa-derived phytonutrients with special reference to phenolics and its potential for encapsulation.

Coconut (Cocos nucifera L.) and its value-added products are rich in medium chain triglycerides, polyphenols and flavonoids with a significant anti-oxidant potential. However, coconut and its products are underutilized for the development of nutraceuticals. Coconut testa is a brown cover of the endosperm, which is characterized with the considerable amount of phytonutrients, especially phenolics and flavonoids. The nutrient rich coconut testa is generally diverted for the production of animal feed or abandoned. Around 10-15% of the coconut kernel is removed as testa while preparing coconut desiccated powder. The coconut testa from the virgin coconut oil (VCO) industry also remains underutilized. Nevertheless, biochemical characterization of coconut testa has revealed its enormous anti-oxidant and nutraceutical potential. On the other hand there are reports describing the suitable encapsulation techniques to develop nutraceuticals from the plant-derived bioactives. In this context this review explores the prospect of utilizing the coconut testa-derived phytonutrients in developing a nutraceutical product.

Auxin enhances grafting success in Carya cathayensis (Chinese hickory).

MAIN CONCLUSION: Application of auxin to root stock and scion increases the success rate of grafting in Chinese hickory. The nuts of the Chinese hickory (Carya cathayensis) tree are considered both delicious and healthy. The popularity and high demand result is that the hickory nuts are of very high economical value for horticulture. This is particularly true for the Zhejiang province in eastern China where this tree is widely cultivated. However, there are several difficulties surrounding the hickory cultivation, such as for example long vegetative growth, tall trees, labour-intensive nut picking, and slow variety improvements. These complications form a great bottleneck in the expansion of the hickory industry. The development of an efficient grafting procedure could surpass at least some of these problems. In this study, we demonstrate that application of the auxin indole-3-acetic acid promotes the grafting process in hickory, whereas application of the auxin transport inhibitor 1-N-naphthylphthalamic acid inhibits the grafting process. Furthermore, we have identified hickory genes in the PIN, ABCB, and AUX/LAX-families known to encode influx and efflux carriers in the polar transport of auxin. We show that increased expression of several of these genes, such as CcPIN1b and CcLAX3, is correlating with successful grafting.

Over-expression of a grafting-responsive gene from hickory increases abiotic stress tolerance in Arabidopsis.

KEY MESSAGE: A grafting response gene CcPIP1;2 was cloned from hickory plant, further functional characterization of the gene for water transport activity and abiotic stress tolerances were carried out through heterologous expression in Xenopus and Arabidopsis. Plasma membrane intrinsic proteins (PIPs) are multifunctional channel proteins belonging to the membrane intrinsic protein (MIP) family. In this study, a grafting-responsive gene from hickory (CcPIP1;2) was cloned and functionally characterized. Application of non-selective water inhibitors (HgCl2 and phloretin) led to the death of grafted hickory plants at 30 days after grafting (DAG). Furthermore, the transcript accumulation of the selected CcPIP1;2 gene was gradually decreased from 0 to 14 DAG in the grafted samples under inhibitor treatment conditions. Transient expression analysis of the GFP-CcPIP1;2 fusion protein showed that CcPIP1;2 was located at plasma membrane. Heterologous expression of CcPIP1;2 protein in the Xenopus oocyte system helped the access of water into the cells. Over-expression of CcPIP1;2 in Arabidopsis improved the percentage of seed germination when the seeds were grown in H2O2-, ABA-, and mannitol-containing media, but had no effect when grown in the salt containing media. CcPIP1;2 transgenic plants grew better under drought conditions. The expression of various ABA-related stress marker genes as well as cell wall expansin marker genes was significantly higher in CcPIP1;2 over-expression Arabidopsis lines than in the wild type (WT).

The effect of surgery report cards on improving radical prostatectomy quality: the SuRep study protocol.

