Prognostic value of high-sensitivity cardiac troponin in non-cardiac surgical patients in intensive care units

Type II myocardial injury following surgical procedures is associated with adverse outcomes. The prognostic value of high-sensitivity cardiac troponin (hs-cTn) due to type II myocardial injury in surgical patients admitted to intensive care unit (ICU) remains unclear. The aim of this study was to assess prognostic value of hs-cTn in type II acute myocardial injury in non-cardiac surgical patients requiring post-operative ICU admission. Retrospective analysis of patients admitted to two level III ICUs following surgery and had hs-cTn measured on the day of ICU admission. Patients who had type I acute myocardial infarction (AMI) during their admission were excluded from the study. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ICU length of stay (LOS) and hospital LOS. A total of 420 patients were included. On univariable analysis, higher hs-cTn was associated with increased hospital mortality (14.6% vs 6.3%, p = 0.008), ICU LOS (41.1 h, vs 25 h, p = 0.004) and hospital LOS (253 h vs 193 h, p = 0.02). On multivariable analysis, hs-cTn was not independently associated with increased risk of hospital mortality. However, in patients who had elective surgery, hs-cTn was associated with increased risk (OR 1.048; 95% CI 1.004-1.094; p = 0.031) of hospital mortality with area under the receiver operating characteristic curve of 0.753 (95% CI 0.598-0.908). In elective surgical patients, hs-cTn was associated with increased risk of mortality. Larger multicentre studies are required to confirm this association that may assist in risk stratification of elective surgical patients requiring ICU admission.

The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

STUDY DESIGN

Systematic review.

OBJECTIVE

Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures.

METHODS

A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed.

RESULTS

Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing.

CONCLUSION

The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

Clinicopathological Spectrum of Xanthogranulomatous Pyelonephritis

Xanthogranulomatous pyelonephritis (XGP) is an uncommon and distinct type of chronic infective pyelonephritis causing destruction of the kidney, severely affecting the renal function. The perinephric adipose tissue and peritoneum is not uncommonly involved. The study was undertaken to decipher the clinicopathologic spectrum of XGP. Forty cases of XGP were diagnosed on histopathology over a period of 13 years (2005–2017). Relevant clinical details and radiological findings were recorded from the case files. Out of a total of 40 cases, 26 were female and 14 were male with a mean age of 39.5 ± 13.6 years. Flank pain was the most common presenting symptom. All the patients had unilateral disease and underwent nephrectomy for a nonfunctional kidney. Gross examination showed enlarged kidney with replacement of cortico-medullary tissue by yellow nodular areas of fatty tissue and dilatation of the pelvicalyceal system. Thirty-six (90%) cases had nephrolithiasis. Histologically, the characteristic feature was the existence of lipid-laden foamy macrophages. Renal parenchymal involvement was diffuse in majority (31, 77.5%). Two (5.0%) of the patients had coexisting carcinoma in the same kidney. Histopathologic examination gives the definitive diagnosis of XGP which relies on the characteristic morphology. Surgical intervention in the form of nephrectomy is the treatment of choice and offers good treatment outcomes.

Incidence and predictors of stroke during the index event in an ethnically diverse Takotsubo cardiomyopathy population

