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Salinity and Miscarriage: Is There a Link? Impact of Climate Change in Coastal Areas of Bangladesh - A Systematic Review

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... Researchers have associated the rise in CVDs, still birth and miscarriage to higher consumption of salt among coastal population [10][11][12]. Also, poor coastal people nd di culties in accessing necessary primary healthcare services particularly maternal and child healthcare (MCH) because of the substandard healthcare delivery system (availability, accessibility, utilization, adequate and effective coverage) and limited skilled healthcare providers compared to other parts of the country [13,14]. ...
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Background: Climate change induced sea level rise, increased soil salinity and poor socio-economic condition have triggered migration around the world. So far, the impact of migration on health and healthcare utilization have not been studied adequately especially in Bangladesh. Our study examines impact of migration on healthcare seeking behavior of people living in low-lying coastal areas of Bangladesh. Methods: We analyzed data from Chakaria, Health and Demographic Surveillance System, 2017-18. Univariate analysis and regression analysis were conducted to assess the determinants of migration. Finally, we assessed differences in health care seeking behavior between migrants in low-lying coastal areas and plain areas. Stata version 14 was used for analysis. Results: In terms of determinants of migration, adults, males, educated, unemployed and poor were significantly more like to migrate compared to children, females, people with little education, those engaged in agriculture or other occupations and wealthier households. For pregnancy related services healthcare utilization was significantly lower in coastal areas compared to the plains. In terms of utilization of maternal and child health services, service use was 2-28 % lower among residents of low-lying coastal regions and 13-70% lower among coastal migrants compared to those living in plains. Conclusion: Our findings suggest that in terms of maternal health services there was geographic inequity in service utilization favoring the residents of plains and being a migrant significantly increases the geographical disadvantage in terms of maternal health services. The existing inequity indicates the necessity of immediate action to address the health and healthcare utilization of residents of coastal area with special attention to the migrants in Bangladesh.
... It can be noted that there is a high prevalence of AMS, mainly in the coastal belt of the state except the Sonpur district. The finding is similar to the recent study in Bangladesh, which states that high salt intake during pregnancy generates a high-risk factor for miscarriage and pregnancy abnormality (Hossain, 2020). Other similar studies have also hinted at a link between high salt intake during pregnancy and the occurrence of miscarriage (Abdoli, 2016;Duley et al., 2005). ...
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The study aimed at examining the prevalence of pregnancy termination by Abortion, Miscarriage, and Stillbirths (AMS) and its determinants in the state of Odisha, India. The NFHS-IV data have been used for this analysis. GIS mapping has been used for the spatial distribution of outcome variables at the district level. Univariate analysis (chi-square) and a multivariable logistic model have been used to identify the potential factors associated with AMS. Out of 8,484 pregnancy cases registered, 969 (11.4%) cases had met with pregnancy termination by AMS. Jagatsinghpur, Jajapur, Subarnapur, Kendrapara, Nayagarh, and Puri have been identified as high prevalent districts. The age group of 30-34 years is more likely of pregnancy termination than the age group 15-19 years (OR=1.254). Women who have completed secondary education have 1.568 times higher odds of pregnancy termination by AMS than those who are illiterate. Pregnancy complications show significantly higher odds (OR=1.091) of pregnancy termination. Among the trio of reasons for pregnancy termination, miscarriage cases are the most prevalent, followed by abortion and stillbirths. Potential factors like age, education, wealth index, place of delivery, and anemia are significant for AMS (p value<0.05). Hence, a robust program must be developed to reduce adverse pregnancy outcomes.
... The rapid development of the aquaculture industry can domesticate more than 123 species of fish in intensive and non-intensive farming systems. However, obtaining good growth rates of fish, depends on a healthy and controlled environment, including temperature, salinity, ammonia and oxygen levels of water (Mommsen, 1998;Fazio et al., 2013;Hossain, 2020;Usman and Alhassan, 2018). ...
