Reference centile charts of first-trimester aneuploidy screening & Doppler parameters for Indian population

Background & objectives: The risk estimation for foetal aneuploidies in the first trimester of pregnancy uses reference curves based on western data. The objective of this study was to construct the reference curves of first-trimester foetal aneuploidy screening parameters for the Indian women. Methods: Cross-sectional data were obtained from 1204 singleton pregnancies between the crown-rump length (CRL) of 40-84 mm. Linear regression models were constructed; the mean, median and standard deviation were derived as a function of CRL. Results: The mean value of CRL was 61.3 mm. The regression analysis showed a significant correlation between all variables and CRL (P< 0.001). There was a positive correlation of CRL with nuchal translucency (NT) (y=0.010x+0.629, R2=0.116) and pregnancy-associated plasma protein-A (PAPP-A) (y=0.107x?1.079, R2=0.173), whereas inverse correlation was seen with free ?-human chorionic gonadotropin (?-hCG) (y=?0.409x+75.025, R2=0.018) and Doppler parameters pulsatility index (PI) (y=?0.008x+1.924 R2=0.053). The centile charts of NT, PAPP-A, free ?-hCG and uterine artery (Ut A) Doppler PI were constructed. Interpretation & conclusions: The reference centile charts of first trimester aneuploidy screening along with Doppler parameters were derived in Indian pregnant women. These centile charts may be used as a reference for clinical use in Indian population.

Dyslipidemia and Superoxide Dismutase Activity in Children with Down Syndrome.

Introduction: Down Syndrome (trisomy 21) provides an interesting natural model to study atherosclerosis, since these individuals appear to be protected from plaque formation. Methodology: We assessed the lipid levels, and superoxide dismutase (SOD) activity in 32 clinically diagnosed children of Down syndrome and 34 children matched for age and sex as controls. Results: SOD activity was found to be significantly higher (p=0.004) in children with Down Syndrome (mean=313.7 IU/ml) than in controls (mean140.2 IU/ ml). Significantly higher levels of serum triglyceride (154.7 mg/dl) and VLDL (33.9 mg/dl) were observed in Down Syndrome as compared to healthy controls (119.6 mg/dl and 23.9 mg/dl respectively; p<0.05 for each). However, the two groups did not show any significant difference in levels of serum HDL-C, LDL-C. Conclusion: The raised antioxidant activity of SOD, because of over expression of genes situated non chromosome 21, probably offers some protection against the development of atherosclerosis despite the occurrence of dyslipidemia.

Hyperinsulinemia in subjects with and without coronary artery disease: a preliminary study from North India.

BACKGROUND: Hyperinsulinemia has been associated with obesity, hypertension, diabetes, and coronary artery disease. However, it is not clear whether hyperinsulinemia by itself is a risk factor for coronary artery disease in the absence of obesity, diabetes, and hypertension. Therefore, we conducted a study to evaluate the role of hyperinsulinemia in coronary artery disease in the absence of diabetes, hypertension, and obesity. METHODS AND RESULTS: A total of 80 cases and 50 controls were studied. Only non-diabetic, normotensive, nonobese men (body-mass index < or = 25) were included. The presence of valvular heart disease or an acute coronary event in the past 6 weeks were exclusion criteria. Serum insulin levels were measured in fasting samples by ELISA assay. The mean fasting insulin was 17.0+/-16.5 microIU/ml and 13.3+/-12.9 microIU/ml in the control and study groups, respectively (reference range 1.5-15.6 microIU/ml). There was no significant association between coronary artery disease and the surrogate markers of insulin resistance, namely, fasting insulin (p value 0.367) and homeostasis model assessment of insulin resistance (p value 0.589). CONCLUSIONS: A high-normal fasting insulin level was present in non-diabetic, nonhypertensive, and nonobese men in the Indian population. We suggest that insulin resistance may not per se be an independent risk factor for coronary artery disease. It may be an innocent bystander in coronary artery disease in an obese, hypertensive, and diabetic population. However, due to our small sample size, further studies are required in this direction.