Takotsubo cardiomyopathy (TTS) is a peculiar clinical condition often affecting postmenopausal women after a stressful trigger. The underlying mechanisms have not been completely elucidated but several hypotheses have been advanced, with catecholamine cardiotoxicity, microvascular dysfunction and coronary artery spasm each suggested to play a role. The incidence of stroke after TTS appears to range from 0% to 7.7%, and interestingly TTS has been described as both a cause and a complication of stroke. We sought to assess the incidence and predictors of stroke during the index event (peri-index event stroke) in a heterogeneous TTS population. We conducted a retrospective descriptive study reviewing patients who were discharged with a diagnosis of TTS from the Einstein Medical Center, Philadelphia, PA and Danbury Hospital, Danbury, CT in the period between 2003 and 2014. A total of Incidence and predictors of stroke during the index event in an ethnically diverse Takotsubo cardiomyopathy population 206 patients met the modified Mayo Clinic criteria and were included in the study. The patients' overall mean age was 67.8 years; 87% (n=179) were females and 25% (n=53) were African Americans. The following incidence rates were found: stroke 7%, in-hospital heart failure 26.7%, and in-hospital death 7%. On multivariate analysis independent predictors (expressed as odds ratios with 95% confidence intervals) of periindex event stroke were: i) African American race (OR 3.2, 95% CI 1.2-10.2, p=0.048); ii) hypertension (OR 10.5, 95% CI 1.3-88, p=0.03). ACE inhibitor use was a protective factor for developing peri-index event stroke (OR 0.15, 95% CI 0.04-0.5, p=0.001). There was a trend towards dual antiplatelet therapy (DAPT) being protective for stroke (OR 0.3, 95% CI 0.05-1.1, p=0.08). The incidence of peri-index event stroke was 7%. African American race and hypertension were found to be independent predictors of peri-index event stroke. Prospective clinical trials are needed to confirm these findings and to better determine the impact of hypertension as a risk factor for stroke and to assess the role of DAPT in preventing it.

Complete urethrovesical disruption following obstructed labor

A 22-years-old lady presented with obstructed labor with a probable preoperative diagnosis of bladder/urethral injury. When a laparotomy was performed there was a complete urethral disruption at the vesicourethral junction with a big anterior forniceal tear in the vagina with intact uterus and cervix. The fetus had pushed itself through the upper vagina and bladder neck into the extraperitoneal space leading to complete urethrovesical disruption as a result of prolonged pressure on the vesicourethral junction against pubic symphysis for which an end to end anastomosis was performed. Although trauma has been mentioned as a cause of such urethral disruption in the literature, no such case has been reported so far following obstructed labor. A brief discussion of various surgical options for such cases is discussed.

Effect of childbirth after treatment on long-term survival from breast cancer

Background

This study quantified long-term absolute and relative mortality risks of survivors of breast cancer with subsequent childbirth.

Methods

The Singapore Birth Register (n = 319 437), Swedish Multi-Generation Register (n = 11 million) and population-based cancer registries were linked to identify 492 women with childbirth after breast cancer. For these women, cumulative mortality risks and standardized mortality ratios (SMRs) were calculated and compared with those of 8529 women aged less than 40 years with breast cancer without subsequent childbirth, and with those predicted by Adjuvant! Online.

Results

Women with subsequent childbirth had a lower 15-year cumulative overall mortality rate than other women with breast cancer (16·8 (95 per cent confidence interval (c.i.) 13·3 to 20·9) versus 40·7 (39·5 to 41·9) per cent), but a higher relative mortality risk than the background population (SMR 13·6, 95 per cent c.i. 10·6 to 17·3). Mortality risks decreased significantly with increasing interval between diagnosis and subsequent childbirth. Mean 10-year cumulative mortality risks of women with subsequent childbirth were within the range of 10-year mortality predicted by Adjuvant! Online for women with T1 N0 tumours in otherwise perfect health.

Conclusion

This study reinforced the view that pregnancy after breast cancer is not detrimental to survival. However, women who gave birth after this diagnosis had substantially higher mortality risks than young women in the general population. This information may be a valuable addition to routine mortality estimates.

Childbirth Following Breast Cancer: An Evaluation of the 'Healthy Mothers' Excess Mortality Risk

Background: The favorable outcome of mothers giving birth after breast cancer compared to those who do not, has been attributed to a healthy mother effect. Mainly former breast cancer patients with excellent health status and outlook proceed to having children after their disease. This study evaluates the excess mortality risk among these 'healthy mothers' and factors modifying this risk.Methods: By linking the Singapore Birth Registry (319'437 individuals) and Swedish Multi-Generation Cohort (11 million women) with the respective national cancer registries we identified all 509 women who gave birth >12 months after a breast cancer diagnosis. We calculated excess absolute mortality risks and Standardized Mortality Ratios (SMRs). We used Poisson regression analysis to calculate relative risks of death by country, period of follow up and interval between cancer diagnosis and subsequent birth.Results: The overall 15-year cumulative mortality was 18.2% (95% CI: 13.3 – 20.7%) which is substantially higher than that of the background population (SMR 13.3, 95%CI: 10.4-16.9). Excess mortality risks remained constant over follow up time and were comparable between Sweden and Singapore. Mortality risks decreased significantly with increasing interval between diagnosis and subsequent birth.Conclusion: Despite being 'healthy mothers', women who give birth after a diagnosis of breast cancer have a substantially higher risk of death than the background population. This information may be useful in a woman's decision whether to have a(another) child after breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3173.

