Relationships of Urinary Beta2- microglobulin in Neonates with Impaired Renal Function in Different Stages of Hypoxic Ischaemic Encephalopathy

Hypoxic Ischaemic Encephalopathy (HIE) is a sequelae of neonates suffering from severe perinatal asphyxia. It may also cause impaired renal function due to acute tubular necrosis followed by elevation of urinary concentration of certain low molecular weight proteins like ?2- microglobulin. This study was designed to evaluate the urinary ?2- microglobulin level in neonates with HIE patients those who have impaired renal function. This prospective case control study was carried out in the Neonatal unit of the department of Pediatrics and in the Labor ward of the department of Obstetrics and Gynecology Bangabandhu Sheik Mujib Medical University, Dhaka during the period of 1st July 2005 to 30th June 2006. This study was designed to estimate urinary ?2- micro globulin level in the asphyxiated newborn as well normal newborns to see any significant changes and to find out its relation with over all outcomes of newborns with perinatal asphyxia. In this study, 42 term newborn babies before 24 hours of age, those who failed to take spontaneous breathing within 5 minutes of the complete delivery were taken as cases and 40 healthy term newborns were taken as control. Asphyxiated newborns were divided into three groups depending on the sarnat and sarnat clinical staging of HIE. Mean±SD value of urinary ?-2- micro globulin in case group 4.1 ± 2.79 mg/l and in the control was 1.35 ± 1.08 mg/l. It shows significant (p<0.01) rise of urinary ?-2 micro globulin levels in case group. The degree of rise of urinary ?-2- micro globulin was related with the severity of HIE but blood urea and serum creatinine levels were not increased significantly in stage I and stage II except in stage III HIE patients. It was concluded from this study that raised urinary â2- microglobulin level may be related with HIE patients irrespective of clinical staging but serum creatinine and blood urea were found to be elevated only in stage III HIE patients. But to draw a conclusive evidence regarding relationship of urinary ?2 microglobulin with advance stages of HIE in neonates with impaired renal function require further large scale study. DOI: http://dx.doi.org/10.3329/bjch.v37i1.15348 BANGLADESH J CHILD HEALTH 2013; VOL 37 (1) : 22-26

Predictors of recovery of ovarian function during aromatase inhibitor therapy

BACKGROUND

Aromatase inhibitors (AIs) may cause a rise in estrogen levels due to ovarian function recovery in women with clinical chemotherapy-induced ovarian failure (CIOF). We carried out a prospective registry trial to identify predictors of ovarian function recovery during AI therapy.

PATIENTS AND METHODS

Women with hormone receptor (HR)-positive breast cancer who remained amenorrheic and had hormonal levels consistent with ovarian failure after adjuvant chemotherapy were enrolled in a multi-institutional clinical trial of anastrozole. Subjects underwent frequent assessment using an ultrasensitive estradiol assay. Multivariable analysis was used to evaluate clinical and biochemical predictors of ovarian function recovery within 48 weeks.

RESULTS

Recovery of ovarian function during AI therapy was observed in 13 of 45 (28.9%) assessable subjects after a median 2.1 months (range 0.6-11.9). Median age at chemotherapy initiation was statistically significantly different between those who regained ovarian function (43 years, range 40-51) and those who remained postmenopausal (49 years, range 44-52; P < 0.0001).

CONCLUSIONS

A significant proportion of women with CIOF recover ovarian function during AI therapy, including a woman over age 50 at initiation of chemotherapy. Tamoxifen remains the standard of care for women with CIOF. If an AI is used, patients should be monitored frequently with high-quality estradiol assays. CLINICALTRIALS.GOV: NCT00555477.

