Pattern of Hemoglobinopathy among the Young Tribes of West Bengal: A Completely Different Scenario from Rest of India

Hemoglobinopathy is a major concern among the tribal population which constitutes 8.6% of the total population, and West Bengal (WB) is the home to 5.3 million tribes. The present study was conducted on 52,880 tribal school students from all the districts of WB. Written informed consent and peripheral blood were collected for complete blood count and high‑performance liquid chromatography analysis. Beta trait was 5.3%, sickle trait was 2.35%, and hemoglobin (Hb) E (HbE) trait was 1.4% in this population. About 37.8% of beta trait belonged to the Santal tribe and 21.5% belonged to Oraon. HbS is mainly found in Alipurduar and Jalpaiguri districts at the prevalence of 3.69% and 5.96%, respectively. HbE trait is found at 6.06% in Alipurduar, of which 51% of cases are from Mech tribe only found in this district. Unlike central and Western parts of India, HbS trait in WB was significantly low among the tribes. A high prevalence of consanguinity among the tribes is considered responsible for the high rate of hemoglobinopathy.

An epidemiological study on sociodemographic and antenatal factors associated with low birth weight in a tertiary care hospital of Kolkata, West Bengal

Background: Birth weight is a critical determinant of child survival and growth and a valuable indicator of maternal health, nutrition, and quality of life. Antenatal care (ANC) provides an array of available medical, nutritional, and educational interventions intended to reduce the incidence of low birth weight (LBW). Objective: This study was done to find out the sociodemographic and antenatal factors associated with LBW among babies delivered in a tertiary care health facility in Kolkata. Materials and Methods: It was a cross-sectional institution based observational study conducted from November 2016 to October 2018 among 410 postnatal mothers in the postnatal ward of the Department of Obstetrics and Gynaecology, Medical College, Kolkata, West Bengal. Data were obtained by interview method along with record analysis (medical and hospital records). Dependent variable was LBW (<2.5 kg). Ethical clearance was obtained from Local Ethics Committee of All India Institute of Hygiene and Public Health Kolkata and Medical College, Kolkata. Results: Out of 410 babies, 112 (27.3%) were LBW. Out of 112 LBW babies, 59 (52.7%) were preterm (<37 weeks); 51(45.5%) were term (37–42 weeks), and 2 (1.8%) were post-term (>42 weeks). Multi-variable logistic regression showed LBW to be significantly associated with poor economic status (below middle class), mothers who belonged to nuclear family, delayed registration (≥12 weeks), anemia in pregnancy, pregnancy-induced hypertension, gestational diabetes mellitus, weight gain in kg less than normal (i.e., below 9 kg), and poor consumption of specific nutritional supplements. Conclusion: Poor economic status and inadequate ANC continue to remain the most important factors for LBW. A good quality ANC package will ensure prevention of LBW babies.

Trabeculectomy with subconjunctival collagen implant in Indian eyes: Long-term results

Purpose: To report long-term safety and efficacy of trabeculectomy with collagen implant in Indian population. Methods: All cases of trabeculectomy with Ologen® Collagen Matrix implant performed over a 7-year period from May 2008 through April 2015 at a tertiary referral institute were reviewed. A total of 30 eyes of 28 patients were included in the study with two patients undergoing bilateral trabeculectomy. Outcomes measured included intraocular pressure (IOP) control, number of antiglaucoma medications used, bleb morphology, and complications/reoperations. Results: Trabeculectomy resulted in reduction in IOP from 36.46 to 11.65 mm Hg in the immediate postoperative period (day 1), a 68% decrease to 15.18 mm Hg at 84 months (58% decrease). The mean IOP reduction decreased over time from 63% in the first year to 55% after 5 years of follow-up. Fourteen eyes attained a follow-up of 5 years and eight eyes a follow-up of ?7 years. No sight-threatening complication such as hypotony, bleb leak, and bleb-related endophthalmitis was observed in our series, and only intervention required was 5-fluorouracil needling in one case. Conclusion: Ologen-augmented trabeculectomy is effective in controlling IOP over a long-term follow up from minimal 3 to maximal 7 years. No untoward events jeopardizing bleb safety were noted at any time. This modality is a viable alternative for patients with contraindications to use of antimetabolites.

Post-transfusion hepatitis C virus infection among ?-thalassaemic individuals with associated clinical parameters

Background & objectives: Multiple transfusions in ?-thalassaemia patients undergoing regular transfusion regimen are at a risk of developing transfusion transmitted infections, including hepatitis C virus (HCV). The present study was conducted to investigate the association of HCV viraemia and genotype with clinical parameters in HCV seroreactive ?-thalassaemic individuals. Methods: A total of 172 HCV seroreactive ?-thalassaemic individuals aged between 2-35 yr with at least 25 units of blood transfusion were catagorized into four groups (2-12 yr, group 1; 13-19 yr, group 2; 20-29 yr, group 3; 30-35 yr, group 4). Aged matched control samples (n=87; ?-thalassaemics without HCV infection) were also included. HCV RNA was detected by nested reverse transcriptase polymerase chain reaction (RT-PCR) based on 5� UTR of HCV genome, viral load was determined by real-time RT-PCR. Nested RT-PCR amplified partial core region was used for DNA sequencing. Liver function parameters [serum total bilirubin, alanine aminotransferase (ALT) and aspartate aminotransferase (AST)] were also determined. Results: Of the 172 HCV seroreactive individuals, 59.30 per cent (n=102) were HCV RNA positive. HCV viral load ranged from 173 to 32.04�[5] IU/ml; 87.65 per cent were infected with HCV genotype 3. Liver enzymes, such as ALT, AST and serum total bilirubin were significantly elevated in all age groups compared to control groups. Serum ferritin levels were found to be high in all individuals, but 16.27 per cent of HCV-infected individuals with >10,000 IU/ml viral load also showed high ferritin levels (>1500 ?g/l) where the majority of them were infected with HCV genotype 3. Interpretation & conclusions: HCV genotype 3 was the major circulating genotype among ?-thalassaemia patients in this region. Our findings indicated an association between HCV replication and hepatic iron load and also highlighted the need for sensitive quantitative RT-PCR-based detection of HCV RNA in the high risk population

Intracranial epidermoid--a 10-year study.