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Recent year’s Iraqi inland water suffered from several water crisis resembling in shortage of waters levels in Tigris and Euphrates river system, the main source of water in Iraq. Therefore, the continuous water crisis led to increase the salinity concentration of Tigris and Euphrates water, which observed significantly in south regions of Iraq. The present study was conducted to investigate the histopathological changes in kidney of common carp fish that cultured in high salinity concentration environment in Al Basra governorate, Iraq at October, 2018. 40 fishes sample were obtained from five fish ponds (eight fishes each pond) in north region of AL-Basra governorate, Iraq. Kidney samples were collected for histopathology examination. The kidney samples showed nephrotoxicity resembling in necrosis of renal tubules and proliferative lesion in glomeruli of affected kidneys. In conclusion, during October, 2018 water crisis, the fish that cultured in ponds with high salinity environment supplied from Tigris and Euphrates Rivers in Al Basra governorate, Iraq induced severe nephrotoxicity in kidneys of 70% of examined fishes. Keywords: high salinity concentration environment, nephrotoxicity, common carp fish, salinity induce nephrotoxicity
Book
The existential threat posed by climate change presents a challenge to all those concerned about the next generation. This Element reviews and discusses its implications for the development of children (ages 0-12) today and in the future, and for the parents, teachers, researchers, and professionals who have responsibility for children. This Element adopts a bioecological model to examine both the direct impacts on children's physical and psychological well-being as well as indirect impacts through all the systems external to the child, emphasizing the greater vulnerability of children in the Global South. Given evidence of well-founded climate anxiety, this Element examines children's coping strategies and discusses the key roles of caregivers and schools in protecting and preparing children to face current and future challenges – with knowledge, hope, and agency as central themes. This Element highlights many under-researched areas and calls for action by all those caring for and about children's future.
Chapter
Research has identified a multidimensional, interactive relationship between climate change variables and an adverse (mostly) impact on the mammalian reproductive systems, reproductive organs, and fertility in animals, but direct evidence establishing the impact of climate change on reproductive health and fertility in humans is limited. Climate change has established direct or indirect linkages with re-emergence, geospatial redistribution of pathogens of likely reproductive health significance in humans. Similarly, alterations in growth, mortality rate, reproduction, and spatiotemporal distribution of vectors (e.g., zika virus – Aedes aegypti) and intermediate hosts (e.g., Schistosomiasis – snail) of certain infectious diseases of reproductive health importance are influenced by climate change variables like temperature, precipitation, and humidity. The exposure channels or effect pathways, through which the regional and global climate change can directly or indirectly influence the human reproductive ability, health, fertility, progeny, and thus, ultimately, demography can broadly be classified as physical variables, chemical hazards, biological agents, factors related to psycho-socio-behavior, and economy. The chapter is an overall account of how each of these factors, as an inherent component of climate change has the potential to cause a variable degree of impact on human reproduction from a medical point of view. As human reproductive systems are highly vulnerable to diseases and other post-catastrophic effects of extreme climate change events, so it is high time to understand the adversity and resort to proper and sustainable control measures for a healthy reproductive life of future generations.
Chapter
Research has identified a multidimensional, interactive relationship between climate change variables and an adverse (mostly) impact on the mammalian reproductive systems, reproductive organs, and fertility in animals, but direct evidence establishing the impact of climate change on reproductive health and fertility in humans is limited. Climate change has established direct or indirect linkages with re-emergence, geospatial redistribution of pathogens of likely reproductive health significance in humans. Similarly, alterations in growth, mortality rate, reproduction, and spatiotemporal distribution of vectors (e.g., zika virus – Aedes aegypti) and intermediate hosts (e.g., Schistosomiasis – snail) of certain infectious diseases of reproductive health importance are influenced by climate change variables like temperature, precipitation, and humidity. The exposure channels or effect pathways, through which the regional and global climate change can directly or indirectly influence the human reproductive ability, health, fertility, progeny, and thus, ultimately, demography can broadly be classified as physical variables, chemical hazards, biological agents, factors related to psycho-socio-behavior, and economy. The chapter is an overall account of how each of these factors, as an inherent component of climate change has the potential to cause a variable degree of impact on human reproduction from a medical point of view. As human reproductive systems are highly vulnerable to diseases and other post-catastrophic effects of extreme climate change events, so it is high time to understand the adversity and resort to proper and sustainable control measures for a healthy reproductive life of future generations.
