Current and proposed biomarkers of anthracycline cardiotoxicity in cancer: emerging opportunities in oxidative damage and autophagy

A biomarker is defined as "a characteristic that is objectively measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or biological responses to a therapeutic intervention". Biomarkers can be utilized to detect disease, evaluate treatment risks, or determine treatment effectiveness. In the case of cancer, anthracyclines such as doxorubicin are front-line therapy to treat a number of different malignancies including breast cancer. However, a significant fraction of patients experience drug-induced cardiotoxicity. This toxicity is dose-limiting and can cause long-term morbidity or mortality. There is an unmet medical need to identify patients who are at risk for doxorubicin-induced cardiotoxicity, to detect cardiac damage early so that patient risk can be minimized, and to monitor the success of cardioprotective strategies. Therefore, doxorubicin treatment of cancer is an excellent example of the need for biomarkers to indicate drug safety in addition to drug efficacy. In this review we will discuss the mechanism of doxorubicinassociated cardiotoxicity, as well as other cancer therapies that induce cardiac toxicity by causing oxidative damage. We will also evaluate established and proposed biomarkers for cardiotoxicity based on our evolving knowledge of oxidative damage and subsequent autophagy. Finally, we will discuss advantages of combining oxidative damage- and autophagy-based protein biomarkers with current biomarkers such as troponins to facilitate early detection and mitigation of cardiotoxicity induced by cancer therapeutic agents.

Predicting long-term outcome after endovascular stroke treatment: the totaled health risks in vascular events score

BACKGROUND AND PURPOSE

Endovascular treatments are being increasingly used in acute ischemic stroke, and better tools are needed to determine which patients may benefit most from these techniques. We hypothesized that specific chronic diseases can be used, along with age and stroke severity, to predict endovascular stroke treatment outcomes.

MATERIALS AND METHODS

Data from 2 single-arm trials of a thrombectomy device, MERCI and Multi MERCI, were pooled for analysis. A predictive score was developed by using the independent contribution of variables in multivariable analysis.

RESULTS

HTN, DM, and AFib were found to predict outcomes. These 3 conditions contribute equally to a CDS that predicts outcomes independent of other predictor variables, including age, stroke severity, and vessel recanalization. A 10-level predictive score, the THRIVE score, which incorporates age, stroke severity, and the CDS, was developed. The THRIVE score strongly predicts outcome and mortality at 90 days.

CONCLUSIONS

Specific chronic diseases influence poststroke outcomes among patients undergoing endovascular stroke treatment, independent of other predictors of outcome. The THRIVE score reflects the contributions of chronic disease, age, and stroke severity and strongly predicts endovascular stroke treatment outcomes.

Fetal birthweight and diastolic blood pressure: association with retinopathy in severe preeclampsia

PURPOSE

To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia.

METHODS

Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study. Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value < or =0.05 was considered significant.

RESULTS

The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SPshowed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy.

CONCLUSIONS

Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiencyand intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.

Mini-trabeculectomy in comparison to conventional trabeculectomy in primary open angle glaucoma

PURPOSE

To evaluate the safety and efficacy of mini-trabeculectomy in comparison to conventional trabeculectomy in primary open angle glaucoma (POAG).

METHODS

A prospective interventional study of mini-trabeculectomy versus conventional trabeculectomy was undertaken on 60 eyes of 54 medically uncontrolled POAG patients requiring glaucoma surgery. They were divided into two groups: Group I underwent mini-trabeculectomy (30 eyes of 26 patients) and Group II underwent conventional trabeculectomy (30 eyes of 28 patients). All patients were followed up for at least 15 months. Statistical analysis was carried using Student's t test and paired t test for quantitative data and Pearson's chi-square test for qualitative data.

RESULTS

The mean intraocular pressures (IOP) at the end of 15 months of follow-up in Groups I and II were 15.80+/-4.3 mmHg and 16.13+/-3.3 mmHg versus mean preoperative IOP of 28.63+/-2.74 and 28.60+/-2.44, p<0.0001, respectively. The difference in IOP control was significant only at 6 months of follow up (13.65+/-3.45 versus 15.98+/-4.05, p=0.041). The complications and failure were comparatively less in Group I.

