Arginine-16 beta2 adrenoceptor genotype predisposes to exacerbations in young asthmatics taking regular salmeterol

BACKGROUND

The homozygous presence of the arginine-16 variant of the beta(2) adrenoceptor gene ADRB2 reverses the benefits from the regular use of short acting beta(2) agonists in asthmatic adults compared with the homozygous glycine-16 genotype. We studied the effect of this polymorphic variation on asthma exacerbations in children and young adults and its relation to long acting beta(2) agonists.

METHODS

A cross-sectional survey was undertaken using electronic records, direct interviews, and genotype determination of position 16 and 27 of the ADRB2 gene in DNA from mouthwash samples of 546 children and young asthmatics attending paediatric and young adult asthma clinics in Tayside, Scotland during 2004-5. The primary outcome measure was asthma exacerbations over the previous 6 months.

RESULTS

There was an increased hazard of asthma exacerbations across all treatment steps of the British Thoracic Society (BTS) asthma guidelines when the homozygous genotypes Arg/Arg and Gly/Gly were compared (OR 2.05, 95% CI 1.19 to 3.53, p = 0.010), particularly in patients treated with salmeterol (OR 3.40, 95% CI 1.19 to 9.40, p = 0.022). The Glu27Gln polymorphism had no significant effect on asthma exacerbations in any treatment group.

CONCLUSIONS

The arginine-16 genotype of ADRB2 predisposes to exacerbations in asthmatic children and young adults, particularly in those exposed to regular salmeterol. This may be explained by genotype selective salmeterol induced downregulation and impaired receptor coupling, and associated subsensitivity of the response.

Apoptosis is induced in leishmanial cells by a novel protein kinase inhibitor withaferin A and is facilitated by apoptotic topoisomerase I-DNA complex

Protein kinase C (PKC) is an important constituent of the signaling pathways involved in apoptosis. We report here that like staurosporine, withaferin A is a potent inhibitor of PKC. In Leishmania donovani, the inhibition of PKC by withaferin A causes depolarization of DeltaPsim and generates ROS inside cells. Loss of DeltaPsim leads to the release of cytochrome c into the cytosol and subsequently activates caspase-like proteases and oligonucleosomal DNA cleavage. Moreover, in treated cells, oxidative DNA lesions facilitate the stabilization of topoisomerase I-mediated cleavable complexes, which also contribute to DNA fragmentation. However, withaferin A and staurosporine cannot induce cleavable complex formation in vitro with recombinant topoisomerase I nor with nuclear extracts from control cells. Taken together, our results indicate that inhibition of PKC by withaferin A is a central event for the induction of apoptosis and that the stabilization of topoisomerase I-DNA complex is necessary to amplify apoptotic process.

Arsenic trioxide for treatment of myelodysplastic syndrome: An experience from India

13156

Background: Myelodysplastic Syndrome (MDS) is a heterogeneous group of clonal diseases of the haematopoietic stem cells. The hallmark of the disease is ineffective haematopoiesis characterized by dysplasia with incomplete maturation and progressive increase in the percentage of myeloblast. No standard treatment is currently available for MDS. The early clinical experience has confirmed the activity of arsenic trioxide in MDS. The drug is able to induce differentiation and apoptosis and to inhibit cell proliferation or angiogenesis. It has the potential to be active in tumour models in MDS. The preliminary result of ongoing studies conducted in patients with MDS suggests that arsenic trioxide produces haematological improvement including durable transfusion independence in 30% of patients. The aim of our study was to see the response of MDS with arsenic trioxide and to see the toxicity profile of arsenic trioxide in Asian Indian population. Methods: During period from July 2005 to December 2005 we selected consecutive 10 patients of MDS in Refractory Anaemia, Refractory anaemia with ringed sideroblasts, Refractory anaemia with blast excess, Refractory anaemia with blast excess in transformations and chronic myelo monocytic leukemia phases. All patients had performance status more than 60%, some karyotypic abnormalities & in cytopenic phase. Median age of the patients 65 years (range 42 to 70 years). All patients were treated with arsenic trioxide 10mg (Alkem/India) daily for 2 hours infusion 28 days. In 15 days interval 3 courses were repeated. Response assessments were done by haematological, cytogenetic & quality of life assessment. All patients were evaluated after 3 courses of arsenic trioxide. Result: Sixty percent (6 patients) patients had shown major haematological response, forty percent minor & twenty percent has major cytogenetic response. Twenty percent of the patients has disease progression where as 20% has stable disease. The only mild adverse effects were seen in forms of nausea, vomiting, diarrhea, abdominal pain & dermatitis in 30% of patients. Only one patient (10%) had QT prolongation in ECG. Conclusion: We concluded that arsenic trioxide is very useful drug in myelodysplastic syndrome. It is also well tolerated in Asian Indian Population.

