Incidence of congenital anomalies in a rural population of Jammu - A prospective study.

BACKGROUND: Congenital anomalies (CAs) are a major cause of stillbirths and neonatal mortality in India. Its magnitude and pattern reportedly vary over time and across geographical locations. OBJECTIVES: The objective of the study is to estimate the incidence of CAs in community development block RS Pura of District Jammu. METHODS: The present study is a community-based prospective study. The field workers were trained with the help of "Birth Defect Surveillance" Atlas issued by WHO and ICBDMS (International Clearinghouse for Birth Defects Monitoring Systems) 2014. Pregnant women (registered or unregistered) with all health institutions in RS Pura Block on or after April 1, 2014, were followed till September 2015 for the ascertainment of CAs. All CAs detected during antenatal period (by ultrasonography), after delivery and abortion at any site were counted as events and classified by organ system according to the 10th version of the WHO International Classification of Diseases-10. RESULTS: A total of 1670 mothers were followed till their pregnancy outcome was recorded. Among 1600 live births recorded, 54 babies had CAs resulting in the incidence rate of 33.7/1000 live births. The incidence rate was comparatively higher among women aged <20 years (71.4/1000 live births) and with Para 4 (43.5/1000 live births) as compared to other women. Digestive system was the most common system involved (35%) followed by the Central nervous system (26.6%). The U-shaped pattern in the incidence of CAs with regards to parity and maternal age was observed. CONCLUSION: The study demonstrated that the CAs continue to occur in Jammu at a similar magnitude as reported from other parts of the country.

Feto-maternal Outcomes in Pregnancies Complicated by Thermal Burns.

BACKGROUND: Burns in pregnancy can be a potentially life-threatening condition for both mother and baby. Human physiology is altered during pregnancy and burns add further stress leading to diminished maternal reserves. Very few studies have been reported for management of such patients. MATERIALS AND METHODS: This was a prospective based study carried out in Department of Burns and Plastic Surgery in collaboration with Department of Obstetrics and Gynaecology and Department of Pediatrics for a period of 20 months from December 2011 to July 2013. Pregnant women with thermal injuries more than 15% TBSA were included in the study. Patients with coexisting obstetrics complications and burns other than thermal were excluded. RESULTS: Out of 3397 female patients of burns admitted, 1382 patients were in reproductive groups, 1116 were married and 67 were pregnant; these were enrolled. Maternal and fetal outcome is inversely linked with the TBSA of the mother (p < 0.001). In TBSA group 15-30%, there was no maternal and fetal mortality, but in TBSA >30-50% maternal mortality was 44%, and in 50-70% maternal mortality was 83% and no mother survived in >70%. In TBSA 30-50%, fetal mortality was 72%. Only one baby survived in 50-70% TBSA group and one in >70% TBSA group after intensive care in NICU for prematurity. Fetal survival was also dependent on gestational age, and there are better outcomes in late trimesters. CONCLUSION: Maternal and fetal outcome are directly related to TBSA of mother, and best care can be offered to such patients with a multidisciplinary team-based approach.

Transition of Immunohistochemical Expression of E-Cadherin and Vimentin from Premalignant to Malignant Lesions of Oral Cavity and Oropharynx.

OBJECTIVES: We sought to study the expression of epithelial-to-mesenchymal transition markers E-cadherin and vimentin in precancerous lesions of the oral cavity and oropharynx and to use the specific pattern of expression to predict invasiveness. METHODS: This cross-sectional study looked at 87 cases of oral and oropharyngeal lesions obtained between December 2012 and November 2014 in the Department of Pathology, Jawaharlal Nehru Medical College, Aligarh Muslim University, India. Fifty-three biopsies from the buccal mucosa, tongue, and pharynx and 34 resected oral specimens were evaluated for premalignant and malignant lesions using hematoxylin and eosin and immunohistochemical stains. Immunohistochemical expression of epithelial marker E-cadherin and mesenchymal marker vimentin was evaluated wherever possible. Slides were examined for staining pattern (cytoplasmic or membrane), proportion, and intensity of staining of tumor cells. Patients follow-up and therapy related changes were also studied. RESULTS: There were 64 premalignant and 23 malignant cases in our study with 65 (74.7%) cases seen in males and 22 (25.3%) cases seen in females. The majority of malignant cases, (n = 15; 64.2%) were seen in the fifth and sixth decades of life while most of the premalignant lesions (n = 36; 56.4%) were seen in the fourth and fifth decade. Amongst the 64 premalignant oral lesions, leukoplakia comprised of 14 cases (21.9%), of which three cases had associated mild to moderate dysplasia. The majority of premalignant lesions showed strong E-cadherin expression and decreased expression of vimentin with negative and weak expression in both dysplasias and carcinoma in situ (p = 0.013). E-cadherin expression was significantly reduced in invasive carcinomas compared to dysplasias and carcinoma in situ and the difference in immunoreactivity was statistically significant (p < 0.050). Vimentin expression increased as the tumor progressed from dysplasias to carcinoma in situ to invasive carcinomas (p < 0.050). CONCLUSIONS: Invasiveness of cancer can be analyzed using E-cadherin and vimentin immunohistochemical stains, which can help in predicting tumor behavior. These biomolecules can also be used as biomarkers for further research on the microinvasion of oral cancers for early diagnosis.

