Association of Epstein Barr Virus Infection (EBV) with Breast Cancer in Rural Indian Women

INTRODUCTION:Breast cancer is the most common malignancy affecting females worldwide but conventional risk factors are able to explain only a small proportion of these cases. A possible viral etiology for breast cancer has been proposed and Epstein-Barr Virus (EBV) is a widely researched candidate virus. The aim of the present study, first one of its kind from India, was to determine if there is a greater association of EBV infection with breast cancer patients as compared to patients with benign breast diseases. METHODS:We looked for expression of Epstein-Barr Virus Nuclear Antigen-1 (EBNA-1) in breast cancer tissue specimens by employing immunohistochemistry (IHC). We also measured levels of anti-EBNA-1 Immunoglobulin (IgG) antibodies in stored sera of these patients using commercial Enzyme linked Immunosorbent Assay (ELISA) kit. Patients with benign breast diseases were used as a comparison group for both immunohistochemical and serological analysis. RESULTS:58 cases of malignant breast disease and 63 of benign breast disease (controls) were included in the study. Using manufacturer determined cut-off of 3 IU/ml, 50/55 tested (90.9%) cases and 27/33 tested (81.8%) controls were seropositive for anti-EBNA-1 IgG. Mean antibody levels were significantly higher for cases (54.22 IU/ml) as compared to controls (18.68 IU/ml). IHC for EBNA-1 was positive in 28/51 cases (54.9%). No IHC positivity was noted in the tested 30 controls. Our results show that EBNA-1 expression is seen in a significant proportion of breast cancer tissue specimens from rural India and as compared to patients with benign breast diseases these patients also have a higher immunological response against EBNA-1

Navigating mixed connective tissue disease in pregnancy: a rare case report

Autoimmune connective tissue diseases (CTDs) in pregnancy present a complex interplay between maternal health and fetal outcomes. While historically discouraged due to potential complications, proper preconception counselling and disease control offer the prospect of safe pregnancies. This case report focuses on mixed connective tissue disease (MCTD), a rare condition combining features of SLE, systemic sclerosis, rheumatoid arthritis, and polymyositis, presenting during pregnancy. A 29-year-old woman, gravida 2, para 1, with a history of rheumatoid arthritis, was referred at 31+4 weeks with a deranged coagulation profile, fetal growth restriction (FGR), and oligohydramnios. Extensive laboratory and imaging investigations confirmed MCTD diagnosis. Treatment involved LMWH, aspirin, hydroxychloroquine, and prednisolone. Comprehensive monitoring and multidisciplinary care were maintained throughout. Despite initial improvement, the patient faced complications at 35+3 weeks, leading to an emergency caesarean section at 36 weeks due to preterm FGR, oligohydramnios, and breech presentation. A male infant weighing 2.1 kgs was delivered, requiring neonatal intensive care due to prematurity and respiratory distress. Postoperatively, the mother resumed medication and was discharged with her baby. This case highlights successful MCTD management during pregnancy through meticulous monitoring and a multidisciplinary approach. The risk of complications necessitates informed preconception counselling, emphasizing the importance of disease remission, close surveillance, and prompt intervention in disease relapse. Comprehensive care, including medications and careful planning, contributes to improved maternal and neonatal outcomes in this rare and challenging scenario

Newborn birth weight: a trend towards positive paradigm shift in rural central India

Background: Birth weight is one of the important determinants of neonatal wellbeing. It has many determinants including maternal nutritional status and gestational age. Low birth weight is associated with high neonatal and childhood mortality and morbidity. Over the years the birth weight is showing the increasing trend in developing countries like India. The study aimed at finding out the changing pattern of birth weight over a decade in rural India.Methods: Retrospective data of 43,114 births was collected through hospital information system. Neonatal birth weight was analyzed over a period of 10 years from 2007-2016. Demographic data was studied to study the determinants.Results: Over the period of 10 years, proportion of newborn with low birth weight (below 2500 grams) declined from 56.35 % to 43.65 %. The rise in mean birth weight was 147 gram in male infant and 114 grams in female. There was overall reduction in proportion of very low birth weight and extremely low birth weight babies. A linear relationship was observed between improved birth weight, socio economic status, age at marriage and maternal weight gain during pregnancy.Conclusions: A positive trend towards improved newborn birth weight was observed in study site of rural central India. Better antenatal care, improved maternal nutrition and improved social status of women in the community are the determinants found to have a positive correlation