Effects of low-dose omega-3 fatty acid substitution in type-2 diabetes mellitus with special reference to oxidative stress--a prospective preliminary study.

BACKGROUND: A state of increased oxidative stress has been recognised in type 2 diabetes mellitus (DM). The present study was done to assess the effects of low dose omega-3 fatty acids substitution in patients with type 2 DM with special reference to oxidative stress. METHOD: Sixty-five patients with type 2 DM of body mass index (BMI) < 27 kg/m2 and thirty age and sex matched healthy controls were evaluated for blood glucose, blood pressure and lipid profile and oxidative stress was assessed in them by measuring lipid peroxides (LP), diene conjugates (DC) and reduced glutathione (RG) in the serum. Of the 65, 40 motivated patients were randomly divided into two groups--group 1 comprising of fifteen patients prescribed a diabetic diet along with a placebo and group 2 consisting of twenty-five patients on the same diet with the addition of 0.6 g omega-3 fatty acids as one capsule Maxigard (containing 180 mg eicosapentaenoic acid and 120 mg docosahexaenoic acid) twice daily. All parameters were reassessed after six weeks. RESULTS: The levels of lipid peroxides (micromol/L), diene conjugates (OD units) and reduced glutathione (mmol GSH/L) were significantly altered indicating increased oxidative stress in the diabetics compared to the healthy controls: 4.106 +/- 0.889, 2.751 +/- 0.424, 1.344 +/- 0.316 and 1.91 +/- 0.541, 1.735 +/- 0.315, 1.919 +/- 0.310, respectively (p < 0.001 for all the three). Patients in group 1 and 2 were comparable in all respects including oxidative stress at the start of therapy. After six weeks, on comparing the mean % changes in the three parameters of oxidative stress between the two groups, it was seen that the % change was significantly higher in group 2 (Maxigard group) compared to group 1 (Placebo; 5.22 +/- 1.056 (p = 0.05), 3.28 +/- 0.608 (p = 0.01), 5.27 +/- 0.585 (p < 0.001) and 0.82 +/- 0.123, 0.18 +/- 0.017, 0.56 +/- 0.035 (p < 0.001), respectively. The patients in group 2 also exhibited significantly greater improvement in glycemic status, blood pressure and lipid profiles. CONCLUSIONS: The present study documented the existence of a state of increased oxidative stress in type 2 diabetics. Significant beneficial effects of low dose omega-3 fatty acids substitution for PUFA-6 were observed not only on oxidative stress parameters but also on blood pressure and metabolic profile.

Haemostatic changes in children with cyanotic and acyanotic congenital heart disease.

This study was undertaken to screen children with congenital heart disease for coagulation abnormalities and to compare the groups of cyanotic and acyanotic children with congenital heart disease with respect to abnormalities of the coagulation system. Following investigations were done in all the patients: complete blood count, erythrocyte sedimentation rate, peripheral smear examination, bleeding time, prothrombin time, activated partial thromboplastin time, assay of fibrinogen, D-dimer, factors VII and VIII and antithrombin III. Red cell indices were determined in 12 control, 12 acyanotic and 20 cyanotic children. Twenty-five patients each, with echocardiographically proven cyanotic and acyanotic congenital heart disease under 12 years of age constituted the study group; as many children of the same age group were included as the control group. The results showed isolated abnormalities of laboratory tests with equal frequency (28%) in acyanotic and cyanotic groups but coexisting abnormalities of more than one test were seen in significantly larger number of cyanotic children (5/25 and 16/25, respectively). A significant association was noted between thrombocytopenia and a high haematocrit in cyanotic patients. It is concluded that laboratory abnormalities of tests of haemostasis are more common in cyanotic congenital heart disease patients. The patterns of laboratory abnormalities suggest a chronic compensated disseminated intravascular coagulation at a subclinical level, reduced synthesis of clotting factors and/or deranged platelet aggregation in different subgroups of patients.