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Background: High sodium intake increases blood pressure, a risk factor for cardiovascular disease, but the effects of sodium intake on global cardiovascular mortality are uncertain. Methods: We collected data from surveys on sodium intake as determined by urinary excretion and diet in persons from 66 countries (accounting for 74.1% of adults throughout the world), and we used these data to quantify the global consumption of sodium according to age, sex, and country. The effects of sodium on blood pressure, according to age, race, and the presence or absence of hypertension, were calculated from data in a new meta-analysis of 107 randomized interventions, and the effects of blood pressure on cardiovascular mortality, according to age, were calculated from a meta-analysis of cohorts. Cause-specific mortality was derived from the Global Burden of Disease Study 2010. Using comparative risk assessment, we estimated the cardiovascular effects of current sodium intake, as compared with a reference intake of 2.0 g of sodium per day, according to age, sex, and country. Results: In 2010, the estimated mean level of global sodium consumption was 3.95 g per day, and regional mean levels ranged from 2.18 to 5.51 g per day. Globally, 1.65 million annual deaths from cardiovascular causes (95% uncertainty interval [confidence interval], 1.10 million to 2.22 million) were attributed to sodium intake above the reference level; 61.9% of these deaths occurred in men and 38.1% occurred in women. These deaths accounted for nearly 1 of every 10 deaths from cardiovascular causes (9.5%). Four of every 5 deaths (84.3%) occurred in low- and middle-income countries, and 2 of every 5 deaths (40.4%) were premature (before 70 years of age). The rate of death from cardiovascular causes associated with sodium intake above the reference level was highest in the country of Georgia and lowest in Kenya. Conclusions: In this modeling study, 1.65 million deaths from cardiovascular causes that occurred in 2010 were attributed to sodium consumption above a reference level of 2.0 g per day. (Funded by the Bill and Melinda Gates Foundation.).
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It is estimated that 884 million people do not have access to clean drinking water in the world. Increasing salinity of natural drinking water sources has been reported as one of the many problems that affect low-income countries, but one which has not been fully explored. This problem is exacerbated by rising sea-levels, owing to climate change, and other contributing factors, like changes in fresh water flow from rivers and increased shrimp farming along the coastal areas. In some countries, desalination plants are used to partly remove salt and other minerals from water sources, but this is unlikely to be a sustainable option for low-income countries affected by high salinity. Using the example of Bangladesh as a model country, the following research indicates that the problem of salinity can have serious implications with regard to rising rates of hypertension and other public health problems among large sectors of the worldwide population.
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To assess the effect of decreased sodium intake on blood pressure, related cardiovascular diseases, and potential adverse effects such as changes in blood lipids, catecholamine levels, and renal function. Systematic review and meta-analysis. Cochrane Central Register of Controlled Trials, Medline, Embase, WHO International Clinical Trials Registry Platform, the Latin American and Caribbean health science literature database, and the reference lists of previous reviews. Randomised controlled trials and prospective cohort studies in non-acutely ill adults and children assessing the relations between sodium intake and blood pressure, renal function, blood lipids, and catecholamine levels, and in non-acutely ill adults all cause mortality, cardiovascular disease, stroke, and coronary heart disease. STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate and study characteristics and outcomes extracted. When possible we conducted a meta-analysis to estimate the effect of lower sodium intake using the inverse variance method and a random effects model. We present results as mean differences or risk ratios, with 95% confidence intervals. We included 14 cohort studies and five randomised controlled trials reporting all cause mortality, cardiovascular disease, stroke, or coronary heart disease; and 37 randomised controlled trials measuring blood pressure, renal function, blood lipids, and catecholamine levels in adults. Nine controlled trials and one cohort study in children reporting on blood pressure were also included. In adults a reduction in sodium intake significantly reduced resting systolic blood pressure by 3.39 mm Hg (95% confidence interval 2.46 to 4.31) and resting diastolic blood pressure by 1.54 mm Hg (0.98 to 2.11). When sodium intake was <2 g/day versus ≥2 g/day, systolic blood pressure was reduced by 3.47 mm Hg (0.76 to 6.18) and diastolic blood pressure by 1.81 mm Hg (0.54 to 3.08). Decreased sodium intake had no significant adverse effect on blood lipids, catecholamine levels, or renal function in adults (P>0.05). There were insufficient randomised controlled trials to assess the effects of reduced sodium intake on mortality and morbidity. The associations in cohort studies between sodium intake and all cause mortality, incident fatal and non-fatal cardiovascular disease, and coronary heart disease were non-significant (P>0.05). Increased sodium intake was associated with an increased risk of stroke (risk ratio 1.24, 95% confidence interval 1.08 to 1.43), stroke mortality (1.63, 1.27 to 2.10), and coronary heart disease mortality (1.32, 1.13 to 1.53). In children, a reduction in sodium intake significantly reduced systolic blood pressure by 0.84 mm Hg (0.25 to 1.43) and diastolic blood pressure by 0.87 mm Hg (0.14 to 1.60). High quality evidence in non-acutely ill adults shows that reduced sodium intake reduces blood pressure and has no adverse effect on blood lipids, catecholamine levels, or renal function, and moderate quality evidence in children shows that a reduction in sodium intake reduces blood pressure. Lower sodium intake is also associated with a reduced risk of stroke and fatal coronary heart disease in adults. The totality of evidence suggests that most people will likely benefit from reducing sodium intake.
