Genomic profiling of thousands of candidate polymorphisms predicts risk of relapse in 778 Danish and German childhood acute lymphoblastic leukemia patients

Childhood acute lymphoblastic leukemia survival approaches 90%. New strategies are needed to identify the 10-15% who evade cure. We applied targeted, sequencing-based genotyping of 25 000 to 34 000 preselected potentially clinically relevant single-nucleotide polymorphisms (SNPs) to identify host genome profiles associated with relapse risk in 352 patients from the Nordic ALL92/2000 protocols and 426 patients from the German Berlin-Frankfurt-Munster (BFM) ALL2000 protocol. Patients were enrolled between 1992 and 2008 (median follow-up: 7.6 years). Eleven cross-validated SNPs were significantly associated with risk of relapse across protocols. SNP and biologic pathway level analyses associated relapse risk with leukemia aggressiveness, glucocorticosteroid pharmacology/response and drug transport/metabolism pathways. Classification and regression tree analysis identified three distinct risk groups defined by end of induction residual leukemia, white blood cell count and variants in myeloperoxidase (MPO), estrogen receptor 1 (ESR1), lamin B1 (LMNB1) and matrix metalloproteinase-7 (MMP7) genes, ATP-binding cassette transporters and glucocorticosteroid transcription regulation pathways. Relapse rates ranged from 4% (95% confidence interval (CI): 1.6-6.3%) for the best group (72% of patients) to 76% (95% CI: 41-90%) for the worst group (5% of patients, P<0.001). Validation of these findings and similar approaches to identify SNPs associated with toxicities may allow future individualized relapse and toxicity risk-based treatments adaptation.

Rapid eye movement sleep behaviour disorder in young- and older-onset Parkinson disease: a questionnaire-based study

BACKGROUND

Rapid eye movement sleep behavior disorder (RBD) is common in Parkinson disease (PD).

OBJECTIVES

To determine the frequency of clinically probable RBD (cpRBD) in young-onset (21 to < or =40 years; YOPD) and older-onset PD (>40 years; OOPD) and characterize its pattern.

METHODS

A total of 156 patients with PD (YOPD-51, OOPD-105) were clinically examined and the presence of RBD was diagnosed using the minimal criteria for diagnosis of RBD (International Classification of Sleep Disorders, ICSD-1). RBD screening questionnaire based on the minimal criteria was used. The bed-partners were also interviewed with Mayo sleep questionnaire. Other scales included Unified Parkinson Disease Rating Scale part III (UPDRS III), Hoehn & Yahr stage, Mini Mental Status Examination, Pittsburgh Sleep Quality Index, Parkinson Disease Sleep Scale, Epworth Sleep Scale, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale.

RESULTS

cpRBD was diagnosed in 30 (19.2%) patients, majority being OOPD rather than YOPD (86.7% vs. 13.3%; P=0.01). The frequency of RBD was significantly higher (P=0.016) in OOPD (24.8%) compared to those with YOPD (7.8%). Most often (72.4%) RBD occurred after the onset of parkinsonian symptoms. RBD was independently associated with higher global PSQI scores, total ESS scores and total PDSS scores after adjusting for the effects of age, gender, Hoehn & Yahr stage and duration of illness.

CONCLUSIONS

Patients with RBD were older with later-onset motor symptoms, a more advanced stage, poorer sleep quality, and more frequent daytime sleepiness. Older-onset PD had a higher frequency of RBD than young-onset PD.

Association between cortical volume loss and cognitive impairments in essential tremor

BACKGROUND AND PURPOSE

Impairment of cognitive functions occurs in essential tremor (ET) although the mechanism is largely unknown. A possible association between cognitive performance and brain atrophy in ET patients was examined using neuropsychological tests and voxel-based morphometry (VBM).

METHODS

Twenty-five patients with ET and 25 matched healthy controls were evaluated. ET was diagnosed using the National Institutes of Health collaborative genetic criteria. Severity of tremor was assessed using the Fahn-Tolosa-Marin (FTM) tremor rating scale. Subjects were assessed using a structured neuropsychological battery. Brain images were acquired using a 3T magnetic resonance imaging scanner. VBM analysis was performed using Statistical Parametric Mapping 8.

RESULTS

The age of the patients was 45.0 ± 10.7 years and of controls 45.4 ± 10.7 years. Tremor duration was 9.84 ± 6.63 years and total FTM score was 37.34 ± 17.67. Patients were divided into two groups: ETCI with cognitive impairment (three or more abnormal neuropsychological tests, 1.5 standard deviation criterion) and ETNCI without cognitive impairment. Compared with controls, the ETCI group had significantly impaired performance in neuropsychological tests. One-way analysis of variance was performed between the three groups (ETCI, ETNCI, controls) followed by the two-sample t test. Compared with controls, grey matter volume (GMV) loss was observed in ETCI in the cerebellum (anterior and posterior lobes) and medial frontal gyrus. GMV loss was observed in ETCI compared with ETNCI in the medial frontal gyrus, post central gyrus, anterior cingulate and insula. Impairment in neuropsychological tests significantly correlated with GMV of the medial frontal gyrus, superior parietal lobe, middle temporal gyrus, occipital lobe, lentiform nucleus, insular and cingulate cortices and cerebellum posterior lobe in ETCI.