Pre- and extra-marital heterosexual behaviour of an urban community in Rajasthan, India.

A study conducted among the teachers of senior secondary schools of a city in Rajasthan state to know the magnitude of pre- and extra-marital heterosexual practices and some related characteristics revealed that one third of unmarried and one fifth of married males had experienced pre-marital sex. The same for unmarried and married females was 11.8 per cent and 1.5 per cent, respectively. The prevalence of extra-marital heterosexual act among married males was 15.5 per cent. One out of ten married males reported to have had both pre- and extra-marital sex. A male having pre-marital sex was 15 times more likely to have extra-marital sex. Friends, acquaintances and relatives were the important sexual partners while role of commercial sex workers was negligible. The study reports that heterosexual act with person other than the legal spouse is very much prevalent among this group of middle class professionals. This situation is conducive for the spread of HIV infection among general population and may adversely influence the sexual attitudes of students. The study, therefore, suggests that, besides intensifying the health education on HIV/AIDS, serious considerations about the sexual behaviours of school teachers are needed.

Evaluation of pulse polio and routine immunisation coverage: Alwar District, Rajasthan.

During the last decade, India achieved 88% reduction in reported poliomyelitis incidence. However, absolute number of reported cases still remains high. As an added effort to eradicate the disease, the country observed its first National Immunisation Days (NIDs) on 9.12.95 and 20.1.96. The present study evaluates the performance of Alwar district, Rajasthan. Modified 30 cluster technique was used to collect information. Overall coverage in rural and urban areas was 89% and 91% respectively. Main source of information was television in urban and health staff in rural areas. Most of the respondents knew about the usefulness of such special activity and had favourable opinion about the facilities provided. Urban Alwar had 80% OPV3 coverage but, in rural area it was almost half. The reported coverage of NIDs and UIP was found to be conflicting with the study results. The existing "dose enumeration method" of calculating reported coverage was attributed to be the cause. The study emphasises the need to incorporate an in-built community-based evaluation of future NIDs and utilisation of such results for planning.

Methods for estimating prevalence and incidence of senile cataract blindness in a district.

The problem of senile cataract blindness (SCB) is very acute in India, contributing to 80 per cent of total blindness. The national objective of reducing the prevalence of blindness from 1.49 per cent, during 1986-89 to 0.3 per cent by AD 2000 has necessitated the surgical correction of SCB to be the major activity. With the introduction of District Blindness Control Society (DBCS), there has been a substantial increase in the number of operations of SCB in those districts. However, in the absence of standard, feasible, simple and cost effective methods to estimate the prevalence and incidence of SCB, the DBCS may find it difficult to plan and execute its major activity in a realistic way. The paper suggests two such methods for the use by DBCS. Only five seemingly rational assumptions have been adopted for the purpose. The authors feel that proper field testing is required to be sure about the reliability and validity of these methods.

An outbreak of viral hepatitis E: role of community practices.

A small localised outbreak of viral hepatitis due to HEV occurred in an educated and well placed community. The overall attack rate was found to be 1.9%; the children and adults were equally affected. No fatality was observed. Five blood samples collected from the cases of jaundice were found negative for Anti HAV IgM, HBsAg and Anti HBc IgM, but positive for Anti HEV. The infection spread by contamination of piped water by sewage system resulting from scarcity of water, intermittent water supply and installation of on-line private booster pumps by the residents. Community action, especially the boiling of drinking water till the quality of piped water improved, restricted jaundice cases to only one incubation period. The outbreak highlights the importance of community behaviour in first precipitating the crisis and then limitating the damage.

Poliomyelitis in Delhi: a projection on pool of at-risk under five during 1995.