CONCLUSIONS

Mini-trabeculectomy is a safe and effective alternative to conventional trabeculectomy in terms of IOP control. A modified tunnel incision employed in mini-trabeculectomy may be responsible for avoiding some of the complications.

Cysticercosis of the eye in South India--a case series

PURPOSE

To study the clinical presentation and treatment outcome of patients with ocular cysticercosis in southern India.

METHODS

This study included 10 patients who were diagnosed to have ocular or adnexal cysticercosis over a period of one year in Pondicherry, India. The clinical presentation, results of investigation and treatment outcome of the cases were analysed retrospectively.

RESULTS

Age of these patients ranged from 12 to 55 years. Four presented with loss of vision, two with a swelling in the eyelid, one with proptosis, one with diplopia and two with conjunctival involvement. ELISA for cysticercus antibodies in serum was positive in all cases. Albendazole and prednisolone were given for the treatment of these cases. Two patients responded well to treatment and were completely cured of the disease. There was partial improvement in 6 cases. Surgery in the form of excision was performed in two cases following a course of medical therapy. There was no significant change in visual acuity in eyes with intraocular cysticercosis following treatment.

CONCLUSION

Ultrasonography B scan and ELISA for anticysticercal antibodies help to establish the diagnosis of ocular cysticercosis. A combination of oral albendazole and corticosteroids is found to be effective in confirmed cases. Intraocular cysticercosis is associated with a poor prognosis for vision.

Acanthamoeba keratitis in Pondicherry

Acanthamoeba keratitis is a potentially devastating infection of the cornea caused by the free-living amoebae, Acanthamoeba species. During the period from 1997 to 2000, a total of 136 corneal scrapings from clinically suspected cases were screened and examined for the presence of the Acanthamoeba. On examination of the direct smear by microscopy, 11 out of 136 cases were positive for Acanthamoeba. Eight patients were males and 3 were females. The age of these patients ranged from 15 to 57 years. All of these cases were agricultural workers who did not use contact lens. Four cases gave a history of injury to the eye and 1 patient gave a history of applying cow dung on the eye after the injury. Rest of the patients did not give any history of trauma or wearing contact lenses. The patients were treated with topical application of neosporin ointment. Many of our cases had complications such as poor vision (all 11 cases had 6/60 or less), scar formation (3 cases), opacity (5 cases) and corneal perforation (2 cases). This report documents for the first time the cases of Acanthamoeba keratitis in Pondicherry.

Corneal perforation due to Acinetobacter junii: a case report

Acinetobacter spp. is emerging as a common cause of nosocomial infections. Community acquired ocular infections due to Acinetobacter are rare. Only one case of perforation of cornea has been reported previously, where old nomenclature was used to describe the causal agent. We report a case of corneal perforation due to Acinetobacter junii for which a therapeutic penetrating keratoplasty was conducted and the patient eventually recovered.

Toward suicide prevention

Suicide is an important mode of death. There are many psychiatrically ill patients in therapy running different degree of suicide risk. The risk of death by suicide is with almost all psychiatric illnesses, but it is found more with depressive disease, schizophrenia and personality disorder. Many studies have reported higher incidences of suicide attempts and suicide among alcoholics, which is often precipitated by family crises. Drug problems, low threshold for tolerance of day to day frustration, unemployement and poor parenting are major causes for youth suicide.There is biological evidence of suicidal behaviour. Fall in the level of serotonin and 5-HIAA in the CSF and in hind brain is found in subjects dying from suicide. Researchers have found decreased melatonin level in depression and suicide attempters. Long term therapy with antidepressants (Tricyclics), mood stabilizers (lithium and valproate) and new SSRIs prevent relapses and lessen suicide. It was concluded that general hospital doctors are in position of reducing suicide rates. Education of physician in detection of depression and suicide prevention will result in decline in number of suicides. The important measures include limiting the ability of methods of self-harm, antidepressants, paracetamol and insecticides.