Hepatitis C virus and other risk factors in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) increased in Egypt in the past years, becoming the most common cancer among men. Hepatitis B virus (HBV) and hepatitis C virus (HCV) are the known primary risk factors for HCC. This study describes the viral profile of HCC in a predominantly rural area in Egypt. We included 148 HCC cases and 148 controls from the Tanta Cancer Center and the Gharbiah Cancer Society in the Nile delta region. Serological (ELISA) and molecular (PCR) analysis for HBV and HCV infection were performed on plasma samples from each subject. Epidemiologic, environmental, and medical histories were collected by interviewing of subjects. Around 90.5% of cases and controls were from rural areas. HCV infection was high in both cases and controls (89.2% and 49.3%, for cases and controls respectively by serology). HCV was the most important HCC risk factor [OR 9.7 (95% CI: 3.3-28.0, P <0.01)], and HBV infection showed marginal tendency of increased risk [OR 5.4 (95% CI: 0.9-31.8, P <0.06)]. Ever worked in farming [OR 2.8 (95% CI: 1.1-7.2, P <0.03)] and history of cirrhosis [OR 3.6 (95% CI: 1.6-8.1, P <0.01)] or blood transfusion [OR 4.2 (95% CI: 0.99-17.8, P <0.05)] were also associated with increased HCC risk. This study in a predominantly rural area in Egypt supports previous reports from other parts of Egypt that HCV infection is the primary HCC risk factor in Egypt. Further understanding of the relationship between infection and other risk factors in the development of HCC could lead to targeted interventions for at-risk individuals.

KEYWORDS

hepatocellular carcinoma; hepatitis; rural; risk factors; Egypt.

Disease severity and radioactive iodine use for thyroid cancer

CONTEXT

Although variation in radioactive iodine (RAI) use for thyroid cancer has been demonstrated, the role of region and nonclinical correlates of use within risk groups has not been investigated.

OBJECTIVE

The objective of the study was to determine the correlates of RAI use within risk groups.

DESIGN/SETTING/PATIENTS

Use of RAI was evaluated across 9 US regions in 85 948 patients with well-differentiated thyroid cancer diagnosed between 2004 and 2008 at 986 hospitals associated with the US National Cancer Database. Cancers were then categorized as low risk (tumor size ≤ 1 cm and American Joint Committee on Cancer stage I disease), medium risk (neither low nor high-risk), and high risk (American Joint Committee on Cancer stage III or IV). Within each risk stratum, the role of region and nonclinical correlates of RAI use were evaluated using hierarchical logistic regression.

MAIN OUTCOME MEASURE

Use of RAI was measured.

RESULTS

Rates of RAI use varied across geographic regions from 49% to 66%. Regional differences persisted after controlling for patient and hospital characteristics and evaluating less vs more intensive regions within low-risk [odds ratio (OR) 0.36 (95% confidence interval [CI] 0.25-0.53)], medium-risk [OR 0.23 (95% CI 0.16-0.34)], and high-risk cancers [OR 0.30 (95% CI 0.19-0.49)]. Patterns of RAI use were similar in medium- and high-risk patients. The most nonclinical correlates of use were in low-risk patients.

CONCLUSION

Similar treatment patterns for the heterogeneous medium-risk thyroid cancer patients compared with the high-risk patients suggest more intensive management in patients with medium-risk disease. The large number of nonclinical correlates of RAI use, including region, imply controversy over indications for RAI.

Enteric fever in an HIV/AIDS patient: Atypical manifestations

Bloodstream infections with Salmonella typhi, is uncommon in human immunodeficiency virus (HIV)-infected persons. The symptoms in such patients are often non-specific and have a rather insidious onset and progression. We report a patient with sepsis and lower limb gangrene due to Salmonella typhi infection in an HIV-infected patient.

PD04-01: Predictors of Recovery of Ovarian Function during Aromatase Inhibitor (AI) Therapy

Background: AIs may cause a paradoxical rise in estrogen levels due to re-activation of ovarian function in women with chemotherapy-induced ovarian failure (CIOF). Therefore, identification of residual ovarian estradiol production is critical if such women are treated with adjuvant AI therapy rather than tamoxifen. We performed a prospective registry trial to identify predictors of recovery of ovarian function during AI therapy.

Methods: Women with hormone receptor (HR) positive breast cancer who were pre- or peri-menopausal at diagnosis and who remained amenorrheic for ≥8 weeks after cyclophosphamide-containing adjuvant chemotherapy were enrolled in a multi-institutional, open-label clinical trial of anastrozole (1 mg/day). Following confirmation that serum estradiol (E2) levels were &lt;20 pg/ml using an ultrasensitive E2 assay (Quest Diagnostics), subjects initiated anastrozole. Serum E2 was assessed biweekly for 12 wks, then less frequently, for 72 wks. Multivariable logistic regression was used to evaluate clinical predictors (age at AI initiation OR chemotherapy, menopausal status at chemotherapy, body mass index (BMI), baseline E2) of recovery of ovarian function defined as elevated serum E2 levels or return of menses.

