Antiphospholipid antibody-related Bell's palsy in young women

The present report describes three young women aged 25, 20 and 15 years who presented with Bell's palsy. Two of the patients had a past history of the disease, which responded to steroid treatment. All three patients were positive for antiphospholipid antibody (APLA). In addition, one of the patients tested positive for antinuclear antibodies; however, there was no clinical evidence of systemic lupus erythematosus. All three patients responded well to steroid therapy. We conclude that Bell's palsy may be one of the manifestations of APLA syndrome, and thus, APLA testing should be done in such cases.

Assessment of Health-Related Quality of Life in school-going adolescents: validation of PedsQL instrument and comparison with WHOQOL-BREF

BACKGROUND

Health-Related Quality of Life (HRQoL) studies are gaining importance. Yet there is a dearth of crossculturally validated generic HRQoL instruments for Indian adolescents. Two HRQoL instruments, namely World Health Organization Quality of Life-Brief (WHOQOL-BREF) and Pediatric Quality of Life inventory™ 4.0 (PedsQL), are widely used internationally, with both measuring four domains (physical, psychological/emotional, social relations and environment/school) but each having different questions with 26 in the former and 23 in the latter. This study was done among adolescents in the city of Lucknow to evaluate the psychometric properties of PedsQL and compare its performance with previously validated and culturally revised WHOQOL-BREF.

METHODS

This cross-sectional study was conducted in February 2010 after institutional ethical approval. Data were collected by a self-administered, redesigned questionnaire in which items of PedsQL and revised WHOQOL-BREF were intermingled. Reliability, content and construct validity were evaluated for PedsQL. Convergent validity of PedsQL with revised WHOQOL-BREF was calculated for domains with similar questions.

RESULTS

Parents of 76.5% adolescents (385/503) provided consent. Mean age of adolescents was 13.6 years (1.6 SD and 44.7% were girls). PedsQL showed substantial reliability (Cronbach alpha=0.82, p<0.00001) but poor to fair validity as compared to revised WHOQOL-BREF.

CONCLUSIONS

For Indian adolescents, PedsQL is a reliable and valid instrument. However, on comparison with revised WHOQOL-BREF, PedsQL has poor to fair validity. We conclude that revised WHOQOL-BREF is a better HRQoL instrument for Indian adolescents.

Municipal solid waste stabilisation by leachate recirculation

The purpose of this study is to determine the impact of leachate recirculation on stabilisation of municipal solid wastes. The study was carried out by using two lab-scale landfill bioreactors containing approximately 10 kg of waste each, in order to follow waste degradation over 16 weeks of time period. The main difference between anaerobic recirculated and without recirculation bioreactors options is determined in leachate quality. Leachate quality is regularly measured by the means of pH, electrical conductivity, calcium, magnesium, total kjeldahl nitrogen, phosphate and chemical oxygen demand (COD). It has been observed that leachate recirculation is more effective on anaerobic degradation of solid waste than non-recirculated degradation. The leachate recirculated bioreactor appears to be the more effective option in the removal of COD by 89.93% and stabilisation of pH at 7.5. After 16 weeks of anaerobic degradation, waste stabilization seemed to have reached for the recirculated bioreactor. Therefore, further studies are required to determine the optimum operational conditions for leachate recirculation rates, also with the operational costs of recirculation for solid waste stabilisation.

Cardiovascular disease in live related renal transplantation

Cardiovascular disease has become the leading cause of morbidity and mortality in renal transplant recipients, although its pathogenesis and treatment are poorly understood. Modifiable cardiovascular risk factors and graft dysfunction both play an important role in development of post transplant cardiovascular events. Prevalence of cardiovascular disease was studied in stable kidney transplant patients on cyclosporine based triple immunosuppression in relation to the various risk factors and post transplant cardiovascular events. Analysis of 562 post transplant patients with stable graft function for 6 months, the patients were evaluated for cardiovascular events in post transplant period. Pre and post transplant risk factors were analyzed using the COX proportional hazard model. 174 patients had undergone pre transplant coronary angiography, 15 of these patients underwent coronary revascularization (angioplasty in 12, CABG in 3). The prevalence of CAD was 7.2% in transplant recipients. Of 42 patients with CAD 31 (73.8%) had cardiovascular event in post transplant period. Age > or = 40 yrs, male sex, graft dysfunction, diabetes as primary renal disease, pre transplant cardiovascular event, chronic rejection showed significant correlation in univariate analysis and there was significant between age > or = 40 years (OR = 2.16 with 95% CI, 0.977-4.78) S creatinine > or = 1.4 mg % (OR = 2.40 with 95% CI, 1.20 - 4.82), diabetes as primary disease (OR with 95% CI 3.67, 3.2-14.82), PTDM (OR 3.67, 95% CI 1.45-9.40), pre-transplant cardiovascular disease (OR 4.14, 95% CI .38-13.15) with post transplant cardiovascular event on multivariate analysis. There was poor patient and graft survival among those who suffered post transplant cardiovascular event. The incidence of cardiovascular disease continues to be high after renal transplantation and modifiable risk factors should be identified to prevent occurrence of events in post transplant period.