No significant financial relationships to disclose.

Assessment of nutrition in cancer patients and its effect on treatment outcome—A study from a developing country

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Background: In developing countries one-third of the people suffer from mal-nutrition. It has been shown that a good nutritional status can reduce complications of treatment, strengthen the immune system and contribute to the patient’s general well being throughout treatment. A good nutritional status is therefore essential for optimal treatment of a cancer patient. The aim of our study was to see the nutritional status of cancer patients on diagnosis and effect of nutrition on outcome of therapy. Methods: In this study we prospectively analyzed the nutritional status of 500 cancer patients in Netaji Subhash Chandra Bose Cancer Research Institute, a tertiary cancer center of eastern India during period from January 2004 to December 2005. The age range of the patients was 19 years to 74 years (median age 46 years). The parameter analyzed were weight for age, total protein, serum albumin and mid arm circumference. The weight for age and mid arm circumference were taken as normal if they were between 3rd and 97th percentile curve of the growth chart recommended by the Indian Council of Medical Research. The albumin level and the total protein were considered normal if the value is equal to or more than 3gm% and 5.8gm%. Result: It was seen that total 120 patients (24%) were low weight for age and 100 patients (20%) had low mid arm circumference. Total 90 patients (18%) had low serum albumin while 130 patients (26%) were low serum protein. Low weight for age, low serum albumin and low mid arm circumference were significant factors in disease free survival and toxicity of chemotherapy (p value < .001) Conclusion: We conclude that mal-nutrition is a major finding in cancer patients in developing country like ours. The patient with mal-nutrition had less disease free survival and more toxicities during therapy as compared to well-nourished patients.

No significant financial relationships to disclose.

Effect of wheat grass juice in supportive care of terminally ill cancer patients— A tertiary cancer centre experience from India

8634

Background: The solid content of juice made from wheat grass is 70% chlorophyll. Chlorophyll is often referred to as “The blood of plant life” and has almost the same chemical structure as haemoglobin. Chlorophyll cleanses the blood by improving the supply of oxygen to the circulatory system. Wheat grass is also a complete protein with about 30 enzymes, vitamins & minerals. Wheat grass juice has been proven over many years to benefit people in numerous ways, building the blood, restoring balance in the body, removing toxic metals from the cells, nourishing the liver & kidneys and restoring vitality. The aim of our study was to see the effect of wheat grass juice in terminally ill cancer patients to improve the quality of life. Methods: During period from January 2003 to December 2005 we selected 400 solid organ cancer patients in our palliative care unit of Netaji Subhash Chandra Bose Cancer Research Institute to see the effect of wheat grass on improvement of haemoglobin level, serum protein & performance status on terminally ill cancer patients. The age range of the patients was 22 year to 87 year (median age 42 years). The different types of cancers were Lung (25%), Breast (20%), Oesophagaus (11%), Colon (9%), Ovary (8%), Hepatocellular carcinoma (6%), Stomach (6%) and others (15%) respectively. We cultivated wheat grass in our campus. When the grasses were 5 days old we took the fresh leaves including roots and made fresh juice out of that and had given 30ml of juice to all our 400 cancer patients for continuous 6 months. Result: The mean levels of haemoglobin, Serum total protein, albumin and performance status were 8gm%, 5.4gm%, 2.2gm% and 50%. Fifty patients required transfusion support & those patients were excluded from the study. Other 348 patients are evaluated 6 months after giving wheat grass juice. The mean values for haemoglobin, total protein & albumin were improved significantly (pvalue < .005) and were observed mean of 9.6gm%, 7.4gm% and 3.1gm%. White blood cell & platelet count were same in both the cases. The performance status was improved from 50% to 70% (Karnofsky) after wheat grass treatment. Conclusion: We concluded that wheat grass juice is an effective alternative of blood transfusion. Its use in terminally ill cancer patients should be encouraged.