BACKGROUND: The goal of radical prostatectomy is to achieve the optimal balance between complete cancer removal and preserving a patient's urinary and sexual function. Performing a wider excision of peri-prostatic tissue helps achieve negative surgical margins, but can compromise urinary and sexual function. Alternatively, sparing peri-prostatic tissue to maintain functional outcomes may result in an increased risk of cancer recurrence. The objective of this study is to determine the effect of providing surgeons with detailed information about their patient outcomes through a surgical report card. METHODS: We propose a prospective cohort quasi-experimental study. The intervention is the provision of feedback to prostate cancer surgeons via surgical report cards. These report cards will be distributed every 3 months by email and will present surgeons with detailed information, including urinary function, erectile function, and surgical margin outcomes of their patients compared to patients treated by other de-identified surgeons in the study. For the first 12 months of the study, pre-operative, 6-month, and 12-month patient data will be collected but there will be no report cards distributed to surgeons. This will form the pre-feedback cohort. After the pre-feedback cohort has completed accrual, surgeons will receive quarterly report cards. Patients treated after the provision of report cards will comprise the post-feedback cohort. The primary comparison will be post-operative function of the pre-feedback cohort vs. post-feedback cohort. The secondary comparison will be the proportion of patients with positive surgical margins in the two cohorts. Outcomes will be stratified or case-mix adjusted, as appropriate. Assuming a baseline potency of 20% and a baseline continence of 70%, 292 patients will be required for 80% power at an alpha of 5% to detect a 10% improvement in functional outcomes. Assuming 30% of patients may be lost to follow-up, a minimum sample size of 210 patients is required in the pre-feedback cohort and 210 patients in the post-feedback cohort. DISCUSSION: The findings from this study will have an immediate impact on surgeon self-evaluation and we hypothesize surgical report cards will result in improved overall outcomes of men treated with radical prostatectomy.

Metastatic renal cell carcinoma without evidence of a primary renal tumour.

Although metastases are common in patients with renal cell carcinoma (rcc), it is extremely rare for patients to present with metastatic rcc (mrcc) without evidence of a primary mass in the kidney. Two cases of mrcc with no detectable primary renal mass are reported here. Both patients had bilateral native kidneys in situ and no significant prior urologic history. The first patient presented with a hip fracture and was found to have multiple radiologic bony and lung metastases. Biopsy of a mass involving the pubic bone demonstrated clear cell mrcc. Multiple scans by computed tomography (ct) and confirmatory imaging by magnetic resonance demonstrated no renal mass. This first patient had disease stabilization for 18 months on sunitinib and was still alive at last follow-up. The second patient was diagnosed with clear-cell mrcc after thickened synovium was discovered and biopsied during a knee arthroplasty. Multiple scans by ct in this second patient demonstrated no primary renal mass. Sunitinib and radiotherapy to the knee lesion were initiated, but unfortunately, the patient deteriorated clinically and passed away from disease progression shortly after diagnosis. Because of the rare nature of these cases, a standardized course of action has not yet been established. However, we hypothesize that it is reasonable to manage metastases in these patients by following established mrcc protocols.

Transcriptomic and metabolomic analyses reveal the importance of ethylene networks in mulberry fruit ripening.

Mulberry (Morus alba L.) is a climacteric and highly perishable fruit. Ethylene has been considered to be an important trigger of fruit ripening process. However, the role of ethylene in the mulberry fruit ripening process remains unclear. In this study, we performed a comprehensive analysis of metabolomic and transcriptomic data of mulberry fruit and the physiological changes accompanying the fruit ripening process. Our study revealed that changes in the accumulation of specific metabolites at different stages of fruit development and ripening were closely correlated to transcriptional changes as well as underlying physiological changes and the development of taste biomolecules. The ripening of mulberry fruits was highly associated with the production of endogenous ethylene, and further application of exogenous ethylene assisted the ripening process. Transcriptomic analysis revealed that differential expression of diverse ripening-related genes was involved in sugar metabolism, anthocyanin biosynthesis, and cell wall modification pathways. Network analysis of transcriptomics and metabolomics data revealed that many transcription factors and ripening-related genes were involved, among which ethylene-responsive transcription factor 3 (MaERF3) plays a crucial role in the ripening process. The role of MaERF3 in ripening was experimentally proven in a transient overexpression assay in apples. Our study indicates that ethylene plays a vital role in modulating mulberry fruit ripening. The results provide a basis for guiding the genetic manipulation of mulberry fruits towards sustainable agricultural practices and improve post-harvest management, potentially enhancing the quality and shelf life of mulberry fruits for sustainable agriculture and forestry.

