Correlation of maternal age and combined assessments on risk of chromosomal anomaly during prenatal screening

Background: Prenatal detection of genetic abnormalities is one of the biggest challenges of current fetal medicine. Prenatal screening for chromosomal abnormalities can be done using biochemical tests. The screening is a risk estimation test and not a diagnostic test.Methods: Statistical data treatment had been performed on a sample of 362 pregnant women for prenatal screening. This was a retrospective data analysis study undertaken at the National Reference Laboratory, Redcliffe Labs.Results: Nine (2.48%) women out of 362 were screen positive for chromosomopathy. The point biserial correlation between variables (Free ?-hCG - Free Beta Human Chorionic Gonadotrophin, PAPP-A- pregnancy associated plasma protein-A and NT-(nuchal translucency) amongst patients with positive and negative screen test was statistically significant. There was a positive correlation between positive screen for chromosomopathy and hCG, MoM, NT MoM whereas a negative correlation between them and PAPP-A. This study indicates that higher values of hCG and lower values of PAPP-A MoM as seen in the positive screen patients is associated with a significant risk of chromosomopathy. A positive correlation between age and screen positive cases was seen. The McNemar’s test indicated a significant reduction in screen positive cases when biomarkers were added to screen for Trisomy 21 in women aged >35 years (n=86). 81 women eventually screened negative.Conclusions: The analyses stresses on the importance of using state-of-the-art, prenatal noninvasive screening software to help provide a predictive outcome, individualized for that pregnant woman.

Detection of foot-and-mouth disease virus type O in recovered as well as healthy cattle to study carrier status in Assam

Foot and mouth disease (FMD), one of the most contagious diseases of animals, affects different host species including wild animals. Asymptomatic FMD recovered animals may remain as carrier, which may be threat to other healthy animals. Hence, it is necessary to monitor the carrier status of the FMD recovered animals to effectively prevent further spread of the disease. Out of all the seven serotypes of FMD, O serotype is most commonly found in livestock. Therefore, in the present study, we chose to detect serotype ‘O’ in oropharyngeal fluid (OP) and to quantify cytokines, viz. IL-1?, IL-1? and IL-2. A total of 30 OP fluids and 30 blood samples were collected from 10 animals (1 in-contact healthy animal) for 3 months post infection. FMD O serotype could be detected in all the animals (100%). The RQ values were found to be 0.014 to 63.118 and 0.162 to 46.889 for IL-1? and IL-1? genes respectively, while insignificant RQ values were obtained for IL-2. In the second and third months, two animals showed down regulation for IL-1? gene, while IL-1? and IL-2 genes were down regulated in 7 animals and in all 10 animals, respectively for all the three months.

The prevalence of persistent metopic sutures comparing the Nepalese bone collection with Korean bone collection / Prevalencia de suturas metópicas persistentes que comparan una colección de huesos nepaleses con una colección de huesos coreanos

SUMMARY: Metopic suture can be visualized from the nasion to the bregma along the arch of the frontal bone in mid-sagittal plane. Persistent metopic suture normally closing between 1st and 2nd year of life has also been related with ethnicity. The present study reports the presence of complete and incomplete metopic sutures in Nepalese and Korean population skulls which helps to shed light on its incidence rate. Out of 121 adult skulls in Nepalese population, metopic suture was found to be present in 33 skulls. Incomplete metopic sutures showed variations of morphology, like linear (6.61 %), V-shaped (8.26 %) and double incomplete (10.74 %) and two cases with complete metopic suture, which showed variation in interdigitation between its anterior and posterior ends. Korean population showed metopic suture to be present in 8 skulls out of 104 with metopism in 3 skulls. Incomplete metopic sutures like double incomplete (1.92 %) and linear (2.88 %) were also noted. Alterations to local strains could be the contributing factor for such variation and complexity of interdigitation, which occur during the growth of the braincase. The knowledge of the metopic suture and its variations according to ethnicity is important and should be considered to prevent wrong diagnosis. The presence of different types of metopic sutures as reported by the present study provides informative value on the presence and variation of such sutures in population depending on ethnicity and ought to be helpful in diagnostic sequences in emergency setting.