CONCLUSIONS

A correlation between neurocognitive deficits in ETCI and GMV was observed suggesting that grey matter atrophy appears to be a correlate of cognitive impairment in ET.

Dietary intake of trace elements, minerals and vitamins among severely malnourished children and its interrelationship with nutritional status:A prospective study

Dietary deficiency of trace elements, minerals and vitamins has been associated with severe malnutrition among young children. Although levels of severe malnutrition among children are high in developing countries, data on dietary intake of trace elements, minerals, vitamins and other nutrients by severely malnourished (SMN) children are limited. The present prospective study was conducted for a period of 12 months in order to assess the intake of trace elements, minerals, vitamins and other nutrients by SMN children and its possible interrelationship with their nutritional status. The nutritional status of 1643 children in the age group of 6 months to < 6 years, registered at 50 Anganwadi centres at district Alwar and Bharatpur in Rajasthan in India, was assessed using weight-for-age criteria. A total of 150 children were identified as severely malnourished. Mothers of 130 of the children consented to their children's participation in the study. At the end of 12 months, full data was available for 60 of the 130 SMN children. The nutritional status and intake of trace elements, minerals, vitamins and other nutrients of the 60 SMN children were analysed at monthly follow-up visits. Results revealed that there was an increase in the intake of trace elements, minerals and other nutrients during the follow-up period as compared to the baseline survey. However, in all of the follow-up visits, an overall deficient intake of all of the trace elements, minerals, vitamins and other nutrients was observed in the SMN children except for protein, calcium and magnesium. Out of 60 children, 35 moved to higher nutritional grades. It was found that the intake of trace elements, minerals, vitamin and macro-nutrients was higher among children whose nutritional status improved as compared with the group that remained in the severe malnutrition category. The present study highlights that the existence of multiple trace element and vitamin deficiencies in the diets of SMN children could play a role in the severe malnutrition of these children.

Hyponatraemia in cancer patients on an inpatient rehabilitation unit

This study identifies the incidence of hyponatraemia in cancer patients on an inpatient rehabilitation unit and examines the association between admission hyponatraemia and rehabilitation length of stay (LOS), functional outcome, and survival. After institutional review committee's approval, we retrospectively reviewed medical records of 295 consecutive patients who were admitted to this inpatient cancer rehabilitation unit between 27 January 2009 through 31 July 2010 in a tertiary cancer centre. The incidence of hyponatraemia in cancer patients admitted to our inpatient rehabilitation unit was 41.4%. Median rehabilitation LOS for patients with mild (Na 130-134 mEq/L) and moderate-severe (Na < 130 mEq/L) hyponatraemia was 11 and 15 days, respectively, which was significantly longer than patients with eunatraemia (10 days; P = 0.03). Functional Independence Measure gain for ambulation and transfers during inpatient rehabilitation stay was not significantly different between three different patient groups. We concluded that large portion of patients who require acute inpatient rehabilitation presented with hyponatraemia, which is associated with prolonged rehabilitation LOS. Whether aggressive management of hyponatraemia will shorten rehabilitation stay needs further study.

Placenta Accreta: Obstetrician's Nightmare; A Case Series of Seven Patients

The incidence of placenta accreta is increasing as a consequence of rising number of cesarean sections and advancing maternal age. A series of seven cases of placenta accreta observed in a short span of four months is being presented. Complication rates in the present series are post partum hemorrhage and major transfusion support (100%), peripartum hysterectomy (100%), ICU admission in four (57%), fever (14%) and bladder injury in one case (14%). Nepal Journal of Obstetrics and Gynaecology / Vol 7 / No. 1 / Issue 13 / Jan- June, 2012 / 56-58 DOI: http://dx.doi.org/10.3126/njog.v7i1.8839

Development and validation of a sensitive enzyme immunoassay (EIA) for blood plasma cortisol in female cattle, buffaloes, and goats

