Prevalence of colonic polyp and its predictors in patients with acromegaly

BACKGROUND

There are conflicting data regarding the prevalence of colorectal polyp in patients with acromegaly.

SUBJECTS AND METHODS

Consecutive forty-seven acromegalic patients (21 men, 26 women), with a mean age of (40 ± 12 years) attending endocrinology outpatient department underwent full colonoscopy. All the patients underwent clinical and biochemical evaluation (glucose suppressed growth hormone (GH), Insulin-like growth factor-1 [IGF-1], fasting insulin, and glucose). The control group (n = 120) for colonoscopy was adult subjects undergoing evaluation for symptoms of irritable bowel syndrome. Clinical and biochemical parameters in acromegalic patients with colonic polyp were compared to those without a polyp.

RESULTS

Patients with acromegaly had significantly higher prevalence of colonic polyp as compared to control subjects (10.6% vs. 0.8%). None of the patients with polyp had skin tags. There was no significant difference between subjects with and without colonic polyp in duration of illness, basal, and glucose-suppressed GH and most recent IGF-1. Fasting blood sugar was significantly higher (P < 0.05) in adenoma group after adjusting for age, body mass index (BMI), and insulin levels. Patients in adenoma group showed a trend toward male gender and younger age as compared to those without adenoma.

CONCLUSIONS

Subjects with acromegaly as compared to control have a higher prevalence of colonic polyps. There was no association of polyps seen with age, BMI, skin tags, homeostasis model assessment of insulin resistance index, duration of disease, and basal and glucose-suppressed GH and IGF-1 levels. There were no specific predictive factors detected. Screening full colonoscopy is recommended in all cases with acromegaly.

Giant Cell Tumor of Bone in Skeletally Immature Patients - A Clinical Perspective

INTRODUCTION

Giant cell tumors of skeleton are very rare in pediatric and adolescent population. Here we report two cases-one a fifteen year old child with swelling distal humerus and another a case of a thirteen year old child with pain and swelling proximal tibia.

CASE REPORT

A fifteen year old child presented to department of orthopedics of our institute with complaint of difficulty in moving upper limb and swelling distal humerus. Another patient who was a 13 years old male had painful ambulation and swelling in upper tibia. MRI followed by core needle biopsy was done in both the patients confirming the mass to be giant cell tumor which is quite rare in this age group. First patient was managed by wide excision and total elbow replacement and second one by curettage, cementation and augmentation with plate-screw construct.

CONCLUSION

Giant cell tumour of skeleton is highly uncommon in pediatric age group. It should be considered as one of the differential diagnosis of epiphyseo metaphyseal lesions in pediatric population in spite of its rarity.

Prevalence of diabetes and other health related problems across India and worldwide: An overview

Diabetes mellitus is a major source of mortality and morbidity along with an economic menace all over the world. In 2000, prevalence of diabetes worldwide was 171,000,000 and in 2030, it will be 366,000,000, nearly one in ten people globally will have some form of diabetes by 2035. There are some 382 million people living with the disease, but that could jump 55% by 2035. The total number of people in India with diabetes to be around 50.8 million in 2010, rising to 87.0 million by 2030 and it is estimated that by 2040 the numbers will increase upto 123.5 million. It has estimated that the prevalence of diabetes in rural populations is one-quarter that of urban population for India and other Indian sub-continent countries such as Bangladesh, Nepal, Bhutan, and Sri Lanka. Indian Council of Medical research (ICMR) revealed that a lower proportion of the population is affected in states of Northern India (Chandigarh 0.12 million, Jharkhand 0.96 million) as compared to Maharashtra (9.2 million) and Tamil Nadu (4.8 million). The National Urban Survey conducted across the metropolitan cities of India reported similar trend: 11.7 per cent in Kolkata (Eastern India), 6.1 per cent in Kashmir Valley (Northern India), 11.6 per cent in New Delhi (Northern India), and 9.3 per cent in West India (Mumbai) compared with (13.5 per cent in Chennai (South India), 16.6 per cent in Hyderabad (south India), and 12.4 per cent Bangalore (South India). Strengthening of health promotion activitiesin different settings, preventive health screening package, better treatment facilities and effective implementation can cure these problems worldwide.

