Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411011EnglishN-0001November30HealthcareImmunohistochemistry
English0001Sachin B. IngleEnglishImmunohistochemistry has become an important adjunct in the evaluation of human neoplasms. The commercial availability of a broad range of reagents (including prediluted reagents in kit form) has made it possible for high-quality immunohistochemistry to be performed in most pathology laboratories. The most commonly employed immunohistochemical techniques are those in which enzymes, such as horseradish peroxidase or alkaline phosphatase, are used in conjunction with specific antibodies to provide color reactions at sites of antigen-antibody interactions. Variations of the avidin-biotin complex (ABC) technique are currently the most widely utilized in current practice. The ABC procedure generally requires three sequential steps: an unlabeled primary antibody, a biotin-labeled anti-immunoglobulin secondary antibody, and, finally, preformed avidin-biotin-peroxidase complexes. One variation of the ABC method employs streptavidin, which has greater sensitivity than avidin and exhibits less nonspecific binding. It should be noted that the sensitivity of any immunohistochemical procedure is, in large part, related to the reagents and detailed procedures employed. As a consequence, it is difficult to compare the results of immunohistochemical studies from different institutions that employ different reagents and methods.
Virtually any type of pathologic specimen may be suitable for immunohistochemical staining, including fresh frozen tissue, fixed tissue, and cytologic preparations. Unfortunately, however, not all antigens are equally well preserved after these various treatments, and the approach taken for immunohistochemical staining must depend on the antigen (s) of interest. For example, although a large number of cytoplasmic antigens are detectable in fixed, paraffin-embedded tissue, other antigens, such as many cell surface-associated antigens, are destroyed or masked by common fixatives and may be demonstrable only in fresh frozen tissue or in cytologic preparations. Antigen retrieval methods, such as pretreatment with proteolytic enzymes or heating (using a microwave oven, steamer, pressure cooker, or autoclave), may permit the identification of otherwise undemonstrable antigens in fixed, paraffin-embedded tissue sections. Finally, not all fixatives are equivalent with regard to antigen preservation. Although cross linking fixatives, such as formaldehyde, are often suitable, they are suboptimal for detecting certain antigens of diagnostic importance, such as those located on intermediate filaments, which are best demonstrated in fresh-frozen or alcohol-fixed tissue. Wishing the readers a happy reading.
Englishhttp://ijcrr.com/abstract.php?article_id=2493http://ijcrr.com/article_html.php?did=2493Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411011EnglishN2018June11HealthcareCultural Specific Syndromes in India - An Overview
English0206Anuja KapoorEnglish Rashi JunejaEnglish Dweep Chand SinghEnglishThe term culture-bound syndrome denotes locality-specific, recurrent patterns of variant behavior and disturbing experience that could conceivably be connected to a specific DSM-IV-TR[2] diagnostic category. A large number of these examples are indigenously thought to be “illness”, or at least afflictions, and most have local names. Culture-bound syndromes are generally limited to specific societies or culture areas and are localized, folk, diagnostic categories that frame coherent meanings for certain repetitive, patterned, and troubling sets of experiences and observations. Present overview paper has focused on various syndromes/disorders that are specific to India or Indian culture.
EnglishCulture bound syndrome, Disorders, IndiaCulture assumes to play a definitive part in shading the psychopathology of different psychiatric disorders and mental health problems. However, certain psychiatric disorders are restricted to particular cultures. These disorders are known as culture bound or culture specific syndrome. For a couple of decades, there has been an expanded interest for the culturally diverse investigation of psychiatric disorders. Culture-specific syndrome is a mixture of symptoms including psychiatric and somatic manifestations that are thought to be a recognizable ailment just inside a particular society or culture. There is no specific biochemical or structural alterations of body organs or capacities, and the same condition is not perceived in different societies.
The term Culture bound syndrome was first introduced in Diagnostic and Statistical Manual of Mental disorders fourth edition.[2] Despite the fact that no obvious diagnostic criteria have been conceived as of now, greater part of culture specific syndrome share the characteristics like categorized as a disease in that culture, widespread recognition in that culture, unknown in different societies, no equitably obvious biochemical or organ abnormality and treated by drug/conventional healers. The beginning and propagation of culture-bound disorders are considered to be connected with the moral, educational, social, mythological and psychodynamic foundation of a given populace group, and they from time to time expand past the limits of such specific culture.
In India, common culture bound syndromes are Possession Syndrome, Dhat Syndrome, Koro, Bhanmati, Gilhari syndrome, Compulsive spitting, Suchibai syndrome, culture-bound suicide (sati, santhra), Jhinjhinia, ascetic syndrome etc.The present paper has discussed about the Sociodemographic, clinical profile and nosological status of different culture bound disorders in the Indian subcontinent.
Possession Syndrome: Diagnosable under Dissociative disorders
Person is possessed usually by ‘soul/spirit’ of dead relative or a local deity.Changed tone, even gender changes at times if the possessing soul is of opposite sex. Usually seen in people from rural areas and most often this is found in females as they found to have more piled up emotions and lesser outlets to express themselves.[1,5] Treatment incorporates cautious investigation of hidden anxiety which encouraged the possession attack. Likewise, to diminish any secondary gains that the individual might get from this conduct. These individuals are looked upon as exceptional by their families and towns which fortify the secondary gains, included in ICD-10 [17] under Dissociative disorders.