No significant financial relationships to disclose.

Mature ovarian teratoma with gliomatosis peritonei--a case report

Gliomatosis peritonei (GP), a rare condition related to ovarian teratomas, is characterized by miliary implants of mature glial tissues on the peritoneum or omentum. We report herein a case of mature teratoma of the ovary with GP with imaging features and pathological correlation.

Idiopathic pulmonary haemosiderosis: two case reports

Idiopathic pulmonary haemosiderosis (IPH) is a rare disorder and is characterised by the occurrence of episodes of diffuse alveolar haemorrhage (DAH). The patients usually present with a history of recurrent haemoptysis, anaemia and alveolar opacities on chest radiograph. The radiographic features are very characteristic and reveal alveolar opacities in middle and lower zones with selective sparing of the upper zones. An extensive diagnostic work-up is needed to exclude other causes of DAH. We report two cases of idiopathic pulmonary haemosiderosis who responded well to treatment with oral glucocorticoids.

Deaf child--a general practitioner's responsibility

The power of a child's speaking language never develops if he is deaf. Deafness persists if it is not detected early. Childhood deafness is either congenital or acquired. At birth, doctors or attendants can detect deafness by arousing the baby with sudden loud noise. At 4 months onwards mothers and doctors can detect deafness. The baby at this age can turn its head or eyes towards the source of the sound. By 12 months to 2 years of age it is very difficult to detect deafness. By the age of 3 years children again become co-operative and it becomes easier to detect deafness. Children should always be screened for deafness while being admitted to nursery classes. In school going age ie, 5 years onwards loss of tests can be employed to detect deafness. If a child is suspected be deaf, a general practitioner's responsibility is to refer him to an ENT specialist earlier. Any child whose mother believes her child is deaf should be given due attention. Otitis media with effusion, enlarged adenoid, chronic suppurative otitis media, recurrent otitis media are some diseases to be carefully looked into by the general practitioners. Now-a-days cochlear implantation surgery is gaining popularity to give hearing to deaf child. Moreover regular screening for deafness should be included school heath programme.

A stepped approach for prediction of obstructive sleep apnea in overtly asymptomatic obese subjects: a hospital based study

BACKGROUND AND PURPOSE

Prevalence of obstructive sleep apnea (OSA) is high in obese subjects, many of whom may not be overtly symptomatic. Polysomnography (PSG) is a costly and time-consuming investigation. Since it is not feasible to subject all obese individuals to PSG, it is useful to define predictors of OSA among these subjects.

PATIENTS AND METHODS

One hundred and eighteen obese subjects [body mass index (BMI)> or =25 kg/m(2)] presenting to the hospital with non-sleep related complaints were included, of which 53 subjects with PSG evidence of OSA [apnea-hypopnea index (AHI)> or =15/h] were defined as cases and 65 subjects without any evidence of OSA (AHI<15/h) were defined as controls. Anthropometry, biochemical investigations, blood gas analysis, pulmonary function tests, and PSG were performed for all subjects.

RESULTS

Waist hip ratio (WHR) (as percentage of a standard) [odds ratio (95% CI): 1.07 (1.00-1.14); P = 0.049] male gender [odds ratio (95% CI): 3.97 (0.99-15.81); P = 0.046] and neck circumference (NC) [odds ratio (95% CI): 1.23 (1.03-1.47); P = 0.023] were found to be independent predictors of OSA. Overnight oxygen desaturation data were evaluated in patients selected as having OSA on the basis of these clinical markers, and the best cut-off for level of desaturation (10%) was defined. The stepped approach had a specificity, sensitivity, positive and negative predictive value of 89.2, 88.5, 86.8 and 90.6%, respectively, for the diagnosis of OSA.

CONCLUSIONS

Male gender, WHR and NC are independent predictors of OSA in overtly asymptomatic obese subjects. A stepped approach to diagnose OSA should be used, as it is accurate and cost-effective.

Effect of reduction in tube current on reader confidence in paediatric computed tomography

BACKGROUND

Computed tomography (CT) contributes significantly to the total radiation dose derived from medical imaging in children. As the number of CT examinations increases there is renewed interest in possible ways to minimize such radiation.

AIM

To study the effect of decremental reduction in tube current settings on structural resolution and on reader confidence in being able to reach a final diagnosis.