A prospective double blind study using oral versus vaginal misoprostol for labour induction

This prospective double blind study was undertaken to compare the safety and efficacy of oral vs vaginal misoprostol in equivalent doses (50 microg) for induction of labour. A total of 128 term pregnancies with indication for induction of labour were allocated to two groups to receive 50 microg misoprostol orally or vaginally, every 4 h until adequate contractions were achieved or a maximum of 200 microg dose. Induction to delivery interval was significantly shorter in the vaginal group compared with the oral group (14.6 h vs 22.5 h; p < 0.001). There was no significant difference between the groups with respect to mode of delivery, neonatal outcome and maternal side-effects. However, the incidence of abnormal contractility pattern was more common in the vaginal group (10/68, 14.6%) as compared with the oral group (4/60, 6.6%) (p = 0.146).

Effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in vitamin D-deficient Asian Indians: a randomized, controlled trial

CONTEXT

Vitamin D deficiency is prevalent worldwide. Vitamin D supplementation has shown variable effect on skeletal muscle strength in the elderly with hypovitaminosis D. There is a paucity of similar data in young individuals.

OBJECTIVE

To study the effect of cholecalciferol and calcium supplementation on muscle strength and energy metabolism in young individuals.

SUBJECTS

Forty healthy volunteers (24 M/16 F, mean age (SD) 31.5 ± 5.0 year) with hypovitaminosis D were randomized to either oral cholecalciferol (60,000 IU D3/week for 8 weeks followed by 60,000 IU/month for 4 months) with 1 g of elemental calcium daily or dual placebos for 6 months.

MEASUREMENTS

Handgrip and gastro-soleus dynamometry, pinch-grip strength, respiratory pressures, 6-min walk-test and muscle energy metabolism on (31) P magnetic resonance spectroscopy were assessed at baseline and after 6 months.

RESULTS

The mean serum 25(OH)D in the supplemented and placebo groups at baseline, two and 6 months were 25.4 ± 9.9, 94.5 ± 53.8 and 56.0 ± 17.0 nm, and 21.1 ± 9.4, 32.8 ± 14.4 and 29.7 ± 15.0 nm, respectively. The supplemented group gained a handgrip strength of 2.4 kg (95% C.I. = 1.2-3.6); gastro-soleus strength of 3.0 Nm (95% C.I. = 0.1-5.9) and walking distance of 15.9 m (95% C.I. = 6.3-25.5) over the placebo group after adjustment for age, gender and respective baseline parameters. Muscle energy parameters were comparable at 6 months.

CONCLUSIONS

Six months of cholecalciferol and calcium supplementation results in enhanced skeletal muscle strength and physical performance despite no change in muscle energy parameters. Cholecalciferol supplementation of 60,000 IU per month could not maintain 25(OH)D levels in the sufficient range.