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The Ganges River supplies water to the southwest region of Bangladesh mainly through one of its distributaries-the Gorai River. India commissioned a barrage on the Ganges River at Farakka in April 1975 to divert water and make the Bhagirathi-Hooghly River navigable. The diversion has reduced the dry season discharge of the Ganges and Gorai rivers in Bangladesh. Statistical analyses indicate that the changes in the dry season discharge of these rivers are significant. Reduced discharge in the Gorai River has induced accelerated sedimentation and increased salinity in the southwest region of Bangladesh. Empirical analyses demonstrate the relationship between discharge in the Gorai River and salinity. Analyses also determine the requirement of flow for the Ganges and Gorai rivers to keep salinity at threshold limits. Increased salinity has caused negative effects on agriculture, forestry, industry, and drinking water in the southwest region of Bangladesh.
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Hypertensive disorders of pregnancy-chronic hypertension, gestational hypertension, and preeclampsia-are uniquely challenging as the pathology and its therapeutic management simultaneously affect mother and fetus, sometimes putting their well-being at odds with each other. Preeclampsia, in particular, is one of the most feared complications of pregnancy. Often presenting as new-onset hypertension and proteinuria during the third trimester, preeclampsia can progress rapidly to serious complications, including death of both mother and fetus. While the cause of preeclampsia is still debated, clinical and pathological studies suggest that the placenta is central to the pathogenesis of this syndrome. In this review, we will discuss the current evidence for the role of abnormal placentation and the role of placental factors such as the antiangiogenic factor, sFLT1 (soluble fms-like tyrosine kinase 1) in the pathogenesis of the maternal syndrome of preeclampsia. We will discuss angiogenic biomarker assays for disease-risk stratification and for the development of therapeutic strategies targeting the angiogenic pathway. Finally, we will review the substantial long-term cardiovascular and metabolic risks to mothers and children associated with gestational hypertensive disorders, in particular, preterm preeclampsia, and the need for an increased focus on interventional studies during the asymptomatic phase to delay the onset of cardiovascular disease in women.
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Early miscarriages are those occurring within the first 12 completed weeks of gestation. Recurrent miscarriage, defined as two or more consecutive pregnancy losses, affects 3% of couples trying to conceive and can cause considerable distress. The risk of miscarriage increases with maternal age. Genetic abnormalities, uterine anomalies, and endocrine dysfunction can all lead to miscarriage. Other causes of miscarriage are autoimmune disorders such as antiphospholipid syndrome and chronic endometritis. Unfortunately, in nearly 50% of couples no clear cause can be identified. Management includes investigating causes, addressing modifiable risk factors, and providing supportive care in the first trimester of pregnancy. For some couples, in vitro fertilization with embryo screening may be an option. © 2018, British Columbia Medical Association. All Rights reserved.
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The International Society of Hypertension and the World Hypertension League have developed a policy statement calling for reducing dietary salt. The policy supports the WHO and the United Nations recommendations, which are based on a comprehensive and up-to-date review of relevant research. The policy statement calls for broad societal action to reduce dietary salt, thus reducing blood pressure and preventing hypertension and its related burden of cardiovascular disease. The hypertension organizations and experts need to become more engaged in the efforts to prevent hypertension and to advocate strongly to have dietary salt reduction policies implemented. The statement is being circulated to national hypertension organizations and to international nongovernmental health organizations for consideration of endorsement. Member organizations of the International Society of Hypertension and the World Hypertension League are urged to support this effort.
