Preponderance of Inferior Wall Myocardial Infarction in Smokers with no other Cardiovascular Risk Factors

Introduction: Smoking is an independent risk factor forischemic heart disease and acute myocardial infarction.Smoking raise both heart rate and blood pressure, thusincreasing myocardial oxygen demand, moreover it alsodecreases the dimension of coronary vessel and coronaryblood flow. Inferior wall Myocardial Infarction is consequenceof disease in usually Right coronary artery, whereas anteriorwall Myocardial Infarction is usually disease in left coronaryartery. The aim of the study is to evaluate whether smokinginfluence the incidence of inferior wall MI (Right coronaryartery). Study objective was to find out whether there was anassociation between smoking and inferior wall MyocardialInfarction and an early association of atherosclerosis andischemic heart disease with smoking.Material and methods: 126 patients of ST ElevationMyocardial Infarction admitted from the outdoor patientdepartment/ emergency department/ Cardiology OPD inMMIMSR, Mullana, Ambala, considered for study. Thosewho are willing to participate and fulfilling the inclusion andexclusion criteria.Result: In our study there was a high proportion of smokerin patient with inferior wall MI than other location of MI.Smokers were prone to get myocardial infarction at a youngerage as compared to others. Mortality was higher in anteriorwall MI as compared to Inferior wall MI. Anterior wall MIpresented with more complications i.e. cardiogenic shock andarrhythmias.Conclusion: Smoking enhance the risk of inferior wall MImore than other MI. Smoking thus appear to adversely affectthe Right coronary artery to greater extent than left coronaryarterial circulation by mechanism yet to be explored. Smokingleads to ischemic heart disease at early age.

Assessing Diagnostic Accuracy of Haemoglobin Colour Scale in Real-life Setting.

The study was undertaken to determine diagnostic accuracy of Haemoglobin Colour Scale (HCS) in hands of village-based community health workers (CHWs) in real-life community setting in India. Participants (501 women) were randomly selected from 8 villages belonging to a project area of SEWA-Rural, a voluntary organization located in India. After receiving a brief training, CHWs and a research assistant obtained haemoglobin readings using HCS and HemoCueTM (reference) respectively. Sensitivity, specificity, positive and negative predictive-values, and likelihood ratios were calculated. Bland-Altman plot was constructed. Mean haemoglobin value, using HCS and HemoCueTM were 11.02 g/dL (CI 10.9-11.2) and 11.07 g/dL (CI 10.9-11.2) respectively. Mean difference between haemoglobin readings was 0.95 g/dL. Sensitivity of HCS was 0.74 (CI 0.65-0.81) and 0.84 (CI 0.8-0.87) whereas specificity was 0.84 (CI:0.51-0.98) and 0.99 (CI:0.97- 0.99) using haemoglobin cutoff limits of 10 g/dL and 7 g/dL respectively. CHWs can accurately diagnose severe and moderately-severe anaemia by using HCS in real-life field condition after a brief training.

Practical issues in implementation of WMA's draft Declaration of Helsinki.

The working group of the World Medical Association (WMA) has published a revised draft of the Declaration of Helsinki for public consultation till June 15, 2013. There are many positive changes in the document with respect to compensation, education of investigators, informed consent in the case of stored samples, etc. The changes represent a step forward for ethics. However, there may be certain points of concern regarding the implementation of the Declaration.

Trisomy 8 in leukemia: A GCRI experience.

Trisomy of chromosome 8 is frequently reported in myeloid lineage disorders and also detected in lymphoid neoplasms as well as solid tumors suggesting its role in neoplastic progression in general. It is likely to be a disease-modulating secondary event with underlying cryptic aberrations as it has been frequently reported in addition to known abnormalities contributing to clinical heterogeneity and modifying prognosis. Here, we share our findings of trisomy 8 in leukemia patients referred for diagnostic and prognostic cytogenetic assessment. Total 60 cases of trisomy 8, as a sole anomaly or in addition to other chromosomal aberrations, were reported (January 2005–September 2008). Unstimulated bone marrow or blood samples were cultured, followed by GTG banding and karyotyping as per the ISCN 2005. Patients with +8 were chronic myeloid leukemia (CML) (36), acute myeloid leukemia (AML) (17), and acute lymphoblastic leukemia (ALL) (7). In 7 patients, trisomy 8 was the sole anomaly, whereas in 6 patients +8 was in addition to normal clone, in 47 patients, the +8 was in addition to t(9;22), t(15;17), and others, including 3 with tetrasomy 8. Only one patient showed constitutional +8. The present study will form the basis of further cumulative studies to correlate potential differential effects of various karyotypic anomalies on disease progression and survival following a therapeutic regime. To unravel the role of extra 8 chromosome, constitutional chromosomal analysis and uniparental disomy will be considered.