Intracameral gnathostomiasins: a first case report from Pondicherry

In this communication, a first case of intracameral gnathostomiasis in a 34 years old woman in Pondicherry and its successful surgical removal is reported. The clinical presentation and epidemiology of the disease are discussed.

Pre-septal cellulitis--varied clinical presentations

Preseptal cellulitis has a typically benign course when treated with antibiotics, the clinical course depending on age of the patient, aetiology and the causative organism. In this study, 14 cases of preseptal cellulitis are documented with the age ranging from 2 to 55 years. The organisms isolated were Staphylococcus aureus (7 cases), Streptococcus pyogenes (2 cases) and Pseudomonas aeruginosa (1 case). In the remaining four patients no organism could be identified. All except four patients were cured within 6 weeks. Complications seen included lagophthalmos, lid abscess, cicatricial ectropion and lid necrosis in one patient each. The prognosis for preseptal cellulitis is good with appropriate antibiotics and surgical therapy.

Positive methane-producing status associated with increased serum cholesterol in subjects with impaired glucose tolerance

OBJECTIVE

To determine if those who produce methane (i.e., have presence of methane in breath) have higher serum cholesterol than those who do not produce methane in subjects with impaired glucose tolerance (IGT).

RESEARCH DESIGN AND METHODS

We measured breath gases and fasting serum total and high-density lipoprotein (HDL) cholesterol and triglyceride (TG) levels in 21 subjects with IGT.

RESULTS

The 11 methane-producers were well matched to the 10 non-methane-producers for age, sex, and body mass index. Methane-producers had higher fasting serum total (6.5 +/- 0.3 vs. 5.5 +/- 0.2 mmol/l; P < 0.02) and low-density lipoprotein (4.3 +/- 0.3 vs. 3.4 +/- 0.2 mmol/l; P < 0.05) cholesterol concentrations with no difference in TG or HDL levels.

CONCLUSIONS

The results suggest that in subjects with IGT, positive methane-producing status may be associated with increased serum cholesterol levels.

Oculocutaneous manifestations in xeroderma pigmentosa

Xeroderma pigmentosum (XP) is a rare genetic disease characterised by defective DNA repair leading to clinical and cellular hypersensitivity to ultraviolet radiation. The oculocutaneous features of 10 patients with XP were studied retrospectively. General features included parental consanguinity (40%), familiarity (60%), onset of symptoms in first 2 years (50%), malignant skin neoplasms (60%), and carcinoma of the tongue (20%). Among the ocular features, 50% of patients presented with photophobia. Lid freckles or atrophic skin lesions were seen in all patients. Lower lid tumours were seen in 30%, chronic conjunctival congestion in 40%, corneal opacification in 40%, squamous cell carcinoma of limbus in 20%, bilateral pterygium in 40%, and visual impairment in 50%. The clinical features (ocular and cutaneous) of the cases are discussed.

Rhinosporidiosis in Pondicherry

One hundred and thirty-nine cases of rhinosporidiosis diagnosed histopathologically over a period of 4 years were analysed. Nasal rhinosporidiosis is common among males who bathe in stagnant ponds while ocular rhinosporidiosis is common among urban females. There is a seasonal variation in the incidence of nasal and ocular rhinosporidiosis.

Cyst of ectopic (choristomatous) lacrimal gland

A rare case of cyst of an ectopic lacrimal gland in the bulbar conjunctiva is reported in a 40 year-old-man. The clinical presentation histopathology, differential diagnosis and treatment of this choristomatous lacrimal ductal cyst (Group IV according to Bullock's classification) is described.

Second-meal effect: low-glycemic-index foods eaten at dinner improve subsequent breakfast glycemic response

The effects of the glycemic index (GI) of carbohydrate eaten the previous night on the glycemic response to a standard test meal eaten subsequently in the morning (breakfast) was studied. On separate evenings normal subjects ate low- or high-GI test meals of the same nutrient composition. The dinners consisted of single foods in two experiments and mixed meals containing several foods in the third. The differences between the observed glycemic responses to low- and high-GI dinners were predicted by their GIs. The glycemic responses to breakfast were significantly lower on mornings after low-GI dinners than after high-GI dinners. Eating, at dinner, foods with different fiber contents but the same GI had no effect on postbreakfast glycemia. We conclude that the GI predicts the difference between glycemic responses of mixed dinner meals; breakfast carbohydrate tolerance is improved when low-GI foods are eaten the previous evening.