A highly sensitive enzyme immunoassay (EIA) that used the second antibody coating technique and the cortisol-horseradish peroxidase conjugate as a label for determination of free and total cortisol in blood plasma of dairy animals (cows, buffaloes, and goats) was developed. For biological validation of the EIA, blood samples were collected from the animals at 48 and 24 h before and 0, 12, 24, 36, 48, 60, 72, 84, 96, 108, 120, and 132 h after dexamethasone administration. The EIA was performed directly with 20 μL of fresh plasma (for free cortisol) and also with 20 μL of heat-treated plasma (for total cortisol) after 1:5 dilutions with PBS. Cortisol standards ranging from 0.39 to 200 pg/well/20 μL were used, and the sensitivity of the EIA procedure was found to be 0.39 pg/well/20 μL, which corresponded to 0.02 ng/mL. In comparison with RIA the EIA was at least 4 times more sensitive and required 5 times less cortisol antiserum. In female cattle, buffaloes, and goats, the total, free, and bound plasma cortisol before dexamethasone administration was significantly (P < 0.05) higher than the total, free, and bound cortisol after dexamethasone administration. It can be concluded from these studies that the direct, sensitive EIA validated for estimating the free and total cortisol concentrations was sufficiently reliable and quick for studying the dynamics of cortisol distribution in blood plasma of dairy animals.

Molecular characterisation of drug resistance in Mycobacterium tuberculosis isolates from North India

SETTING

A tertiary care hospital in North India.

OBJECTIVES

To analyse the frequency of mutations associated with resistance to rifampicin (RMP), isoniazid (INH) and streptomycin (SM) in Mycobacterium tuberculosis.

DESIGN

M. tuberculosis isolates from 171 pulmonary tuberculosis (TB) patients (newly diagnosed 102, 59.6%; retreated 69, 40.3%) were analysed. Drug susceptibility testing was performed using the proportion method and resistant isolates were characterised using the polymerase chain reaction, followed by restriction fragment length polymorphism and/or DNA sequencing, to screen for mutations in rpoB, katG, mabA-inhA and rpsL.

RESULTS

Of the 171 isolates, 16.9% (29/171) were multidrug-resistant. Of the 102 newly diagnosed and 69 retreated cases, respectively 5.9% (6/102) and 33.3% (23/69) were multidrug-resistant. rpoB mutations were found in 100% (31/31) of the RMP-resistant isolates, the most common being S531L in 74.2% (23/31); katG315 mutations were found in 79.6% (35/44) of the INH-resistant isolates; however, no mabA-inhA (-15) mutation was found; rpsL mutations were found in 48.9% (24/49) of the SM-resistant isolates, and codon 43 mutation were found in 42.5% (21/49).

CONCLUSIONS

This study characterises drug resistance-associated mutations in M. tuberculosis, information that could be used for the rapid screening of drug-resistant TB.

Mucinous cystadenocarcinoma arising in an ectopic kidney simulating a retroperitoneal dermoid cyst: a rare tumour presenting as a diagnostic dilemma

Primary mucinous cystic neoplasms are rare tumours of the kidney, with a very few case reports in the literature. They arise from metaplasia of renal pelvic urothelium. We describe here a 45-year-old male who presented with pain in the abdomen and a lump in the left iliac fossa for two months. Ultrasound and CT scan showed a large, complex, heterogenous mass in the central abdomen and left iliac fossa, suggesting the possibility of dermoid cyst. Excision of the mass showed an enlarged multicystic kidney filled with mucin, destruction of renal parenchyma and a small viable area of grey white tumour. Histopathology revealed a peripherally located mucinous cystadenocarcinoma arising in the background of chronic pyelonephritis and mucinous metaplasia. We report this case for the rarity of the lesion and the associated clinical and radiological diagnostic dilemma.

Ayurvedic concepts related to psychotherapy

The perfect balance of mind, body and soul is considered as complete health in Ayurveda. Ayurveda has its own identity as most ancient and traditional System of Medicine in India. Even Ayurveda emphasizes its treatment modalities into three parts viz. Satwawajay Chikitsa, Yuktivyapashray and Daivyapashray Chikitsa. Sattvavajaya therapy mentioned in Charakasamhita and it used as new concept of psychotherapy in Ayurveda. The effectiveness of "traditional mental health promoting practices" was identified as health regimens (swasthvrtt), correct behavior (sadvrtt), and yoga. Sattvavajaya as psychotherapy, is the mental restraint, or a "mind control" as referred by Caraka, is achieved through "spiritual knowledge, philosophy, fortitude, remembrance and concentration. Ayurvedic psychotherapy would play a dual role: First, as a revival of authentic medical culture, the exercise of a practice with an assumed primordial dimension, and second as a discovery of authentic subjectivity, the revelation of a self with an assumed interior depth. When we integrate the contemporary art of psychotherapy with the ancient science of Ayurveda, it becomes a powerful combination that is called Psycho Veda. The integration of Psycho and Veda is motivated by the complete integration of the immense but fairly contemporary view of the mind, emotions and psyche and how this performs in our lives. Integrating Psychotherapy and Vedic principles teaches us how to rediscover critical knowledge and awareness of the natural forces and rhythms that compliment and strengthen our human experience, through the understanding of the psyche and what our inner experiences are and also involving practical daily activities with thorough attention to our total environment to bring about radical changes in our mental outlook and in physical health.