MATERIALS AND METHODS

The study involved spiral CT of children aged 0-13 years. CT performed at reduced mA settings (60-75, 76-90 and 91-130 mA for thoracic, abdominal and pelvic examinations, and 76-90 and 91-130 mA for cranial examinations) were compared with similar investigations at conventional settings (180-240 mA). Images were scored by two blinded readers for structural resolution and diagnostic confidence. Structural resolution was scored on a binary (adequate or not) scale for six structures each in cranial, thoracic and pelvic examinations and for eight structures in abdominal studies, and reader confidence was scored on a four-point scale as 25-100%. Scores from the two readers were averaged for comparison in subgroup analyses.

RESULTS

Reduction of tube current settings to 75-90 mA for thoracic, abdominal and pelvic examinations and to 90-130 mA for cranial examinations was not associated with any significant deterioration in image quality. The number of scans considered satisfactory were comparable even at 60-75 mA, although the total relative scores for structural resolution at this setting were lower.

CONCLUSION

Tube current settings can be significantly reduced in all paediatric age groups, in all regions. In younger children the impact of such reduction in tube current is likely to be greater. Cranial scans are more sensitive to such reductions as compared to thoracic or abdominopelvic examinations.

Aortic Aneurysm and Dissection : Evaluation with Spiral CT Angiography

The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm,aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aorticaneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findingswere compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; andsurgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation ofaortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhancedCT axial images and those of angiography in the form of 3D reformatted images.Key Words: Aortic aneurysm, dissection, pseudoaneurysm, CT angiography.

Aortic aneurysm and dissection: evaluation with spiral CT angiography

The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm, aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aortic aneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findings were compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; and surgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation of aortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhanced CT axial images and those of angiography in the form of 3D reformatted images.

Transcatheter closure of coronary-to-pulmonary fistula by nonconventional coils in a patient with tetralogy of Fallot

We report a case in which a coronary-to-pulmonary fistula was successfully occluded in a patient with tetralogy of Fallot by employing the cut floppy tips of coronary angioplasty guidewires using a new technique.

Lymphangioleiomyomatosis: a rare cause of breathlessness

A 24-year-old female presented with complaints of cough with scanty expectoration, breathlessness on exertion and chest pain for the last three years. These symptoms had appeared during the 12th week of her third pregnancy. She was given anti-tuberculosis treatment at another hospital for nine months without any improvement in symptoms. Four years ago she had been diagnosed to have leprosy of borderline variety for which she had received treatment. On examination, she was tachypnoeic with a respiratory rate of 33 breaths per minute. She had clubbing and small, discrete and firm lymph nodes in the anterior cervical region. Chest examination revealed wheezing with bibasilar end-inspiratory crepitations.

Tracheobronchial amyloidosis masquerading as bronchial asthma

A case of localized tracheobronchial primary amyloidosis masquerading as "bronchial asthma" is presented. Computed tomography of the chest and fiberoptic bronchoscopy image are included. Tracheobronchial primary amyloidosis is a rare, but potentially curable cause of airway obstruction mimicking asthma.

Effect of arsenic on cell growth of the cellular slime mould, Dictyostelium discoideum

The growing D. discoideum cells were killed in a dose-dependent manner when exposed to 100 and 140 ppm of arsenic (As2O3) at mid-log phase for 20 min. Reduced plaque sizes and changed cell and colony morphologies were observed in the treated cells. Endocytotic functions (both phagocytosis and pinocytosis) were also inhibited in the treated cells. Arsenic treated cell showed a lower DNA and protein synthetic activities. These findings are discussed in relation to known mechanism of action of the heavy metal on growth-related cellular functions.

X-linked Charcot-Marie-Tooth disease with myokymia: report of a family

The clinical and electrophysiologic profiles of two brothers suffering from Charcot-Marie-Tooth disease are presented. Both had widespread muscle twitching in the legs which showed electrophysiologic features of myokymia. Pedigree analysis suggested an x-linked recessive form of inheritance. This appears to be the first report of an Indian family with x-linked Charcot-Marie-Tooth disease.

Primary osteosarcoma of the skull. A report of 3 cases

Osteosarcomas are malignant bone tumors, which commonly affect the long bones of young adults. Primary osteosarcomas of the skull are exceedingly rare. We herein report 3 cases of primary osteosarcoma of the skull involving the calvaria, diagnosed over a period of 8 years at the Department of Pathology of our Institute.