Background Chlamydia trachomatis is responsible for trachoma, the primary cause of preventable blindness worldwide. Plans to eradicate trachoma using the World Health Organization's SAFE program (Surgery, Antibiotics, Facial Cleanliness and Environment Improvement) have resulted in recurrence of infection and disease following cessation of treatment in many endemic countries, suggesting the need for a vaccine to control infection and trachomatous disease. Vaccine development requires, in part, knowledge of the mucosal host immune responses in both healthy and trachomatous conjuctivae—an area of research that remains insufficiently studied.Methodology/Principal FindingsWe characterized 25 secreted cytokines and chemokines from the conjunctival mucosa of individuals residing in a trachoma endemic region of Nepal using Luminex X100 multiplexing technology. Immunomodulating effects of concurrent C. trachomatis infection were also examined. We found that proinflammatory cytokines IL-1β (r = 0.259, P = 0.001) and TNFα (r = 0.168, P<0.05) were significantly associated with trachomatous disease and concurrent C. trachomatis infection compared with age and sex matched controls from the same region who did not have trachoma. In support of these findings, anti-inflammatory cytokine IL-1 receptor antagonist (IL-1Ra) was negatively associated with chronic scarring trachoma (r = −0.249, P = 0.001). Additional cytokines (Th1, IL-12p40 [r = −0.212, P<0.01], and Th2, IL-4 and IL-13 [r = −0.165 and −0.189, respectively, P<0.05 for both]) were negatively associated with chronic scarring trachoma, suggesting a protective role. Conversely, a pathogenic role for the Th3/Tr1 cytokine IL-10 (r = 0.180, P<0.05) was evident with increased levels for all trachoma grades. New risk factors for chronic scarring trachoma included IL-6 and IL-15 (r = 0.259 and 0.292, respectively, P<0.005 for both) with increased levels for concurrent C. trachomatis infections (r = 0.206, P<0.05, and r = 0.304, P<0.005, respectively). Chemokine protein levels for CCL11 (Eotaxin), CXCL8 (IL-8), CXCL9 (MIG), and CCL2 (MCP-1) were elevated in chronic scarring trachoma compared with age and sex matched controls (P<0.05, for all).Conclusions/SignificanceOur quantitative detection of previously uncharacterized and partially characterized cytokines, a soluble cytokine receptor, and chemokines for each trachoma grade and associations with C. trachomatis infections provide, to date, the most comprehensive immunologic evaluation of trachoma. These findings highlight novel pathologic and protective factors involved in trachomatous disease, which will aid in designing immunomodulating therapeutics and a vaccine.
Deaths due to hanging are common among suicides. Various studies in the forensic literature have reported considerable differences in the frequency of hyoid bone or thyroid cartilage fractures and injuries to the musculature and the vasculature of the neck. Some important reasons to which these variations could be attributed include: lack of a common method for examination of neck structures, varying degrees of thoroughness in examining the neck structures and lack of seriousness in the documentation of the findings (as cases of hanging are almost always suicidal) thus affecting the results of retrospective studies. The present study was conducted retrospectively (1994 to 1999) and prospectively (2000 to 2003) on 108 cases of hanging. Seventy-one per cent of the cases were male and 29% female, aged between 15 to 60 years. Hanging was typical in 20% of cases and atypical in 80%; it was complete hanging in 46% of cases and incomplete in 54% of cases. Neck structure fractures were found to be more common in atypical complete hangings; the incidence was found to be 10% in the retrospective group and 27% in the prospective group. Contusions and lacerations of musculature were found in 20% of cases in the retrospective group and 34% in the prospective group, thus stressing the need for thorough postmortem examinations and meticulous documentation of the findings.
Injuries and fatalities occur in all forms of transportation, but numerically, road-traffic accidents account for the great majority worldwide. There is little that the autopsy surgeon can contribute to the elucidation of factors leading to the accident as it is largely the circumstantial and forensic laboratory evidence which is likely to reveal a non-accidental cause. However, the doctor's role in detecting the compatibility/incompatibility of the injuries with those usually sustained in traffic accidents (to detect any which are 'atypical', e.g. focal depressed fracture of the skull), distinguishing antemortem from postmortem injuries, demonstrating the presence of any disease capable of creating sudden incapacity and analysing samples for alcohol/drugs, etc., can go a long way in assigning roles to the human and to some extent vehicular and environmental factors. This warrants that a meticulous autopsy be conducted and not merely a catalogue of injuries. It must be appreciated that a fatal accident is likely to result in litigation and the extent of litigation cannot be anticipated at the time of the autopsy. One must, therefore, aim at the close study of any accident victim and a careful assessment of the case is always rewarding. The present study was undertaken in the Department of Forensic Medicine at (a) Government Medical College, Jammu (1991-93), (b) Mulana Azad Medical College, New Delhi (1993-95) and (c) Government Medical College, Chandigarh (1994-June 2000), with the object of doing a comparative analysis of the various aspects of the road-traffic accidents and accidental deaths in three topographically and demographically different cities in India and to suggest remedial measures to bring down the accident rate.
A twenty-one years retrospective study (1980-2000) of acute poisoning deaths carried out at the Department of Forensic Medicine and Toxicology at Government Medical College Hospital, Jammu and Gov't. Medical College Hospital, Chandigarh--the two demographically different zones of Northern India. Union Territory of Chandigarh, which is the capital of Punjab and Haryana states, is one of the most developed parts of India, whereas Jammu primarily represents the rural India. The study is an attempt to analyze the various changing trends in acute poisoning in these zones with the aim that it will help immensely the health policy-makers to equip health care institutions accordingly. The present study reveals a steep increase in the number of acute poisoning cases and a change in the trends of the most commonly used poisons with the passage of time. Males outnumbered females and youth formed the majority of fatalities. The main victims were unemployed youth and students, followed by agricultural and domestic workers. Despite India's predominantly rural character, the urban preponderance of deaths by poisoning may reflect the role of leading a more stressful life in urban areas.
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