Bcl-2 and p53 expressions in Indian women with complete hydatidiform mole

INTRODUCTION

Hydatidiform moles have a high incidence rate in Asian countries like India. The molecular pathway leading to the pathogenesis and progression of hydatidiform moles is not yet understood. This study aimed to investigate the biological significance of Bcl-2 and p53 in complete hydatidiform moles (CHMs) as well as their influence on disease progression in the Indian population.

METHODS

Archival tissues from 35 patients with CHMs and 35 age-matched controls were examined for Bcl-2 and p53 expressions by immunohistochemistry.

RESULTS

Bcl-2 was found to be immunolocalised in the cytoplasm of the syncytiotrophoblast, whereas p53 was observed in both the nucleus and cytoplasm of the syncytiotrophoblast and cytotrophoblasts. In CHMs, Bcl-2 was detected in 23 percent of patients and p53 nuclear expression, in 66 percent. A significant decrease in Bcl-2 expression was observed in CHMs (p-value is 0.015), and the down-regulation of Bcl-2 significantly correlated with higher nuclear expression of p53 (p-value is 0.002), indicating an inverse association between the two proteins (p-value is 0.0001). However, no correlation was found between the clinical progress of patients with CHMs and p53 and those with Bcl-2 protein expression.

CONCLUSION

The current study demonstrated the significance of Bcl-2 and p53 in the pathogenesis of CHMs but did not reveal any association with disease progression.

Dual therapy versus monotherapy of trandolapril and telmisartan on diabetic nephropathy in experimentally induced type 2 diabetes mellitus rats

Objective: To investigate the combination of telmisartan with trandolapril therapy versus monotherapy of trandolapril and telmisartan on diabetic nephropathy in type 2 diabetes mellitus rats.

Material and methods: Neonatal rats (2 days old) were used for inducing type 2 diabetes mellitus. Streptozotocin at a dose of 90 mg/kg, in freshly prepared citrate buffer (0.1M, pH 4.5), was injected intraperitoneally. There were five groups: (1) normal control, (2) diabetic control, (3) diabetic treated with telmisartan, (4) diabetic treated with trandolapril and (5) diabetic treated with telmisartan and trandolapril. Albumin excretion rate, total protein excretion rate, plasma fibronectin, transforming growth factor beta 1(TGF-β1), tumour necrosis factor-α (TNF-α) concentration and renal structural changes were measured.

Results: Albumin excretion rate, total protein excretion rate, plasma fibronectin, TGF-β1, TNF-α concentration and renal structural changes increased significantly in untreated diabetic rats compared with normal control rats. Administration of telmisartan, trandolapril, or both decreased these changes.

Conclusions: Addition of the telmisartan to trandolapril was more effective in reducing renal structural changes and improvement of renal function than monotherapy with either drug, possibly due to dual inhibitory effect on the renin— angiotensin system, and thus suppression of TGF-β1, TNF-α.

Morphology and morphometric analysis of stromal capillaries in full term human placental villi of smoking mothers: an electron microscopic study

OBJECTIVES

The capillaries of placental villi play a very important role in the feto-maternal exchange of gases and nutrients. A morphological change in their structure may lead to the impairment of placental function. In this study an attempt has been made to find out the morphological and morphometric features of the capillaries in full term placental villi of non smoking mothers as well as active and passive smoking mothers under an electron microscope.

MATERIALS AND METHODS

A total number of 163 placentae from active, passive and nonsmoking mother (n = 61+42+60) were processed for electron microscopic study. The ultrathin sections were examined under electron microscope and images were recorded. Morphometry and statistical analysis were carried out with the help of software.