Gut Enterobacteriaceae and uraemic toxins - Perpetrators for ageing.

Ageing is a complex process that is associated with changes in the composition and functions of gut microbiota. Reduction of gut commensals is the hallmarks of ageing, which favours the expansion of pathogens even in healthy centenarians. Interestingly, gut Enterobacteriaceae have been found to be increased with age and also consistently observed in the patients with metabolic diseases. Thus, they are associated with all-cause mortality, regardless of genetic origin, lifestyle, and fatality rate. Moreover, Enterobacteriaceae are also implicated in accelerating the ageing process through telomere attrition, cellular senescence, inflammasome activation and impairing the functions of mitochondria. However, acceleration of ageing is likely to be determined by intrinsic interactions between Enterobacteriaceae and other associated gut bacteria. Several studies suggested that Enterobacteriaceae possess genes for the synthesis of uraemic toxins. In addition to intestine, Enterobacteriaceae and their toxic metabolites have also been found in other organs, such as adipose tissue and liver and that are implicated in multiorgan dysfunction and age-related diseases. Therefore, targeting Enterobacteriaceae is a nuance approach for reducing inflammaging and enhancing the longevity of older people. This review is intended to highlight the current knowledge of Enterobacteriaceae-mediated acceleration of ageing process.

Current status of microbes involved in the degradation of pharmaceutical and personal care products (PPCPs) pollutants in the aquatic ecosystem.

Contamination of aquatic systems with pharmaceuticals, personal care products, steroid hormones, and agrochemicals has been an immense problem for the earth's ecosystem and health impacts. The environmental issues of well-known persistence pollutants, their metabolites, and other micro-pollutants in diverse aquatic systems around the world were collated and exposed in this review assessment. Waste Water Treatment Plant (WWTP) influents and effluents, as well as industrial, hospital, and residential effluents, include detectable concentrations of known and undiscovered persistence pollutants and metabolites. These components have been found in surface water, groundwater, drinking water, and natural water reservoirs receiving treated and untreated effluents. Several studies have found that these persistence pollutants, and also similar recalcitrant pollutants, are hazardous to a variety of non-targeted creatures in the environment. In human and animals, they can also have severe and persistent harmful consequences. Because these pollutants are harmful to aquatic organisms, microbial degradation of these persistence pollutants had the least efficiency. Fortunately, only a few wild and Genetically Modified (GMOs) microbial species have the ability to degrade these PPCPs contaminants. Hence, researchers have been studying the degradation competence of microbial communities in persistence pollutants of Pharmaceutical and Personal Care Products (PPCPs) and respective metabolites for decades, as well as possible degradation processes in various aquatic systems. As a result, this review provides comprehensive information about environmental issues and the degradation of PPCPs and their metabolites, as well as other micro-pollutants, in aquatic systems.

Cutaneous metastasis of renal cell carcinoma masquerading as an infected sebaceous cyst.

Renal cell carcinoma (RCC) is the third most common genitourinary malignancy with an estimated one third of cases with metastatic disease at the time of diagnosis. Though rare, cutaneous metastasis from RCC is more frequent than any other genitourinary malignancy. Metastasis of RCC to skin carries poor prognosis as coexistent visceral spread is the norm. A 38-year-old man presented one year after radical nephrectomy for clear cell carcinoma of the left kidney with a submental lesion that proved to be metastatic. Clinical appearance of cutaneous RCC metastasis is varied and can closely mimic other skin lesions. It is incumbent on general practitioners, dermatologists and urologists to exercise diligence in clinical diagnosis of skin lesions in the background of previous oncological diagnosis.