RESUMEN: La sutura metópica se puede visualizar desde nasión hasta el bregma a lo largo del arco del hueso frontal en el plano mediano sagital. La sutura metópica persistente que normalmente se cierra entre el primer y segundo año de vida, también se ha relacionado con el origen étnico. El presente estudio informa la presencia de suturas metópicas completas e incompletas en los cráneos de la población nepalesa y coreana, lo que además de entregar información sobre su tasa de incidencia. De 121 cráneos adultos en la población nepalesa, en 33 de ellos se encontró la sutura metópica. Las suturas metópicas incompletas mostraron variaciones de la morfología, como lineal (6,61 %), en forma de V (8,26 %) y doble incompleta (10,74 %), además de dos casos con sutura metópica completa, que mostraron variación en la interdigitación entre sus extremos anterior y posterior. De los 104 cráneos de la población coreana en 8 se presentó la sutura metópica y en 3 metopismo. También se observaron suturas metópicas incompletas como doble incompleta (1,92 %) y lineal (2,88 %). Las alteraciones en las etnias locales podrían ser el factor contribuyente para tal variación y complejidad de la interdigitación, que ocurre durante el crecimiento de la cráneo. El conocimiento de la sutura metópica y sus variaciones según el origen étnico es importante y debe considerarse para prevenir un diagnóstico incorrecto. La presencia de diferentes tipos de suturas metópicas según lo informado en el estudio, proporciona un valor informativo sobre la presencia y la variación de tales suturas en la población, dependiendo de la etnia, y debería ser útil en las secuencias de diagnóstico en situaciones de emergencia.

25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch

Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.

Evaluation of tongue/mandible volume ratio in children with obstructive sleep apnea

ABSTRACT Objective: The present study was an attempt to investigate tongue/mandible volume ratio in children, using volumetric magnetic resonance imaging (MRI) for early screening and to aid in treatment planning. Methods: Volumetric evaluation of tongue volume/mandible volume ratio (TV/MV ratio) in children with obstructive sleep apnea (OSA) using MRI was carried out retrospectively on available DICOM MR images of children in the age group of 10-14 years. MRI image records of patients diagnosed with OSA were obtained from interventional radiology department records, at Sharad Pawar Dental College and Hospital (Datta Meghe Institute of Medical Sciences, Nagpur/India). The age, gender, height and weight of the subjects were retrieved from patient database and registered. For the control group, available MRI images of healthy subjects without OSA were retrieved. Body mass index (BMI) was also calculated using the height and the weight present in the records. Measurements from MR images were made using DICOM image processing software. Soft tissue and bony structure segmentation was performed by manual tracing. The tongue volume and mandible volume were directly computed using the software. The tongue volume/mandible volume ratio (TV/MV) was generated using the above values and expressed as a percentage for both groups. Results: The difference between OSA group and control group with respect to TV/MV ratio was found to be highly significant at 0.05 level of significance. There was no significant correlation between BMI and TV/MV ratio in OSA group (p= 0.451) as well as in control group (p= 0.094). Conclusion: TV/MV ratio may be an appropriate variable to evaluate the risk of OSA, representing the balance between skeletal morphology and soft tissue morphology in craniofacial complex.

Resumo Objetivo: o presente estudo foi uma tentativa de investigar a relação volumétrica língua/mandíbula em crianças, usando imagens de ressonância magnética (IRM), para triagem inicial e como meio auxiliar no plano de tratamento. Métodos: a avaliação da relação volume da língua/volume da mandíbula (relação VL/VM) em crianças com apneia obstrutiva do sono (AOS) utilizando IRM foi realizada retrospectivamente em imagens de RM em formato DICOM disponíveis de crianças na faixa etária de 10 a 14 anos. As documentações com IRM de pacientes com diagnóstico de AOS foram obtidas nos arquivos do departamento de radiologia da Sharad Pawar Dental College and Hospital (Datta Meghe Institute of Medical Sciences, Nagpur/Índia). A idade, o sexo, altura e peso dos indivíduos foram obtidos a partir dos registros dos pacientes. Para o grupo controle, foram selecionadas imagens de RM disponíveis de indivíduos saudáveis sem AOS. O índice de massa corporal (IMC) também foi calculado a partir da altura e do peso constantes nos registros. As medições nas imagens de RM foram feitas usando um software de processamento de imagens DICOM. A segmentação entre tecidos moles e estrutura óssea foi realizada por delineamento manual. O volume da língua e o volume da mandíbula foram calculados diretamente com o software. A relação volume da língua/volume da mandíbula (VL/VM) foi calculada usando os valores acima e expressa em porcentagens, para ambos os grupos. Resultados: a diferença entre o grupo com AOS e o grupo controle, quanto à relação VL/VM, foi altamente significativa ao nível de significância de 0,05. Não houve, porém, correlação significativa entre o IMC e a relação VL/VM, nem no grupo AOS (p= 0,451), nem no grupo controle (p= 0,094). Conclusão: a relação VL/VM pode ser uma variável apropriada para se avaliar o risco de AOS, representando o equilíbrio entre a morfologia esquelética e a morfologia dos tecidos moles no complexo craniofacial.