RESULTS

The study revealed that the endothelial cells of stromal capillaries of the placental villi were oedematous and the cytoplasm was rich in dilated endoplasmic reticulum, mitochondria, fibrils and fine filaments in both groups of the smokers' placenta in comparison to control. Morphometric analysis showed a significant reduction in the perimeter of the stromal capillary of the tertiary villi of placenta in both active and passive smokers from mean value of 71.65 ± 47.82 µ to mean value of 59.77 ± 29.72 µ (p = 0.07) and 49.49 ± 20.94 µ (p = 0.0005) respectively. In case of passive smoker, area of the capillary (µm²) reduced significantly (p = 0.00004) from mean value of 266.29 ± 331.86 µm² to 116.64 ± 83.62 µm² whereas the number of capillary per villus increased significantly (p = 0.046) from mean value 2.42 ± 1.84 to 4.2 ± 3.16. The thickness of basement membrane of the endothelial cells of stromal capillaries of the placenta increased significantly in active as well as passive smokers (p = 0.00001).

CONCLUSIONS

The ultrastructural changes noticed in the endothelial cells of placental villi may be due to hypoxia resulting from tobacco consumption either in active or passive form by the pregnant mothers. Thus, targeted therapy may be implicated for hypoxia, which is one of the major cause of the life threatening disorders of pregnancy.

Primary nonunion of intertrochanteric fractures of femur: An analysis of results of valgization and bone grafting

BACKGROUND

Nonunion of intertrochanteric fractures is uncommon because there is excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). There is only one published series that exclusively describes seven primary nonunions of intertrochanteric fractures. The aim of the present study was to analyze the results of internal fixation, valgization with 135° dynamic hip screw (DHS), and bone grafting in patients with primary nonunion of intertrochanteric fractures.

MATERIALS AND METHODS

Eighteen patients with primary intertrochanteric nonunion were included in the study; 16 were male and 2 were female. The age range was 30-70 years (mean: 46.9 years). The mean duration since index injury was 8.5 months (range: 4-18 months). As per the AO classification, the fractures were 31A 1.1 (n=1), 1.2 (n=1), 2.2 (n=3), 2.3 (n=9), and 3.3 (n=4). Three patients had hypermobile nonunion and 15 had stiff nonunion. The surgical principle was excision of pseudarthrosis, if present (n=3); freshening of the bone ends; stable fixation with 135° DHS, with good proximal purchase; bone grafting; and valgization.

RESULTS

Union was achieved in all patients at an average of 5.62 months (range: 4-7 months). The Harris hip score improved from 38 points preoperatively to 86 postoperatively at healing. The average limb shortening improved by 2 cm (range: 1.5 cm-3 cm). There was no infection and pain at the hip at final follow-up in any of the cases. All patients were subjectively satisfied with the outcome. All were capable of full weight bearing on their affected limb.

CONCLUSION

Union in primary nonunion of intertrochanteric fractures in physiologically young patients with a well-preserved femoral head and good bone stock can be achieved with internal fixation, valgization, and grafting procedures.

Assessment of daily intake of trace elements by Kakrapar adult population through ingestion pathway

Concentration of trace elements such as Fe, Cu, Ni, and Zn were measured in cereals, pulses, vegetables, fish, meat, milk, egg, and water samples collected around Kakrapar, Gujarat, India. A wide variation of the trace element concentration was observed among all the dietary matrices. The concentration of Fe is comparatively more in all the dietary matrices. The concentrations of these elements are translated into intake rates through ingestion pathways. Daily intake (milligrams/day) of Fe, Cu, Ni, and Zn by adult population of Kakrapar, Gujarat were 16.5 +/- 6.2, 3.3 +/- 1.2, 1.8 +/- 1.0, and 3.6 +/- 1.3, respectively. Dietary sources of Fe, Cu, and Ni by Kakrapar adult population are comparable with RDA. In case of Zn, the daily dietary intake is comparatively lower than that of RDA.