Maternal hemoglobin: socio-demographic and obstetric determinants in rural Central India

Background: Maternal Anemia is a global health problem with adverse implications on materno-fetal outcome. Various socio-demographic and obstetric factors affect prevalence of anemia.Methods: A hospital based, cross-sectional, observational study was carried out among pregnant women seeking antenatal care at Kasturba Hospital of MGIMS, Sewagram, a rural tertiary care institute in central India. Information was collected about demographic variables, age, gravidity, parity, literacy, area of residence and socioeconomic status. Hemoglobin levels in first trimester and pre delivery were measured by coulter and correlated with socio-demographic and obstetric factors.Results: Among 500 pregnant women of first trimester, 249 (49.8%) had anemia, 154 (30.8%) mild, 86 (17.2%) moderate and 9 (1.8%) severe anemia. More women with anemia were of lesser age, resided in rural area, belonged to middle and lower economic class, lived with joint families and had less than 12 years of formal education.Conclusions: Anemia is prevalent in pregnant women in this geographic region of central India. Age, higher gravidity, higher parity, rural residence, low socioeconomic status and less than 12 years of formal education, are risk factors. Appropriate age at marriage, small family norm, education of girl child, anemia prevention strategy in adolescent girls and financial empowerment of women are suggested strategies for prevention of anemia and improved maternofetal outcome

Unmasking the mimic: when sepsis disguises as dengue shock syndrome

This case report delves into the diagnostic challenges faced when differentiating between sepsis and dengue shock syndrome (DSS), particularly in regions where both are endemic. A 23-year-old female initially diagnosed with DSS presented with fever, thrombocytopenia, and multi-organ dysfunction. Despite aggressive DSS management, the patient's condition worsened, prompting further investigation. Blood cultures eventually revealed Klebsiella pneumoniae, leading to a shift in diagnosis to sepsis. This case underscores the importance of comprehensive diagnostic evaluation, which included blood cultures, serological tests, and imaging. Prompt initiation of targeted antibiotics and comprehensive critical care resulted in significant improvement, highlighting the critical role of early recognition and intervention in optimizing outcomes. The complexities in distinguishing between sepsis and DSS underscore the need for continuous vigilance and a thorough diagnostic approach in similar clinical scenarios

Previous published studies which evaluated EBNA-1 by IHC on breast cancer specimens.

*<p>IHC was done on EBV-DNA PCR positive samples only.</p

Newborn birth weight: a trend towards positive paradigm shift in rural central India

Background: Birth weight is one of the important determinants of neonatal wellbeing. It has many determinants including maternal nutritional status and gestational age. Low birth weight is associated with high neonatal and childhood mortality and morbidity. Over the years the birth weight is showing the increasing trend in developing countries like India. The study aimed at finding out the changing pattern of birth weight over a decade in rural India.Methods: Retrospective data of 43,114 births was collected through hospital information system. Neonatal birth weight was analyzed over a period of 10 years from 2007-2016. Demographic data was studied to study the determinants.Results: Over the period of 10 years, proportion of newborn with low birth weight (below 2500 grams) declined from 56.35 % to 43.65 %. The rise in mean birth weight was 147 gram in male infant and 114 grams in female. There was overall reduction in proportion of very low birth weight and extremely low birth weight babies. A linear relationship was observed between improved birth weight, socio economic status, age at marriage and maternal weight gain during pregnancy.Conclusions: A positive trend towards improved newborn birth weight was observed in study site of rural central India. Better antenatal care, improved maternal nutrition and improved social status of women in the community are the determinants found to have a positive correlation

Box plot showing anti-EBNA-1 IgG antibody levels in women with benign and malignant breast disease, stratified by age.

<p>The central horizontal line in the box indicates the median value, edges of the box indicate inter-quartile range, and the whiskers indicate values at 5^th and 95^th percentiles. The values at the bottom of the box indicate the number of women in whom serology was done, out of the total number of eligible women in particular category. The mean IgG levels in 25 to 45 year age group were significantly higher in women with malignant breast disease (48.15; SD 47.38 IU/ml) as compared to those with benign breast disease (17.37; SD 16.89 IU/mL) (p = 0.01).</p