Quantum Rényi relative entropies affirm universality of thermodynamics

We formulate a complete theory of quantum thermodynamics in the Rényi entropic formalism exploiting the Rényi relative entropies, starting from the maximum entropy principle. In establishing the first and second laws of quantum thermodynamics, we have correctly identified accessible work and heat exchange in both equilibrium and nonequilibrium cases. The free energy (internal energy minus temperature times entropy) remains unaltered, when all the entities entering this relation are suitably defined. Exploiting Rényi relative entropies we have shown that this "form invariance" holds even beyond equilibrium and has profound operational significance in isothermal process. These results reduce to the Gibbs-von Neumann results when the Rényi entropic parameter α approaches 1. Moreover, it is shown that the universality of the Carnot statement of the second law is the consequence of the form invariance of the free energy, which is in turn the consequence of maximum entropy principle. Further, the Clausius inequality, which is the precursor to the Carnot statement, is also shown to hold based on the data processing inequalities for the traditional and sandwiched Rényi relative entropies. Thus, we find that the thermodynamics of nonequilibrium state and its deviation from equilibrium together determine the thermodynamic laws. This is another important manifestation of the concepts of information theory in thermodynamics when they are extended to the quantum realm. Our work is a substantial step towards formulating a complete theory of quantum thermodynamics and corresponding resource theory.

Declining trend of resistance to first-line anti-tubercular drugs in clinical isolates of Mycobacterium tuberculosis in a tertiary care north Indian hospital after implementation of revised national Tuberculosis control programme

Trends showing drug-resistance pattern are needed to understand direction of tuberculosis (TB) control programme. The drug-resistance pattern in state of Uttar Pradesh, India, is not documented. Here we are reporting the prevalence of multi-drug-resistant (MDR) and drug-resistant TB in previously treated cases of pulmonary tuberculosis following launch of revised national TB control programme (RNTCP) in whole of Uttar Pradesh. Isolates of Mycobacterium tuberculosis, from patients of pulmonary tuberculosis, who were treated with antitubercular drugs for more than 4 weeks, were tested for resistance to first-line drugs; streptomycin (S), Ethambutol (E), Rifampicin (R) and isoniazid (H) over a period of 4 years, 2009-2012. Total 2496 isolates of M. tuberculosis were tested, of which 1139 isolates (45.6%) were pan-sensitive and 370 (14.8%) were pan-resistant. Total 695 isolates (27.8%) were MDR. Maximum resistance was with Isoniazid (n=1069, 42.8%) followed by streptomycin (n=840, 33.7%), rifampicin (n=742, 29.7%), and ethambutol (n=613, 24.6%). A decline in number of MDR strains and individual drug resistance was seen. Total MDR strains in the year 2009, 2010, 2011 and 2012 were 35.6%, 30.8%, 26.7% and 22.8% respectively. The drug resistance pattern reported from time to time may vary substantially. The decline in drug resistance visible over last four years, after implementation of DOTS, appears promising.

Bovine Circadian Locomotor Output Cycles Kaput (CLOCK) and Clusterin (CLU) mRNA Quantitation in Ejaculated Crossbred Bull Spermatozoa

Mammalian circadian locomotor output cycles kaput (CLOCK) gene encodes a transcription factor that affects both the persistence and the period of circadian rhythms. Earlier reports suggested that CLOCK gene might be associated with male infertility in human. Present investigation, for the first time, reports that CLOCK gene expresses differentially between good and poor quality crossbred bull semen. The relative expression of CLOCK was significantly (p < 0.05) higher among good quality bull semen than motility-impaired ones. Clusterins (CLU) are series of genes associated with a variety of physiological activities including spermatogenesis, apoptosis and degenerative disease conditions. In the present context, we also investigated that the expression of CLU gene was significantly (p < 0.05) higher among motility-impaired crossbred bull semen compared to the good quality one.