Results: Sixty-nine women were enrolled; current status is given in Table 1.

Threshold estimation based on a p-value framework in dose-response and regression settings

We use p-values to identify the threshold level at which a regression function leaves its baseline value, a problem motivated by applications in toxicological and pharmacological dose-response studies and environmental statistics. We study the problem in two sampling settings: one where multiple responses can be obtained at a number of different covariate levels, and the other the standard regression setting involving limited number of response values at each covariate. Our procedure involves testing the hypothesis that the regression function is at its baseline at each covariate value and then computing the potentially approximate p-value of the test. An estimate of the threshold is obtained by fitting a piecewise constant function with a single jump discontinuity, known as a stump, to these observed p-values, as they behave in markedly different ways on the two sides of the threshold. The estimate is shown to be consistent and its finite sample properties are studied through simulations. Our approach is computationally simple and extends to the estimation of the baseline value of the regression function, heteroscedastic errors and to time series. It is illustrated on some real data applications.

Dengue: A Clinicohaematological Profile

BACKGROUND

Fifty cases of fever, clinically suspected to be dengue were studied.

METHODS

Complete clinical, haematological evaluation and IgM capture assay was done.

RESULT

54% of patients clinically suspected to have dengue were positive for IgM antibodies by enzyme-linked immunosorbent assay (ELISA). The commonest clinical feature was fever with rash (85%). Thrombocytopenia was seen in 19% of patients only. One patient died of dengue shock syndrome (DSS).

CONCLUSION

Out of the 27 cases of seropositive dengue there was one death due to dengue shock syndrome. Thrombocytopenia may not always be a feature of dengue.

Changes in arterial stiffness but not carotid intimal thickness in acromegaly

CONTEXT

Acromegaly increases cardiovascular morbidity. We tested the hypothesis that increased arterial stiffness together with left ventricular hypertrophy may be a contributory factor.

PATIENTS AND DESIGN

Fifty-six patients (40 males, 54 ± 13 yr; 25 active disease, 31 in remission) and 46 healthy controls (30 males, 52 ± 13 yr) underwent measurements of aortic pulse wave velocity (PWV), carotid Doppler (IMT), echocardiography, and cardiovascular risk factors.

RESULTS

Mean serum IGF-I was 323 ± 286 ng/ml (sd score 1.8 ± 1.9) in all patients. Age, body mass index, diastolic blood pressure (BP), and lipid levels were similar comparing patients and controls. Systolic BP (130.8 ± 19.9 vs. 122 ± 14 mm Hg controls, P < 0.01) and PWV (11.7 ± 3.8 vs. 9.7 ± 2.8 m/sec, 95% confidence interval -3.4 to -0.7, P <0.01) were higher in patients than controls. Regression analysis revealed age, presence of acromegaly, systolic BP, and body mass index, inversely, as significantly and independently associated with PWV. No difference in carotid IMT was seen (0.8 ± 0.2 patients vs. 0.7 ± 0.2 mm controls, P = 0.5) or between active/controlled disease. In the subset of participants with echocardiography (n = 32), left ventricular mass was higher by a mean of 38.2 g (95% confidence interval -80.9 to +4.6, P = 0.08).

CONCLUSION

In summary, patients with acromegaly had independently and significantly increased aortic PWV as evidence of arterial stiffening but unaltered carotid IMT compared with controls, also influenced by age and systolic BP. Premature cardiovascular disease in patients with acromegaly is likely related to pressure-related arterial and left ventricular stiffening rather than atherosclerotic disease.

