Prognostic significance of hs-CRP in acute ischemic stroke patients

Background: Stroke, a serious neurological disease is a major cause of death and disability throughout world. The pathophysiology of stroke involves inflammatory pathways, oxidative damage, apoptosis, angiogenesis and neuroprotection. High sensitivity C - reactive protein (hs-CRP) is associated with atherosclerosis and predict incident stroke in many patients. Objective of present study was to find out change in pattern of hs-CRP in acute ischemic stroke (AIS) patients during 3-months follow up and its prognostic significance.Methods: Single centre prospective cross-sectional time bound study. 256 were screened and 130 meet the inclusion and exclusion criteria, of which 100 gave informed consent and 80 patients completed the study at 3 months. Demographic, clinical parameters including NIHSS scoring, biochemical analysis was collected at enrolment, discharge and at end of the study.Results: hs-CRP levels in AIS increased significantly (within 24 hours of stroke) and continued to increase further at discharge, while decreased significantly during 3 months follow up. >7mg/dl hs-CRP at admission had 3.5 fold higher risk of mortality. Age >60 years, metabolic syndrome, hyperlipidemic, SBP >160mmHg and hs-CRP > 7 mg/dL increases relative risk in AIS stroke patients by 1.42, 1.09, 1.11, 1.577 and 3.23 fold respectively.Conclusions: hs-CRP increased significantly in AIS patients during 1st weeks of stroke with subsequent gradual decrease by the end of 3 months, the severity scoring system could determine prognosis on admission to ICU while hs-CRP is the main factor determining short as well as long term prognosis. We recommend serial measurements of hs-CRP for prognostication in AIS subjects.

Violation of Human Rights of Leprosy Afflicted Persons: Some Real Life Experiences

In the present study an attempt has been made to understand the observance of marginalization and social exclusion of leprosy patients in their family and community and their violation of human rights. A total of forty (40) leprosy Afflicted Persons (LAPs), 20 without deformities and 20 having deformities were selected through stratified random sampling method from 'The Leprosy Mission Hospital (TLM)' of Allahabad district of Uttar Pradesh (India). Narratives of lived experiences of LAPs, supplement with observations, were used for data collection to observe the interaction patterns of LAPs with their family, neighbors and community members. The content analysis of data indicates that some of the LAPs experienced isolation and discrimination in their family, community and economic life. Some of the medical personnel also showed their hesitance in providing health services to them. It is also found that socio-economic problems became more in case of LAPs with visible deformities in comparison to LAPs who did not have deformities. Traditional cultural beliefs of the disease like the 'sin of previous birth', 'punishment of God', and 'fear of infection by germs', appear to be contributing to social, cultural, economic isolation of these patients. On the contrary lack of awareness about the ailment and also modern medical belief system like disease is not infectious and curable are may be helping in promoting their integration into their family and community, however, these aspects need to be studied in depth in current scenario. As present study is just based on some examples from a select group, it can not be considered as representative of all LAPs across the country which, however, should not be ignored at person level specially from the perspective of human rights. Health education programmes should be better implemented to prevent the physical disabilities, to reduce the traditional cultural beliefs and values associated with leprosy.

Determinants of Neonatal Mortality in Rural Haryana: A Retrospective Population Based Study.