Due to lacunae in coverage and limitation in efficacy, immunization with oral polio vaccine has left a group of susceptible children at risk of developing poliomyelitis. The present study, with the help of statistics, projects the size of that susceptible pool of underfive children in Delhi during 1995. With the help of available data and some assumption, a formula has been developed for the purpose. The size of the pool thus estimated is about 3.7 lakh. There is a need to develop methodology for finding such susceptibles at community level, particularly at the terminal phase of eradication. An additional approach of immunization has also been suggested to facilitate the prospect of polio eradication.

Acute paralytic poliomyelitis in Delhi (1975-1992).

Incidence of poliomyelitis in Delhi between 1975 and 1992, estimated from available data, shows a ladder-pattern type of decline from 15.65 in 1975 to 5.90 in 1992. The linear regression analysis shows a declining trend of incidence by 66.28% during the period. Huge increase of population with fast growing slums and resettlement colonies in Delhi was attributed to be responsible for partly counteracting different poliomyelitis control/eradication activities. The population representativeness of estimated incidence showed constant improvement during 1980 to 1991.

Tobacco smoking in a defined community of Delhi.

A Community based study was conducted in urban Delhi. It was found that Smokers constituted about 32 percent of adult males in Delhi Admin. Flats, Timarpur. Proportion of smokers was highest in 41-50 years age. 31 percent of school teachers were smokers. Out of all who tried to live-up smoking, 8 percent reverted back after abstinence of two year or more. About three fourth of the smokers were worried ill effects of smoking's on them and others. Significantly higher number of non-smokers expressed opinion for total stopping of advertisement and complete ban of sale of smoking tobacco.

Case series evaluation of BCG vaccine efficacy against tubercular meningitis in children in Delhi.

Tubercular meningitis (TBM) is a very serious disease of childhood. BCG vaccination under Universal Immunisation Programme is the only available way of preventing this disease. The present series using case-control method, evaluated efficacy of BCG against TBM in children to be 57 per cent. Suggestion has been made to initiate TBM surveillance in children and conduct multicentric prospective case-control study of similar type.

Epidemiology of a jaundice outbreak in Rairangpur town in Orissa.

A jaundice epidemic broke out in Rairangpur town of Orissa during December 1989 to January 1990. The attack rate was 1.2 per cent with 89.8 per cent cases among 11-40 years age group. Male-female ratio of cases was 2.3:1. The source of infection was traced to contamination of drinking water from leakage in the pipe line which was confirmed by a subsequent case control study. The outbreak was due to enterically transmitted Non A Non B hepatitis virus.

Review of the Journal of Communicable Diseases from 1982 through 1991.

Review of medical journals is not common in India. A quantitative review of the articles published in the Journal of Communicable Diseases from 1982 through 1991 was undertaken in the present study to give feedback to all concerned and stimulate them for initiating constructive criticism of medical journals published in India. Articles were categorised as per the classes of four predetermined parameters and variations in the proportions of number of articles under different classes of each parameter are briefly discussed.

Epidemiological profile of Japanese encephalitis in Gorakhpur district, Uttar Pradesh, 1982-1988.

An in-depth study of Japanese Encephalitis (JE) situation in Gorakhpur district of Uttar Pradesh from 1982-1988 showed increasing trend in the incidence of JE. Total number of annual cases and case fatality rate (CFR) rose from 118 and 23.7 per cent in 1982 to 772 and 32.2 per cent in 1988 respectively. A definite increase was noticed in the number of cases per block following lull years in 1984 and 1987. Among the total affected 1201 villages, 1083 were affected only once. All age groups were affected and the disease showed marked seasonality during August to November. JE, which came in epidemic form in earlier years has established in the area in endemic form.

Antibiotic resistance of coliforms in drinking water in rural areas.

The antibiotic sensitivity of 197 coliform sp. isolated from drinking water in five rural areas was studied. Twelve strains (6.1%) showed multiple antibiotic resistance, three (1.5%) of which were able to transfer the resistances to an Escherichia coli K-12 recipient. It seems unlikely that the occurrence of transmissible multiple antibiotic resistance among coliforms in drinking water in the areas studied poses a significant public health risk.