Twenty-eight cases of intracranial epidermoids were operated over a period of 10 years at the Bangur Institute of Neurology, Kolkata; 17 of them were male and 11 were female with an age range of 11 to 55 (mean 28.21) years. Their locations include--cerebellopontine angle region (n = 15), fourth ventricle (n = 6), lateral ventricle (n = 3), corpus callosum (n = 2), pineal region (n = 1) and basal cistern near temporal lobe (n = l). Hearing loss and vertigo were commonest features of cerebellopontine angle epidermoids. Fourth ventricular tumours presented with gait disturbances and cerebellar signs. Symptomatology of other lesions were varied. CT scan was diagnostic in 23 cases. Sixteen patients had ventriculomegaly and 10 of them required ventriculoperitoneal shunt. Total removal was achieved in 6, near total in 14 and partial in 8 cases. Five patients died. Postoperative complications included chemical meningitis in 7, worsening of cerebellar functions in 3 and aggravation of cranial nerve deficits in 2 patients. All of them except one case of cranial nerve deficit resolved with time. Nineteen patients were followed up over a mean duration of 5 years and 10 months. Reoperation was required in one. Rest had satisfactory outcome.

A case of primary mucus secreting adenocarcinoma of the appendix.

Primary mucus secreting adenocarcinoma of the appendix is a rare finding, one in 2500 cases of intestinal malignancies. This is a report of a young man with vague abdominal symptoms for about two years followed by appendicitis. Interval appendectomy revealed a neoplasm of the appendix. Histopathology confirmed the diagnosis of mucus secreting adenocarcinoma and right hemicolectomy was done.

Modern concepts in the management of biliary stones (gallstones).

Biliary stones or gallstones are concretions formed anywhere in the biliary tree. Asymptomatic gall bladder stones do not need treatment except the conditions mentioned in this article. Symptomatic uncomplicated gall bladder stones may be treated by laparoscopic or open cholecystectomy or by non-surgical methods. Symptomatic complicated gall bladder stones need cholecystectomy or percutaneous cholecystolithotomy. Common bile duct stones once detected should always be removed and only in difficult cases drainage operations should be done. Treatment of some special conditions arising in gallstone disease has been discussed. Prevention of gallstones is in the experimental stage.

Novel putative protective antigens of Plasmodium falciparum.

In an attempt to identify putative host-protective antigens of the human malarial parasite P. falciparum, a differential immunoscreen of a cDNA expression library of the parasite was performed using malaria immune and patient sera. Eight expression clones were identified which showed no reactivity with acute patient sera but reacted extensively with malaria immune sera. Southern Blot analysis of five of these genes showed that these were coded by unique single genes, and sequence of the cDNA inserts showed that these were as yet unidentified genes of P. falciparum. The clone which was reactive to the largest number of immune sera, has been shown to be the ribosomal phosphoprotein, P0, of P. falciparum. The presence of multiple transcripts and a differential expression of the transcripts of P0 in different erythrocytic substages of the parasite was observed. An extensive characterisation using antibodies to the P0 protein has been performed. The results show that in addition to its role in the ribosomal assembly, the P0 protein is also localized on the parasite surface, and plays an important role in the red blood cell invasion. Most of the other differential cDNA clones were found to be rare transcripts, and the expression domains were not very immunogenic. PCR analysis of three of these genes demonstrated that these are conserved throughout the Plasmodium species. These protein domains, therefore, constitute potential protective target epitopes of the malarial parasite.

Aortoarteritis involving supra-aortic trunks: a profile of six cases.

Six patients (2 male, 4 female; age range 24 to 36 years) with aortoarteritis involving the supra-aortic trunks were investigated and surgically managed by bypass graft with either preclotted dacron or polytetrafluoroethylene (PTFE) in an urban institute. There has been no mortality and post-operative functional recovery has been satisfactory in all the cases.

Percutaneous retrogasserian radiofrequency thermal rhizotomy for trigeminal neuralgia.

Forty patients suffering from intractable unilateral trigeminal neuralgia involving more than one division of the trigeminal nerve were treated by percutaneous radiofrequency thermocoagulation of the trigeminal sensory root. The aim of the operation was to relieve the pain without producing dense sensory deficit in the face. This goal was achieved by making selective lesions in the sensory root with gradually increasing temperature 60 degrees C to 90 degrees C. Three to four consecutive lesions each for 60 seconds have been found to produce excellent pain relief in 77.7% with good and fair results in the rest. The recurrence rate has been found to be 15% during 2 years of follow-up. Considerable dysaesthesia was observed in 5% of cases. Corneal anaesthesia was found in 5% cases while one patient developed neuroparalytic keratitis. Transient trigeminal motor weakness was observed in 10% of patients.

Interaction of chlorpromazine with hemoglobin.

Binding of chlorpromazine (CPZ), a widely used antidepressant tranquilizer, with hemoglobin has been studied by equilibrium dialysis method. r/Cf versus r plot was typically concave downwards revealing the positive cooperative nature of binding. Binding parameters, namely the affinity constant (K) and the degree of cooperativity (nH) were determined from the Hill plot. Oxygen was found to be released gradually from hemoglobin with gradual addition of CPZ, the extent of oxygen release depending on the stoichiometric ratio of CPZ: hemoglobin (D/P).