Blood lead levels in antenatal women and its association with iron deficiency anemia and adverse pregnancy outcomes.

OBJECTIVES: Lead is one of the most toxic heavy metal prevalent in the environment, which affects almost all major organs including heart, brain, intestines, kidneys as well as reproductive organs. It has been known that serum iron deficiency is associated with increased serum lead levels as lead is a particularly pernicious element to iron metabolism. Lead is also known to freely cross the placenta too; hence, this study was planned to determine any association between antenatal iron deficiency anemia (IDA), raised blood lead levels (BPb), and adverse pregnancy outcomes. MATERIALS AND METHODS: This was an observational study done on 99 antenatal women with IDA and 41 nonanemic antenatal women. Lead levels were assessed in these 140 antenatal women and they were followed for adverse pregnancy outcomes. Chi-square test was used to find a difference in quantitative variables and Pearson's correlation test was used to assess association between BPb and hemoglobin levels. RESULTS: We found that in 11 out of 99 (11.11%) women with IDA, BPb levels were high as compared to high BPb levels in only 1 out of 41 (2.4%) women without IDA and the high BPb levels ranged from 4 µg/dl-16.9 µg/dl with a mean BPb of 8.1 µg/dl. The difference in BPb among anemic and nonanemic antenatal women was significant (P < 0.05) and there was a negative dose effect relationship between BPb levels and hemoglobin levels. This difference in antenatal outcomes among women with and without high BPb levels was also significant with increased incidence of pre-eclampsia, FGR, and preterm deliveries in women with raised BPb levels. The incidence of NICU admission was also higher in the neonates of mothers with high BPb levels. CONCLUSIONS: We propose screening of high-risk women based on their social, occupational, environmental, and personal factors, with serum lead levels in the preconception period itself. All public and personal measures must be taken to reduce lead consumption and exposure in the preconception and antenatal period.

Vitamin C in disease prevention and cure: an overview.

The recognition of vitamin C is associated with a history of an unrelenting search for the cause of the ancient haemorrhagic disease scurvy. Isolated in 1928, vitamin C is essential for the development and maintenance of connective tissues. It plays an important role in bone formation, wound healing and the maintenance of healthy gums. Vitamin C plays an important role in a number of metabolic functions including the activation of the B vitamin, folic acid, the conversion of cholesterol to bile acids and the conversion of the amino acid, tryptophan, to the neurotransmitter, serotonin. It is an antioxidant that protects body from free radical damage. It is used as therapeutic agent in many diseases and disorders. Vitamin C protects the immune system, reduces the severity of allergic reactions and helps to fight off infections. However the significance and beneficial effect of vitamin C in respect to human disease such as cancer, atherosclerosis, diabetes, neurodegenerative disease and metal toxicity however remains equivocal. Thus further continuous uninterrupted efforts may open new vistas to understand its significance in disease management.

Role of cerebrospinal fluid adenosine deaminase level estimation in diagnosis of tuberculous meningitis.

Five lakh patients of tuberculosis die every year in India. Meningeal tuberculosis is an endemic disease with 7-12% incidence. Delay in diagnosis and in initiating treatment results in poor prognosis and sequelae in upto 25% of cases. The aim of the present study is to look for a simple, rapid, cost effective and non-invasive test for diagnosing this disease. Forty patients between 6-24 months of age having symptoms and signs of meningitis were selected and divided into two groups tuberculous and non-tuberculous, depending upon the accepted criteria. Cerebrospinal fluid (CSF) was drawn and adenosine deaminase (ADA) estimated. Out of 19 tuberculous patients, 18 patients had CSF ADA at or above the cut-off value while 1 had below the cut-off value. Out of 21 non-tuberculous patients, 2 patients had at or above the cut-off value while 19 were below this value. Results of this study indicate that ADA level estimation in CSF is not only of considerable value in the diagnosis of tuberculous meningitis, CSF ADA level of 10 U/L as a cut-off value exhibited 94.73% sensitivity and 90.47% specificity in differentiating tuberculous from non-tuberculous meningitis; it also has 90.00% positive predictive value and 95.00% negative predictive value. ADA estimation in CSF is simple, inexpensive, rapid and fairly specific method for making a diagnosis of tuberculous aetiology in TBM; especially when there is a dilemma of differentiating the tuberculous aetiology from non-tuberculous and for this reason ADA estimation in TBM may find a place as a routine investigation.