DNA content can improve the detection and prognosis of carcinoma of the cervix

In all malignant diseases, several clinical and histopathological tests are established as standard methods for diagnosis. Alternative diagnostic quantitative methods are still lacking or conflicting in cancer of the cervix. Although DNA analysis was one of the earliest applications in flow cytometry and the DNA content of fresh/frozen tissue have shown good prognostic results in many diseases including cervical cancer, prognostic ability cannot be easily clarified quantitatively by biochemical values. Thus, our objective was to determine whether the addition of a DNA content study using flow cytometry improves the detection of cervix cancer. The quantification of DNA content was done by high resolution DNA flow cytometry in fresh/frozen tissues of healthy cervix (control, n = 38) and from cancer of the cervix (n = 62). Results show that the mean fraction of Total S phase, Total Aneuploid and G2-M (Diploid) are significantly higher (p < 0.01); while G0-G1 (Diploid) and G0-G1 (Aneuploid) are significantly lower (p < 0.01) in cancer patients as compared to control. Among cell cycle parameters, G0-G1 (Diploid) shows a classifying ability of 97% and at a criterion/threshold value of ? 79.88, it discriminates cases with the highest sensitivity of 96.77 (88.8-99.5; 95% CI) and specificity 100.0 (90.7-100.0; 95% CI) and with Total S phase or Aneuploid, it discriminates cases with 100% sensitivity. G0-G1 (Diploid) also showed a direct and significant correlation (r = 0.66; p < 0.01) with patient survival indicating prognostic significance. Cell cycle parameters will be very helpful in false positive results or where the clinician is unable to diagnose the stage of cervix cancer clinically or histopathologically.

Spectrum of hypertension in post transplant

AIM

Elucidate the incidence and causes of post transplant hypertension in our transplant population.

METHODS

All patients transplanted between June 1989 Dec 2002 who had a functioning graft of 6 months post transplant were studied. Hypertension was defined as Systolic BP > or = 140 mmHg/Diastolic BP > or = 90 mmHg/usage of antihypertensive medication. Donor and recepient characteristics were recorded and compared. 86.2% (485) were hypertensive in post renal transplant period.

RESULTS

Age > or = 40 years, male sex, graft dysfunction, use of calcineurin inhibitors, high doses of steroids, chronic rejection were statistically significant correlate of post RTHT in univariate analysis. On multivariate analysis, age > or = 40 yrs (RR 2.06, 95% CI, 1.20-3.54), use of cyclosporine (RR 2.70, 95% CI, 1.54-4.75), usage of high doses of steroids (RR 2.56, 95% CI, 1.31-4.98) only were associated with post transplant hypertension. The patient and graft survival was inferior in patients with post transplant hypertension. The systolic BP at 12 months, diastolic BP at 6 months and 12 months post transplant, had significant detrimental effect on renal allografts survival.

CONCLUSION

Diagnosis, identification of risk factors and aggressive treatment of post transplant HT and of the various modifiable risk factors is important for improving renal allograft and patient survival.

Decreased number and impaired functionality of endothelial progenitor cells in subjects with metabolic syndrome: implications for increased cardiovascular risk

OBJECTIVE

Metabolic syndrome (MetS) is characterized by low-grade inflammation and confers an increased risk for cardiovascular disease. Endothelial progenitor cells (EPCs) are a measure of vascular health and are decreased in patients with various risk factors for cardiovascular disease (CVD). There is a paucity of data examining the EPC status especially in terms of their functionality in MetS subjects without diabetes or cardiovascular disease. We aimed to enumerate and functionally characterize EPCs in subjects with MetS in comparison to healthy controls.

METHODS

The study was performed at the University of California Davis Medical Center. Healthy controls (n=31) and MetS (n=46) subjects were included in the study. EPCs were enumerated in fasting blood by KDR/CD34 dual positivity. Functionality was assessed by the colony forming units (CFU) assay, migration and tubule formation.

RESULTS

Subjects with MetS had significantly decreased number of EPCs compared to control subjects. Furthermore, EPCs from MetS subjects depicted significantly impaired clonogenic capacity, i.e., decreased colony forming units, and impaired capacity to incorporate into tubular structures suggesting functional impairment of EPCs from MetS subjects.

CONCLUSIONS

We make the novel observation that MetS subjects without diabetes or CVD have decreased EPC number and impaired functionality as compared to control subjects. These findings could contribute to the increased CV risk in this population.

A huffing manoeuvre, immediately before induction of anaesthesia, prevents fentanyl-induced coughing: a prospective, randomized, and controlled study

BACKGROUND

Preinduction i.v. fentanyl bolus is associated with coughing in 28-65% of patients. Fentanyl-induced coughing (FIC) is not always benign and can be remarkably troublesome at the most critical moment of induction of anaesthesia when airway reflex is lost. We postulated that the huffing manoeuvre, a forced expiration against open glottis, just before i.v. fentanyl, may suppress this undesirable spasmodic cough.