High rate of prevalence of clock 3′UTR polymorphism rs1801260 and a novel variation: Association with diurnal preference

There are a number of reports which show CLOCK 3111 T/C SNP rs1801260 is associated with ‘eveningness’ circadian type, but the results are not consistent across different populations. The present study tried to address the effect of CLOCK polymorphisms on Diurnal preference in the South Indian population. 108 subjects were genotyped for rs1801260 polymorphism by direct sequencing. Demographic data was collected from genotypically stratified groups of subjects using a modified sleep wake cycle questionnaire. Data from the questionnaire recorded the subjects sleep wake pattern and their peak performance time of the day. The sequencing data was aligned and analyzed using Mutation Survey software for new mutations. We found a new variation in the 3′UTR region of the CLOCK gene (BankIt1368312 Seq1 HM626403, BankIt1368312 Seq2 HM626404) which may be a possible miRNA binding site. Our study found that CLOCK 3111 T/C polymorphism is negatively associated with Eveningness with a significance of 0.038. We found that the prevalence rate of rs1801260 is high and the ancestral genotype is associated with eveningness. Though the sample size was small this was a homogenous group from south India selected for the study. It is the first study in south Indian population to document the effect of CLOCK polymorphisms on Circadian rhythm.

Synthesis and evaluation of 1,3 di-substituted schiff, mannich bases and spiro isatin derivatives

Schiff bases of isatin with aminothiazole, its N-mannich bases and Spiro isatin derivatives were synthesized. Their chemical structures were confirmed by Infrared, 1H-Nuclear Magnetic Resonance data and elemental analysis. Antimicrobial evaluation was performed by the agar diffusion method against four pathogenic bacteria and two pathogenic fungi. Anti-inflammatory activity was tested by carragenin-induced rat paw edema and compounds were evaluated for analgesic action by the acetic acid-induced writhing method; Compounds Aa, Ab and A5, A6 were found to be active against bacteria and fungi. The compounds A3, A6, Aa and Ab showed anti-inflammatory activity, having a percentage protection value of 34.69, 32.65, 38.77 and 36.73 as compared with that of indomethacin, with % protection of 46.93. Similarly, the compounds Aa, Ab and A6 showed analgesic activity, with % protection of 67.51, 64.78 and 49.81 as compared with the standard with % protection of 79.56.

Abstract PD08-06: Duloxetine for Treatment of Aromatase Inhibitor (AI)-Associated Musculoskeletal Syndrome (AIMSS)

Background: Approximately 50% of postmenopausal women with hormone receptor positive early stage breast cancer treated with an aromatase inhibitor (AI) develop arthralgias. Standard analgesics are relatively ineffective. Duloxetine is a serotonin and norepinephrine receptor inhibitor with proven efficacy for treatment of multiple chronic pain states. We investigated the hypothesis that duloxetine would be efficacious for treatment of AIMSS.

Methods: We performed a single-arm, open-label phase II study of duloxetine in 35 postmenopausal women who had been treated with AI therapy for at least 2 weeks and who developed new or worsening pain after starting AI therapy that was rated at least 4 on a 10 point Visual Analog Scale. Enrollment was completed in June 2010. Subjects were treated with duloxetine 30 mg daily for one week, and then 60 mg daily for 3 weeks. Depending on patient-perceived response to therapy, patients had the option of continuing duloxetine 60 mg daily or increasing the dose to 60 mg twice daily for the subsequent 4 weeks. Change in patient-reported pain was assessed. Outcome measures included the Brief Pain Inventory (BPI) and modified Health Assessment Questionnaire (HAQ). Benefit from therapy was defined as a 30% decrease in average pain score from baseline to 8 weeks. Paired t tests were used for statistical analysis.

Results: Of the 35 enrolled subjects, 20 subjects completed the 8-week study period, 6 subjects discontinued therapy early because of duloxetine-associated toxicity, and 9 subjects had been enrolled less than 8 weeks at the time of this analysis and were therefore not evaluable. In an intent-to-treat analysis, 16 of 26 evaluable subjects (61.5%) experienced at least a 30% decrease in average pain, and 14 of 20 subjects (70%) who completed all 8 weeks of protocol-directed treatment chose to continue duloxetine therapy. There were statistically significant reductions in average pain severity (p &lt; 0.0001) and maximum pain severity (p &lt; 0.0001) from baseline to 8 weeks. The mean percent reduction in average pain severity between baseline and 8 weeks was 56.1% (95% CI 37.9%-74.2%) and in maximum pain severity was 55.7% (95% CI 37.3%-74.1%). No grade 3 or 4 adverse events were reported. The most common adverse events were fatigue and drowsiness, xerostomia, nausea, and headache.