Tyrosine hydroxylase in the olfactory system, forebrain and pituitary of the Indian major carp, Cirrhinus cirrhosus: organisation and interaction with neuropeptide Y in the preoptic area

Dopamine (DA) inhibits, whereas gonadotrophin-releasing hormone (GnRH) stimulates, luteinisiing (LH) cells in the pituitary of some but not all teleosts. A reduction in the hypophysiotropic dopaminergic tone is necessary for the stimulatory effect of GnRH on LH cells. Neuropeptide Y (NPY) has emerged as one of the potent, endogenous agent that modulates LH secretion directly or indirectly via GnRH. Involvement of NPY in the regulation of hypophysiotropic DA neurones, however, is not known, but there is good evidence suggesting an interaction in the mammalian hypothalamus. DA neurones, identified by tyrosine hydroxylase (TH)-immunoreactivity, were observed widely throughout the brain of the Indian major carp, Cirrhinus cirrhosus. The granule cells and ganglion cells of terminal nerve in the olfactory bulb, and cells in ventral telencephalon and preoptic area (POA) showed conspicuous TH immunoreactivity. In the POA, the nucleus preopticus periventricularis (NPP), divisible into anterior (NPPa) and posterior (NPPp) components, showed prominent TH-immunoreactivity. The majority of TH neurones in NPPa showed axonal extensions to the pituitary and were closely associated with LH cells. The NPPa also appeared to be the site for intense interaction between NPY and DA because it contains a rich network of NPY fibres and few immunoreactive cells. Approximately 89.7 ± 1.5% TH neurones in NPPa were contacted by NPY fibres. Superfused POA slices treated with a NPY Y2 -receptor agonist, NPY 13-36 resulted in a significant (P < 0.001) reduction in TH-immunoreactivity in NPPa. TH neurones in NPPa did not respond to NPY Y1 -receptor agonist, [Leu(31) , Pro(34) ] Neuropeptide Y treatment. We suggest that, by inhibiting DAergic neurones in NPPa via Y2 -receptors, NPY may contribute to the up-regulation of the GnRH-LH cells axis. The microcircuitry of DA and NPY and their interaction in NPPa might be a crucial component in the central regulation of LH secretion in the teleosts.

Genetic polymorphism and association of kappa-casein gene with milk production traits among Frieswal (HF × Sahiwal) cross breed of Indian origin

The aim of the present study was to screen the genotype profile of bovine kappa-casein gene among Frieswal (HF × Sahiwal) crossbred cattle developed in India. A total number of two hundred Frieswal cows were evaluated for HinfI RFLP based genotyping of kappa-casein gene. We observed that only two genotypes (AA and AB) exist among the studied population with the genotype frequency of 0.58 (n=117) and 0.42 (n=83), respectively. The calculated allele frequency for A and B was 0.79 and 0.21, respectively. Association of genotypes with certain milk production traits revealed that AB had significant (P<0.05) effect on total milk yield, peak yield, yield at 300 days and SNF% as compared to AA.

A prospective double blind study comparing the effects of oxytocin and human chorionic gonadotrophin as trigger for ovulation

This study was undertaken to compare the effect of oxytocin and human chorionic gonadotrophin (hCG) on ovulation and conception. A total of 100 women with anovulatory infertility were allocated into two equal groups to take clomiphene citrate plus hCG or clomiphene citrate plus oxytocin. The size and number of follicles by transvaginal sonography determined the administration of hCG or oxytocin. The serum progesterone concentration was measured to provide evidence for ovulation. The ovulation and pregnancy rate of the two groups were compared. There was no significant difference between the groups with respect to mean number of follicles, mean follicular size and rate of ovulation in three cycles. The rate of pregnancy was higher in the oxytocin group compared with the hCG group (12% vs 4%) but it failed to reach statistical difference (p = 0.140). Mild pain was the only side-effect observed in the two groups. Oxytocin was found to be a viable alternative to hCG for triggering ovulation in infertile patients.