Ocular myotoxic effects of local anesthetics

Of 650 patients who underwent various surgical procedures on the anterior segment in which 2% lidocaine hydrochloride plus 1:100,000 epinephrine was used as a local anesthetic, 5 experienced postoperative complications attributed to the anesthetic: ptosis (in 2 cases), horizontal rectus muscle palsy (in 2) and lagophthalmos (in 1). The cause of the complications may have been inadvertent direct infiltration of the anesthetic into the levator palpebrae superioris, the horizontal rectus muscles and the orbicularis oculi respectively. All the patients recovered spontaneously in 8 to 12 weeks. The clinical course was compatible with myotoxic effects of local anesthetics.

Ocular malignant fibrous histiocytoma: clinical and histopathological characteristics

A rare case of malignant fibrous histiocytoma involving the whole eye is reported in an Oriental 60-year-old man. Six months' follow-up after exenteration did not show any evidence of local recurrence or distant metastases.

Unusual cause of acquired inflammatory Brown's syndrome

A 24-year-old East Indian woman presented with an inflammatory swelling in the supranasal quadrant of the left orbit and vertical diplopia. The motility disorder was of typical acquired Brown's syndrome. Histopathological examination of the lesion revealed Cysticercus cellulosae, a parasitic cyst known to produce a severe inflammatory reaction. To our knowledge this is the first report of acquired inflammatory Brown's syndrome caused by cysticercosis.

Diverticulum of the lacrimal sac associated with rhinosporidiosis

A rare case of diverticulum of the lacrimal sac associated with rhinosporidiosis is reported. The clinical presentation and possible pathogenesis are discussed.

Glucose and free fatty acid response to intravenous glucose during pregnancy

Intravenous glucose tolerance tests were performed in undernourished and well-nourished normal pregnant women and for toxemic women near term. Both blood glucose and free fatty acid levels were analyzed, till 90 min after glucose load. The results suggested that glucose response to intravenous load was poor both in normal undernourished and toxemic women as compared to well-nourished women. However, the free fatty acid pattern was abnormal only in toxemic women in that the levels free fatty acid levels were analyzed, till 90 min after glucose load. The results suggested that glucose response to intravenous load was poor both in normal undernourished and toxemic women as compared to well-nourished women. However, the free fatty acid pattern was abnormal only in toxemic women in that the levels free fatty acid levels were analyzed, till 90 min after glucose load. The results suggested that glucose response to intravenous load was poor both in normal undernourished and toxemic women as compared to well-nourished women. However, the free fatty acid pattern was abnormal only in toxemic women in that the levels did not return to basal value even after 90 min of glucose load. Since human placental lactogen in pregnancy is known to regulate free fatty acid release for energy utilization, its deficiency in toxemia (commonly known to occur) could be implicated in the abnormal free fatty acid response seen in this investigation.

Influence of maternal levels of blood glucose on fetal outcome

The effect of maternal levels of fasting blood glucose on fetal outcome was studied in 500 women with normal and toxemic pregnancies. Forty percent of the mothers with low glucose levels gave birth to low birth weight infants. In cases of severe preeclamptic toxemia, low fasting glucose levels were associated with a higher incidence of low birth weight, prematurity and stillbirths. Thus, in a population subsisting on poor caloric and protein intake, maternal levels of fasting blood glucose may be an important index in predicting high-risk pregnancy.

Significance of amniotic fluid glucose in pregnancy

Amniotic fluid glucose values were measured in 285 women with normal and abnormal pregnancies. A progressive decrease in glucose values was observed with advancing gestation. Complications in pregnancy did not influence the amniotic fluid glucose value for the given gestational age. In patients with diabetes, very high levels were found, but these progressively decreased with advancing gestation. Since abnormal conditions in pregnancy, other than diabetes, do not affect the amniotic fluid glucose level, it seems to be a reliable tool in assessing fetal maturity. Values above 15 mg/100 ml rule out term pregnancies and those below 5 mg/100 ml, prematurity.