Dhat Syndrome
Dhat disorder is a clinical condition in which night time discharges severe anxiety, uneasiness and hypochondriasis, frequently related with sexual ineptitude. Presentation of the disorder usually includes various psychological, somatic and sexual symptoms. Patient attributes it to the releasing of whitish discharge which he believed to be semen (Dhat), in his urine. Susruta Samhita (ancient Indian text book of surgery) has portrayed seven Dhatus (fine fluids) in the body.[15] Aggravations of Dhat may cause mental and physical problems. Semen is the most valuablefinal seventh product of the process. Charak Samhita depicts Dhat Disorder by the name 'Shukrameha'. Shukranu is the term used for sperms in Sanskrit. Semen is also known as with another name in Sanskrit which is ‘Veerya’ which means bravery. Forty drops of bone marrow are said to be equivalent to one drop of semen. This gave rise to the belief that loss of semen in any form will lead to physical weakness and ultimately sexual impotency. On the other hand, semen preservation will prompt vigour, wellbeing and long life span. Therefore, the faith in valuable and life-saving properties of semen is profoundly imbued in Indian culture. The conviction is additionally strengthened by conventional healers what's more, sustained by companions and seniors who had experienced this ‘disorder’.Whitish discharge is faulted by patient to be the in charge of the mental and physical issues which sufferer goes through. However, there is no target confirmation of such a release. Often patients report of bad smelling semen, body pains, loss of appetite, fatigue and weight reduction, loss of consideration, worrying excessively, low mood and panic attacks. Sexual grievances are that of premature discharge and erectile dysfunction. In majority of cases, there is absence of any physical diseases like diabetes, nearby genital abnormalities and sexually transmitted illnesses.[3] The disorder is seen mostly in individuals from lower strata that look for assistance from customary healers and it’s seen throughout the nation.Comorbid psychiatric conditions like depression, anxiety, somatoform disorder may be present. Treatment comprises of bursting myths by psychoeducation, consoling the patient, treating comorbid psychiatric condition (if any present), even symptomatic alleviation (of extreme tension that these patients endure) with the assistance of medicines in introductory phases of treatment is required to gain patient's trust.[1]
Koro
This disorder is mostly seen in northeastern states like Assam. This condition is related with an extraordinary dread of genitalia shrinkage and withdrawing into abdomen driving eventually to death and is seen in both the sexes. If in this triad of subjective symptomatology any of the components is missing, or the syndrome appears outside the endemic areas, it is referred to as "koro-like" or "atypical koro". Individual applies outside retractors to the genitalia in type of cinches, chains and so forth to maintain a strategic distance from it withdrawing back. It is depicted as a syndrome in ICD-10[17] and DSM-IV[2]. Yap portrayed Koro patients as dependent, immature and lacking confidence in their virility and being in steady sexual conflicts. In the event that reports of koro events that likewise address the issues of its premorbid personality, the traits extant surviving in the patients fit Yap's depiction.[18]
The treatment methodologies can be partitioned into four primary roads: (1) preventive measures as endorsed by the culturally embedded myths[7];(2) manipulatory techniques (pulling the penis outward, affixing of cinches and strings to the penis) performed by the patient himself, relatives or companions; (3) people mending proposals to battle the confusion, including unique weight control plans containing yang substances (e.g., bamboo, deer horn, red pepper stick, dark pepper powder, ginger) [8] and execution of ceremonies to pursue away the insidious soul (striking gongs, setting off fireworks); (4) the modern medical origination, which mulls over the likelihood of koro superimposed on a psychiatric issue, secondary to the organic illness, evoked by a psychological trigger, or any blend of these.
Bhanmati Sorcery
This is seen in South India. It is believed to be due to presence of psychiatric illness like somatization disorders, conversion disorders, dysthymia, anxiety disorder, schizophrenia etc. Nosological status is unclear.[5,11]
Gilhari syndrome
Gilhari syndrome is also known as the “squirrel or lizard syndrome” and is highly prevalent among the regions of west Rajasthan. As per the individuals suffering with this describe it as a little blood filled swelling on the body changing its position now and again as though squirrel or lizard is moving in the body from back and reaches the neck prompting obstacle of airways took after by death in the event that it isn't pulverized. The individual emphatically trusts that the condition is intense and lethal. Medicinal professionals explain that the Gilhari disorder is only the strong contraction or movements of the particular group of muscles that is caused by the serious tension and stress in a person[16]. It influences for the mostly young adults who are having the false social convictions of lizards and being under a greater amount of physical, biological and mental burdens. The physical examination uncovers no physical illness in the person. They simply address these symptoms as tactile hallucinations with delusions. The patients can be sorted as having somatoform issue related with maladaptive practices.The treatment of this disorder is essentially centered around reassuring the patient and giving supportive psychotherapy. Anti-anxiety drugs are considered to be valuable in diminishing the manifestations in couple of patients.
Culture-bound suicide (sati,jouhar,santhra)
Sati is an act of self-immolation by a dowager on her spouse's fire-bed. As indicated by Hindu mythology, Sati the aspect of Dakhsha was so overcome at the death of her husband that she immolated herself on his memorial service fire and consumed herself to ashes.From that point forwarded the name as‘Sati’which has come to be symptomatic of self-immolation by a widow. Seen for the most part in Upper Castes outstandingly Brahmins and Kshatriyas. It is prohibited in India since nineteenth century. Nevertheless, one case has been reported in Rajasthan after 1904. Another classification of culture bound suicide is Jauhar. It is a suicide conferred by ladies even before the passing of her husband when looked by prospect of shame from another man (normally an overcoming lord). Most striking case in the history is Rani Padmini of Chittor(Rajasthan) to evade the attacking armed force of Sultan from Delhi in fifteenth century.[10]
Next critical sort is Santhara/Sallekhana. In this people, deliberately surrender life by fasting unto demise over some undefined time frame for religious motivations to attain Moksha(salvation). It is mostly seen as a part of Jain Community who commends these occasions as religious celebrations. Individual at first takes fluids, later notwithstanding declining to take them. It is believed that the individual (performing the act) will get rid of anger, ego, attachment, greed, old age and terminal illnesses.[12]
Jhinjhinia
In vernacular "Jhin-Jhini" means tingling and numbness. As tingling and numbness are the presenting symptoms of the strange disease it was called "Jhin-Jhini". As an epidemic was first reported in the village Arkhali situated in West Bengal.[13] The disease struck an individual unexpectedly with sensation of tingling and numbness in the legs which spread upward all through the body. Inside a couple of moments, the patient is seized with the loathsomeness of looming demise and sobs for help before he ends up noticeably astounded and unmoving. Unless saved, he would crash on the ground. With the aid of local remedy offered by a "rescue squad" (made during the epidemic) improvised for the occasion, he would recover after l/2hr. to 2 hrs. "Jhin-Jhini" gives off an impression of being a functional mental disorder which harrows a man drastically and vanishes inside a couple of hours, leaving no detectable trace. The disorder spreads quickly inside a span of a couple of kilometers and its frequency drops to nil inside a couple of months. It has, without a doubt, every one of the qualities of a scourge psychogenic confusion like an epidemic psychogenic disorder like contagious hysteria or epidemic koro.
Ascetic syndrome
In the first place it was depicted by Neki. Disorder is seen in teenagers and youthful grown-ups. It is portrayed by social withdrawal, serious sexual restraint, routine with regards to religious austerities, and absence of worry with physical appearance and excess loss of weight. Not much literature is available.[14]
Suudu
It is a culture specific disorder of excruciating pain in urination and pelvic "heat" recognizable in south India, particularly in the Tamil culture.[5] It happens in both male and females. It is prominently ascribed to an increase in the "inner heat" of the body frequently because of dehydration.Individuals believe that it is frequently caused by high temperature amid summers, long travel, lack of healthy foods and fluids, lack of sleep and so on. The person presents with the objections of extreme abdomen torment, dark yellow urine, painful and burning micturition, headaches, fatigue, constipation and dry mouth.It is typically treated through:
1. Applying a couple of drops of sesame oil or castor oil in the navel and the pelvic area.
2. Having an oil massage took after by a warm water shower.
3.Intake of fenugreek seeds doused overnight in water.