Diagnosis of acute humoral rejection using immunofluorescence in renal allograft biopsies- one step towards better understanding!

Immunofluorescence (IF) studies are important diagnostic tool in understanding pathogenesis involved in graft injury. Acute humoral rejection (AHR) associated with circulating donor-specific cytotoxic antibodies, is a poor prognosticator for graft survival. It can be diagnosed by staining for C4d antibody using indirect IF technique. C4d staining required to diagnose AHR was made mandatory for reporting renal allograft biopsies in 7th Banff conference. We present 2 years experience of IF studies using C4d polyclonal antibody on 546 renal allograft biopsies belonging to two groups of patients; 464 from group A (tolerance induction protocol) and 82 from group B (controls). We observed C4d focal positivity in 4 (0.9%) biopsies from group A and 4 (4.9%) from group B. We conclude that it is advisable to collect simultaneous core biopsy samples for IF studies and light microscopy to give better definition of allograft injury and thereby support in clinical management.

Utility of urinary biomarkers in oral cancer.

OBJECTIVE: Oral cancer is the leading malignancy in India, with tobacco playing a major role in the etiology. The aim of the present study was to quantify nitrate+nitrite (NO2+NO3) in tobacco products as well as to study tobacco exposure related biomarkers in controls, patients with oral precancers (OPC) and oral cancer patients. MATERIALS & METHODS: Healthy individuals (n=90) were grouped into without habit of tobacco (NHT, n=30) and healthy individuals with habit of tobacco (WHT, n=60). Oral cancer patients with a tobacco habit were classified into abstinence (n=62) and non-abstinence (n=64) groups according to status at the study time. Urinary nicotine and cotinine levels were analyzed by modified high-pressure liquid chromatography (HPLC) using a UV detector. Levels of NO2+NO3 in tobacco and urine, and urinary thioether levels were estimated by spectrophotometry. RESULTS: NO2+NO3 levels in different types of tobacco product ranged between 0.13 to 3.39 mg/g. The Odds Ratio (OR) analysis indicated positive associations of both smoking and chewing habits of tobacco with high risk of development of oral cancer. Urinary nicotine, cotinine and NO2+NO3 levels were significantly elevated in WHT, patients with OPC and oral cancer patients as compared with the NHT group. This was also the case for urinary thioether levels. Levels of urinary nicotine and cotinine were also higher in the non-abstinence group with oral cancers. CONCLUSION: The results confirmed that tobacco chewing and smoking habits are prominent risk factors for development of oral cancer in the western part of India (Gujarat). Urinary nicotine, cotinine, NO2+NO3 and thioether levels can be helpful for screening programs for oral cancer.

Cardiovascular risk factor prevalence among men in a large industry of northern India.