Ninety-six hours ordeal of priapism induced by paroxetine--A case report and literature review.

Priapism is a rare but severe medical condition of sustained and painful erection of penis in the absence of any sexual stimulation, in which the penis does not return to a flaccid state. It is considered to be a medical emergency because without treatment it can lead to permanent damage and fibrosis of penis and in the long run to impotency. Albeit that there is no uniform consensus regarding the duration of sustained erection, an erection lasting more than 4 h is generally considered as an emergency which needs immediate medical attention and care. Priapism is commonly associated with iatrogenic, pharmacologic, underlying medical, or traumatic causes. In this report, we present the case of a 42-year-old African American man who developed priapism after three weeks of therapy with paroxetine which lasted for more than 96 h before coming to the attention of his health-care providers. This case is unique in that there are no reports in literature of an erection lasting for such a long duration following therapy with paroxetine. The objective of this report is to highlight the importance of recognizing the possibility of priapism with selective serotonin reuptake inhibitors in general and paroxetine in particular since this condition is not commonly seen in clinical practice to be associated with selective serotonin reuptake inhibitors and may go unrecognized. Also, potential biological mechanisms involved in the development of paroxetine-induced priapism are presented.

Lead toxicity: a review.

Lead toxicity is an important environmental disease and its effects on the human body are devastating. There is almost no function in the human body which is not affected by lead toxicity. Though in countries like US and Canada the use of lead has been controlled up to a certain extent, it is still used vehemently in the developing countries. This is primarily because lead bears unique physical and chemical properties that make it suitable for a large number of applications for which humans have exploited its benefits from historical times and thus it has become a common environmental pollutant. Lead is highly persistent in the environment and because of its continuous use its levels rise in almost every country, posing serious threats. This article reviews the works listed in the literature with recent updates regarding the toxicity of lead. Focus is also on toxic effects of lead on the renal, reproductive and nervous system. Finally the techniques available for treating lead toxicity are presented with some recent updates.

Omega-3 fatty acids and the treatment of depression: a review of scientific evidence.

Depression is a condition in which an individual feels lethargic, irritable, and guilty, has difficulty and trouble, no enjoyment in life, mood swings, sometimes suicidal ideation and thoughts, and loss of pleasure in activities. There are hundreds of millions of individuals suffering from major depression disorder all over the world. This leads to a considerable portion of the economy going for treatment as large amounts of money are spent on drugs every year. Pharmaceutical drugs are not very effective and they also have side effects that compound the problem. There are number of studies which shows that omega-3 fatty acids are proving to be very effective against the treatment of major depression disorder and other psychiatric disorders. However, the data regarding the efficacy of omega-3 fatty acids in depression treatment are conflicted. This article reviews the recent research showing the relation between omega-3 fatty acids and depression. The roles of the omega-3 fatty acids in the treatment of depression are being studied with increased pace in the last decade due to heightened prevalence of depression. It is emphasized that omega-3 fatty acids have no record of associated side effects, which deserves greater attention for further research.

Blood injury and injection phobia: the neglected one.

Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males (n = 1648) and females (n = 1613). Cronbach' alpha (α) of 0.972 of internal consistency was reported. The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it.

Effect of nickel and chromium exposure on buccal cells of electroplaters.