Mass Hysteria
Short enduring scourges of Mass Hysteria where hundreds to thousands of individuals apparently was accepting and carrying on in a way in which commonly they won’t. In a report by Choudhary et al. of an atypical hysteria epidemic in a tribal village of the State of Tripura, India where four malesand eight females were affected within a span of ten days. The central feature of the episodic is a trance state of 5 to 15 minutes with restlessness, attempts at self-injury, running away, inappropriate behaviour, inability to identify family members, refusal of food and intermittent mimicking of animal sounds. The illness was self-limiting and the individual showed improvement in symptoms in the course of one to three days’ duration.[6]
Suchi-bai Syndrome
In Bengal customs influence individual conduct to a degree which verges on pathological level. A vernacular term 'suchi-bai' in Bengali dialect means a condition like obsessional neurosis.[4] Certain group of individuals, especially widows in the days of yore had multitudinous taboos forced on them. They were relied upon to take after the standards totally, for dread of social ostracisation. Many of them often became over-stringent about pollution rules, their conduct going past the points of confinement of custom and circumscribing on the ludicrous. The people group still perceives such individuals as abnormal and the condition is referred to in the vernacular dialect as ‘suchi-bai’, truly, immaculateness insanity. The people group endures individuals with ‘suchi-bai’. They are from time to time treated; regularly a ‘specialty’ in the family is found for an influenced grandmother or an aunt. Common symptoms of these patients include washing too often; not eating anywhere outside; changing of street clothes (own and sometime compulsorily for all family members); washing of money (including currency notes); bathing for four hours twice a day; hanging out street clothes outside on a tree and entering house naked; hopping while walking (to avoid touching anything dirty in the streets); remaining immersed in the holy river for best part of the day; sprinkling of cow dung water on all visitors etc.
Gas Syndrome
One of the common complaints that are being heard from individuals coming to medical set upsis ‘Gas’ or ‘vayu’ etc. Individuals come up with number of symptoms like abdominal discomfort, headache, chest pain, joint pains, somatic complaints, back pain to ‘Gas’. ‘Gas’ is reported to be the cause for the distress and the primary duty of the treating clinician is to relieve them of the gas. The problem of troubling Gas or vayu has been affecting Indian culture since a long time. We do see a good amount of patients visiting different specialists attributing all their problems to Gas. 'Gas Syndrome’ is proposed as a culture bound syndrome.[9] Ancient Indian text Charak Samhita has also talked about vayu. To deal with such a condition it becomes really important to understand the individual’s deep rooted beliefs and understanding of the illness. Otherwise, the gap between the clinician and patient can result in dissatisfaction. If the clinician keeps himself/herself distant from understanding patient’s traditional health beliefs, then the patient may not accept the treatment or become non-compliant.
Discussion
The famous cultural psychiatrist Yap[21] suggested that although cultural beliefs play a major role in coloring psychopathology in a number of illnesses but in certain illnesses, these may exert pathoplastic effects to an extent that it makes the illness to appear significantly different from the original one. Suggesting that the type of illness is still conspicuously universal involve the view that any new clinical condition must be a variety of something already perceived and depicted. As Yap[4] said, two problems that would come up then: First, how much do we know about the culture-bound syndromes for us to be able to fit them into standard classification; and second, whether such a standard and exhaustive classification in fact exists.
Another bunch of cultural psychiatrists[9] have also suggested that a culture-bound syndrome may have different manifestations which may fall into different sections of conventional classificatory systems such as the DSM IV or DSM 5 which argues against a simplistic reduction of culture-bound syndromes to a category of the conventional classificatory systems. Also, the nosological status of culture-bound syndromes has been debated.[17]
Conclusion
Each person’s experience with the mental health and illness is unique. It isthe bio-psycho-social processes that contribute to somatic distress or syndrome. We believe that there is a need of studying attribution patterns and explanatory models with respect to the cultures regarding the symptomology of culture bound syndromes. Therapeutic management needs to be developed and established with respect to the culture. By ensuring evidence-based treatment and therapy and developing culturally responsive services, these common yet complicated conditions can be studied more and can provide more adequate treatment options.
Englishhttp://ijcrr.com/abstract.php?article_id=2494http://ijcrr.com/article_html.php?did=2494
Akhtar S (1988). Four culture bound psychiatric syndromes in India. Int J Soc Psychiatry; 34:70-74.
American Psychiatric Association (1994/2000/2004). Diagnostic and statistical manual of mental disorders (4th ed., Text Revision). Washington, DC: Author.
Bhatia MS,and Malik SC (1991). Dhat syndrome – a useful diagnostic entity in Indian culture. Br J Psychiatry; 159:691-95.
Chakraborty, A., and Banerjee, G. (1977). RITUAL, A CULTURE SPECIFIC NEUROSIS, AND OBSESSIONAL STATES IN BENGALI CULTURE. Indian Journal of Psychiatry. 17(1975): 211-16.
Chhabra, V., Bhatia, M. S., and Gupta, R. (2008). Cultural Bound Syndromes in India. DELHI PSYCHIATRY JOURNAL, 11(1), 15-18.
Chowdhury, A., Nath, A., and Chakraborty, J. (1993). An Atypical Hysteria Epidemic in Tripura, India. Transcultural Psychiatric Research Review,30(2), 143-151. doi:10.1177/136346159303000202
Durst, R., and Rosca-Rebaudengo, P. (1991). The Disorder Named Koro. Behavioural Neurology,4(1), 1-13. doi:10.1155/1991/525393.
Edwards, J. W. (1984). Indigenous Koro, a genital retraction syndrome of insular Southeast Asia: a critical review.
Guarnaccia, P. J., and Rogler, L. H. (1999, September 1). Research on Culture-Bound Syndromes: New Directions.
Kakunje, A., Puthran, S., et al (2013). Short Report: ‘Gas Syndrome’ - A Culture Bound Syndrome. Online Journal of Health and Allied Sciences, 12(4), 1-2.
Kaman. R. (2014). Status of Women in India in the Rigvedic Age and Medieval Age. THE INTERNATIONAL JOURNAL OF HUMANITIES and SOCIAL STUDIES, 2(9), 31-32.
Kaur, D. R. (2017, April). WHERE CULTURE MEETSPSYCHIATRY. SCIENCE REPORTER, 27-30.
Mehta, D. R.,Sogani, K. C., Jain, K. and Bothra, S.Santh?r?/Sallekhan?.https://www.isjs.in/sites/isjs.in/files/docs/Santhara%20by%20Shri%20D.R.%20Mehta_0.pdf
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Neki JS (1972). The Ascetic syndrome. Mimeographed. New Delhi: All India Institute of Medical Sciences; 1-5.
Patil B, Nadkarni R, Dhalve HS (1996). Sexual misconceptions of semen. Indian J Behav.Sci; 6: 17-22.