Tuberculosis of the spine: a fresh look at an old disease

The dismal outcome of tuberculosis of the spine in the pre-antibiotic era has improved significantly because of the use of potent antitubercular drugs, modern diagnostic aids and advances in surgical management. MRI allows the diagnosis of a tuberculous lesion, with a sensitivity of 100% and specificity of 88%, well before deformity develops. Neurological deficit and deformity are the worst complications of spinal tuberculosis. Patients treated conservatively show an increase in deformity of about 15 degrees . In children, a kyphosis continues to increase with growth even after the lesion has healed. Tuberculosis of the spine is a medical disease which is not primarily treated surgically, but operation is required to prevent and treat the complications. Panvertebral lesions, therapeutically refractory disease, severe kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery. Patients who present with a kyphosis of 60 degrees or more, or one which is likely to progress, require anterior decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior bone grafting in the active stage of the disease. Late-onset paraplegia is best prevented rather than treated. The awareness and suspicion of an atypical presentation of spinal tuberculosis should be high in order to obtain a good outcome. Therapeutically refractory cases of tuberculosis of the spine are increasing in association with the presence of HIV and multidrug-resistant tuberculosis.

Thickness of glomerular and tubular basement membranes in preclinical and clinical stages of diabetic nephropathy

AIMS

This study aimed to elucidate the early renal changes in diabetes mellitus (DM) with and without clinical symptoms related to renal damage.

METHODS

Renal biopsy was studied in 25 patients (14 with microalbuminuria and 11 with albuminuria) both by light and electron microscopies (LM and EM, respectively) for renal changes and morphometry was performed to study glomerular and tubular basement membranes (GBM and TBM, respectively) width using a Soft Imaging System GmBH (analysis 3).

RESULTS

A significant increase was noted in the mean GBM and TBM thickness in both the preclinical and clinical groups compared to the control group. The changes in the TBM were noted to be predominant in both preclinical and clinical patients.

CONCLUSIONS

This study indicates the importance of morphometric evaluation of the GBM and TBM width in the elucidation of early renal damage in diabetic nephropathy, especially in the absence of LM changes. The significance of identification of early renal changes using morphometric techniques for better management of these patients requires further studies.

Bilateral central serous chorioretinopathy resolving rapidly with treatment for obstructive sleep apnea

BACKGROUND

Central serous chorioretinopathy (CSR) is a common disorder that affects many individuals, often for unknown reasons; we present a case of bilateral CSR that rapidly resolved with treatment of obstructive sleep apnea (OSA).

METHODS

Observational case report.

RESULTS

Bilateral decreased vision to 20/30 OD and 20/40 OS due to typical CSR lesions. Systemic evaluation led to a diagnosis of OSA, which was treated and resulted in rapid resolution of the CSR and improvement of visual acuity in both eyes.

DISCUSSION

We present the first case of rapidly resolving bilateral CSR due to the treatment of OSA.

Life insurance for living kidney donors: a Canadian undercover investigation

Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied.

Development and Characterization of Mucoadhesive Microspheres Bearing Salbutamol for Nasal Delivery

Mucoadhesive drug delivery systems are those that provide intimate contact of the drug with the mucosa for an extended period of time. In our present work, mucoadhesive chitosan microspheres were prepared by emulsion solvent method. Formulations were characterized for various physicochemical attributes, shape, surface morphology, size, and size distribution, drug payload, swelling ability, and mucoadhesion. The effect of drug, citric acid, and permeation enhancer concentration on the physicochemical properties was studied. Crosslinked chitosan microspheres showed very good mucoadhesion, which was decreased on increasing the drug concentration and citric acid concentration, and slightly improved upon incorporation of permeation enhancer. The in vitro drug release and in vitro drug permeability through mucous membrane were performed, and slow release/permeation was noted with chitosan citrate complexed microspheres compared with noncomplexed chitosan microspheres. The in vivo performance of mucoadhesive microspheres formulations showed prolonged and controlled release of salbutamol as compared with oral administration of conventional dosage form.

