High prevalence of poor sleep quality among secondary school students in Malaysia

No abstract provided.

Live birth following in vitro fertilization in a breast cancer survivor: A case report and review of literature

The well-being of young cancer survivors is hampered due to the toxic effects of chemotherapy on the ovaries, resulting in infertility. We report a case of a 42-year-old woman with a history of bilateral ductal carcinoma of the breast who underwent radical mastectomy with chemotherapy and radiotherapy was anxious to conceive. In vitro fertilization was performed with donor oocyte; the patient became pregnant and delivered a full term baby with no congenital anomalies. As very few have a background for providing guidance and treatment in this setting, this report highlights the possibility of improving the quality of reproductive life of young survivors by various assisted reproductive techniques, the importance of fertility preservation and a multidisciplinary team approach.

Molecular evolution and functional characterisation of haplotypes of an important rubber biosynthesis gene in Hevea brasiliensis

Hydroxy-methylglutaryl coenzyme-A synthase (HMGS) is a rate-limiting enzyme in the cytoplasmic isoprenoid biosynthesis pathway leading to natural rubber production in Hevea brasiliensis (rubber). Analysis of the structural variants of this gene is imperative to understand their functional significance in rubber biosynthesis so that they can be properly utilised for ongoing crop improvement programmes in Hevea. We report here allele richness and diversity of the HMGS gene in selected popular rubber clones. Haplotypes consisting of single nucleotide polymorphisms (SNPs) from the coding and non-coding regions with a high degree of heterozygosity were identified. Segregation and linkage disequilibrium analysis confirmed that recombination is the major contributor to the generation of allelic diversity, rather than point mutations. The evolutionarily conserved nature of some SNPs was identified by comparative DNA sequence analysis of HMGS orthologues from diverse taxa, demonstrating the molecular evolution of rubber biosynthesis genes in general. In silico three-dimensional structural studies highlighting the structural positioning of non-synonymous SNPs from different HMGS haplotypes revealed that the ligand-binding site on the enzyme remains impervious to the reported sequence variations. In contrast, gene expression results indicated the possibility of association between specific haplotypes and HMGS expression in Hevea clones, which may have a downstream impact up to the level of rubber production. Moreover, haplotype diversity of the HMGS gene and its putative association with gene expression can be the basis for further genetic association studies in rubber. Furthermore, the data also show the role of SNPs in the evolution of candidate genes coding for functional traits in plants.

Pericentric inversion of chromosome 9 causing infertility and subsequent successful in vitro fertilization

One of the most common and benign variants of normal human karyotype is pericentric inversion of chromosome 9 (inv[9][p11q13]). Despite being categorized as a normal variant, there are several reports of its association with various disease conditions. Here, we report a 27 year old female, who presented to us with primary infertility. The woman was diagnosed with inv (9)(p11q13) which was acknowledged as the reason for her otherwise unexplained infertility. The couple thereupon underwent in vitro fertilization using donor oocyte resulting in live birth. The clinical significance of this minor chromosomal rearrangement, need for genetic counseling, and subsequent reproductive guidance is highlighted in this report.

Successful pregnancy following single blastocyst transfer in a renal transplant recipient

Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients.

Vitamin D insufficiency among children with cancer in India

BACKGROUND

Vitamin D plays an important role in regulating various homeostatic mechanisms and has yet untapped potential in cancer prevention and prognosis. Only a few studies have been done worldwide in relating the Vitamin D levels in pediatric cancer patients to the general population but none so far in an Indian setting to the best of our knowledge.

OBJECTIVE

To compare the Vitamin D levels in a group of children with cancer to that of the general pediatric population and to note differences in the prevalence of Vitamin D insufficiency and make inferences arising from demographic and therapeutic variations.

MATERIALS AND METHODS

Vitamin D levels were found by immuno-chemilumino-metric assay in 102 children (51 cases and 51 controls) over a 6 months period.

RESULTS

In comparing the Vitamin D levels of children with cancer and controls from a healthy population we found an increased incidence of Vitamin D insufficiency in cancer children (80.39%) when compared to controls (50.98%) and a much lower mean Vitamin D value in cancer children (22.8 ng/ml) when compared to controls (33 ng/dl). It was also found that cancer children above 6 years had a greater chance for developing Vitamin D insufficiency (P = 0.038) as did children suffering from hematological malignancies (P = 0.025).

CONCLUSION

Our study showed an increased prevalence of Vitamin D insufficiency in children with cancer and hence we suggest routine measurement of Vitamin D levels in children with cancer and subsequent supplementation.

Does diffusion restriction changes in magnetic resonance imaging predict neurological outcome in neonatal seizures?

BACKGROUND

Neonatal seizures are a common manifestation of brain dysfunction. Neonatal magnetic resonance imaging (MRI) has rapidly become the study of choice for the evaluation of central nervous systems disorders in newborns. According to a study conducted in Wilhelmina Children's Hospital, University Medical Center Utrecht, diffusion Restriction (DR) changes in the MRI is a good indicator of cell dysfunction (reversible or irreversible) within one week of insult.

OBJECTIVES

The main aim of this study was to find the association of DR changes in MRI of brain for neonatal seizures with long term neurodevelopment outcome.

METHODS

This is a retrospective observational study conducted in Sri Ramachandra University. Retrospective data was collected for the time period of January 2010 to December 2011 from medical records department (MRD) for patient data, neonatal intensive care unit and reports from PACS for MRI images and the Karthikeyan child development unit for their developmental follow up reports.