General principles and methods for routine automated microRNA in situ hybridization and double labeling with immunohistochemistry

MicroRNAs (miRNAs) are small non-coding RNAs that modulate gene expression by binding to complementary sequences on target messenger RNA transcripts. Changes in the expression levels of specific miRNAs have been associated with a variety of disease conditions. We developed a reliable and high throughput in situ hybridization (ISH) method and optimized tissue fixation conditions for formalin fixed, paraffin embedded (FFPE) tissues. ISH methods were automated to visualize four miRNAs: miRNA-145 (smooth muscle cells), miRNA-126 (endothelial cells), miRNA-21 (neoplastic cells) and U6 small nuclear RNA (nuclear marker) using locked nucleic acid (LNA) probes and the Discovery Ultra Ventana(™) platform. The FFPE tissue sections were pretreated with protease 3, hybridized with probe concentrations of ≤ 25 nM; signal was detected using an enhanced, polymer-based detection method. The ISH signal was stronger and more uniform for tissue samples fixed for ≥ 48 h. To investigate the specificity of the method, we developed an automated dual ISH for miRNA-145 coupled with immunohistochemistry for smooth muscle actin, which confirmed the specific distribution of miRNA-145 to smooth muscle cells. These methods may be used routinely for exploratory studies of biomarker development, sample screening and understanding the role of miRNA in the pathophysiology of specific diseases.

Patterns and determinants of dyslipidaemia in 'Young' versus 'Not so Young' patients of coronary artery disease: a multicentric, randomised observational study in northern India

AIMS

The aims of the study were to ascertain difference in lipid levels of 'Young' onset of coronary artery disease (CAD) (≤ 45 years) vs. 'Not so Young' onset of CAD (≥ 55 years) among north Indians and also to investigate determinants of 'dyslipidaemia' in CAD patients.

METHODS

This was a prospective, multicentric, randomised, observational study carried in eight centres of UP, India. All blood investigations were performed employing a central laboratory.

RESULTS

Out of a total 435 patients studied, 218 were in the 'young group' (YG) and 235 were in the 'Not so Young Group' (NSYG). Dyslipidaemia was more common in YG as evident by significantly higher levels of total cholesterol, triglycerides, low- and very low-density lipoprotein cholesterol as compared to NSYG. Diabetes, hypertension, urban lifestyle, and family history of CAD were found to be important determinants of dyslipidaemia in YG.

CONCLUSION

We conclude that lipid levels among north Indians are significantly higher in younger patients with CAD when compared with elderly.

Syndromic versus nonsyndromic atlantoaxial dislocation: do clinico-radiological differences have a bearing on management?

BACKGROUND

This prospective study attempts to study the clinico-radiological differences between patients with syndromic AAD (SAAD), non-syndromic AAD (NSAAD), and AAD with Klippel-Feil anomaly (AADKFA) that may impact management.

METHODS

In 46 patients with AAD [SAAD (including Morquio, Down, Larson and Marshall syndrome and achondroplasia; n = 6); NSAAD(n = 20); and, AADKFS (n = 20)], myelopathy was graded as mild (n = 17, 37 %), moderate (15, 32.5 %) or severe (14, 30.5 %) based on Japanese Orthopaedic Association Score modified for Indian patients (mJOAS). Basilar invagination (BI), basal angle, odontoid hypoplasia, facet-joint angle, effective canal diameter, Ishihara curvature index, and angle of retroversion of odontoid and vertebral artery (VA) variations were also studied.

STATISTICS

Clinico-radiological differences were assessed by Fisher's exact test, and mean craniometric values by Kruskal-Wallis test (p value ≤ 0.05 significant)

RESULTS

Incidence of irreducible AAD in SAAD (n = 0), NSA AD (11.55 %) and AADKFS (n = 18.90 %) showed significant difference (p = 0.01). High incidence of kyphoscoliosis (83 %) and odontoid hypoplasia (83 %) in SAAD, and assimilated atlas and BI in NSAAD and AADKFA groups were found. In AADKFA, effective canal diameter was significantly reduced(p = 0.017) with increased Ishihara index and increased angle of odontoid retroversion; 61 % patients had VA variations. Thirty-five patients underwent single-stage transoral decompression with posterior fusion (for irreducible AAD) or direct posterior stabilization (for reducible AAD). Postoperative mJOAS evaluation often revealed persistent residual myelopathy despite clinical improvement.