Educational inequalities associated with health-related behaviours in the adult population of Singapore

INTRODUCTION

Socioeconomic differences in health-related behaviours have been widely studied in the Western populations, but are seldom considered in Asian populations. We examined the effect of education attainment on health-related behaviours (physical activity, cigarette smoking and alcohol consumption) among non-institutionalised Singaporeans aged 18-69 years.

METHODS

We used data from the Singapore National Health Survey 2004. Information on physical activity, cigarette smoking, alcohol consumption and sociodemographic characteristics was collected from 4,084 adults. Age-adjusted prevalence of the three health-related behaviours by educational attainment was calculated by the direct method. Logistic regression models, adjusted for age, gender, ethnic group and employment status, were used to estimate the odds ratio and 95% confidence interval, in order to study the prevalence of health-related behaviours according to educational attainment.

RESULTS

The prevalence of physical inactivity, daily smoking and regular alcohol consumption was found to be consistently highest among men and women with the least education. Prevalence of physical inactivity and smoking was inversely related to educational attainment for both genders. However, no clear gradient was found between education and alcohol consumption for men and women.

CONCLUSION

Less-educated Singaporeans were more likely to smoke daily, drink alcohol regularly or not to exercise regularly. Health promotion policies or programmes aimed at encouraging healthy lifestyles in the Singapore population should take into account the educational inequalities in these health-related behaviours.

Changes in the levels of major cardiovascular risk factors in the multi-ethnic population in Singapore after 12 years of a national non-communicable disease intervention programme

INTRODUCTION

The National Healthy Lifestyle Programme, a population-wide non-communicable disease intervention programme, was started in 1992. A National Health Survey is carried out every six years to evaluate the impact of this programme on the cardiovascular risk factor profile of the resident population of Singapore.

METHODS

The 2004 National Health Survey (NHS 04) was a population-based survey carried out over a period of four months from September to December 2004. A combination of disproportionate stratified sampling and systematic sampling was used to select a representative sample (n=7,078) for the survey. The reference population comprised 2.4 million multi-racial Singaporeans aged 18-69 years. Anthropometric and blood pressure measurements were carried out on all subjects and blood samples were taken for biochemical analysis. The results were compared with those of a similar survey conducted in 1998.

RESULTS

A total of 4,084 Singapore residents took part in the survey, giving a response rate of 57.7 percent. The age-standardised prevalence of hypertension (greater than or equal to 140/90 mmHg) in Singapore residents aged 30-69 years decreased from 28.0 percent in 1998 to 24.0 percent (p-value is less than 0.001) in 2004. The prevalence of high total cholesterol (greater than or equal to 6.2 mmol/L) among those aged 18-69 years fell from 26.0 percent in 1998 to 18.1 percent (p-value is less than 0.001) in 2004. The prevalence of diabetes mellitus in residents aged 18-69 years in 2004 was 7.8 percent, compared to the 1998 level of 9.5 percent (p-value is less than 0.01). The level of obesity (body mass index is greater than or equal to 30 kg/sqm) increased slightly from 6.2 percent in 1998 to 6.8 percent (p-value equals 0.1627). The prevalence of daily smoking decreased from 15.0 percent in 1998 to 12.5 percent in 2004 (p-value is less than 0.001), while that of regular exercise increased from 17.0 percent to 25.0 percent (p-value is less than 0.001). Ethnic differences in the prevalence of diabetes mellitus, hypertension, hypercholesterolaemia, and exercise were observed.

CONCLUSION

The NHS 04 results suggest that the National Healthy Lifestyle Programme significantly decreased daily smoking, high blood cholesterol and hypertension, and increased regular exercise over 1998 levels. The results also suggest that the programme stabilised the prevalence of obesity and diabetes mellitus.