The electroplating industry commonly involves the use of nickel and chromium. An assessment of the genotoxic effects of these metals can be carried out by micronucleus (MN) test in buccal cells. Other nuclear anomalies (NA) observed in buccal cells viz., karyorrhexis, pyknosis and karyolysis are also the indicators of genotoxicity. The current study aims at determining the extent of genotoxic damage in relation to the duration of exposure to nickel and hexavalent chromium via micronuclei induction and other nuclear anomalies. The present investigation included 150 subjects of which 50 individuals with no history of nickel/chromium exposure (Group I) were taken as control, 50 electroplaters exposed to nickel and hexavalent chromium for duration of less than 10 years (Group II) and 50 electroplaters exposed for ≥10 years (Group III) were included. Slides of buccal cells were prepared and the frequency of MN (‰) and NA (‰) were calculated. ANOVA was applied to test significance. Results were considered significant at p < 0.05 and p < 0.001. Group III showed the highest MN frequency (1.08 ± 0.54‰, p < 0.05), karyorrhexis (20.75 ± 6.29, p < 0.05), karyolysis (3.50 ± 1.91, p < 0.001), binucleate (4.75 ± 2.75, p < 0.05) and enucleated cells (5.75 ± 1.70, p < 0.05). Significant increase in frequencies between Group II and III was found as duration of exposure increased. Plasma nickel and chromium levels were also determined which showed a positive correlation with frequency MN and other nuclear abnormalities (p < 0.01).

Detection and relevance of germline genetic polymorphisms in glutathione S-transferases (GSTs) in breast cancer patients from northern Indian population.

INTRODUCTION: Glutathione S-transferases (GSTs) are polymorphic superfamily of detoxification enzymes that detoxify therapeutic drugs and various carcinogens. We undertook a case-control study in northern Indian population based sample consisting of 413 patients and 410 controls to evaluate association of null genotype in GSTM1 and GSTT1 along with polymorphism in GSTP1 (A-->G) with breast cancer risk. METHODS: Genotyping analyses were performed by PCR-based methods, and odds ratios (ORs) were calculated by unconditional logistic regression analysis adjusting for various confounding factors. RESULTS: In this case-control study, we observed a positive correlation between family history of breast cancer and risk of breast cancer (OR = 2.06; 95% CI = 1.47-2.92). We found a significantly increased breast cancer risk associated with GSTM1 null genotype (OR = 2.28; 95% CI = 1.65-2.97) and homozygote mutants in GSTP1 (OR = 2.59; 95% CI = 1.67-4.39). However, we found no association between GSTT1 null genotype with overall breast cancer risk (OR = 1.04; 95% CI = 0.76-1.59). The three-way combination of GSTP1 105AA/AG and null genotypes for both GSTM1 and GSTT1 resulted in fourfold increase in breast cancer risk (OR = 4.02; 95% CI = 1.99-8.51). CONCLUSION: The findings of this study are in line with previously published reports that show an overall association with GSTM1 and GSTP1 polymorphisms with breast cancer risk. Our results suggest that the variants in low penetrance genes such as GSTM1, GSTT1 and GSTP1 are associated with an increased breast cancer risk thereby suggesting their contribution in the etiology of breast cancer.

Invivo antioxidant status: a putative target of antidepressant action.

Oxidative stress is a critical route of damage in various psychological stress-induced disorders, such as depression. Antidepressants are widely prescribed to treat these conditions; however, few animal studies have investigated the effect of these drugs on endogenous antioxidant status in the brain. The present study employed a 21-day chronic regimen of random exposure to restraint stress to induce oxidative stress in brain, and behavioural aberrations, in rodents. The forced swimming (FST) and sucrose preference tests were used to identify depression-like phenotypes, and reversal in these indices indicated the effectiveness of treatment with fluoxetine (FLU; 20 mg/kg/day, p.o.; selective serotonin reuptake inhibitor), imipramine (IMI; 10 mg/kg/day, p.o.; tricyclic antidepressant) and venlafaxine (VEN; 10 mg/kg/day, p.o.; dual serotonin/norepinephrine reuptake inhibitor) following restraint stress. The antioxidant status was investigated in the brain of these animals. The results evidenced a significant recovery in the activities of superoxide dismutase (SOD), catalase (CAT), glutathione S-transferase (GST), glutathione reductase (GR) and glutathione (GSH) levels by antidepressant treatments following a restraint stress-induced decline of these parameters. The severely accumulated lipid peroxidation product malondialdehyde (MDA) and protein carbonyl contents in stressed animals were significantly normalized by antidepressant treatments. The altered oxidative status is implicated in various aspects of cellular function affecting the brain. Thus, it is possible that augmentation of in vivo antioxidant defenses could serve as a convergence point for multiple classes of antidepressants as an important mechanism underlying the neuroprotective pharmacological effects of these drugs observed clinically in the treatment of various stress disorders. Consequently, pharmacological modulation of stress-induced oxidative damage as a possible stress-management approach should be an important avenue of further research.