CONCLUSIONS

Myelopathy is induced by recurrent cord trauma due to reducible AAD in SAAD, and compromised cervicomedullary canal diameter in NSAAD and AADKFA. SAAD in children may be missed due to incomplete odontoid ossification or coexisting angular deformities. In AADKFA, decisions regarding vertebral levels to be included in posterior stabilization should take into consideration intact intervening motion segments and compensatory cervical hyperlordosis. Following VA injury, endovascular primary vessel occlusion/stenting across pseudoaneurysm preempts delayed rehemorrhage.

A comparative evaluation of local application of the combination of eutectic mixture of local anesthetics and capsaicin for attenuation of venipuncture pain

BACKGROUND

Topical capsaicin and eutectic mixture of local anesthetics (EMLA) have been found to be equally effective in minimizing the pain of venipuncture. After the injection of capsaicin, both tertiary amine local anesthetics and their quaternary ammonium derivatives can elicit a prolonged and predominantly sensory/nociceptor selective block. We hypothesized that the combined application of capsaicin and ELMA will be more effective than their individual effect, and lower concentrations of individual drugs in this mixture may also be associated with reduced side effects.

METHODS

One hundred twenty patients were randomized into 4 equal groups. The control group received plain lubricant cream; the EMLA group received EMLA cream; the capsaicin group received Myolaxin ointment (containing oleoresin capsaicin equivalent to capsaicin 0.075% w/w, methylsalicylate IP 20% w/w, menthol IP 10% w/w, camphor USP 5% w/w, and eucalyptus oil IP 5% w/w); and the EMLA + capsaicin group received EMLA cream and Myolaxin ointment mixed in equal amounts. An anesthesiologist applied the cream to a 10-cm(2) area (site of venous cannulation) on the dorsum of the nondominant hand of the patient 1 hour before venipuncture and covered the area with an occlusive transparent dressing. Venipuncture was performed with an 18-gauge cannula after removing the dressing. Venipuncture pain was graded by the patient on a 0 to 10 visual analog scale, where 0 means no pain and 10 means worst imaginable pain. P values (after correction for multiple comparisons) of <0.05 were considered significant.

RESULTS

The incidence of no pain on venous cannulation (primary end point) was 0% in the control group (0/30). The incidence of no pain were significantly higher in the EMLA group (32%, 9/28, 95% corrected confidence interval for the difference 12%-57%, P = 0.0025), capsaicin group (30%, 9/30, 10%-53%, P = 0.0031), and EMLA + capsaicin groups (47%, 14/30, 25%-69%, P < 0.0001). Severity of venipuncture pain as assessed by visual analog scale median (interquartile range) was lower in the EMLA + capsaicin group 1 (2) compared with other groups 3 (1), 1.5 (3), and 1.5 (3) for control, EMLA, and capsaicin, respectively (P < 0.001, P = 0.04, and P = 0.04, respectively).

CONCLUSION

We observed that the combination of capsaicin and EMLA in a low concentration is as effective in managing venous cannulation as when applied as an individual drug alone. Larger studies with varying concentration of capsaicin and EMLA are recommended to more fully evaluate the potential advantages.

Large and giant vestibular schwannomas: does cisterna magna hyperproteinorrhachia influence visual status?

BACKGROUND

Hyperproteinorrhachia associated with vestibular schwannomas (VSs) may influence visual status independent of the effect caused by raised intracranial pressure. The role of cisterna magna CSF protein levels (CMCP) in determining visual outcome in patients with large to giant vestibular schwannomas (VSs) was prospectively investigated.

METHODS

The mean CMCP levels in VSs and control group; and, levels in VSs with or without visual deterioration were compared. Spearman's rank correlation coefficient tested for relationships between CMCP level with symptom duration and tumour volume (Kawamoto's method). Vision was regarded as normal when visual acuity was >6/18; and, deteriorated when it was between 6/18 and PL negative in the worse eye. Papilloedema (n = 26)/secondary optic atrophy (n = 6) and hydrocephalus (based on Evan's ratio, mild to moderate: n = 22; none: n = 18) were also recorded. The analysis of factors predicting diminished vision was done using logistic regression analysis (p < 0.05 significant).