A comparison of the clinical profile of Kawasaki disease in children from Northern India above and below 5 years of age.

OBJECTIVE: Clinical experience collated over the last 11 years at our center suggests that Kawasaki disease (KD) affects older children more frequently as compared to the Western literature. In this study we have compared the clinical profile of KD in children above 5 years of age (Group I) with those below 5 years (Group II). DESIGN: Chart review of children with KD during the period January 1994-April 2006. RESULTS: Of the 97 children, 38 (39.2%) were in Group I and 59 (60.8%) were in Group II. Mean age at presentation of children in Group I was 8.12 +/- 2.0 years while that in Group II was 2.83 +/- 1.50 years. Mean time interval to make the diagnosis was 11.2 +/- 6.4 days in Group I as compared to 10.8 +/- 6.03 days Group II but the difference was not significant (p > 0.05). Non-purulent conjunctivitis, mucosal changes in oropharynx, cervical lymphadenopathy and hepatomegaly were seen more frequently in Group II than in Group I, but this difference was also not statistically significant. Desquamation at presentation and arthralgia/arthritis were significantly more common in Group I, while edema over hands and feet was significantly more frequent in Group II (p < 0.05). Among laboratory parameters, hemoglobin level was lower in children in Group II as compared to Group I (p = 0.001), while there was no difference in parameters of inflammation. Cardiac abnormalities were noted in about 12% children but there was no statistically significant difference between the two groups. CONCLUSION: In Chandigarh, KD occurs more frequently in children above 5 years of age as compared to the West. Older children with KD have a different clinical profile. However, cardiac complications do not differ between the 2 groups.

Receptor-targeted co-transport of DNA and magnetic resonance contrast agents.

BACKGROUND: Ligand molecules conjugated to polylysine can be electrostatically bound to DNA and can bind receptors or antigens on the surface of cells, delivering the DNA into specific cells and tissues. Several researchers have used this approach to generate non-viral vehicles for the efficient delivery of DNA to specific cells. We have attempted to adopt this general approach to the cell-specific delivery of magnetic contrast agents for use in magnetic resonance imaging (MRI). RESULTS: We have synthesized a new class of agents capable of both transfecting genes into cells and enhancing the contrast of the targeted cells for MRI. DNA is used both to encode a marker gene and as a molecular scaffold, which electrostatically binds polylysine conjugated to transferrin, an iron uptake protein, and polylysine modified with gadolinium chelated to diethylenetriaminepetaacetic acid. When cells displaying the transferrin receptor are treated with these particles, high levels of gene expression are observed, higher than with control particles composed only of transferrin, polylysine and DNA. The treated cells show specific MRI contrast enhancement, which did not require expression of the marker gene. CONCLUSIONS: The development of this class of particles permits the use of novel protocols by which genes for genetic therapy and agents for MRI contrast are co-transported. These protocols may allow non-invasive MRI monitoring of DNA delivery for gene therapy in real time.

Zidovudine use in pregnancy: a report on 104 cases and the occurrence of birth defects.

As more women of childbearing age are being identified as HIV infected, vertical transmission to the fetus and/or neonate is an increasingly significant therapeutic problem. Currently the use of zidovudine is one of the few specific measures available, and as a potentially teratogenic and fetotoxic agent, any decision for its use requires evaluation of the potential for fetal damage. In a series of 104 cases of intentional or inadvertent use of zidovudine at differing gestations in pregnancy, there were eight spontaneous first trimester abortions, eight therapeutic terminations, and eight cases of fetal abnormality occurring among a total of 88 cases where the pregnancy progressed. Analysis and correlation of antenatal data and drug therapy with individual cases failed to show any specific abnormality that could reasonably be attributed to zidovudine therapy. While not proving safety, these data add to previous smaller series with similar findings, thus lending tenuous support to the use of this agent. Continuing studies are required, particularly to clarify the possibility of long-term developmental defects.