METHODS

Three hundred patients of ASA I and II, aged 18-60 yr, undergoing elective surgical procedures were randomly allocated into two groups consisting of 150 patients. Both groups received i.v. fentanyl (2.5 microg kg(-1)). Group 1 patients breathed normally whereas Group 2 patients were asked to perform huffing manoeuvre just before the fentanyl injection. The incidence of cough was recorded for 1 min before the induction of anaesthesia, and graded as mild (1-2 cough), moderate (3-5 cough), and severe (>5 cough). The incidence of FIC was analysed with Fisher's exact test and severity was analysed with the Mann-Whitney U-test. A P-value of <0.05 was considered significant.

RESULTS

The incidence of cough was 32% in the control group and 4% in the huffing manoeuvre group (P<0.00). In the control group, 12% of FIC cases were moderate to severe in nature whereas no patient suffered severe coughing in the huffing manoeuvre group (P=0.049).

CONCLUSIONS

A huffing manoeuvre performed just before i.v. fentanyl (2.5 microg kg(-1)) significantly reduces the incidence and severity of FIC in the majority of the patients.

Risk-factors and strategies for control of carcinoma cervix in India: hospital based cytological screening experience of 35 years

PURPOSE

Role of risk factors in cervical carcinogenesis and strategies for control of the disease have been assessed from the accumulated cytological data, derived from 35 years of hospital-based screening in Lucknow, North India.

MATERIALS AND METHODS

A total of 36,484 women have been cytologically screened during a span of 35 years (April 1971 - June 2005) in the Gynaecology out patient department (OPD) of Queen Mary's Hospital.

RESULTS

The frequency of Squamous Intraepithelial Lesion (SIL) and carcinoma was found to be 7.2% and 0.6%, respectively, in the present study. The study revealed high age and parity as a predominant factor in cervical carcinogenesis, while viral sexually transmitted disease (STDs) -human papilloma virus (HPV) and Herpes simplex virus (HSV) were also largely associated with SIL cases. The study emphasized great value of clinically downstaging the cervical cancer by detecting cervical cancer in the early stage. The study also revealed a significant difference in the frequency of SIL in symptomatic and asymptomatic women.

CONCLUSION

Based on the analyzed data, it was felt that single lifetime screening, which appears to be the most feasible and affordable mode for control of carcinoma cervix in developing countries like India, should be carried out in all women of high parity irrespective of age (with three or more children) and in older women above the age of 40 years irrespective of parity.

Characterization of RPO B gene for detection of rifampicin drug resistance by SSCP and sequence analysis

PURPOSE

Because of the emergence of multidrug-resistant tuberculosis in recent times, the rapid detection of resistance to the first-line anti-tuberculosis drug rifampicin was felt worldwide. Accordingly, this study was conducted to evaluate the diagnostic potential of polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) for checking its utility as a rapid screening test for determination of rifampicin drug resistance.

MATERIALS AND METHODS

A total of 34 isolates of Mycobacterium tuberculosis (M. tuberculosis) (22 rifampicin resistant, 11 rifampicin sensitive and one control H37Rv) strains were analysed by PCR-SSCP and DNA sequencing within the 157-bp region of the rpo B gene (Ala 500-Val 550).

RESULTS

Rifampicin resistance was detected successfully by PCR-SSCP in 20/22(90.90%) of rifampicin-resistant strains showing a total of nine different mutations in seven codon positions: codon 513 (CAA-->CCA), 516 (GAC-->GTC), 507 (GGC-->GAC), 526 (CAC-->GAC, TAC), 531 (TCG-->TTG, TGG), 522 (TCG-->TGG) and 533 (GTG-->CCG). Two rifampicin-resistant strains showed an identical PCR-SSCP pattern with the wild type H37Rv; 77.27% rifampicin-resistant strains showed a single point mutation and 9.09% had no mutation. Three rifampicin-resistant strains showed characteristic double mutations at codon positions 526 and 531. Sensitivity and specificity were calculated as 90.90% and 100%.

CONCLUSIONS

Rifampicin-resistant genotypes were mainly found in codon positions 516, 526 and 531. PCR-SSCP seems to be an efficacious method of predicting rifampicin resistance and substantially reduces the time required for susceptibility testing from 4 to 6 weeks to a few weeks.