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Multiple sclerosis (MS) is a debilitating autoimmune neuroinflammatory disease influenced by genetics and the environment. MS incidence in female subjects has approximately tripled in the last century, suggesting a sex-specific environmental influence. Recent animal and human studies have implicated dietary sodium as a risk factor in MS, whereby high sodium augmented the generation of T helper (Th) 17 cells and exacerbated experimental autoimmune encephalomyelitis (EAE), the principal model of MS. However, whether dietary sodium interacts with sex or genetics remains unknown. Here, we show that high dietary sodium exacerbates EAE in a strain- and sex-specific fashion. In C57BL6/J mice, exposure to a high-salt diet exacerbated disease in both sexes, while in SJL/JCrHsd mice, it did so only in females. In further support of a genetic component, we found that sodium failed to modify EAE course in C57BL6/J mice carrying a 129/Sv-derived interval on chromosome 17. Furthermore, we found that the high-sodium diet did not augment Th17 or Th1 responses, but it did result in increased blood-brain barrier permeability and brain pathology. Our results demonstrate that the effects of dietary sodium on autoimmune neuroinflammation are sex specific, genetically controlled, and CNS mediated.-Krementsov, D. N., Case, L. K., Hickey, W. F., Teuscher, C. Exacerbation of autoimmune neuroinflammation by dietary sodium is genetically controlled and sex specific.
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There is considerable confusion about what ranges of dietary salta could be considered low, normal, or high and also what ranges of reduction in dietary salt are small or large. The World Hypertension League with other organizations involved in dietary salt reduction have proposed a standardized nomenclature based on normal ancestral levels of salt intake and also on ranges of reduction in salt intake in clinical and population interventions. Low daily salt (sodium) intake where harm due to deficiency would be expected to occur is recommended to remain undefined because of inadequate research but likely <0.25 g (100 mg), normal (physiological) intake <2.5 g (1000 mg), recommended intake <5.0 g (2000 mg), high ≥5.0 g (2000 mg), very high >10 to 15 g (4000–6000 mg), and extremely high >15 g (6000 mg). Reductions in daily salt (sodium) intake are recommended to be called small if <2.5 g (1000 mg), moderate if 2.5 to 5.0 g (1000–2000 mg) and large if >5.0 g (2000 mg). Use of this nomenclature is likely to result in less confusion about salt intake and interventions to reduce dietary sodium.
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Type 17 helper (Th17) cells are primary mediators of inflammation. Data from two recent studies suggest that salt enhances the inflammatory responses of Th17 cells in the mouse, as well as the severity of disease in a mouse model of multiple sclerosis.
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This review provides an overview of our current understanding of the relation of salt consumption to hypertension and cardiovascular disease.
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Bangladesh is a deltaic country with total area of 147,570 km 2 . The major part (80%) of the country consists of alluvial sediments deposited by the rivers Ganges, Brahmaputra, Tista, Jamuna, Meghna and their tributaries. Terraces with an altitude of 20-30 m cover about 8% of the country, while hilly areas with an altitude of 10-1000 m occur in the southeastern and northeastern part. The coastal region covers almost 29,000 km 2 or about 20% of the country. Again, the coastal areas of Bangladesh cover more than 30% of the cultivable lands of the country. About 53% of the coastal areas are affected by salinity. Agricultural land use in these areas is very poor, which is much lower than country's average cropping intensity. Salinity causes unfavorable environment and hydrological situation that restrict the normal crop production throughout the year. The factors which contribute significantly to the development of saline soil are, tidal flooding during wet season (June-October), direct inundation by saline water, and upward or lateral movement of saline ground water during dry season (November-May). The severity of salinity problem in Bangladesh increases with the desiccation of the soil. It affects crops depending on degree of salinity at the critical stages of growth, which reduces yield and in severe cases total yield is lost. Soil reaction values (pH) in coastal regions range from 6.0-8.4. The organic matter content of the soils is also pretty low (1.0-1.5%). Nutrient deficiencies of N and P are quite dominant in saline soils. Micro-nutrients, such as Cu and Zn are widespread. During the wet monsoon the severity of salt injury is reduced due to dilution of the salt in the root-zone of the standing crop. The dominant crop grown in the saline areas is local transplanted Aman rice crop with low yields. The cropping patterns followed in the coastal areas are mainly Fallow-Fallow-Transplanted Aman rice. Salinity problem received very little attention in the past. It has become imperative to explore the possibilities of increasing potential of these (saline) lands for increased production of crops. Thus is necessary to have an appraisal of the present state of land areas affected by salinity.