Interspousal and intrafamilial transmission of hepatitis C virus: a myth or a concern?

OBJECTIVE: To investigate intrafamilial and interspousal transmission of hepatitis C virus. METHODS: The incidence of anti-hepatitis C virus antibodies in 224 family members of 65 index patients was studied. Sixty-five of the 94 index patients were asymptomatic, apparently healthy parturient Egyptian women, who were detected to be anti-hepatitis C virus positive at routine antenatal screening and whose spouses resided in the United Arab Emirates. The serologic status of family members of seropositive index patients was compared with that of 218 family contacts of 65 matched healthy anti-hepatitis C virus-negative parturient Egyptian women (control group). To determine interspousal transmission, hepatitis C virus genotype was determined in 35 of 36 hepatitis C virus-RNA positive index patient-spouse pairs and 22 of 25 nonrelated RNA positive pairs by polymerase chain reaction. Subsequently nucleotide sequencing of the hepatitis C virus genome was done. RESULTS: In comparison with the control group, a significantly greater number of family members of the index patients were anti-hepatitis C virus positive (five of 218 versus 60 of 224; P < .004). Husbands of index patients had the highest prevalence of anti-hepatitis C virus (74%), with longer duration of marriage being an important risk factor. Of the 35 index patient-spouse pairs analyzed, 33 (94%) had the same hepatitis C virus genotype. On nucleotide sequencing, 30 (91%) couples showed 100% homology, and two had a high (> 97%) homology. Among nonspouse pairs, six pairs (27%) had the same hepatitis C virus genotype; however, low nucleotide sequence homologies (less than 88%) were noted. CONCLUSION: These data suggest that interspousal transmission of hepatitis C virus occurs and that this may be an important route of intrafamilial spread of hepatitis C virus infection.

Pregnancy outcome in women with beta-thalassemia major and HIV infection.

OBJECTIVES: To conduct a study of maternal and foetal outcome in pregnant transfusion-dependent beta-thalassemia major (beta-TM) women with HIV-1 disease. STUDY DESIGN: The course and outcome of pregnancy was studied prospectively in 123 women with transfusion-dependent beta-thalassemia major, of which 81 were HIV-1 positive, at Sanjay Gandhi hospital Manipur, India, from January 1990 to January 1997. The clinical and immunological status of the seropositive women was compared with matched seronegative thalassemic control groups. RESULTS: Over a period of 7 years, 123 women with beta-TM conceived. One hundred and eleven (90%) conceptions were spontaneous including the 81 HIV-1 positive women and 12 (10%) conceptions occurred after induction of ovulation. Among these 81 patients the following stages of HIV-1 infection were represented: 39 C2 stage (AIDS indicator conditions); 42 A2 stage (asymptomatic) (CDC 1993). Of these 39 women, 12/39 (31%) underwent medical termination of pregnancy (MTP) by 8 weeks gestation and five (13%) died undelivered by 32 weeks gestation due to fulminating pneumocystis carinii pneumonia. There were 80/123 (65%) singleton vaginal deliveries of which 22/80 (28%) were preterm and 58 (71%) term. All 22 preterm births occurred in mothers with aids indicator conditions, were vaginal deliveries, and they had positive viral cultures for HIV-1 within one week of birth. Ten of these neonates died by 8 weeks of AIDS and the remaining 12 died of AIDS indicator disease by 15 months of age. At term a significant 25% (31/123) of women delivered by elective caesarean section due to cephalopelvic disproportion. Except for those inflicted with AIDS, the remaining women remained well throughout pregnancy. CONCLUSION: Successful outcome of pregnancies does occur in women with beta-TM and also in those with asymptomatic HIV disease. Associated AIDS indicator conditions cause appreciable perinatal and maternal morbidity and mortality.