Non-smokers are more prone to pulmonary oedema than smokers during acute coronary syndrome

OBJECTIVES

Acute coronary syndrome (ACS) patients are prone to develop pulmonary oedema with varied degree of hypoxaemia. The aim was to compare the risk for pulmonary oedema and related complications during ACS amongst non-smokers vs. smokers.

METHODS

Prospective, observational study was performed in consecutive 68 patients presenting with ACS. They were divided into two groups; group 1 (n = 33) non-smokers and group 2 (n = 35) chronic smokers. Standard conservative treatment was given to maintain mean arterial pressure >or= 60 mmHg, oxygen saturation > 95%. The bedside chest x-ray was graded for Battler grading (0-4) for pulmonary oedema. All patients were evaluated for troponin, serial creatinine kinase, echocardiography, arterial blood gas, renal function and correlated with inotropes requirement, active respiratory support, coronary care unit (CCU) stay and hospital outcome.

RESULTS

Patients in both the groups had similar cardiac involvement for cardiothoracic ratio, troponin, ejection fraction and creatinine kinase muscle and brain (CK-MB). The bedside chest x-ray revealed significant (p < 0.05) lung oedema grades (3 and 4) in 60% non-smokers (group 1) vs. smokers (11%). These patients (group 1) also presented with significant (p < 0.001) hypoxaemia (lower PaO(2)/FiO(2)-201 +/- 44), metabolic acidosis (higher lactate; 2.1 +/- 0.72 mmol/l, base deficit; -5.1 +/- 4.8) and hypocarbia (28 +/- 2.9 mmHg) than smokers (group 2). The risk estimates for active respiratory support (OR =1.716) and inotrope use (OR = 1.836) was three times higher in non-smokers than smokers.

CONCLUSIONS

The higher degree of pulmonary oedema and hypoxemia probably contributed to poor short-term outcome in non-smokers than smokers. It would be important to recognise and treat hypoxaemia in non-smokers during ACS.

Evaluation of a single preoperative dose of pregabalin for attenuation of postoperative pain after laparoscopic cholecystectomy

BACKGROUND

Postoperative pain is the dominating complaint and the primary reason for prolonged convalescence after laparoscopic cholecystectomy. We have evaluated the efficacy of a single preoperative dose of pregabalin for attenuating postoperative pain and fentanyl consumption after laparoscopic cholecystectomy.

METHODS

Sixty adults (16-60 yr), ASA physical status I and II, of either sex undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized placebo controlled, double-blind study. Subjects were divided into two groups of 30 each to receive either a matching placebo or pregabalin 150 mg, administered orally 1 h before surgery. Postoperative pain (static and dynamic) was assessed by a 100 mm visual analogue scale, where 0, no pain; 100, worst imaginable pain. Subjects received patient-controlled i.v. fentanyl analgesia during the postoperative period. Results were analysed by Student's t-test, chi(2) test, Mann-Whitney U-test, and Fisher's exact test.

RESULTS

Postoperative pain (static and dynamic) and postoperative patient-controlled fentanyl consumption were reduced in the pregabalin group compared with the placebo group (P<0.05). Side-effects were similar in both groups.

CONCLUSIONS

A single preoperative oral dose of pregabalin 150 mg is an effective method for reducing postoperative pain and fentanyl consumption in patients undergoing laparoscopic cholecystectomy.

Antenatal diagnosis of large sacro-coccygeal teratoma with foetal cardiomegaly and hydrops

We report the case of a young primigravida who presented with a 20 weeks pregnancy with a previous diagnosis of uterine fibroid. However, ultrasound evaluation revealed the presence of a large sacro-coccygeal teratoma in the foetus which was heterogeneous with cystic areas and calcific foci, and showed increased vascularity. There was also evidence of foetal cardiomegaly and hydrops foetalis, indicated by subcutaneous oedema in the foetus,thickened placenta and polyhydramnios. The presence of hydrops with sacro-coccygeal teratoma has a grave prognosis for the mother and child; hence termination of pregnancy was done. A 20 weeks old foetus with a huge sacro-coccygeal mass, which was ruptured at many places and showed areas of active bleed, was expelled.