Prakash S, Sharan P, Sood M. A study on phenomenology of Dhat syndrome in men in a general medical setting. Indian J Psychiatry 2016;58:129-41
Verma, K., Bhojak, M., Singhal, A., Jhirwal, O., and Khunteta, A. (2001). “GILAHARI (LIZARD) SYNDROME” IS IT A NEW CULTURE BOUND SYNDROME? - A CASE REPORT.
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Yap, PM (1965). The Culture bound reactive syndromes in: Caudill W, Lin T (Eds). Mental Health Research in Asia and the Pacific. Honolulu: East West Centre Press; 72-75.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411011EnglishN2018June11HealthcarePrevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study
English0710Deep Jitendra MeisheriEnglish Ashwin DevasyaEnglish Giri DKEnglish Ravi AcharyaEnglish Jha MSEnglishBackground: Molar incisor hypomineralization (MIH) describes the clinical picture of hypomineralization of systemic origin affecting one or more first permanent molar and incisors. Although the reported prevalence of MIH ranges from 2.4% to 40.2% worldwide, very little data is available from Nepal.
Objective: To assess the prevalence of MIH in children aged 7-13 years of Biratnagar, Nepal.
Study design: This cross-sectional descriptive study consisted of 567 children aged 7-13 years selected by cluster sampling method. Examinations were performed by one calibrated pediatric dentist. The European Academy of Pediatric Dentistry (EAPD) 2003 criteria was used for diagnosis.
Results: The prevalence of MIH was 8.6% in the age group of 7 to 13 years. The prevalence of MIH was 8.33% in males and 9.01% in females. The prevalence and severity of MIH increased with increase in age. The prevalence of MIH was 10.54% in the age group of 10 to 13 years as compared to 5.95% in the age group of 7-9 years.
Conclusion: The prevalence of MIH was 8.6% in the age group of 7 to 13 years. Developmental dental defects hold significance for scientists and practitioners from both medicine and dentistry. Dental interest has recently swung toward Molar Hypomineralisation. MIH imposes a significant burden on global health and has potential to become medically preventable, being linked to infantile illness.
EnglishFirst permanent molars, MIH in Nepal, Molar-incisor hypomineralizationINTRODUCTION:
Developmental dental defects hold significance for scientists and clinicians from both medicine and dentistry. Dental interest has recently swung toward Molar Incisor Hypomineralisation (MIH), a prevalent condition characterized by well-demarcated opacities in enamel. Molar incisor hypomineralization is defined as the developmentally derived dental defect that involves hypomineralization of one to four permanent molars, frequently associated with similarly affected permanent incisors.[1] MIH is also named as idiopathic enamel hypomineralization, nonfluoride hypomineralization in first permanent molars, and cheese molars.[2,3,4] The condition is attributed to disruption of ameloblastic activity during the transitional and maturational stages of ameloblasts.[5] MIH clinical appearance may vary from white to yellow opacities and from soft to porous enamel. The porous enamel when subjected to masticatory stress lead to post eruptive breakdown of enamel, making tooth susceptible to thermal and cold stimuli.
The MIH prevalence varies from 2.4% to 40.2% globally. [1] Most of the studies have been carried out in Northern Europe and the rates between 3.6% and 25% were reported. The reported prevalence of MIH varied from 2.4% in Germany and Bulgaria, 40% in Leeds, and 44% in Sydney. [1,3,4] Very little data is available for the prevalence of MIH in children in Nepal. The objective of this study is to assess the prevalence of MIH in children aged 7-13 years of Biratnagar, Nepal.
Materials and methods
The study was approved by the Institutional Review Committee of the Nobel Medical College Teaching Hospital. The nature and purpose of the study was explained to the heads of the schools and prior permission was obtained to conduct the survey in their schools. The study was conducted during the period of Oct-Feb 2017/18.
Study Population
The study population consisted of 600 children aged 7-13-yrs old recruited from the schools. The socio-economic status was almost similar and rated low moderate according to parental education and occupation. A cluster sampling method was used in this study (schools as clusters). The children with generalized hypoplastic/hypomineralized defects, such as amelogenesis imperfecta and those suffering from any chronic illness were excluded from the present study.
Selection Criteria
All the children who participated in the present study were instructed to brush prior to the clinical examination. The status of permanent incisors and molars was evaluated and recorded, according to the European Academy of Paediatric Dentistry (EAPD) 2003 criteria.[1] Teeth were inspected visually in daylight with a torch, while the child is seated in an ordinary chair by a single pediatric dentist. To examine, sterilized mouth mirror and probe were used. The probe was occasionally used to remove plaque. All the children diagnosed with MIH were reexamined by a second investigator to rule out any discrepancy. The entire indexed tooth was kept wet while examination to rule out opacities due to excessive drying, and the size of lesion was not taken into consideration.
Statistical Analysis:
Statistical analysis was performed using the Statistical package for the Social Sciences (SPSS) (SPSS Inc, Version 16 Chicago, IL, USA) to analyze the data. Karl Pearson Chi-square test is used to compare the proportions. Differences were considered statistically significant if P ≤ 0.05.
Results:
In total, 600 children aged 7 to 13 years were examined of which 567 were included in the study. Data of 49 children diagnosed with MIH were statistically analyzed. The interexaminer agreement was good (kappa = 0.879). A total of 26 male and 23 female children were diagnosed with MIH. Distribution of the subjects by age and gender is presented in (Table 1). Prevalence of hypomineralized lesions was assessed; the majority of children were unaffected, whereas 49 (8.6%) had either molar/incisor or both affected with MIH. The children diagnosed were divided into three categories on the basis of tooth affected, viz., molars, molars with incisors, and incisors with opacities. 37(75.5%) children had only molars affected compared to 9(18.3%) which had both incisors and molars affected. Only 3(6.12%) children had only incisors with opacities. (Table 2)
MIH in single molars were the most common finding at 38.77% with all the four molars least affected at only 10.2%. (Table 3)
The prevalence of MIH was 8.6% in the age group of 7 to 13 years. The prevalence of MIH was 8.33% in males and 9.01% in females. The prevalence and severity of MIH increased with increase in age. The prevalence of MIH was 10.54% in the age group of 10 to 13 years as compared to 5.95% in the age group of 7-9 years. (Table 4)
Discussion:
In our study, the prevalence of MIH was found to be 8.6%, which was well within the range observed in other studies conducted in various parts of the world. As far as Asia was concerned the prevalence rate was estimated to be the least (2.8%) in Hong Kong and highest (18.6%) in Iraq (2003-2011). [6-8] No significant correlation was found between age groups and the number of affected teeth. The present study also found 18.3% of children diagnosed with MIH presented lesions in both permanent first molars and incisors which is much lower than global values. [9-14]The incisors of the MIH affected children revealed demarcated enamel opacities and enamel loss with higher rate of opacities. This finding tends to be in line with most other studies which found affected incisors to have rarely exhibited posteruptive breakdown because of the absence of masticatory forces upon these surfaces. [15-21] One possible limitation for this study may be the association of MIH with past medical history which was not possible due to lack of information available with the parents and schools. Future studies can overcome this limitation by using the child’s medical records and thorough history given by parents. There is also a need to better understand the condition in the country of Nepal. There is also a need for longitudinal studies with large sample size to better obtain the prevalence rate and also understand the etiological factors associated with MIH in Nepal.