Conclusions: Duloxetine appears to be effective and well-tolerated for treatment of AIMSS. Final results from the entire cohort will be presented. Future randomized, placebo-controlled studies are warranted. Clinicaltrials. gov NCT01028352.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD08-06.

Association of glutathione S-transferase (GSTM1, T1 and P1) gene polymorphisms with type 2 diabetes mellitus in north Indian population

BACKGROUND

Diabetes mellitus is associated with an increased production of reactive oxygen species (ROS) and a reduction in antioxidant defense. The oxidative stress becomes evident as a result of accumulation of ROS in conditions of inflammation and Type 2 diabetes mellitus (T2DM). The genes involved in redox balance, which determines the susceptibility to T2DM remain unclear. In humans, the glutathione S-transferase (GST) family comprises several classes of GST isozymes, the polymorphic variants of GSTM1, T1 and P1 genes result in decreased or loss of enzyme activity.

AIMS

The present study evaluated the effect of genetic polymorphisms of the GST gene family on the risk of developing T2DM in the North Indian population.

SETTINGS AND DESIGN

GSTM1, T1 and P1 polymorphisms were genotyped in 100 T2DM patients and 200 healthy controls from North India to analyze their association with T2DM susceptibility.

MATERIALS AND METHODS

Analysis of GSTM1 and GSTT1 gene polymorphisms was performed by multiplex polymerase chain reaction (PCR) and GSTP1 by PCR-Restriction Fragment Length Polymorphism (RFLP).

STATISTICAL ANALYSIS

Fisher's exact test and chi2 statistics using SPSS software (Version-15.0).

RESULTS

We observed significant association of GSTM1 null (P=0.004, OR= 2.042, 95%CI= 1.254-3.325) and GSTP1 (I/V) (P=0.001, OR= 0.397, 95%CI=0.225-0.701) with T2DM and no significant association with GSTT1 (P=0.493). The combined analysis of the three genotypes GSTM1 null, T1 present and P1 (I/I) demonstrated an increase in T2DM risk (P= 0.005, OR= 2.431 95% CI=1.315-4.496).

CONCLUSIONS

This is the first study showing the association of a combined effect of GSTM1, T1 and P1 genotypes in a representative cohort of Indian patients with T2DM. Since significant association was seen in GSTM1 null and GSTP1 (I/V) and multiple association in GSTM1 null, T1 present and P1 (I/I), these polymorphisms can be screened in the population to determine the diabetic risk.

Biological cell-electrical field interaction: stochastic approach

The present work demonstrates how a stochastic model can be implemented to obtain a realistic description of the interaction of a biological cell with an external electric field. In our model formulation, the stochasticity is adopted by introducing various levels of forcing intensities in model parameters. The presence of noise in nuclear membrane capacitance has the most significant effect on the current flow through a biological cell. A plausible explanation based on underlying physics and biological structure of the nuclear membrane is proposed to explain such results.

Arterial spin labeling demonstrates that focal amygdalar glutamatergic agonist infusion leads to rapid diffuse cerebral activation

OBJECTIVES

To investigate acute effects of intra-amygdalar excitatory amino acid administration on blood flow, relaxation time and apparent diffusion coefficient in rat brain.

MATERIALS AND METHODS

Several days after MR-compatible cannula placement in right basolateral amygdala, anesthetized rats were imaged at 7 T. Relative cerebral blood flow (CBF) was measured before and 60 min after infusion of 10 nmol KA, cAMPA, ATPA, or normal saline using arterial spin labeling. Quantitative T(2) and diffusion-weighted images were acquired. rCBF, T(2) and ADC values were evaluated in bilateral basolateral amygdala, hippocampus, basal ganglia, frontal and parietal regions.

RESULTS

KA led to the highest, and ATPA lowest bilateral rCBF increases. Time courses varied among drugs. T(2) for KA and AMPA was higher while ADC was lower for KA.

CONCLUSIONS

Intra-amygdalar injection of GluR agonists evoked bilateral seizure activity and increased rCBF, greater for KA and AMPA than selective ATPA GluR5 activation.