Novel method of using dynamic electrical impedance signals for noninvasive diagnosis of knee osteoarthritis

Osteoarthritis (OA) of knee is the most commonly occurring non-fatal irreversible disease, mainly in the elderly population and particularly in female. Various invasive and non-invasive methods are reported for the diagnosis of this articular cartilage pathology. Well known techniques such as X-ray, computed tomography, magnetic resonance imaging, arthroscopy and arthrography are having their disadvantages, and diagnosis of OA in early stages with simple effective noninvasive method is still a biomedical engineering problem. Analyzing knee joint noninvasive signals around knee might give simple solution for diagnosis of knee OA. We used electrical impedance data from knees to compare normal and osteoarthritic subjects during the most common dynamic conditions of the knee, i.e. walking and knee swing. It was found that there is substantial difference in the properties of the walking cycle (WC) and knee swing cycle (KS) signals. In experiments on 90 pathological (combined for KS and WC signals) and 72 normal signals (combined), suitable features were drawn. Then signals were used to classify as normal or pathological. Artificial multilayer feed forward neural network was trained using back propagation algorithm for the classification. On a training data set of 54 signals for KS signals, the classification efficiency for a test set of 54 was 70.37% and 85.19% with and without normalization respectively wrt base impedance. Similarly, the training set of 27 WC signals and test set of 27 signals resulted in 77.78% and 66.67% classification efficiency. The results indicate that dynamic electrical impedance signals have potential to be used as a novel method for noninvasive diagnosis of knee OA.

Structure and content of the Entamoeba histolytica genome

The intestinal parasite Entamoeba histolytica is one of the first protists for which a draft genome sequence has been published. Although the genome is still incomplete, it is unlikely that many genes are missing from the list of those already identified. In this chapter we summarise the features of the genome as they are currently understood and provide previously unpublished analyses of many of the genes.

Human C-reactive protein promotes oxidized low density lipoprotein uptake and matrix metalloproteinase-9 release in Wistar rats

C-reactive protein (CRP) is present in the atherosclerotic plaques and appears to promote atherogenesis. Intraplaque CRP colocalizes with oxidized low density lipoprotein (OxLDL) and macrophages in human atherosclerotic lesions. Matrix metalloproteinase-9 (MMP-9) has been implicated in plaque rupture. CRP promotes OxLDL uptake and MMP induction in vitro; however, these have not been investigated in vivo. We examined the effect of CRP on OxLDL uptake and MMP-9 production in vivo in Wistar rats. CRP significantly increased OxLDL uptake in the peritoneal and sterile pouch macrophages compared with human serum albumin (huSA). CRP also significantly increased intracellular cholesteryl ester accumulation compared with huSA. The increased uptake of OxLDL by CRP was inhibited by pretreatment with antibodies to CD32, CD64, CD36, and fucoidin, suggesting uptake by both scavenger receptors and Fc-gamma receptors. Furthermore, CRP treatment increased MMP-9 activity in macrophages compared with huSA, which was abrogated by inhibitors to p38 mitogen-activated protein kinase, extracellular signal-regulated kinase (ERK), and nuclear factor (NF)-kappaB but not Jun N-terminal kinase (JNK) before human CRP treatment. Because OxLDL uptake by macrophages contributes to foam cell formation and MMP release contributes to plaque instability, this study provides novel in vivo evidence for the role of CRP in atherosclerosis.

Comparison of the incidence and severity of cough induced by sufentanil and fentanyl: a prospective, randomised, double-blind study

We compared the incidence and severity of cough following a bolus of sufentanil with that following fentanyl in 510 patients, randomly allocated to receive sufentanil 0.3 microg.kg(-1), fentanyl 3 microg.kg(-1) or 5 ml sterile water intravenously over 5 s. Coughing was graded depending on the number of coughs as mild (1-2), moderate (3-5) and severe (> 5). The incidence of coughing was higher after sufentanil (26/165; 15%) and fentanyl (54/169; 32%) than in the control group (0/168; p < 0.001). Sufentanil was also associated with a lesser severity (p = 0.039) of coughing compared with fentanyl. We conclude that equipotent boluses of sufentanil and fentanyl increase the incidence of cough, although the incidence and severity of coughing with sufentanil are less than those with fentanyl.