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This paper examines the impact of shrimp farming on rice ecosystem in a village in Southwestern Bangladesh. The village Damarpota has experienced transformation of 274 ha (79%) of its prime quality rice fields into shrimp farms during the period between 1985 and 2003. Prolonged shrimp farming for 5-, 10-, and 15-year period has increased soil salinity, acidity, and depleted soil Ca, K, Mg, and organic C content of all three types of soils in the villages to a variable degree and caused soil degradation that significantly affected the rice yield. Declined yield and acreage of rice jointly reduced the total production of rice and animal fodder. Soil degradation and loss of acreage under rice have threatened the sustainability of the village rice ecosystem.
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Miscarriage is one of the most common complications of pregnancy: 15% of clinically recognized pregnancies end in miscarriage. The major cause of spontaneous miscarriage is genetic or developmental abnormalities of the fetus. Other causes include thrombophilia, cervical weakness, infection and endocrine, anatomical and immune factors. Treatments to prevent miscarriage remain largely untested by randomized controlled trials or evidence-based practice. The resulting consequences have been disappointing for both patients and health-care providers. This article is therefore designed to enhance critical thinking and improve clinical skills in an area with extensive and confusing literature.
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Excess dietary salt is a major cause of hypertension. Nevertheless, the specific mechanisms by which salt increases arterial constriction and peripheral vascular resistance, and thereby raises blood pressure (BP), are poorly understood. Here we summarize recent evidence that defines specific molecular links between Na(+) and the elevated vascular resistance that directly produces high BP. In this new paradigm, high dietary salt raises cerebrospinal fluid [Na(+)]. This leads, via the Na(+)-sensing circumventricular organs of the brain, to increased sympathetic nerve activity (SNA), a major trigger of vasoconstriction. Plasma levels of endogenous ouabain (EO), the Na(+) pump ligand, also become elevated. Remarkably, high cerebrospinal fluid [Na(+)]-evoked, locally secreted (hypothalamic) EO participates in a pathway that mediates the sustained increase in SNA. This hypothalamic signaling chain includes aldosterone, epithelial Na(+) channels, EO, ouabain-sensitive α(2) Na(+) pumps, and angiotensin II (ANG II). The EO increases (e.g.) hypothalamic ANG-II type-1 receptor and NADPH oxidase and decreases neuronal nitric oxide synthase protein expression. The aldosterone-epithelial Na(+) channel-EO-α(2) Na(+) pump-ANG-II pathway modulates the activity of brain cardiovascular control centers that regulate the BP set point and induce sustained changes in SNA. In the periphery, the EO secreted by the adrenal cortex directly enhances vasoconstriction via an EO-α(2) Na(+) pump-Na(+)/Ca(2+) exchanger-Ca(2+) signaling pathway. Circulating EO also activates an EO-α(2) Na(+) pump-Src kinase signaling cascade. This increases the expression of the Na(+)/Ca(2+) exchanger-transient receptor potential cation channel Ca(2+) signaling pathway in arterial smooth muscle but decreases the expression of endothelial vasodilator mechanisms. Additionally, EO is a growth factor and may directly participate in the arterial structural remodeling and lumen narrowing that is frequently observed in established hypertension. These several central and peripheral mechanisms are coordinated, in part by EO, to effect and maintain the salt-induced elevation of BP.