Conclusion:
The present study reports a prevalence of 8.6% in children of age group 8 to 12 years. Thus, MIH is a frequently occurring dental ailment in the pediatric population. Children with MIH require therapy shortly after tooth eruption. This study shows that the severity of MIH lesions increases with age. Therefore, dentists must be aware of the clinical consequences and pay special attention to children with MIH. This data could be helpful in estimating the baseline data of MIH among the Nepalese population. The first step in effective management of MIH should be the implementation of comparable, representative studies of MIH prevalence among different populations throughout the world. The awareness about the condition would help in the preventive and therapeutic measures for combating this alarming developmental disturbance of teeth which is also of relevance for public health authorities.
Englishhttp://ijcrr.com/abstract.php?article_id=2495http://ijcrr.com/article_html.php?did=2495
Weerheijm KL, Duggal M, Mejàre I, Papagiannoulis L, Koch G, Martens LC, Hallonsten AL. Judgement criteria for molarincisor- hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, 2003. Eur J Paediatr Dent 2003 Sep;4(3):110-113.
Koch G, Hallonsten AL, Ludvigsson N, Hansson BO, Holst A, Ullbro C. Epidemiologic study of idiopathic enamel hypomineralisation in permanent teeth of Swedish children. Community Dent Oral Epidemiol 1987;15:279-85.
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Muratbegovic A, Markovic N, Ganibegovic Selimovic M. Molar-Incisor Hypomineralization in Bosnia and Herzegovina: Aetiology and clinical consequences in medium caries activity population. Eur Arch Paediatr Dent 2007;8:189-94.
Alaluusua S, Lukinmaa PL, Vartiainen T, Partanen M, Torppa J, Tuomisto J. Polychlorinated dibenzo-p-dioxins and dibenzofurans via mother’s milk may cause developmental defects in the child’s teeth. Environ Toxicol Pharmacol 1996;1:193-7.
Jasulaityte l, Veerkamp JS, Weerheijm KL. Molar-incisor hypomineralization: Review and prevalence data from a study of primary school children in Kaunas/Lithuania. Eur Arch Paediatr Dent 2007;8:87-94.
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Beentjes VEVM, Weerheijm KL, Groen HJ. Factors involved in the aetiology of molar-incisor hypomineralisation. Eur J Paediatr Dent 2002 Mar;3(1):9-13.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411011EnglishN2018June11HealthcareAntioxidant Efficacy of Black Tea and Green Tea Equally Modulates Vasculogenic Factors in Preeclamptic Placental Trophoblast: A Comparative Study
English1119Padmini EkambaramEnglish Christina Joseph Mary SusaiEnglishAim: Preeclampsia is hypertensive disorder of human pregnancy. Trophoblast, a prime cell of the placenta, is affected during preeclampsia due to the imbalance between oxidant and antioxidants resulting in aberrant cellular vascularization. Vasculogenesis is regulated by the endothelial nitric oxide synthase (eNOS), a potent vasodilator, regulating the expression of growth factors. Vascular endothelial growth factor (VEGF) is a prime regulator of vasculogenesis. Placental growth factor (PLGF) plays a crucial role in placental development during pregnancy. Synthetic drugs can hardly be used under complicated pregnancy. The requirement for herbal remedies renders essential regulatory mechanism to ensure adequate protection from preeclampsia.
Methodology: In the current study, black tea and green tea were used to assess the stress markers (LPO and TAC) and vasculogenic factors (ADMA, eNOS, VEGF-C, and PLGF) in normotensive and preeclamptic placental trophoblast.
Results: The increased expression of LPO, ADMA and decreased TAC, eNOS, VEGF-C, PLGF were observed in preeclamptic placental trophoblast. On tea incubation, vasculogenic proteins were significantly altered in preeclamptic placental trophoblast when compared with their respective subjects.
Discussion: Our present study results reveal that protective effect of black tea is equal to the green tea. This may be due to the tea polyphenols produces a beneficiary effect in the case of the preeclamptic placenta.
Conclusion: The present study concludes that tea with or without fermentation process has a significant impact on crucial vasculogenic factors. This effect can be suitably exploited to avoid further complications in preeclamptic pregnancy.
EnglishHypoxia, Preeclampsia, Tea, Trophoblast and Vasculogenic factorsINTRODUCTION
Preeclampsia is a pregnancy-specific disorder characterized by the development of hypertension and proteinuria; it is a leading cause of materno-fetal morbidity and mortality.(1) The etiology of preeclampsia has not been defined. However, Julian and his colleagues(2) reported that hypoxia might serve as an essential factor in the pathophysiology of preeclampsia. In the present study, placental trophoblast was analyzed as they are the structural unit of the placenta and it plays a crucial role in placental development, mediated by the invasion of extravillous trophoblast into the endometrium.(3) This, in turn, regulates the blood perfusion in the fetus during normal pregnancy. Improper trophoblast invasion plays a critical role in propagating endothelial dysfunction associated with preeclampsia resulting in the poorly perfused placenta with vascular dysfunction. Asymmetric dimethylarginine serves as the prime factor for mediating the endothelial dysfunction via endothelial nitric oxide synthase inhibition under hypoxic conditions.(4)
Nitric oxide is synthesized through constitutive calcium sensitive isoforms; nitric oxide synthase, i.e., endothelial nitric oxide synthase and neuronal nitric oxide synthase, or by inducible isoform (inducible nitric oxide synthase) which is calcium?independent.(5) Nitric oxide is a pleiotropic molecule, regulates diverse biochemical and physiological function including regulation of vascular tone, vascular remodeling, and protection against stress-induced cell damage.(6) The formation of nitric oxide by placental nitric oxide synthase and its following release in the intervillous space prevents platelet adhesion and aggregation; thereby it increases the blood flow to the placental villi leading to vasorelaxation.(7) Establishment of the proper cellular vascular system is essential during pregnancy and is mainly regulated by endothelial nitric oxide synthase through its impact on the expression of growth factors.(8)
Vascular endothelial growth factor plays a potential role in fetoplacental vessel formation by the processes of vasculogenesis and angiogenesis leading to the placental development.(9) Vascular endothelial growth factor is a 45 kDa disulphide linked homodimeric glycoprotein. The vascular endothelial growth factor family contains seven homologies such as vascular endothelial growth factor A, B, C, D, E, F, and placental growth factor, which all have a common vascular endothelial growth factor homology domain.(10) In the present study, placental trophoblasts determine the vascular endothelial growth factor-C expression for adult tissues prominently expressed vascular endothelial growth factor-C in heart, placenta, ovary, small intestine, and the thyroid gland. The actions of vascular endothelial growth factor are mediated through kinase domain receptor and soluble form of fms-like tyrosine kinase receptors. (11) Expression of vascular endothelial growth factor-C in the placenta can increase vascular permeability, stimulate the migration and proliferation of endothelial cells, through its binding to vascular endothelial growth factor receptor 2 and 3/sFLT-4 receptor.(12) Adequate and organized interaction of vascular growth factors and their receptors are required for proper placental vascular development.(9)
Placental growth factor is a homodimeric glycoprotein, 46-50 kDa in size, belongs to the vascular endothelial growth factor sub-family.(13) During pregnancy, expression of placental growth factor in villous trophoblast is essential for trophoblast invasion to the maternal decidua resulting in proper placentation and angiogenesis.(14) Placental growth factor regulates endothelial cell survival and proliferation by activating extracellular signal-regulated kinase 1 and 2 activity. Hence, the limited expression of placental growth factor in placental tissue is used as a predictive marker for preeclampsia.