To study the oxidative stress induced by lindane in epileptic rats brains and their modulation by neurosteroids.

Background: Lindane is pesticide has been shown to affect the nervous system adversely. Previous work has shown that lindane is proconvulsant and neurosteroids (NS) has been shown to be neuroprotective against lindane-induced convulsions. As the mechanisms of lindane in epileptogenesis is not completely understood. The present study was designed to investigate the oxidative stress parameters of lindane toxicity in epileptogenesis and their modulation by NS like allopregnanolone (AP), and 4ʹ-chlorodiazepam (4ʹ-CD) in pentylenetetrazole (PTZ) kindling methods. Methods: Kindling was induced by injecting PTZ (30 mg/kg; s.c.) on alternate days i.e., 3 times in a week. Lindane was also administered (15 mg/kg p.o) on alternate days for 6 weeks. AP (2.5 mg/kg, intaperitoneal [i.p.]) and 4ʹ-CD (0.5 mg/kg, i.p.) single dose was given in kindled rats before lindane. Results: Following per oral administration of lindane for 6 weeks produced signifi cant oxidative stress in epileptic brain. There was an increase in brain malondialdehyde (MDA) level and decrease in reduced glutathione (GSH) levels. AP (2.5 mg/kg, i.p.) and 4ʹ-CD (0.5 mg/kg, i.p.) single dose administration were not able to reverse the effect of chronic exposure of lindane. Conclusion: The result of the present study provides evidence that oxidative stress produced in the brain after chronic exposure of lindane may be the mechanism of epileptogenesis. Though NS have been shown to be neuroprotective, but they failed to reverse chronic oxidative stress produced by lindane. Further studies are required to demonstrate interaction of NS with lindane in oxidative stress.

Peripheral interaction of opioid and nmda receptors in inflammatory pain in rats.

Both opioid and NMDA receptors have been known to be involved in pain processing in the central nervous system as well as in the periphery. The effect of drugs acting on opioid and NMDA receptors, and their role in modulation of pain response was observed in the formalin model of inflammatory pain in rats. We have demonstrated that morphine has significant antinociceptive effect in the formalin model and this effect was enhanced when given in combination with ketamine. We have also reported modulation of pain response when naloxone or NMDA were co-administered with morphine or ketamine in various combinations. A noteworthy observation in our study is that low dose naloxone when co-administered with ketamine and morphine, or with ketamine and NMDA, caused decrease in the pain response. These observations may suggest that low dose naloxone can cause modulation of opioid and NMDA receptors resulting in antinociceptive effect. Our study thus introduces a new concept of more than two drugs acting on opioid and NMDA receptors to modulate pain response.

Modulation of Oxidative Stress, Serum Lipids and Renal Dysfunction by Benazepril in Diabetes Mellitus.

Present study assessed the effect of benazepril on oxidative stress, serum lipids and renal dysfunction in alloxan induced diabetic rabbits. Benazepril reversed the increase in level of malondialdehyde and decrease in level of glutathione and superoxide dismutase activity caused by induction of diabetes. It also had a beneficial effect on diabetic dyslipidemia as manifested by elevation in serum HDL cholesterol. However, it had no effect on serum LDL, total cholesterol or triglycerides. Benazepril also attenuated the renal dysfunction induced by diabetes. It resulted in significant reduction in blood urea, serum creatinine and urine albumin excretion as compared to diabetic control rabbits. Further, kidney weight was significantly less in benazepril treated rabbits as compared to diabetic rabbits. To conclude, benazepril was found to be effective in preventing the oxidative stress and renal dysfunction as well as beneficial on serum lipids in experimentally-induced diabetes mellitus.

Comparison of continuous thoracic epidural and paravertebral block for postoperative analgesia after robotic-assisted coronary artery bypass surgery.

Minimally invasive surgery with robotic assistance should elicit minimal pain. Regional analgesic techniques have shown excellent analgesia after thoracotomy. Thus the aim of this study was to compare thoracic epidural analgesia (TEA) technique with paravertebral block (PVB) technique in these patients with regard to quality of analgesia, complications, and haemodynamic and respiratory parameters. This was a prospective randomised study involving 36 patients undergoing elective robotic-assisted coronary artery bypass grafting (CABG). TEA or PVB were administered in these patients. The results revealed no significant differences with regard to demographics, haemodynamics, and arterial blood gases. Pulmonary functions were better maintained in PVB group postoperatively; however, this was statistically insignificant. The quality of analgesia was also comparable in both the groups. We conclude that PVB is a safe and effective technique for postoperative analgesia after robotic-assisted CABG and is comparable to TEA with regard to quality of analgesia.