A clinical and pharmacodynamic evaluation of sulpiride

In a double-blind study the therapeutic efficacy of sulpiride was compared to that of haloperidol--an established neuroleptic agent. A total of 30 female patients with a diagnosis of chronic schizophrenia were initially stabilised on the dosage of haloperidol which produced optimum therapeutic response when given once or twice daily. The patients were then randomly allocated to receive either sulpiride or haloperidol over a period of 12 weeks. Plasma drug concentrations and prolactin levels were determined. Clinical effects were evaluated by Brief Psychiatric Rating Scale (BPRS), Wing Rating Scale, and Extrapyramidal Symptoms Rating Scale (EPS). A standardised side-effects checklist was used. Treatment with sulpiride was associated with a significant rise in plasma prolactin level, but paradoxically these patients had significantly reduced extrapyramidal symptoms. No significant correlation was found between plasma sulpiride concentration and prolactin level or any of the clinical variables. The study confirms the antipsychotic activity of sulpiride.

Neuroendocrine studies in affective disorders. Part 2. Plasma thyroid-stimulating hormone response to thyrotropin-releasing hormone in affective disorders: effect of ECT

The plasma thyroid-stimulating hormone response to thyrotropin-releasing hormone in controls and patients with affective disorders has been studied. The results of the investigation do not suggest any abnormality of this response in monopolar or unipolar depressed patients or bipolar patients undergoing a manic phase of their illness. No significant difference in this response could be detected between 'sporadic depressive disease' patients and 'familial pure depressive disease' patients, and age- and sex-matched controls. The neuroendocrine response was essentially unchanged after treatment by ECT.

Neuroendocrine studies in affective disorders. Part 1. Plasma prolactin response to thyrotropin-releasing hormone in affective disorders: effect of ECT

The plasma prolactin response to thyrotropin-releasing hormone, which is thought to be mediated by central 5-HT mechanisms, has been studied in patients with affective disorders. There was no difference between depressive patients (taken as a whole), bipolar patients undergoing a manic phase and controls in the prolactin response to thyrotropin-releasing hormone. When the depressive patients were divided on a genetic basis into familial pure and sporadic depressive disease it was found that the sporadic patients had an enhanced response. The results do not provide any strong evidence to suggest that central 5-HT mechanisms as measured by the prolactin response to thyrotropin-releasing hormone are abnormal in depressed patients or bipolar patients undergoing a manic phase. Patients after ECT had an increased prolactin response to thyrotropin-releasing hormone which may indicate increased sensitivity of central 5-HT receptors following this treatment.

Clinical state, plasma levels of haloperidol and prolactin: a correlation study in chronic schizophrenia

Chronic schizophrenic patients were maintained for six months on a dosage of haloperidol adjusted to give optimum clinical effect. A correlation was found between extrapyramidal symptoms and prolactin levels and also between plasma haloperidol concentration and plasma prolactin levels. Estimation of plasma prolactin would be a reliable measurement of patients' compliance with medication.

Classification of depression and response to amitriptyline therapy

Fifty-four patients suffering from primary depressive illness were rated on the Newcastle diagnostic scale while taking part in a pharmacokinetic study of amitriptyline therapy, and their clinical response was assessed by the Hamilton Rating Scale for depression. Patients with a Newcastle score of 4-8 showed the best response to amitriptyline. Patients with low Newcastle scores, representing the non-endogenous or neurotic group, responded poorly. Patients with high scores on the Newcastle scale, representing those with marked endogenous features, also responded poorly.

Mianserin in the prophylactic treatment of bipolar affective illness

Mianserin in a dosage of 20 mg 3 times daily, was given to 13 patients with bipolar affective illness, who were previously maintained on lithium. 3 patients left the trial at their own request within a few days due to drowsiness in 2 cases and insomnia in the third. Of the remaining 10 patients, 6 became manic within the 3-month trial period. This result indicates that mianserin may be capable of precipitating mania in susceptible subjects with bipolar affective illness. This may be a general property of antidepressants, since it has been previously described with other groups of antidepressants.