Oesophageal wall stress and muscle hypertrophy in high amplitude oesophageal contractions

Excessive wall stress is a known stimulus for muscle growth. We recently reported a thickened muscularis propria in patients with high amplitude oesophageal contractions (HAEC). The goal of this study was to determine oesophageal wall stress in normal subjects and patients with HAEC. A manometry catheter equipped with a high frequency ultrasound (US) transducer was used to record pressure and US images simultaneously in 10 healthy subjects and 11 patients with HAEC. Recordings were obtained at 2 and 10 cm above the lower oesophageal sphincter during water swallows. The changes in circumferential wall stress during oesophageal contraction in both groups are relatively small because of an increase in the wall thickness-to-radius ratio during contraction. Patients show a greater muscle thickness than normal subjects at rest and at the peak of contraction. The wall stress in patients is elevated at the 2 cm but not at the 10-cm level as compared to normal subjects. Wall strain is not different between the two groups. Increase in wall thickness during oesophageal contraction maintains low wall stress. A greater wall stress in patients with HAEC may be a stimulus for the increased wall thickness.

Upfront submandibular salivary gland transfer in pharyngeal cancers

Head and neck irradiation results in salivary dysfunction and subsequent xerostomia. Twenty two patients with squamous cancer of oropharynx or hypopharynx underwent contralateral submandibular salivary gland transfer (SMSGT) to submental triangle to shield it from subsequent radiotherapy. Resting salivary outputs of transferred and untransferred gland (control) were measured before and after SMSGT and following radiotherapy, by cannulating individual submandibular duct. They were compared by paired samples t-test. Following radiation therapy transferred gland retained 73% and untransferred gland (control) retained 27% of baseline salivary output. This significant difference in post-radiation salivary outputs suggests preservation of function of transferred salivary gland.

Recurrent and de novo diabetic nephropathy in renal allografts

BACKGROUND

Histologic findings of diabetic nephropathy (DN) are observed in allografts of patients with pretransplant (PreTx) diabetes mellitus (DM) and in patients who develop DM posttransplant (PostTx). Patients with allograft biopsies (Bx) were retrospectively studied to determine the incidence of recurrent and de novo DN and to ascertain what, if any, risk factors predispose to histologic DN in either patient population.

METHODS

From the renal transplant services at four hospitals from 1992 to 2000, the authors identified all patients with PreTxDM and PostTxDM (n=81). Those with renal biopsies performed >/=18 months PostTx were classified according to the presence or absence of histologic DN (Bx-positive, n=23; Bx-negative, n=35). Patients were then subdivided into four categories-recurrent DN (n=16), de novo DN (n=7), no recurrent DN (n=27), and no de novo DN (n=8)-for analyses.

RESULTS

Among these 58 patients, 74.1% had PreTx and 25.9% had PostTx diabetes. Of those with histologic DN, 69.6% were recurrent DN and 30.4% were de novo DN, making de novo DN at least as likely to develop as recurrent DN. After the onset of diabetes in the de novo population, the time to development of histologic DN was similar in the recurrent and the de novo patients (6.68+/-3.86 years vs. 5.90+/-3.13 years, P=0.66) and more rapid than previously reported. Apart from a more frequent family history of hypertension in patients with allograft DN compared with those without allograft DN, known risk factors for the development of native DN did not significantly differ among patients in the four cohorts. Proposed risk factors related to transplantation did not correlate with the development of recurrent or de novo DN.

CONCLUSION

Among patients with histologic DN, de novo DN occurred at least as frequently as recurrent DN, and the time to onset of histologically apparent DN was more rapid than previously reported. Neither the usual clinical predictors of DN nor clinical variables related to transplantation clearly distinguished the group with DN from the group without it, potentially implicating novel mechanisms in its pathogenesis.

