Toxicity of copper on marine diatoms,Chaetoceros calcitrans and Nitzchia closterium from Cochin estuary,India

The effects of copper (Cu) toxicity on the growth, pigments, protein, carbohydrate, lipid and antioxidant enzyme activities of two endemic microalgae, Chaetoceros calcitrans and Nitzchia closterium from Cochin estuary were studied and compared. The 96?h median inhibition concentration (IC₅₀) of Cu for C. calcitrans was 143.8?µg?L^?1 and that for N. closterium was 204.5?µg?L^?1. No observable effect concentration (NOEC), lowest observable effect concentration (LOEC) and chronic value of Cu on C. calcitrans were 17.93?µg?L^?1, 31.91?µg?L^?1and 24.92?µg?L^?1 respectively, whereas that for N. closterium were 18.35?µg?L^?1, 36.04?µg?L^?1 and 27.2?µg?L^?1 respectively. Chlorophyll a and c showed significant variation from the control at NOEC in both species. Carotenoid content showed significant increase at LOEC. The chlorophyll a/c ratio significantly decreased at NOEC and LOEC of N. closterium. In N. closterium catalase (CAT) activity showed significant increase at NOEC and LOEC, but in C. calcitrans it varied significantly above LOEC. Protein content showed a significant decrease at NOEC of C. calcitrans. No significant variation was observed for N. closterium. Carbohydrate showed significant variation between the species at NOEC. Lipid content varied significantly at NOEC of C. calcitrans. Chaetoceros calcitrans was observed to be more sensitive to copper toxicity than N. closterium. The metal stress tolerance mechanism of N. closterium and its bioremediation capacity can be established in further studies. This study also provides an insight on the biochemical changes that happened at NOEC.

     

ABCB1 G2677 allele is associated with high dose requirement of cyclosporin A to prevent renal allograft rejection in North India

BACKGROUND: Interindividual heterogeneity in expression of ABCB1 gene has been suspected to be one of the factors resulting in cyclosporin (CsA) pharmacokinetic variation. The present study explored the association of ABCB1 SNPs on CsA dose requirements and dose-adjusted C2 levels (CsA level/daily dose requirement) in renal allograft recipients. METHODS: Daily doses (mg/kg/day) and dose-adjusted C2 levels (mug/mL per mg/kg/day) at 1 and 3 months for 155 recipients on CsA therapy were compared according to allelic status of ABCB1 c.1236C>T, c. 2064-76T>A, c.2677G>T and c.3435C>T. RESULTS: Dose-adjusted C2 levels were lower in ABCB1 c.2677G>T GG genotype as compared to GT/TT genotypes at 1 and 3 months, suggesting that for a given dose their CsA blood concentration is lower (p = 0.009 and p = 0.043). GG genotype was further associated with lower allograft survival as revealed by Kaplan-Meier analysis (p = 0.021). CONCLUSIONS: Identification of ABCB12677GG patients may have a clinically significant impact on allograft outcome and may be helpful in providing pre-transplant pharmacogenetic information to individualize CsA dosing.     

Tacrolimus concentration to dose ratio in solid organ transplant patients treated with fecal microbiota transplantation for recurrent Clostridium difficile infection

Fecal microbiota transplantation (FMT ) is increasingly being performed for Clostridium difficile infection in solid organ transplant (SOT ) patients; however, little is known about the potential pharmacokinetic or pharmacomicrobial effects this may have on tacrolimus levels. We reviewed the medical records of 10 SOT patients from September 2012‐December 2016 who were taking tacrolimus at time of FMT for recurrent C. difficile infection. We compared the differences in tacrolimus concentration/dose ratio (C/D ratio) 3 months prior to FMT vs 3 months after FMT . The mean of the differences in C/D ratio calculated as (ng/mL)/(mg/kg/d) was ?17.65 (95% CI ?1.25 to 0.58) (ng/mL)/(mg/kg/d), P ‐value .43 by Wilcoxon signed‐rank test. The mean of the differences in C/D ratio calculated as (ng/mL)/(mg/d) was ?0.33 (95% CI ?1.25 to 0.58) (ng/mL)/(mg/d), P ‐value .28 by Wilcoxon signed‐rank test. Of these patients, 2/10 underwent allograft biopsy for allograft dysfunction in the year after FMT , with no evidence of allograft rejection on pathology. These preliminary data suggest that FMT may not predictably alter tacrolimus levels and support its safety for SOT patients however further study in randomized trials is needed.     