Article
Recurrent pregnancy loss (RPL) is defined as the occurrence of three or more consecutive miscarriages prior to 20 weeks gestation. Exaggerated maternal immune response to fetal antigens has been proposed to be one of the mechanisms underlying recurrent pregnancy loss. A comprehensive literature search was conducted from the websites of the National Library of Medicine (http://www.ncbl.nlm.nih.gov) and Pubmed Central, the US National Library of Medicine's digital archive of life sciences literature (http://www.pubmedcentral.nih.gov/). The data was assessed from books and journals that published relevant articles in this field. In normal pregnancy, tolerance of the genetically incompatible fetus by the maternal immune system depends on the interactions of an array of cytokines secreted by maternal and fetal cells at the site of implantation. Earlier research indicated that altered immunity in RPL is dominated by the Th1/Th2 hypothesis, which proposed that the fetus escapes maternal-derived T-cell responses through skewing the Th0 differentiation toward Th2 pathway which dampens pro-inflammatory Th1-type immunity. Recent studies indicate the role of proinflammatory Th17 cells and immunoregulatory Treg cells in RPL in addition to Th1/Th2 interactions. Cytokines form a complex regulatory network which maintains homeostasis between the fetal unit and the maternal immune system. If this delicate balance is adversely affected, immunoregulatory mechanisms may be insufficient to restore homeostasis and this may lead to pregnancy failure.
Article
Although recurrent miscarriage (RM) affects only 1-3% of couples, it has a major influence on the wellbeing and psychosocial status of patients. Therefore, research into improved diagnosis and development of new treatment strategies is essential. In this review, we summarize current concepts on diagnosis and treatment in RM, drawing upon research reports and international guidelines to provide insights into the pathophysiology of pregnancy disrupted by repeated miscarriage. Anatomical malformations, infectious diseases, endocrine disorders, autoimmune defects as well as acquired and inherited thrombophilia are established risk factors in RM. In addition, our recent findings indicate an impact on miscarriage incidence of glycoproteins such as glycodelin, and nuclear hormone receptors such as the peroxisome proliferator-activated receptors (PPARs). Significantly reduced glycodelin expression is associated with miscarriage, whereas up-regulation of PPARs appears to compensate for either the activated immune response or the disturbed cytotrophoblast differentiation in RM patients. There is also evidence that circulating placental microparticles are increased in a subgroup of RM patients, indicating an acquired procoagulant state even outside pregnancy. Treatment strategies like aspirin and low molecular weight heparin (LMWH) are standard medications in RM, although only a few placebo-controlled trials have proven their benefit in respect to live birth rate. There is emerging evidence that new treatment options, including drugs like TNFalpha inhibitors and granulocyte colony-stimulating factor (G-CSF) might be beneficial in some cases of RM. However, larger clinical trials must be completed to further prove or disprove benefits of these drugs in the treatment of RM patients.
Article
Human reproduction is extraordinarily wasteful. The reasons for this have taxed all of the contributors to this book. As we move into the 21st century it is sobering to reflect on the fact that we have failed to harness the power of the evolving revolution in molecular medical biology to answer the fundamental question: why is the fate of a fertilized egg so hazardous and so unsuccessful? The following account summarizes our limited knowledge of the epidemiology of miscarriage and then moves on to consider some of the medical causes of miscarriage. The contribution of genetic abnormalities to the problem of pregnancy wastage is discussed elsewhere in this volume.
Article
Water-related crises are not a new problem in Bangladesh. The discovery of arsenic in drinking water was deemed "the largest mass poisoning of a population in history" threatening the lives of millions. Now Bangladesh is facing another environmental and health threat due to man-made and natural factors: increased salinity. Estimates indicate that Bangladesh has about 2.8 million hectares of land that is affected by salinity-ie a third of the 9 million hectares of total national cultivated area and about a fifth of the total area of Bangladesh. Saline intrusion from sea water owing to reduction of freshwater flow from upstream (partly owing to the establishment of the Farrakka Barrage on the Ganges near the border of Bangladesh) is expected to be aggravated by climate change and sea-level rises. It has already had adverse effects on crop productivity and grain production. Now it appears to be a threat to the well-being of communities who live in coastal areas of this low-lying nation. (excerpt)
Investigating the impact of relative sea level rise on coastal communities and their livelihoods in Bangladesh
  • N Mohal
  • M M A Hossain
Mohal, N., & Hossain, M. M. A. (2007). Investigating the impact of relative sea level rise on coastal communities and their livelihoods in Bangladesh. Draft Final Report. Dhaka: Institute of Water Modelling (IWM) and Center for Environmental and Geographic Information Services (CEGIS). Submitted to UK Department for Environment Food and Rural Affairs in May.