Effect of growth factors on proliferation of normal, borderline, and malignant breast epithelial cells

Growth factors play an important role in the development and growth regulation of normal breast. They are also known to be autocrine or paracrine stimulators of breast cancer cells. However, their role on cells of proliferative breast disease has not been studied so far. This study was undertaken to quantitate the proliferative effect of various growth factors on "normal," borderline, and malignant breast epithelial cells. For this purpose, epithelial cell lines of histologically normal human breast and histologically proven proliferative breast diseases were established. Cell lines MCF-7 and T47D were used as malignant cells. The growth factors under study include epidermal growth factor, fibroblast growth factors acidic and basic, platelet-derived growth factor, and insulin-like growth factors 1 (IGF-1) and 2 (IGF-2). Their proliferative effect was determined by incubating the cells with growth factors for 24 h after achieving basal conditions in serum-free medium for 72 h, followed by quantitating the S-phase fraction by flow cytometry. All of the growth factors were found to be capable of inducing cellular proliferation on the entire range of mammary epithelia. Epidermal growth factor was consistently found to be a potent mitogen. Fibroblast growth factor acidic had a higher effect compared to fibroblast growth factor basic in inducing the cells to move from G(0)/G(1) to S-phase. Platelet-derived growth factor had a moderate proliferative response. In the family of insulin-like growth factors, IGF-1 was the dominant mitogen for normal cells and IGF-2 was the dominant proliferative stimulus for the cell line MCF-7. In the cell lines of proliferative breast disease and T47D, both were at par as mitogenic agents. These results suggest that the cells of proliferative breast disease develop some of the biological characteristics of malignancy.

Genetic epidemiology of non-insulin-dependent diabetes mellitus in north India: preliminary analyses of some genetic markers in Punjabis

Studies on monozygotic (MZ) twins and admixed populations show that the predisposition to non-insulin-dependent diabetes mellitus has a large genetic component. We have examined the distribution of some genetic polymorphisms (ABO, GLO, ESD, AK, ACPA, and GPI) in control and diabetic Punjabis from north India. The distribution of various genetic markers indicate that the differences between the control and diabetic samples are statistically not significant. Moreover, a contingency chi-square analysis over all loci suggests nonsignificant genetic differentiation (p = 0.50) between the Punjabi samples.

Studies on glyoxalase 1 isoenzymes in semen stains: polymorphism in Himachal (India) population

One hundred and ten pairs of blood and semen samples and their stains were studied to type glyoxalase 1 (GLO 1) isoenzymes using agarose-starch medium. A good agreement was observed between the phenotypes expressed in blood and semen samples of the same donor. No GLO 1 activity however could be demonstrated in the vaginal swabs tested. The gene frequencies of GLO 1 polymorphs in Himachal population has been worked out and their stability studies carried out at -12 degrees C and at room temperature.

Malaneese of Malana glen: analysis of morphometric data and ethnic relationship with some neighbouring populations of Himachal Pradesh, India

A morphometric study of the Malaneese - an isolated community living in the midst of Himalayas in district Kullu, Himachal Pradesh - is undertaken with a view to tracing their ethnic relationship with some neighbouring populations viz. Kinnauras, Kulwis and Lahulies, with whom they share some linguistic and cultural experiences. The data consist of 23 anthropometric variables which include 7 linear body measurements, 6 body diameters and circumferences and 10 head and face measurements. The Mahalanobis generalized distance statistics (D2) was used as the primary basis of analysis. The results show that Malaneese are a distinct population clearly distinguishable from the neighbouring populations of Himachal Pradesh. The distance statistics reveal closer morphometric affinity of Malaneese with the Kulwis and Kinnauras than with Lahulies. The lexicostatistical data together with historical records of the movement of people in this region lend support to the above findings.

Effect of centchroman on tubal transport and preimplantation embryonic development in rats

A single oral administration of centchroman (1.25 mg/kg) to adult female rats within 24 h of mating induced slight acceleration in the rate of transport of embryos through the oviducts. The compound did not seem to produce any deleterious effect on preimplantation embryonic development since well organized and apparently normal embryos were collected from the genital tract up to Day 12 of pregnancy. The recovery rate of embryos from centchroman-treated rats was, however, significantly reduced after Day 4 of pregnancy. There was some stimulation in the rate of cleavage of embryos and morula to blastocyst transformation, but retardation in the shedding of the zona pellucida. The rate of blastocyst formation was not altered when 6-8-cell embryos collected from the oviducts of control rats were transferred to the uteri of control or centchroman-treated females. A delay in zona shedding was observed in the centchroman-treated recipients.