Postmortem diagnosis of acute haemorrhagic pancreatitis

Forensic pathologists can help in the investigation of sudden unexpected deaths in co-operation with the officials responsible for the maintenance of law and order to administer justice. Sudden unexpected deaths form the subject of medicolegal investigation if they occur in apparently healthy individuals, wherein an autopsy would shed light regarding the cause of death. A 4 year retrospective review of autopsy files at the Department of Forensic Medicine, Kasturba Medical College, Mangalore, South India was undertaken for cases of sudden unexpected deaths due to acute haemorrhagic pancreatitis occurring between May 2004 and April 2008. A total of seven cases of acute haemorrhagic pancreatitis diagnosed at autopsy as the cause of sudden unexpected death during the study period are discussed herein.     

Erectile Dysfunction Precedes and Is Associated with Severity of Coronary Artery Disease among Asian Indians

IntroductionErectile dysfunction (ED) and coronary artery disease (CAD) often share common risk factors, and there is growing evidence that ED might serve as a clinical marker for cardiovascular disease. Despite rising trends of CAD in Asian Indians, limited data are available on the prevalence of ED and its correlation with CAD severity in such patients.AimTo study the prevalence of ED in Asian Indian patients undergoing coronary angiography and to assess if the severity of ED correlates with angiographic severity of CAD.MethodsIn all patients undergoing coronary angiography, ED was assessed using the International Index of Erectile Function‐5 questionnaire.Main Outcome Measures and ResultsAmong 175 male patients, ED was present in 70%; patients with ED had a higher incidence of multivessel CAD (80% vs. 36%, P 0.001), diffuse CAD (81% vs. 34%, P 0.001), and higher number of mean coronary vessels involved compared with those without ED. Those with severe ED had higher prevalence of multivessel CAD and higher number of mean coronary vessels involved compared with those with milder grades of ED. Onset of symptoms of ED preceded symptoms of CAD by a mean of 24.6 months in 84% of patients. The presence of severe ED was associated with a 21‐fold higher risk of having triple‐vessel disease (odds ratio [OR] 21.94, 95% confidence interval [CI] 3.41–141.09, P = 0.001) and an 18‐fold higher risk of having diffuse angiographic CAD (OR 17.91, 95% CI 3.11–111.09, P = 0.001).ConclusionAsian Indians with angiographic CAD frequently have ED; symptoms of ED precede that of CAD in most patients. Incidence of multivessel and diffuse CAD is significantly more common in patients with ED. It is important for physicians to be aware of the close relationship between the two conditions so that patients with ED can have optimal risk stratification for concomitant CAD whenever required.     

Subcostal versus transcostal mini donor nephrectomy: is rib resection responsible for pain related donor morbidity

PURPOSE: Conventional donor nephrectomy is associated with significant postoperative morbidity. Whether this morbidity is associated with rib resection or a long incision is not clear. We designed a prospective randomized study of subcostal and transcostal mini incision donor nephrectomy and compared the results. MATERIALS AND METHODS: We performed 82 donor nephrectomies in the study period of December 2000 to July 2001. Open donor nephrectomies were randomized to subcostal (25) or transcostal (24) mini incision techniques. Results were compared and analyzed using the independent t test. RESULTS: The subcostal and transcostal groups were comparable in terms of patient age, body mass index, nephrectomy side, number of renal vessels and incision length (9.32 vs 9.72 cm). Patients in the subcostal group had a lesser postoperative analgesic requirement (304 +/- 49.8 vs 487 +/- 74.1 mg, p = 0.0001), shorter hospital stay (2.36 +/- 0.7 vs 3.71 +/- 0.81 days, p = 0.0001) and early convalescence (26.56 +/- 4.06 vs 37.46 +/- 6.05 days) compared with the transcostal group. Warm ischemia time and recipient outcome were similar in the groups. CONCLUSIONS: Rib sparing, subcostal mini incision donor nephrectomy has significantly less morbidity and a shorter hospital stay compared with the rib resection transcostal technique.     

Brugada pattern mimicking acute coronary syndrome in a febrile state

The Brugada type pattern is characterized by a coved or saddleback shaped ST-segment elevation in the right precordial leads (V1-V3) on a surface 12 lead electrocardiogram (ECG). This pattern can be seen spontaneously, induced by sodium channel blocking drugs or rarely by hyperthermia. The mechanism is secondary to an alteration in the sodium channels induced by a febrile state. Such ECG's could easily be mistaken for acute ST segment elevation myocardial infarction and thus pose a unique clinical challenge to emergency room physicians. We report such a case of fever induced Brugada pattern and discuss the underlying mechanisms.