BACKGROUND: Industrial settings, with their intramural resources and healthcare infrastructure, are ideal for initiating preventive activities to increase the awareness and control of cardiovascular diseases (CVD). However, there are no reliable estimates of CVD and risk factor burden, nor of its awareness and treatment status in urban Indian industrial settings. We aimed to evaluate the prevalence of CVD and its risk factors, and to assess the status of awareness and control of CVD risk factors among a large industrial population of northern India. METHODS: We conducted a cross-sectional survey among all employees aged 20-59 years of a large industry near Delhi (n=2935), to evaluate their cardiovascular risk profile--by employing a structured questionnaire and clinical and biochemical estimations. The presence of coronary heart disease was ascertained by evidence of its treatment, Rose angina questionnaire and Minnesota coded electrocardiograms. RESULTS: The results for 2122 men, in whom complete information was available, are reported here. The mean age was 42 years and 90% of the men were below 50 years of age. The prevalence of major CVD risk factors (95% CI) was: hypertension 30% (28%-32%), diabetes 15% (14%-17%), high serum total cholesterol/HDL ratio (> or = 4.5) 62% (60%-64%) and current smoking 36% (34%-38%). Forty-seven per cent of the respondents had at least two of these risk factors. Another 44% (95% CI: 42%-46%) had pre-hypertension (INC VII criteria) and 37% (95% CI: 35%-39%) had evidence of either impaired fasting glucose or impaired glucose tolerance. Thirty-five per cent (95% CI: 33%-37%) of the individuals were overweight (BMI > or = 25 kg/m2) while 43% (95% CI: 40%-45%) had central obesity (waist circumference >90 cm). The metabolic syndrome was present in 28%-35% of the individuals depending on the diagnostic criteria used. The prevalence of several risk factors and the metabolic syndrome was high with increasing age, BMI and waist circumference. A third of those who had hypertension (31.5%) and diabetes (31%) were aware of their status. Among those aware, adequate control of blood pressure and blood glucose was present in only 38% of those with hypertension and 31% of those with diabetes, respectively. Coronary heart disease was present in 7.3% of the individuals while 0.3% had a history of stroke. CONCLUSION: This study demonstrates the high prevalence of CVD and its risk factors against a background of poor awareness and control among a comparatively young male population in a north Indian industrial setting.

Loss of sex chromosome in acute myeloid leukemia.

Loss of sex chromosomes has been reported in normal and malignant marrows and its frequency increases with age in both situations. It is not clear whether the sex chromosome loss is a critical mutational event for neoplastic transformation or a genetic change related to ageing. The present study was undertaken to analyze incidence of loss of sex chromosomes in leukemia patients. Karyotypic analysis in bone marrow cells was carried out in total 270 AML patients registered at G.C.& R.I. during January 2000 to October 2003. Out of 270, 22 patients had loss of sex chromosome in addition to other disease specific chromosomal abnormalities. Out of 22 patients, 50% (11 of 22) were of the pediatric age (up to 14 years), and only 10% (3 of 22) patients were above the age of 50 years, maximum age being 65 years. On follow-up, only in patients with pathological remission normal 46XX/XY karyotypes were seen. Whereas in patients with persistent leukemic activity, clones with loss of sex chromosome were observed. The results indicate that sex chromosome loss in these cases may be equivalent of a clonal cytogenetic process rather than related to ageing process.

An Increased Incidence Of C-Band Heteromorphism In Hereditary Breast Cancer Patients and Their Healthy Blood Relatives An Indian Experience.

Healthy blood relatives (HBR) of the hereditary breast cancer (HBC) patients are considered to be at higher risk to develop cancer. However, all of them do not suffer from same. This may indicate the possibility of association with genetic polymorphism among them. We have studied this genetic polymorphism in terms of C-band heteromorphism among 11 HBC patients, 36 HBR and results were compared with 22 control females. Significantly higher incidence (p < 0.001) of C-band heteromorphism has been observed among the HBC patients and their HBR as compared to the control females. At the same time, however, the difference in incidence of C-band heteromorphism among HBC patients and their HBR were not statistically significant. The findings indicate possibilities of (i) an association between C-band heteromorphism and hereditary breast cancer, and (ii) C-band heteromorphism may be one of the important factors conferring HBR at an elevated risk to develop the breast cancer.

Constitutive Heterochromatin Polymorphism In Pediatric Cancer Patients.

Incidence of constitutive C-band heteromorphism (CBH) is reported to be higher in patients with malignancy by some studies, while in others no difference is reported between control and malignant conditions. We have studied incidence of CBH in pediatric cancer patients in terms of > 25% size difference between the homologues of chromosome #1, #9 and #16 and compared it with (i) age-matched controls, (ii) controls with minimum 60 years of age and (iii) parents/siblings of pediatric cancer patients and overall prevalence of CBH was comparable between patients and three groups of control subjects. Statistically significant difference was observed between the total lengths of C-band of chromosome #1 for pediatric cancer patients and first degree relatives group (p < 0.01). 17 families of pediatric cancer patients were studied for the pattern of CBH. In three patients, CBH analysis, more number of cancer families and normal pedigrees will be more informative. The problem still remains unresolved and should be analyzed qualitatively using techniques of molecular cytogenetics.