Management of preeclampsia with natural remedy having vasodilating property is essential to improve placental blood flow and preclude hypertension. Various medications including antihypertensive, anticonvulsants and corticosteroids are available for managing preeclamptic complications. However, they are found to cause extreme side effects to both mother and fetus. Hence natural remedy is recommended to manage complications. Previously, our laboratory established the beneficiary effect of black tea on placental cells.(15) The present study riveted on evaluating the effect of black tea on vasculogenic factors in preeclamptic placental trophoblast in comparison with green tea. Both black tea and green tea are derived from the same plant Camellia sinensis, unique in its diverse medicinal properties.(16) Tea is the second most-consumed beverage in the world. Tea is also recommended as complementary and alternative medicines due to its anti-stress, anti-inflammatory and vasodilatory properties.(17) These properties may be attributed to the bioavailability of its key components present in green tea and black tea such as catechins and theaflavins which directly acts against or neutralizes the free radicals at the cellular level.(18) So far, the beneficiary effect of black tea and green tea on vasculogenic factors during preeclampsia is not explored in preeclamptic placental trophoblast. Therefore, our study aims to inquire the efficacy of black tea and green tea by analyzing the expression of vasculogenic factors in before and after tea incubation.
MATERIALS AND METHODS
Selection of subjects
Patient registered in a public sector hospital in Chennai were enrolled in this study. Clearance was obtained from Institute Ethical Committee (IEC/S/BWC/609/2014) prior to the commencement of study and the informed consent was received from all the subjects (Table-1). Placenta was collected from both normal (n=14) and preeclamptic (n=14) pregnant women in the age group of 20-40 years, post delivery. Patients with preeclampsia were defined on the basis of the following laboratory criteria: blood pressure >140/90 mmHg but 300 mg/L and xanthine oxidase activity of approximately 2.6 units/ mg protein.(19) Patients with severe preeclampsia and other severe maternal complications were excluded from the study.
Isolation of placental Trophoblast
Third-trimester villous trophoblast cells, which were used for comparison, were isolated from term placentas by the method of Douglas and King.(20) Human term placenta from the preeclampsia and normotensive subjects were obtained immediately after delivery in accordance with the established guidelines of the institutional ethical committee along with the informed consent of the patient. Briefly, placental villi were cut and thoroughly washed to remove blood. Thereafter, they were incubated four times in a enzyme digestion medium composed of HBSS, containing trypsin and deoxyribonuclease for 30 min at 37ºC in a water bath with continuous shaking. The dispersed cells were layered on top of a discontinuous 5–70% Percoll gradient, and centrifuged for 25 min at 507 Xg. The intermediate layers (density between 1.048 & 1.062) containing cytotrophoblast cells were removed and washed and following trophoblast isolation, cells were seeded at a density of approximately 1.6×106 cells per plate in a 5 mL cell culture plate. The complete culture medium, constituted of M199, 2mm glutamine & 10% FBS. All the experiments were performed within a day of trophoblast isolation in-order to overrule the influence of cultivation process.
Cell viability by MTT assay
The viability of placental trophoblast cells was determined using the MTT assay (Mosmann).(21) The trophoblast cells were resuspended in PBS buffer and serially diluted to a concentration of 200 mg of protein per mL of suspension using the same buffer system. One hundred mL of the dilutions were plated out into the wells of a microtiter plate in duplicate. In the control wells, PBS alone was incubated to provide the blank for absorbance readings. Ten mL of MTT reagent was added to each well, including controls. After incubation for 1 h, the visualized purple precipitate (formazan product) was solubilised with 1 mL acidic isopropanol. The plates were covered and left in the dark for 4 h at room temperature. Absorbance was measured at 560 nm. The relative viability was calculated by dividing the optical density of sample by the optical density of control well having the PBS buffer solution with MTT reagent, and multiplying by 100.
Estimation of protein
The protein concentration was estimated by the method of Bradford(22) the use of bovine serum albumin as the standard. The result was expressed as mg protein/g. The lysate was used for the estimation of the following parameters.
Preparation of black tea and green tea extracts
About 2 grams of commercially available South Indian black tea and green tea leaves were brewed and extracted with 100 mL of PBS by heating for 10 minutes. The extract was filtered using Whatmann filter paper (No.2). The resulting filtrate was diluted (1:100) with PBS and was diluted to get the necessary concentration of 2%.
Incubation studies
The isolated placental trophoblast from both normotensive and preeclamptic groups were incubated with 0.02% of black tea and green tea in 5% CO2 atmosphere at 37°C, for a maximum of 48 hrs.
Estimation of lipid peroxide
Lipid peroxide analysis was determined by the method of Ohkawa et al.(23) The lipid peroxide content was expressed as nanomoles of MDA/ mg of protein.
Estimation of total antioxidant capacity
Total antioxidant capacity analysis was performed by the method of Prieto et al.(24) The total antioxidant activity was expressed as Trolox equivalent in mmol/ L.
Quantification of stress signaling molecules
The expression of signaling molecules were quantified by using asymmetric dimethyl arginine (MBS264847), endothelial nitric oxide synthase (SEA868Hu), vascular endothelial growth factor-C (E-EL-H1600), placental growth factor (SEA114Hu), according to the manufacturer’s instructions.
Statistical analysis
Data were analyzed using statistical software package version 7.0. Student’s t-test and SPSS package were used to ascertain the significance of variations between normotensive and preeclamptic trophoblast. All data were presented as mean ± SD of 14 samples. Differences were considered significant at pNS, pEnglishhttp://ijcrr.com/abstract.php?article_id=2496http://ijcrr.com/article_html.php?did=2496
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411011EnglishN2018June11HealthcareAnencephaly: Incidence, Risk Factors and Biochemical Analysis of Mother
English2025Shilpa K.English Priya RanganathEnglish Sumathi S.EnglishIntroduction: Anencephaly is a common & lethal neural tube defect (NTD) which occurs due to the defective closure of rostral pore of neural tube. The study aims to identify the risk factors associated with anencephaly in our population. Attempt was made to correlate the incidence of anencephaly with associated systemic and congenital anomalies, maternal factors, biochemical analysis of mother for ACE, alpha fetoprotein, folic acid & random blood sugar.