Cyclooxygenase-2 derived PGE2 and PGI2 play an important role via EP2 and PPARdelta receptors in early steps of oil induced decidualization in mice

Differentiation of endometrial stromal cells into decidual cells (decidualization) is prerequisite for blastocyst implantation. Different prostanoids are shown to be involved in the cascade of events found in implantation and decidualization. Previous reports described that cyclooxygenase-2 (COX2) derived prostacyclin (PGI2) plays an important role via peroxisome proliferator activated receptor (PPARdelta) nuclear receptor in implantation and decidualization. Herein, we investigated the role of COX2 derived PGE2 and PGI2 and examined the protein expression and regulation of COX1, COX2, membrane-bound prostaglandin E synthase (mPGES-1), prostaglandin I synthase (PGIS), PGE2 receptor (EP2) and PPARdelta in hormone primed oil infused uterine horn as well as in non-infused uterine horn (control horn). Our results show that selective COX2 inhibitor (Nimesulide) inhibits decidualization while COX1 inhibitor (SC560) does not affect decidualization. COX2, mPGES-1, PGIS, EP2 and PPARdelta immunostaining are strongly observed at 24 h and 48 h in oil-induced horn and than significantly reduced at 72 h and 120 h and absent in non-infused horn. However COX1 immunostaining is observed in infused as well as in non-infused horn. Our immunohistochemical studies corroborated well with follow up western blotting of the same proteins. PGE2 and PGI2 products were also elevated at 24h and 48 h after oil induction in infused horn in comparison to control horn. Our data suggest that COX2 derived both PGE2 and PGI2 mediate its function via EP2 and PPARdelta receptors in early steps of decidualization in mice.

Excision of pituitary adenomas: randomized comparison of surgical modalities

The aim of this randomized prospective study was to compare the efficacy of endoscopic versus standard microsurgical excision of pituitary adenomas, and to evaluate the merits and demerits of each approach. Twenty patients with a pituitary adenoma were randomly divided into two groups comprising of 10 cases each. Ten cases were operated by endoscopic endonasal trans-sphenoidal approach by endoscopic rhinologist (EETSS group) and other 10 cases were excised by microsurgical endonasal trans-sphenoidal approach by a neurosurgeon (SMETSS group). In both the groups complete excision was achieved in 50% of patients (unpaired t-test, p = 1.00). In EETSS group mean operative time was 64.5 +/- 19.16 min (range 50 - 100 min). In the SMETSS group, mean operative time was 75.5 +/- 18.48 min (range 55 - 120 min; unpaired t-test, p = 0.64, statistically not significant). In the EETSS group blood loss ranged between 100 and 190 ml (mean 100 +/- 42.16 ml). In the SMETSS group blood loss ranged between 50 and 250 ml (mean loss of 120 +/- 58.69 ml; unpaired t-test, p < 0.05, statistically significant). Postoperative nasoseptal complications were more common in SMETSS group (Chi-square test, p < 0.05, statistically significant). Endoscopic approach provides a wide surgical field and broad lateral vision making easier distinction of tumour tissue: gland and gland diaphragm interface. Thus, there is less blood loss and nasoseptal complications, whereas there was no statistically significant difference in operative time and complete tumour removal.

Receptor-interacting protein 2 is a marker for resolution of peritoneal dialysis-associated peritonitis

There are no predictive factors for peritoneal dialysis-associated peritonitis; however, its resolution correlates with a cell-mediated Th1 immune response. We tested the hypothesis that induction of receptor-interacting protein 2 (RIP2), an assumed kinase linked with Th1 responses, is a useful marker in this clinical setting. Basal RIP2 expression was measured in human immune cells and during dialysis-associated peritonitis. RIP2 increased with bacterial toxin cell activation and the temporal profile for this differed depending on immune cell involvement in the innate or adaptive phases of the response. Importantly, RIP2 expression increased in peritoneal immune cells during dialysis-associated peritonitis and this upregulation correlated with clinical outcome. An early induction in peritoneal CD14(+) cells correlated with rapid resolution, whereas minimal induction correlated with protracted infection and with catheter loss in 36% of patients. These latter patients had higher levels of MCP-1 consistent with a delayed transition from innate to adaptive immunity. Our study shows that upregulation of RIP2 is a useful marker to monitor dialysis-associated peritonitis and in predicting the clinical outcome of these infections.