Seroprevalence and mother-to-infant transmission of hepatitis C in asymptomatic Egyptian women.

OBJECTIVES: In this study, we sought to determine (1) the prevalence of hepatitis C virus (HCV) RNA, or its antibodies, in a healthy parturient Egyptian population and (2) the risk of mother-to-infant transmission in this population. METHOD: The serum of 499 pregnant Egyptian women was tested for anti-HCV with ELISA-3 and for HCV RNA by polymerase chain reaction (PCR). Neonatal cord blood and infant blood were similarly tested for anti-HCV and HCV RNA. RESULTS: Recombinant immunoblot assay (RIBA) detected anti-HCV in 65/499 (13%) women; of these, 20/65 (31%) were PCR-positive. The total number of babies born was 499. Of the original group, 97 mothers and infants (HCV-negative) were lost to follow up and were excluded. Sixty-five anti-HCV-positive infants were born vaginally to the 65 anti-HCV-positive mothers, of which twenty (31%) corresponding mothers and babies were also positive for HCV RNA. Of these twenty babies, three died of hepatocellular disease by six months of age; sixteen developed chronic liver disease; the remaining nine remained asymptomatic but were serologically and PCR-positive. The mother-to-infant transmission rate was significantly increased (5%; P < 0.0001). Of the seropositive children, 45/65 (69%; P < 0.0001) seroreverted by eighteen months of age. CONCLUSION: There is a high prevalence of anti-HCV in healthy pregnant Egyptian women and vertical transmission is a major risk for chronic HCV carriers.

PIP: Hepatitis C virus (HCV) seropositivity among Egyptian women has been estimated at 13-22%. This study investigated the magnitude of risk of vertical HCV transmission in 499 consecutive, apparently healthy Egyptian women attending antenatal clinics at United Arab Emirates university teaching hospitals in 1994-96. 65 maternal serum samples (13%) were positive for HCV by confirmatory recombinant immunoblot assay and the infants of all these women were anti-HCV positive. HCV RNA was detected by polymerase chain reaction in 20 (31%) of these maternal-infant pairs. Of the 20 infants who were HCV RNA-positive at birth, 4 died of hepatocellular disease before 18 months of age and the remaining 16 developed chronic liver disease. 45 (69%) of the 65 infants seropositive at birth seroconverted over the course of the 18-month follow-up period (mean age of seroconversion, 15 months). These findings indicate that high levels of HCV viremia, like enhanced levels of HIV viremia, facilitate maternal-infant virus transmission. The presence of HCV RNA in the cord blood of the 3 infants who died in the first 3 months of life suggests transplacental pathogenesis in a small proportion of cases. Acquisition at delivery remains the predominant mode of HCV transmission, however, and can be reduced by appropriate screening and counseling of pregnant seropositive chronic carriers of disease.

Sero-prevalence and mother-to-infant transmission of hepatitis E virus among pregnant women in the United Arab Emirates.