FINDINGS

There was a significant difference (p < 0.001) in mean CMCP levels between VS (456.3 SD 213.6 mg/dl) and control groups (96.3 SD 74.3 mg/dl). The mean CMCP levels in the VS group were also markedly higher than the ventricular mean protein levels. The CMCP levels in patients with visual diminution (<6/18 to PL negative; n = 23) was 561.4 SD 186.9 mg/dl and those without visual loss (n = 17) was 314.2 SD 160.8 mg/dl (p < 0.001). Their grade of visual diminution had a positive correlation with mean CMCP levels (p < 0.001). There was a negative correlation between total duration of symptoms and CMCP levels (p < 0.015). Logistic regression analysis using five independent factors (symptom duration, papilloedema/secondary optic atrophy, tumour volume, hydrocephalus and mean CMCP level) revealed that only CMCP level had a significant association with visual diminution.

CONCLUSION

Elevated cisternal CSF proteins may play an important role in determining visual outcome in large to giant VSs. Ventricular CSF analysis is often unable confirm the presence of VS-associated cisternal hyperproteinorrhachia. High CMCP levels may influence decision-making while instituting a permanent CSF diversion for postoperative hydrocephalus or recalcitrant pseudomeningocoele.

Interaction between dopamine- and isotocin-containing neurones in the preoptic area of the catfish, Clarias batrachus: role in the regulation of luteinising hormone cells

Apart from gonadotrophin-releasing hormone (GnRH) and dopamine (DA), oxytocin has emerged as an important endogenous agent that regulates reproduction. Although the interaction between these factors has been extensively studied in mammals, parallel information in teleosts is much limited. We studied the organisation of tyrosine hydroxylase (TH; a marker for dopamine) and isotocin neurones in the preoptic area (POA) and hypothalamus of the catfish, Clarias batrachus and its implication in the regulation of luteinising hormone (LH) cells in the pituitary. Nucleus preopticus periventricularis (NPP), a major dopaminergic centre in the brain, consists of anterior (NPPa) and posterior (NPPp) subdivisions. Using retrograde neuronal tracing, we found that majority of the DA neurones in NPPa, but none from NPPp, project to the pituitary. The nucleus preopticus (NPO) of C. batrachus contains a conspicuous assemblage of large isotocin-positive neurones. It consists of a paraventricular subdivision (NPOpv) located on either side of the third ventricle and lies roughly sandwiched between the dopaminergic neurones of NPPa and NPPp. An additional subset of isotocin neurones was located above the optic chiasm in the supraoptic subdivision of the NPO (NPOso). Isotocin-containing neurones in both the subdivisions of NPO were densely innervated by DA fibres. Superfusion of the POA-containing brain slices with DA D(1) -like receptor agonist (SKF-38393) resulted in significant increase in isotocin immunoreactivity in the NPOpv neurones; NPOso neurones did not respond. However, treatment with DA D(2) -like receptor agonist (quinpirole) reduced isotocin immunoreactivity in the NPOso, but not in the NPOpv. Thus, DA appears to differentially regulate the components of isotocinergic system. Isotocin fibres extend to the pituitary and terminate on LH cells and the superfused pituitary slices treated with isotocin caused significant reduction in LHβ-immunoreactivity. An elaborate interplay between the DA and isotocin systems appears to be an important component of the LH regulatory system.

Evaluation of the changes in serum iron levels in pre-eclampsia

Serum iron levels were studied in 50 patients with pre-eclampsia and the results were compared with 50 control cases. Their serum iron levels were found to be higher than the controls. Increase in serum iron was directly proportional to the increased levels of uric acid, urea and creatinine. Mean reticulocyte counts, plasma free haemoglobin and unconjugated bilirubin levels were also higher in these patients. It is suggested that haemolysis may be a major contributory factor for the increased levels of serum iron in pre-eclampsia.