Electrical impedance signal analysis in assessing the possibility of non-invasive diagnosis of knee osteoarthritis

Knee osteoarthritis (OA) is a degenerating disorder that leads to pain, disability and dependence. Although significant numbers of elderly people are affected by this irreversible damage, not many non-invasive methods have been found that can detect onset of OA. The traditional x-ray has the disadvantage of detecting a problem only after many changes have taken place. Others, such as MRI and ultrasound, are either expensive or unsuitable for mass screening and repeated use. In this paper, an attempt has been made to study the usefulness of electrical impedance plethysmography (EIP) in non-invasive diagnosis of knee OA. In two experiments on 10 OA knees and eight control knees in groups aged 45 - 65 years (OA group: 62.40 +/- 3.47 years, controls: 53.38 +/- 8.55 years), knee swing (active flexion and extension of leg in sitting position, KS) and normal walking (WN) electrical impedance changes (DeltaZ) around the knee were analysed. The results indicate that there is significant difference in amplitudes of signals. Difference in mean of variances of two groups was significant (p < 0.05) for KS and WN. The difference in the mean rms values was also significant (p < 0.05) for KS and WN. Impedance changes suggest that EIP signal around the knee have the potential for non-invasive diagnosis of knee OA.

Evaluation of gemcitabine versus cisplatinum as an adjunct to radiotherapy in locally advanced carcinoma uterine cervix

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Background: Locally advanced carcinoma cervix patients are treated by a combination of external beam radiation and brachytherapy. Concurrent chemo-radiotherapy has been an active area of investigation in such patients. In this present study, we have compared two chemotherapy drugs- cisplatinum vs gemcitabine along with radiotherapy in loco-regionally advanced carcinoma cervix with the purpose of evaluating loco-regional disease control and tolerability of these combinations. Methods: This study was undertaken on 65 biopsy-proven patients with stage IIb- IIIb carcinoma cervix. All patients were treated with 50 Gy of external beam radiation with 2 Gy per fraction, 5 days a week followed by intra-cavitary radiotherapy (ICRT). Dose of ICRT delivered by high dose rate brachytherapy was 18 Gy by either of the two schedules, viz. 3 fractions of 6 Gy at weekly interval or 2 fractions of 9 Gy each at one week apart. The concurrent chemotherapy was either inj. Cisplatinum 35 mg/m2 IVI weekly (control group), or inj. gemcitabine 150 mg/m2 IVI weekly (Study group). Results: A total of 65 age and stage matched patients were recruited in the two arms of the study. We analyzed sixty patients who completed the above treatment protocol with 32 patients in control group and 28 in study group. Eighty-nine percent patients in study group had complete response (CR) to the above combination treatment vs. 72% CR in control arm (p< 0.05). However, overall response rate (CR+ PR) was similar in both the groups (96% in study group vs. 100% in control group). No patient in both the groups had grade IV skin reaction with only one patient in study group developing grade III skin toxicity. Grade III gastrointestinal (GI) toxicity was higher in study group as compared to controls (14% vs. 3%) with none of the patients experiencing grade IV GI toxicity. No other significant toxicity was encountered in this study. Conclusions: We can conclude that synchronous chemo-radiotherapy using either gemcitabine or cisplatinum as radiation sensitizer is feasible in locally advanced carcinoma cervix with similar overall response rate and acute toxicity profile with a significantly higher complete response rate when gemcitabine is used as a chemotherapeutic drug.

No significant financial relationships to disclose.

Vitamin E: inflammation and atherosclerosis

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the western world with its incidence increasing lately in developing countries. Several lines of evidence support a role for inflammation in atherogenesis. Hence, dietary micronutrients having antiinflammatory properties may have a potential beneficial effect with regard to CVD. Vitamin E is a potent antioxidant with antiinflammatory properties. It comprises eight different isoforms: four tocopherols (T) (alpha, beta, gamma, and delta) and four tocotrienols (T3) (alpha, beta, gamma, and delta). A wealth of data is available for the preventive efficacy of alpha-T. alpha-T supplementation in human subjects and animal models has been shown to be antioxidant and antiinflammatory in terms of decreasing C-reactive protein (CRP) and release of proinflammatory cytokines, the chemokine IL-8 and PAI-1 levels especially at high doses. gamma-T is effective in decreasing reactive nitrogen species and also appears to have antiinflammatory properties; however, there are scanty data examining pure gamma-T preparations. Furthermore, tocotrienols (alpha and gamma) also have implications for prevention of CVD; however, there are conflicting and insufficient data in the literature with regards to their potency. In this chapter, we have gathered recent emerging data on alpha-T specifically and also have given a composite view of gamma-T and tocotrienols especially with regards to their effect on inflammation as it relates to CVD.