RESULTS

Comparison of composite score for various domains with DR changes was done with a t-test and comparison of babies with developmental delay and DR changes with Chi-square test. MRI DR changes with developmental outcome in different domains namely cognition, language-receptive/expressive, fine and gross motor was studied. There is no statistical significance among those who have DR changes and with those who do not have DR changes.

CONCLUSION

Though diffusion restriction changes in MRI may not predict adverse long term neuro developmental outcome, they can be of use with regards to individual etiological profile as in stroke. Larger group study and long term follow up is required to substantiate these findings.

Knowledge, attitude, and awareness of childhood cancer among undergraduate medical students in South India

Background:

In India roughly 60000 childhood cancer cases are diagnosed annually with only nearly 100 pediatric oncologists. So it's pertinent that the physicians and pediatricians are adequately equipped to recognize and refer them appropriately. Hence this study was conducted to assess the knowledge, attitude and awareness of childhood cancer among undergraduate medical students in South India.

Materials and Methods:

The study was conducted among 240 undergraduate students from all over South India in a undergraduate pediatric clinical training. A 24 point questionnaire was given to assess their understanding of pediatric malignancies and their interest towards pediatric oncology. Statistical analysis was done with SPSS 18.V software.

Results:

50% were interested in pursuing pediatrics as their career but 80% of them were not interested in pursuing pediatric oncology as their career. 55% of the students have not encountered any pediatric oncology patients in the ward. 40% did not have any lecture classes on pediatric oncology. 65.5% felt that their knowledge of childhood cancer did not make them competent to suspect and refer appropriately during their practice. 84% supported that there is a need to improve pediatric oncology teaching in their medical curriculum.

Conclusions:

The study unambiguously states that the future physicians lack confidence in identifying and managing childhood malignancies and pediatric oncology is far down in their career options. There is a need to reform the undergraduate medical students by increasing their exposure to pediatric oncology to improve their competence levels and interest in pursuing it as a career also.

Two cases of suprascapular neuropathy in a family

Suprascapular entrapment neuropathy is well known in certain athletes, especially volleyball players. A brother and sister presented with right shoulder pain and wasting of the scapular muscles, particularly the infraspinatus. They had played volleyball for over six years and were forced to retire because of disability. Investigations showed involvement of the rhomboid muscles also, suggesting a probable extension of this syndrome to other nerves in the region such as the dorsal scapular nerve.

Paraquat poisoning with acute renal failure--a case report

Paraquat poisoning is relatively rare and is associated with mortality varying from 35 to 50%. A patient who consumed paraquat developed features of non-oliguric acute renal failure and recovered following haemodialysis. Renal biopsy done during the early recovery phase showed features of acute tubulo-interstitial nephritis with no disruption of tubular basement membrane. On recovery the patient had no evidence of proximal renal tubular dysfunction.

Communicating cystic craniopharyngioma

The case of a 12-year-old boy, who presented with a suprasellar cystic craniopharyngioma that freely communicated with the third ventricle, as demonstrated by ventriculography, is reported. This observation was confirmed at autopsy. The literature is reviewed briefly and the compatibility with life is discussed.

Carpal tunnel syndrome: an unusual presentation of brachial hypertrophy

A patient with carpal tunnel syndrome in association with congenital hypertrophy of right upper limb is described. The median nerve also showed hypertrophy. The symptoms were relieved by decompression of the carpal tunnel.

"Grand mal type" of spike discharge as interseizure phenomenon

Grand mal type of sequential spike discharges at 8-12 cps are rare as interseizure phenomena. When the grand mal component is prominent, it usually indicates a greater tendency for major convulsions. The case of a 15 year old girl who developed akinetic seizures along with her menarche and whose electroencephalogram showed recurring sharp waves at 10-11 cps, is reported, and its clinical significance discussed.

Cauda equina compression presenting as spontaneous priapism

Disturbance of autonomic function is an unusual feature of compression of the cauda equina. A 61 year old man who had complete occlusion of the lumbar spinal canal with compression of the cauda equina from a large centrally prolapsed disc, had spontaneous priapism, precipitated by walking and relieved by resting. This symptom was comparable to claudication by compression of cauda equina. It subsided completely after surgical removal of a prolapsed L4-5 disc.

Toxic encephalopathy from chlorobenzilate poisoning: report of a case

Chlorobenzilate is an organochlorine insecticide with toxicity like those of Dichlorodiphenyltrichloroethane (DDT). A patient who developed toxic encephalopathy after exposure to chlorobenzilate mist, with associated clinical and EEG abnormalities, is briefly reported. Some unusual features of his clinical picture are pointed out.

Single case study. Contact epilepsy: a rare form of reflex epilepsy

An 80-year-old male is presented who had violent myoclonic seizures with occasional brief loss of consciousness, triggered by tactile stimuli directed to the upper extremities and upper part of the trunk which evolved over a 10-year period. Physical examination revealed very few neurological abnormalities. His resting electroencephalograms were normal, but generalized spikes, polyspikes, and slow wave discharges were precipitated by tactile stimuli with the patient sitting up. He showed no significant response to standard anticonvulsant therapy. The relevant literature is reviewed briefly.

Focal cerebral dysrhythmia--presenting as headache: report of a case

A 14 year old girl developed persistent headache of 6 weeks duration, which she described as a feeling of pressure, accompanied by dizziness, nausea and vomiting. Her EEG showed focal slow waves arising from the right temporo-occipital region. All other investigations were negative. Other medication was ineffective but she responded well to standard anticonvulsant therapy, and her EEG abnormality became minimal. In a case with focal slowing and pain and other handicapping symptoms, which do not respond to other remedies, a trial of antiepileptic medication is indicated even in the absence of clinical seizures and/or EEG evidence of seizure activity.