Material & Method: The present study included 60 anencephalic fetuses of 20-30 weeks & mothers of the fetuses from Victoria & Vani Vilas hospital attached to Bangalore Medical College & Research Institute. Study was conducted over a time period of 3 years from August 2014 to June 2017.
Results: The incidence of anencephaly in Victoria and Vanivilas hospital was 1.04 in 1000 births. 23 (38.4%) were males & 37(61.6%) were females. The alpha fetoprotein is high in 100% of cases & ACE level was normal in 85 % cases, in 1.6% it was high & in 13.4% cases it was low. In 15%, folic acid was low & 15% cases were hyperglycemic.
Conclusion: Better knowledge of unexpected fetal loss is the promise for better parental counseling & for prevention of recurrences. Understanding & identifying the risk factors associated with anencephaly in our population, allows approaches to avoid them & there by lower the incidence of anencephaly in our population.
EnglishIntroduction:
Anencephaly is a common & lethal neural tube defect (NTD) which occurs due to the defective closure of rostral pore of neural tube. It is also known by other name like acrania (absence of skull), acephaly (absence of head), merocrania & meroanencephaly. Anencephaly can diagnosed by ultrasound examination (USG) & by elevated maternal alpha feto protein1 & Amniocentesis2. Studies show that a woman who had one child of NTD such as anencephaly will also have 3% risk of having another child with a NTD3. Women taking certain medications for epilepsy & women with insulin-dependent- diabetes mellitus have a higher risk4. The study aims to identify the risk factors associated with anencephaly in our population. Attempt was made to correlate the incidence with associated systemic anomalies, maternal factors, biochemical analysis of mother for ACE, Alpha fetoprotien, Folic acid & RBS, correlation of biochemical analysis with associated anomalies.
Material & Methods:
The present study included 60 anencephalic fetuses (23 males & 37 females) of 20-30 weeks & mothers of the fetuses from Victoria & Vani vilas hospital attached to Bangalore Medical College & Research Institute, Bangalore. Study was conducted over a time period of 3 years from August 2014 to June 2017. The total number of deliveries during this period was 57429. All the procedures were approved by research board & ethical committee of BMCRI, Bangalore. Consent for autopsy was requested compassionately, respectfully & fully informed. Complete history regarding the age of mother, febrile illness during pregnancy, medications taken during pregnancy, maternal diabetes, family history for NTDs & Folic acid supplementation were taken. The fetuses were dissected & the dissecting instruments required for fetal autopsy are small scissors & forceps & scalpels. Measurements of crown heel, crown rump, head circumference, foot length, & weight are taken for comparison with standard chart. Dissection was performed by positioning of the body. The body was kept in supine position with a wooden block under the shoulder to keep the neck in extended position.
A curved incision was made bilaterally from the acromion process through the medial border of shoulder joint to mid-axillary line laterally; this continued to the iliac crest over the inguinal ligament to meet pubic symphysis. The skin with the superficial tissue flap was reflected up the root of the neck, then to the inferior margin of mandible bilaterally, taking care not to injure the neck structures and rectus sheath. This way, whole of the front of the neck, chest and abdomen was exposed5.
Opening the abdominal cavity: A paramedian incision was made on rectus near pubic symphysis up to xiphoid process.
Opening thoracic cavity: Sternum was removed by cutting at costochondral junction and then separating sternoclavicular joint. All the major organs (lungs, heart, spleen, kidney, adrenal gland) were weighed & data recorded with expected values. Photographs were taken. The samples were fixed with 10% buffered formaldehyde approximately to 24 hours. The associated abnormalities were grouped according to main organ system to which they belonged.
Maternal analysis: 2 ml of blood with EDTA & 2 ml of whole blood was withdrawn from the mother before delivery; sent for analysis of alpha fetoprotein, folic acid, acetyl cholinesterase and blood glucose (random blood sugar).
Anencephaly & associated anomalies were compared with the biochemical analysis of mother. The observed data were subjected to Fisher's exact tests and the significance was determined with P< 0.05 for statistical significance. The statistical tests were performed using software SPSS 15 (Statistical Package for Social Sciences).
Results: The number of deliveries conducted between August 2014 to June 2017 at Victoria Hospital, Bangalore is shown in Table 1. The total number of deliveries during this period was 57429. Of these deliveries 60 fetuses (males 23 &37 females) with anencephaly, of age 20 to 30 weeks were collected from Department of OBG, Victoria & Vani Vilas hospital attached to Bangalore Medical College & Research Institute, Bangalore.
Classification of mothers according to age showed that maternal age in 1.6% were < 20year, 83.4% were 21-35 years, 13.4% were 36-40 years and 1.6% was >40 years. The mean of maternal age is 24.4 years. When mothers were classified according to their level of education, it was noticed that 91.6% were found to be high school were 3.4%. The study showed that 76.7% of mothers were unemployed (housewives) & 46% of the respondents were found to have regular visits to antenatal care centers. When respondents were inquired about experiencing any form of febrile illness during pregnancy (specifically the first trimester), 86.6% of mothers had no febrile illness during pregnancy; only 14.4% of them reported so. Season of birth were 40% were born in winter, 16.6% were in spring, summer & 26.7% in autumn. The study showed that 8.3% of mothers had multiple abortions, 1.6% had abortion with asthma, diabetes with obesity & hypertension, 5% were diabetic & 81.6 % were normal. 10% of mothers reported taking medications during pregnancy, 1.6% mentioned antiemetic, 5% NSAID (paracetamol & aspirin), 1.6% mentioned herbal medication. None of the respondents was found to have been exposed to any form of radiation during pregnancy. 15% mothers got consanguineous marriage, all were 1st cousins & remaining 51 (85%) cases were unrelated.
The study showed that 76.7% of mothers were taking folic acid during pregnancy. Regarding the timing of folic acid consumption during pregnancy, only 5% took folic acid preconception (Chart 1).
The comparison of control group (normal fetuses) & case group (anencephalic fetuses) indicates that there is no difference seen. The weight of fetus with anencephaly is more than the control group, and weight of liver was less than control group, and these were statistically significant.
Associated anomalies were present in 42 (70%) fetuses (Table 2). Out of 42 fetuses, those who had associated anomalies were 17 (40.4%) males and 25 (59.6%) were females. All the fetuses had acrania (100%) & 19 (45.3%) fetuses had spina bifida; there were no anomalies found in reproductive system.