OBJECTIVES: (1) To study the prevalence of HEV infection in a cohort of pregnant women in the United Arab Emirates (UAE). (2) The rate of mother-to-infant transmission. METHOD: Sera of 469 pregnant women residing in the UAE was tested for anti-HEV with ELISA and for HEV-RNA by polymerase chain reaction (PCR). Neonatal cord-blood and infant blood was similarly tested for anti-HEV and HEV-RNA. Out of these 469 women, 33% were UAE nationals (Group A) and Egyptians (Group B), respectively, and 34% were from the Indian sub-continent (Group C). RESULTS: Out of 469 mothers 93 (20%) were anti-HEV positive and 28 (30%) of these 93 were HEV-RNA positive and symptomatic with on-going infection. The prevalence of anti-HEV was significantly increased amongst Groups B and C (Group A:B, P<0.001; Group A:C, P<0.001). Twelve of these 28 symptomatic women developed acute hepatic disease and two died undelivered, thus, were excluded from further study. Six of the remaining 10 women had non-fulminant acute viral hepatitis and four developed fulminant hepatic failure, of which one died in the early post-partum period. The remaining 16 women had mild symptomatic disease with complete recovery as did the remaining nine women with acute illness. Of the 10 babies born to mothers with acute disease, two were pre-term, three had anicteric hepatitis and two babies were born with hypothermia and hypoglycaemia and died within 48h. Noteworthy is the fact that, the 26 infants born to the 26 HEV-RNA positive mothers developed acute/on-going clinical infection and were HEV-RNA positive. Apart from the two early neonatal deaths, the remaining 24 infants had full recovery. No infant of the other mothers were symptomatic or had HEV-RNA. Thus, the mother-to-infant transmission was 100%. The remaining 65 sero-positive women remained asymptomatic with no evidence of clinical infection, continued to be HEV-RNA negative and delivered at term. Their infants had no evidence of infection and were sero-negative by 9 months of age, suggesting transplacental transmission of IgG antibodies. CONCLUSIONS: There is a high prevalence of anti-HEV among pregnant women residing in the UAE. Twelve of infected women developed fulminant/acute hepatitis resulting in three fatalities. Evidence suggests significant vertical transmission of HEV among HEV-RNA positive mothers with appreciable perinatal morbidity and mortality. Excluding mothers with acute hepatic disease, Breast-feeding appears to be safe in HEV sero-positive mothers.

Impact of maternal HIV-1 infection on perinatal outcome.

OBJECTIVES: To study the impact of HIV-1 infection on pregnancy and maternal and early fetal outcome. METHOD: From January 1992 to January 1993, 160 HIV-1 seropositive women and 164 HIV-1 seronegative age- and parity-matched pregnant tribal women from Manipur, India, were recruited into a prospective study. Mother and infant were followed until 6 weeks postpartum. RESULTS: Nine percent (15/160) of subjects had AIDS (CDC IV), 38% (60/160) were symptomatic (CDC III) and 53% (85/160) were asymptomatic (CDC I/II). Symptomatic (CDC III/IV) HIV-1 infection is associated with a significantly increased rate of miscarriage, low birth weight, intrauterine fetal death and preterm delivery. Perinatal, infant and maternal deaths were limited to symptomatic women. HIV-1 infected women were significantly younger than their HIV-1 negative counterparts both in age and age at sexual debut. Placental membrane inflammation was significantly higher in the seropositive group and this correlated well with a higher risk of preterm delivery and postpartum endometritis. Asymptomatic HIV-1 infection was not associated with adverse pregnancy outcome. CONCLUSION: Symptomatic (CDC III/IV) HIV-1 infection in Indian tribal women is associated with adverse maternal and fetal outcome.

Beta-thalassemia major and successful pregnancy.

OBJECTIVE: To conduct a study of maternal and fetal outcome in pregnant women with transfusion-dependent beta-thalassemia major. STUDY DESIGN: The course and outcome of pregnancy were studied prospectively in 32 pregnant women with transfusion-dependent beta-thalassemia major, of which 10 were HIV 1 positive, at Sanjay Gandhi Hospital, Manipur, India, from January 1990 to July 1996. RESULTS: Over a period of six years, 32 women with transfusion-dependent beta-thalassemia major conceived. Twenty conceptions were spontaneous (63%), and 12 (37%) followed induction of ovulation. There were 24 (75%) singleton vaginal deliveries, all of which were term. At term, eight (25%) women delivered by elective cesarean section due to cephalopelvic disproportion. All the women remained well throughout pregnancy. Despite increased blood transfusion requirements during pregnancy to maintain the hemoglobin level > 10 g/dL, serum ferritin levels remained stable in all patients. CONCLUSION: Successful outcomes of pregnancy occurred in some women with transfusion-dependent beta-thalassemia major.