Attitudinal and demographic correlates of food supplementation practices

Attitudinal and demographic correlates to food supplement use were ascertained for 689 adults residing in seven Western states. Of the 689, 372 (54%) were food supplement users and 317 (46%) were non-users. The only attitudinal variable significantly (p less than .001) related to the practice of food supplementation was the belief that vitamin C could cure and prevent a cold. More users than non-users agreed with the statement that "vitamin C can both prevent and cure a cold." Demographic variables found to be significantly (p less than .05) related to food supplement use included education, marital status, home type, employment status, and population of town/city in which the respondent resided. Food supplement users tended to be living together without marriage, never married, or divorced and living in town houses or "other" types of dwellings. More users than non-users resided in communities with populations of 2,500 or in communities with populations of 10,000 to 49,999.

Esterase D polymorphism in Indians: stability studies in bloodstains

One hundred and twenty bloodstains of a heterogeneous population have been successfully typed for the esterase D enzyme. Stability studies of the enzyme in bloodstains stored at room temperature and in lysates stored at —20°C and 4°C have been carried out. Frequencies of EsD phenotypes in Indian populations have also been worked out.

Isoagglutinin levels in twins and families. A study of the inheritance of naturally occurring antibodies in human serum

Anti-A and anti-B titers were measured in 60 twin pairs and their families. Family data shows high correlations of antibody titer values for first degree relatives but no significant spousal correlations.

Haemagglutinins and lysins in plants and their application in characterising human and animal red cells

Saline extracts of 207 seed varieties belonging to 53 families were tested for haemagglutinating and haemolytic activity against the erythrocytes of eleven vertebrate species (man, monkey, rabbit, rat, goat, sheep, cow, buffalo, horse, mule and fowl). Of these, 85 seed extracts showed haemagglutinating activity and 49 seed extracts showed haemolytic activity against the red cells of one or more animal species. Several seed extracts were found to react in a species specific manner agglutinating or lysing the red cells exclusively of one animal species each. The possible practical application of the species specific plant agglutinins and haemolysins in characterising the red cells of different animal species is discussed.

Conversion of glycine max seed agglutinins from nonspecific to anti-(A + B)

The seeds of glycine max contain agglutinins which are typically nonspecific in their reactivity. Our investigations show that the phytagglutinins in GM can be converted from nonspecific to anti-(A + B) after the lectin is absorbed with horse red cells. The anti-A and anti-B fractions can be further separated by suitably absorbing the lectin with human red cells. The lectin absorbed with horse red cells or with group-0 human red cells shows an A-stressed activity.

Familial transmission of preauricular fistula in a seven generation Indian pedigree

Familial occurrence of fistula auris congenita (ear pits) is described in a Muslin kindred of Indian origin. The pedigree was traced through seven generations. The abnormality appeared in sixty individuals comparising equal number of males and females. No sexual dimorphism was indicated in the expression of the trait, which occurred bilaterally as a small pit just anterior to the crus at the root of the ascending helix. The abnormality was found to be inherited through an autosomal dominant gene with incomplete penetrance. The expression of the trait does not show any dosage effect.

Lectin studies. III. A survey of phytohemagglutinins: interaction of lectins with erythrocytes of ten vertebrate species

Extracts of seeds from 79 plant species were tested for agglutinating and lytic activity with the red cells of ten vertebrate species (man, monkey, rabbit, rat, goat, sheep, guinea pig, horse, fowl, dog). Of these extracts, 24 were hemagglutinating and 15 were hemolytic. The results suggest that some lectins can serve as useful diagnostic reagents in distinguishing the blood of one animal species from that of another.

Isonymy in a Bhatia leut

Isonymy has been described in a North Indian Hindu Community, which shows surname exogamy. A modification is suggested in the formula of Crow and Mange for the estimation of FIS to make it applicable to populations exhibiting clan exogamy. The values of FIS obtained by different methods are compared.