Expression and Functional Analysis of Fibulin-1 (Fbln1) During Normal and Abnormal Placental Development of the Mouse

The extracellular matrix protein fibulin-1 (FBLN1) is an important component of blood vessel walls, as shown by the lethality of mice with homozygous targeted deletion of the Fbln1 gene. Here, we show that a murine placental overgrowth phenotype is associated with elevated Fbln1 transcript levels, suggesting that the gene and its product have a functional role in placentation. Fbln1 exhibits a specific expression pattern in the mouse placenta. Transcripts could not be detected prior to day 12. In subsequent stages, Fbln1 was expressed strongly in the spongiotrophoblast. Other sites of expression were endothelia of large fetal blood vessels, a tissue type reported to not express this gene. In addition, a subset of giant cells expressed the gene. This giant cell specific expression was strongly increased in hyperplastic placentas. Analysis of the placentation in fibulin null mice did not show any abnormality. Attempts to rescue the placental phenotypes of a congenic model of interspecies hybrid placental dysplasia (IHPD) by normalizing expression of Fbln1 proved that Fbln1 alone is not the key cause of phenotypes in these models of placental hyperplasia.

Expression and function of the gene encoding the voltage-dependent calcium channel beta3-subunit in the mouse placenta

Voltage-dependent Ca(2+) channels (VDCC) exist in most excitable cells and their properly regulated activity is essential for critical biological processes as many of these are sensitive to cellular Ca(2+) ion concentration. The ancillary cytoplasmic Ca(2+) channel beta subunits (CACNB) modulate Ca(2+) channel function and are required to enhance the number of functional channels in the plasma membrane. There are four genes encoding CACNB subunits and the gene encoding CACNB3 is over expressed in hyperplastic placentas of mouse interspecies hybrids. To determine the role of CACNB3 in the mouse placenta, we performed an expression and function analysis. Our results show that Cacnb3 exhibits specific spatial and temporal expression in the mouse placenta. Deletion of Cacnb3 does not produce a strong placental phenotype, which may be due to expression of other CACNB subunit encoding genes; however, sporadic occurrence of a labyrinthine architecture phenotype, characterized by reduced density of fetal blood vessels and decrease in pericyte number, could be observed. Down-regulation of Cacnb3 expression did not rescue placental hyperplasia in a model of interspecies hybrid placentas, which indicates that up-regulation in the hyperplastic placentas is a downstream event.

Quality of life and gender role behavior in disorders of sexual differentiation in India

OBJECTIVE

Culture-specific tools to assess longterm psychosocial outcomes for patients with disorders of sexual differentiation are scant. We conducted a study to develop tools for evaluating gender role behavior and health related quality of life for Indian adolescent patients with intersex disorders. We also studied factors important to parents while deciding sex of rearing for their baby.

METHODS

A 29-item gender role behavior questionnaire and an 18-item health related quality-of-life questionnaire were administered to 82 healthy controls, 13 patients with intersex disorders and 18 patients with type 1 diabetes mellitus. Internal consistency was checked by Cronbach's alpha and test-retest reliability using intra-class correlation coefficient. Responses of 28 parents to a questionnaire on factors affecting the decision of sex of rearing were recorded on a 5-point Likert scale in order of importance.

RESULTS

Cronbach's alpha was 0.92 and 0.75, and intra-class correlation coefficient 0.76 and 0.75, for the gender role behavior and quality-of-life questionnaires respectively, indicating a high degree of internal consistency and stability. The mean composite scores for healthy girls on the gender role behavior questionnaire (82.5 +/- 8.7) differed significantly from that for healthy boys (53.2 +/- 7.1, p <0.001). Factors important to parents while making decisions for sex of rearing were appearance of the genitalia, medical advice, ability to bear children and economic independence.

CONCLUSIONS

We have created valid tools to study gender role behavior and quality of life in adolescent patients with intersex disorders in India. We have also identified in a quantitative way the factors of greatest importance to parents while deciding sex of rearing. These results have direct utility in the management of patients with intersex disorders in India and other similar cultures.