Early diagnosis of leptospirosis by conventional methods: one-year prospective study.

Several techniques are available for the diagnosis of leptospirosis and microscopic agglutination test is considered as gold standard, but these require sophisticated techniques and instruments. This study was conducted to know the sensitivity and specificity of dark field microscopy (DFM) as compared to IgM enzyme-linked immunosorbent assay (ELISA) in correlation with clinical diagnosis. It is a prospective study of 297 samples received from clinically suspected cases of leptospirosis for DFM and IgM ELISA. We tried to evaluate the easily available technique, DFM. We got promising results with DFM. Specificity and sensitivity were observed to be 61% and 60%, respectively, alone and 95.8% efficacy when combined with IgM ELISA. Thus, DFM should be tried for where other diagnostic tools are not easily available. It is an easy and rapid technique, which can help in the early diagnosis and management of patients.

Attenuation of the effect of lindane on immune responses and oxidative stress by Ocimum sanctum seed oil (OSSO) in rats.

Present study was done to evaluate the effect of Ocimum sanctum seed oil (OSSO) on the immunotoxicity and oxidative activity of lindane in rats. Rats were divided into four groups (n = 8) and were treated with lindane (10 mg/kg, po) and/or OSSO (1 mg/kg, po) during the study period. Humoral immunity was assessed by measuring haemagglutination titre to sheep red blood cells (SRBC) and delayed type hypersensitivity (DTH) was assessed by measuring foot pad thickness. Lindane showed significant decrease in anti-SRBC antibody titre and also decreased percentage change in foot pad thickness in DTH response as compared to control group. OSSO per se produced significant increase in anti-SRBC antibody titre, but did not produce significant change in the foot pad thickness as compared to control group. However, it significantly antagonized the effect of lindane on the anti-SRBC antibody titre and foot pad thickness parameters. Lindane produced oxidative stress as indicated by increase in the levels of MDA and decrease in GSH levels. Treatment with OSSO per se showed antioxidant activity and also reversed the oxidative stress produced by lindane. The results suggest that OSSO can attenuate the immunotoxicity and oxidative stress produced by lindane.

Prevalence of infections in renal transplant recipients of north India.

Renal transplant is usually performed at the end stage of renal disease. Most of the transplant recipients become susceptible to infections due to chronic uremia, protein depletion, anemia and administration of immunosuppressive drugs. It is a retrospective study of 510 post renal transplant recipients. 378 (74%) renal transplant recipients suffered from the infections. Most common site of infection was urinary tract infection (53%). Out of 26% of wound infections, the deep wound infection (23%) was six times higher than superficial wound infection (3.5%). Chest infection and bacteraemia were noticed to be 18% and 8%, respectively. The common isolate was Escherichia coli (160) followed by Staphylococcus aureus (140), Enterococcus (86) and Pseudomonas (69).

Peri-operative Considerations in Total Endoscopic Atrial Septal Defect Repair with Robotic Assistance.

The development of minimally invasive techniques represents a significant improvement in the repair of atrial septal defect by total endoscopy. Robot-assisted repair obviates the need for a sternotomy or thoracotomy. This is the case report of a 45-year-old male, who underwent atrial septal defect repair through the total endoscopic technique. The peri-operative management and associated problems in the post-operative period have also been described.

Involvement of GABA-A receptor chloride channel complex in isolation stress-induced free choice ethanol consumption in rats.

The present study revealed the effect of diazepam, a benzodiazepine, and progesterone, a pregnane precursor of neurosteroids, which act via modulating GABA-A chloride channel complex on the isolation stress-induced free choice ethanol consumption in adult rats. Isolation stress for 24 hr over a period of 6 days produced a significant increase in ethanol consumption, which persisted during the 6-day recovery period. Pretreating the animals with diazepam (5 mg/kg, i.p.), or progesterone (5 mg/kg, i.p.), blocked the isolation stress-induced increase in ethanol consumption. Bicuculline (2 mg/kg, i.p.), a GABA-A receptor antagonist significantly attenuated the effect of both diazepam and progesterone on stress-induced modulation of ethanol consumption. Isolation stress also caused an increase in total fluid consumption, which was antagonised by both diazepam and progesterone. Like ethanol consumption, this effect of diazepam and progesterone on isolation stress-induced increase in total fluid consumption was attenuated by bicuculline. Neither diazepam nor progesterone produced an increase in ethanol consumption in non-stressed rats. However, unlike diazepam, progesterone administration to non-stressed rats caused a significant increase in total fluid consumption. Results of the present study thus show that GABAergic mechanisms may be playing an important role in isolation stress-induced increase in ethanol consumption.