Objective: To identify the determinants of neonatal mortality. Study design: Nested case-control study. Study setting: 28 villages under the intensive field practice area of Comprehensive Rural Health Services Project, Ballabgarh, Haryana serving a population of 87,016, as on 31st December 2009. The study period was from 2005 to 2009. Methods: The data were obtained from Health Management Information System and analyzed using multivariate logistic regression analysis. A hierarchical approach was used to analyze the factors associated with neonatal deaths, using community level factors, socio-economic status and biological determinants. The population attributable fractions were estimated for significant variables. Results: The total live births during the study period were 10392 and neonatal deaths were 248. The infant and neonatal mortality rates during the study period were 45.6 and 23.8 per 1000 live births, respectively. Socio-economic determinants (Low educational status of parents [OR 2.1, 95% CI; 1.4, 3.3]; father’s occupation [OR 1.8, 95% CI; 1.0, 3.0]; Rajput caste [OR 2.0, 95% CI; 1.2, 3.4] appeared to explain a major fraction (45.7%) of neonatal deaths. Community level factors (villages with no health facility [OR 1.5, 95% CI; 1.0, 2.1]; villages with population >6000 [OR 1.7, 95% CI; 1.2, 2.5]) were associated with 27.3% of all neonatal deaths. Proximate determinants (early childbearing age of mother (<20 years) [OR 2.0, 95% CI; 1.2, 3.2]) were least important. All the three level of variables seemed to act independently with little mediation among them. Conclusion: Neonatal mortality is affected by socioeconomic, community level and proximate biological determinants.

UreC PCR based diagnosis of Helicobacter pylori infection and detection of cag A gene in gastric biopsies.

Polymerase chain reaction assay using ureC gene specific primers for the detection of Helicobacter pylori in gastric biopsy specimens from 116 dyspeptic patients was compared with other routine invasive diagnostic methods (culture, rapid urease test [RUT] and histology). In parallel, gastric biospy specimens from 54 patients and their corresponding Helicobacter pylori isolates were subjected to PCR with cagA targeting primers using standard protocols. Helicobacter pylori were detected in 53%, 43%, 48% and 50% of patients by PCR, RUT, culture and histological examination respectively. Based on histology and culture positive and at least three test positive result, 44 (37%), 46 (39%) and 26 (22%), and 56 (48%), 52 (44%) and 8 (6%) patients were classified as Helicobacter pylori positive, negative and indeterminate respectively. The sensitivity and specificity of PCR assay was the highest-95% and 100% when compared with both culture and histology positive, and at least any three positive results respectively. The result of cagA positivity in 54 gastric biopsy specimens and their corresponding Helicobacter pylori isolates were identical; 18 of 20 (90%) duodenal ulcer patients and 23 of 28 (82%) patients with chronic gastritis and 2 (40%) of 5 patients with portal hypertension and one gastric biopsy specimens from gastric cancer patients were found to be cagA positive. PCR-based method to detect Helicobacter pylori and the virulence gene cag A directly from gastric biopsy specimens appears to be promising and can curtail the lengthy process of culture-based approaches. The procedure proved to be rapid and reliable and could be utilized for diagnostic purposes.

Lindane mediated induction of cytochrome P-450 mRNA in rat liver: studies with a nonradioactive cDNA probe.

Effect of lindane on the induction of cytochrome P-450 mRNA in rat liver was studied using a biotinylated cDNA probe. Exposure to lindane resulted in an increase in the levels of P-450 mRNA. The observed increase in mRNA was maximal (5-6-fold) after 18 hr of lindane treatment and lesser (50%) than mediated by phenobarbital for the same duration.

Chronic ocular lesions in Bhopal gas tragedy.

A comprehensive eye checkup programme was carried out in 1140 cases of affected community to evaluate the exposure response and exposure effect with Methyl Isocynate on human eyes. The final evaluation of these cases was made with standard control group of same socioeconomic status in a non-gas affected slum area of Bhopal. The main chronic lesions noticed were chronic conjunctivitis, refractive changes, deficiency of tear secretion and persistent corneal opacities of various forms.

Effect of leprosy sera and foetal calf serum (FCS) on the T cell number of peripheral blood of leprosy patients.

Study was conducted in 24 cases of various types of leprosy and 10 healthy controls to find out the effect of various sera on the T cell count of peripheral blood lymphocytes by sheep erythrocyte rosetting method. The percentage of T lymphocytes in lepromatous and tuberculoid cases were significantly lower compared to that in normal healthy controls. All sera except FCS had a stimulatory effect on the number of T cells. The cells incubated for 24 hours in FCS did not show any stimulatory effect on the number of T cells, however, these FCS incubated cells showed a significant elevation in the number of T cells when further incubated in sera either from leprosy cases or from healthy subjects.