RESUMEN
Introduction Various studies have linked suicidal behavior, stress, affective disorders, and dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis resulting from chronic stress. Chronic stress has been shown to cause enlargement of the adrenal glands, altering their function and potentially leading to suicidal behaviors in individuals with depression. This study aimed to compare the histological changes in the adrenal glands of individuals who died by suicide with those who experienced sudden death. Suicide victims are exposed to chronic stress, while individuals with sudden deaths face acute stress related to the act of dying. Methods This analytical study, approved by the Institutional Ethics Committee (IEC), was conducted in the Department of Forensic Medicine and Toxicology at Gandhi Medical College, Bhopal. The study included 100 confirmed cases of suicide, irrespective of gender, aged 15-60 years, with notable autopsy findings, relevant history, no signs of decomposition, and varying survival periods (including immediate deaths within 24 hours). Additionally, 20 controls were selected, involving individuals who died suddenly from causes other than suicide within 24 hours of the incident. Informed consent was obtained using a prescribed proforma from relatives and the police. Histological examination slides of the adrenals were prepared and analyzed. Data were collected and statistically analyzed using GraphPad software and Epi Info 7. Results Capsular hemorrhage was observed in 98% of suicide cases and 40% of controls. Nodulation was present in 48% of suicidal cases and 20% of controls. Zonal extension of zona fasciculata was specific to chronic stress in suicidal cases. In 25% of suicidal cases, a prominent extension of the medulla was noted. Irregular thinning of zona glomerulosa with shrunken cells and increased nuclear density in 88% of cases were considered specific to chronic stress conditions and suicide, not observed in controls. Lipid depletion was observed in all suicidal cases, with diffuse depletion in 47% and focal depletion in 53% of cases. In contrast, 45% of those exposed to the acute stress of dying showed focal depletion, with none exhibiting diffuse depletion. Suicidal cases displayed dilated prominent sinusoids in all three zones and the adrenal medulla (98-99%), absent in controls. Adrenal hemorrhage and necrosis were specific to chronic stress conditions, with 7%, 8%, 32%, and 16% of cases showing hemorrhage in all three zones and adrenal medulla, respectively, and none in controls. Conclusion Histological changes observed in acute stress conditions included focal lipid depletion, capsular hemorrhage, nodular hyperplasia, and hemorrhage and necrosis with edema. However, the proportion and severity of these changes were lower than those observed in the suicidal group, suggesting that these findings may be considered non-specific for differentiating between acute and chronic stress.
RESUMEN
Central India faced major dengue outbreaks in 2019 and 2021. In the present study, we aimed to identify the dengue virus serotypes and genotypes circulating in Central India during the COVID pre-pandemic year (2019) and ongoing-pandemic year (2021). For this purpose, the suspected cases were first tested by serological assays. Sero-positive samples were then subjected to molecular diagnosis by RT-PCR and semi-nested PCR. The serotypes obtained were confirmed by nucleotide sequencing. A phylogenetic analysis of serotypes was performed to identify the circulating genotypes. All four DENV serotypes were detected during 2019 and 2021, with the predominance of DENV2. Cases with multiple DENV serotype infections were also identified, involving DENV-2 in all the coinfections. Genotyping revealed that DENV-1 (Genotype V, American/African), DENV-2 (Genotype IV, Cosmopolitan), DENV-3 (Genotype III, Cosmopolitan), and DENV-4 (Genotype I) were involved during both outbreaks. DENV-2 detected in 2019 and 2021 has diverged from the previous strains detected in Central India (2016 and 2018), which may account for the higher transmission of DENV-2 during these outbreaks. The detection of heterologous DENV serotypes with high transmission efficiency calls for continuous viral monitoring and surveillance, which will contribute to a better understanding of changing viral dynamics and transmission patterns.
RESUMEN
Introduction Chronic stress breaches the normal homeostasis of the hypothalamic-pituitary-adrenal axis, leads to chronic adrenal fatigue, and causes hypertrophy and hyperplasia of the adrenal gland. The current study was carried out with the aim of observing the difference in gross morphological changes in the adrenals of people dying by suicide and from sudden death, as persons committing suicide are exposed to chronic stress (depression), while those dying suddenly are exposed to the acute stress of dying. Materials and methods The present analytical study was carried out in the Department of Forensic Medicine and Toxicology, Gandhi Medical College, Bhopal, India, after approval from the Institutional Ethics Committee (IEC). A total of 100 established cases of suicide with prominent autopsy findings and relevant history without signs of decomposition, aged 15-60 years, irrespective of gender, and a variable survival period (immediate death to within 24 hours) were selected. A total of 20 controls included those who died suddenly from an act other than suicide within 24 hours of the incident. Due consent was obtained from the relatives and police in the prescribed proforma. Kidneys, along with peri-renal fat and adrenal glands on both sides, were carefully removed and examined. Results A total of 25% of suicide victims reported a history of chronic stress, 13% self-destructive behavior, 3% untreated depression, and 8% reported financial or marital difficulties. The right adrenal gland was found to be heavier than the left in the control group. In addition, both left and right adrenal glands weighed more in males. Among the suicidal cases, the weight of the left adrenal gland was greater than that of the right, and the weight of the gland in males was higher than that in females. The difference in adrenal gland weight among males was significant in both case and control groups (combined p-value = 0.0001) but was insignificant in females, probably due to their disproportionate ratio in both groups. There was no significant relationship between adrenal gland weight and individual age or weight. However, adrenal gland weight in both groups was significantly associated with the height of the individual (p-value = 0.001 in the study group and < 0.05 in the control group). The difference in adrenal gland volume between the suicidal and control groups was not significant, indicating that the increase in size is not a differentiating criterion for acute and chronic stress. The relative adrenal gland weight was significantly higher in the suicidal group. Conclusion The external appearance of the adrenal gland may be regarded as a normal response to stress in relation to the mode of death. The left adrenal gland is more likely to show an increase in weight in response to chronic stress. The weight of the adrenal gland in both groups is significantly associated with the height of the deceased. Relative adrenal weight can be considered as specific for suicidal cases exposed to chronic stress. However, the volume of the adrenal gland may be considered an unreliable criterion in the differentiation of chronic stress from acute stress.