The 6 cases (14.3%) had facial defects (4.7% were males & 9.5% were females). The most common defect was cleft palate & cleft lip (9.5% cases), it was found to be statistically significant. In 19 cases (45.3%), spina bifida was very common, in 1 (2.3%) along with spina bifida, cleft lip & palate was also found. The spina bifida upto sacral region was seen in 4.7% of cases & it was found to be statistically significant.
Anomalies in limbs: 1 case (2.3%) had Amelia of right lower limb, congenital dislocation of right elbow joint, malrotation of gut towards left, which was found to be statistically significant (Figure 1).
CVS: in 1 male fetus (2.3%), there was a single ventricle (mono ventricle) on the left side, with two outlets (aorta & pulmonary trunk), which was found to be statistically significant (Figure 2 a&b).
Lungs: in 1 case (2.3%), left lung had 2 fissures & 3 lobes, in 1 (2.3%) right lung had 3 fissures with 4 lobes. In 2 cases (4.7%) both lungs had single oblique fissure with 2 lobes (Fig 3). In 1 case (2.3%), there was malrotation of gut towards left side & also absence of pancreas (Fig 4).
Urinary system: 1 case (2.3%) had unilateral biureter on left side (Fig 5) & 1 case (2.3%) had horse shoe shaped kidney; both are statistically significant (Figure 6a& b).
There were no anomalies found in reproductive system. In 2 male cases (4.7%), there was umbilical hernia (Fig 7). Diaphragmatic hernia was not seen. Amniotic band syndrome (fig 8), encephalocele (fig 9) & omphalocele (fig 10) were seen in 2.3% of cases.
Male fetuses had 40.4% of overall associated anomalies & female fetuses 59.6% of associated anomalies. The female anencephalic fetuses were found to have more number of associated anomalies.
Biochemical Analysis of mother: In 100% of mothers AFP were high, this was a confirmatory test for anencephaly (NTDs).
Normal Values
AFP - upto 10 IU/ml
Folic acid -3.1-17.5ng/ml
Acetylcholine esterase-1700-5778U/L
Blood glucose (RBS) –upto 140 mg/dl
ACE- The 85% of cases ACE level were normal, 13.3% low & 1.7% of cases it was high. Folic acid level in 68.3% cases were normal, 28.3% of cases were low & 3.4% cases were high. RBS were high in 15% of cases all mothers were diabetic, 3.4% cases low & 81.6% were normal.
The Mean, SD & P values are given in (Table 3).
ACE level were high in 1.6% of cases of spina bifida & it was low in anomalies of limb , GIT, Urinary system & umbilical hernia (1.6%cases).
Folic acid was low in 1.6% of cases with anomalies of skull & face, limb, CVS & urinary system & high in 5% of cases with spina bifida.
RBS was high in 1.6% of cases with anomalies of GIT, Urinary system and other anomalies & 3.2% with spina bifida. It was low in 1.6% of cases with spina bifida & umbilical hernia.
Discussion: Incidence of anencephaly is reported to be 1:1000 to 1:20000. In the present study the incidence of anencephaly in Victoria and Vanivilas hospital was 1.04 in 1000 births.
Literature showed that anencephaly is more common in females6,7. In the present study, 23(38.4%) were males & 37(61.6%) were females. The birth was of 1st order in 40% of cases , 35% cases were 2nd order, 21.6% were 3rd order & 3.4% cases were 4th order.
Age of mother in 1.6% cases were 40.
Season of birth: 16.7% cases were born in spring, 26.7% in autumn, 40% in winter & 16.6%were summer which was similar in some studies8.
Maternal occupation: 76.7% cases mothers were house wives, 10% cases farmers, 1.6% were tailor & teacher & 3.4 % were group D.
Family history of both the mother & father was taken in which 1.6% cases had Down’s syndrome for 1st cousin & in 1.6% father of the fetus had hyperthyroidism.
15% mothers got consanguinity, all were first cousins & 85% were unrelated which was similar in few studies9,10,11
The rate of anencephaly could be higher in underdeveloped countries due to possible misdiagnosis, most probably due to poor diet; improper maternal health care, inappropriate treatment & environmental factors also contribute to it9. The ratio of anencephaly is higher in Iranian population than compared to European population. It has been calculated that in Iranian population 13.1/10,000 newborns had anencephaly whose mothers aged >35 years & consanguineous marriage contributes 36 % to anencephaly which was found to be similar in present study12.
Congenital anomalies vary in different studies. The study of malformation is greatly helpful in genetic counseling & prenatal diagnosis in successive pregnancies13. Anomalies were found in 42 cases (70%) in the present study & it is compared with the other studies.
In present study, out of 42 cases, 25 females (41.7%) & 17 males (28.3%) showed associated anomalies; majority of anomalies were in female anencephalic fetuses which was similar to some studies. Cleft lip & palate were the most common defect (14.3%) & 19 (45.3%) had spina bifida. There were no reproductive system anomalies in the present study.
Most of the organs in the present study were anatomically normal when it was compared with the control group & some studies19.
Literature showed that anencephalic fetuses were successful donors of hearts & kidneys for transplantation7.
The intake of 4mg per day of folic acid intake is recommended in mothers with history of neural tube defect7,20.
The alpha fetoprotein is high in 100% of cases which was similar in a study21 & ACE level was normal in 85 % cases, in 1.6% it was high & in 13.4% cases it was low (22,23,24,25,26
In 15%, folic acid was low & 15% cases were hyperglycemic20
The intake of 4mg per day of folic acid intake is recommended in mothers with history of neural tube defect7,20.
In present study ACE level were high in 1.6% of cases of spina bifida & it was low in anomalies of (1.6%cases) Limb, GIT, Urinary system & umbilical hernia.
Folic acid was low in 1.6% of cases with anomalies of skull & face, limb, CVS & Urinary system &high in 5% of cases with spina bifida.
RBS was high in 1.6% of cases with anomalies of GIT, Urinary system and other anomalies & 3.2% with spina bifida. It was low in 1.6% of cases with Spina bifida & umbilical hernia.
Conclusion:
Better knowledge of unexpected fetal loss is the promise for better parental counseling & for prevention of recurrences. Understanding & identifying the risk factors associated with anencephaly in our population, allows approaches to avoid them & thereby lower the incidence of anencephaly in our population. To prevent the NTD, dietary supplements should be provided to low socioeconomic pregnant females. Peri-conceptional & 1st trimester folic acid supplementation is of prime importance. All pregnant mothers have to go in for triple marker tests; that is, beta HCG, alpha fetoprotein and estradiol.
Amniocentesis could be made compulsory for mothers with a history of an anencephalic child. The mother has to be counseled regarding the risks of another such fetus. The family has to be told about pedigree charts, incidence and occurrence of anencephaly in the population.
Englishhttp://ijcrr.com/abstract.php?article_id=2497http://ijcrr.com/article_html.php?did=2497
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