Ytterbium-selective polymeric membrane electrode based on substituted urea and thiourea as a suitable carrier

Plasticized membranes using 1-phenyl-3-(2-thiazolyl)-2-thiourea (PTT) and 1-phenyl-3-(2-thiazolyl)-2-urea (PTU) have been prepared and explored as ytterbium ion-selective sensors. Effect of various plasticizers, viz. chloronaphthalene (CN), o-nitrophenyloctyl ether (o-NPOE), dibutylphthalate (DBP), dioctylsebacate (DOS) and anion excluders, sodium tetraphenylborate (NaTPB) and oleic acid (OA) was studied and improved membrane performance was observed. Optimum performance was noted with membrane of PTT having composition of PTT (3.5):PVC (80):DOS (160):NaTPB (1.5) in mg. The sensor works satisfactorily in the concentration range 1.2x10(-7) to 1.0x10(-2) M (detection limit 5.5x10(-8) M) with a Nernstian slope of 19.7 mV decade(-1) of activity. Wide pH range (3.0-8.0), fast response time (10 s), non-aqueous tolerance (up to 20%) and adequate shelf life (12 weeks) indicate the vital utility of the proposed sensor. The proposed electrode comparatively shows good selectivity for Yb3+ ion with respect to alkali, alkaline earth, transition and rare earth metals ions and can be used for its determination in binary mixtures and sulfite determination in white and red wine samples.

An iron(III) ion-selective sensor based on a mu-bis(tridentate) ligand

A mu-bis(tridentate) ligand named 2-phenyl-1,3-bis[3'-aza-4'-(2'-hydroxyphenyl)-prop-4-en-1'-yl]-1,3-imidazolidine (I) has been synthesized and scrutinized to develop iron(III)-selective sensors. The addition of sodium tetraphenyl borate and various plasticizers, viz., chloronaphthalene, dioctylphthalate, o-nitrophenyl octyl ether and dibutylphthalate has been used to substantially improve the performance of the sensors. The membranes of various compositions of the ligand were investigated and it was found that the best performance was obtained for the membrane of composition (I) (10mg):PVC (150mg):chloronaphthalene (200mg):sodium tetraphenyl borate (9mg). The sensor showed a linear potential response to iron(III) over wide concentration range 6.3x10(-6) to 1.0x10(-1)M (detection limit 5.0x10(-6)M) with Nernstian slope (20.0mV/decade of activity) between pH 3.5 and 5.5 with a quick response time of 15s. The potentiometric selectivity coefficient values as determined by match potential method (MPM) indicate excellent selectivity for Fe(3+) ions over interfering cations. The sensor exhibits adequate life of 2 months with good reproducibility. The sensor could be used in direct potentiometry.

Non-Pseudomonas Gram-negative peritonitis

Non-Pseudomonas Gram-negative organisms account for over 10% of cases of peritoneal dialysis-associated peritonitis. The key findings from a paper by Szeto et al. are discussed and compared with those from previous publications. This type of peritonitis has a high rate of catheter removal and technique failure. Results may be better with more aggressive antibiotic treatment. Other developments in the field are reviewed.

Subtrochanteric periosteal chondroma: A case report and tumor overview

We report a rare case of subtrochanteric periosteal chondroma in a 16 years boy. The purpose of this presentation is to stress the importance of a proper clinico-radiological and histopathological diagnosis of this lesion. Awareness of the features of this lesion helps to prevent overtreatment of this benign condition, since its differentiation with malignant lesions may be extremely difficult, even at histology; and since conservative surgery with complete excision of the lesion leads to permanent cure.

Avian human influenza : diagnosis, case management and treatment

The H5N1 influenza virus infected human in 1997 for the first time in Hong Kong leading to development of influenza like symptoms. Its incubation period is 8-17 days. Cases of influenza can be confirmed with possible viral culture for H5N1 or positive PCR for H5N1 or positive IFA test using monoclonal antibodies against H5N1 or a four-fold rise in H5N1 specific antibody titre. The plain x-ray chest may show patchy opacities involving at least two zones, lobar consolidation with air and ultimately rapidly evolving ground glass appearance may occur. WHO recommends use of oseltamivir for case management. Public health measures include to report all suspected cases of influenza and to identify all cases might have been exposed to common source of infection and they should be monitored for 7 days.