Macrodactyly

Abstract not required.J Nepal Paediatr Soc 2014;34(3):252-253 DOI: http://dx.doi.org/10.3126/jnps.v34i3.11686

Cardiac conduction system- A detailed study in 46 cases of sudden death

Background: Atherosclerotic coronary artery disease is the modern pandemic and is said to be responsible for a major chunk of sudden cardiac deaths. However, in few cases; especially among the young, conduction system abnormalities were found to be the cause of death with absence of significant coronary lesions. These days, examination of the cardiac conduction system during autopsy has been abandoned as it is said to be a time consuming process. The present study was undertaken to highlight the importance of examining the cardiac conduction system in all sudden death cases.Materials and Methods: This study was a prospective one, conducted from June 2007 to June 2009 in the department of Pathology, Kasturba Medical College, Mangalore. Forty six hearts of persons who died suddenly were studied.Results: Our study showed that even though atherosclerotic coronary lesions were the most common cause of sudden death, cardiac conduction defects also contributed to a significant number of cases; especially in the young. In our study of 46 cases; 6 cases showed only conduction system abnormalities. These were young adults who had died suddenly. The predominant lesion identified in them was fibromuscular dysplasia of the nodal arteries.Conclusion: A detailed examination of the coronaries and the cardiac conduction system should be made mandatory in all sudden death cases, especially in the young as they will help to throw some light into the cause of death.Journal of Pathology of Nepal (2015) Vol. 5, 709-716

Combination simvastatin and metformin induces G1-phase cell cycle arrest and Ripk1- and Ripk3-dependent necrosis in C4-2B osseous metastatic castration-resistant prostate cancer cells

Castration-resistant prostate cancer (CRPC) cells acquire resistance to chemotherapy and apoptosis, in part, due to enhanced aerobic glycolysis and biomass production, known as the Warburg effect. We previously demonstrated that combination simvastatin (SIM) and metformin (MET) ameliorates critical Warburg effect-related metabolic aberrations of C4-2B cells, synergistically and significantly decreases CRPC cell viability and metastatic properties, with minimal effect on normal prostate epithelial cells, and inhibits primary prostate tumor growth, metastasis, and biochemical failure in an orthotopic model of metastatic CRPC, more effectively than docetaxel chemotherapy. Several modes of cell death activated by individual treatment of SIM or MET have been reported; however, the cell death process induced by combination SIM and MET treatment in metastatic CRPC cells remains unknown. This must be determined prior to advancing combination SIM and MET to clinical trial for metastatic CRPC. Treatment of C4-2B cells with combination 4 μM SIM and 2 mM MET (SIM+MET) led to significant G1-phase cell cycle arrest and decrease in the percentage of DNA-replicating cells in the S-phase by 24 h; arrest was sustained throughout the 96-h treatment. SIM+MET treatment led to enhanced autophagic flux in C4-2B cells by 72–96 h, ascertained by increased LC3B-II (further enhanced with lysosomal inhibitor chloroquine) and reduced Sequestosome-1 protein expression, significantly increased percentage of acidic vesicular organelle-positive cells, and increased autophagic structure accumulation assessed by transmission electron microscopy. Chloroquine, however, could not rescue CRPC cell viability, eliminating autophagic cell death; rather, autophagy was upregulated by C4-2B cells in attempt to withstand chemotherapy. Instead, SIM+MET treatment led to Ripk1- and Ripk3-dependent necrosis by 48–96 h, determined by propidium iodide-Annexin V flow cytometry, increase in Ripk1 and Ripk3 protein expression, necrosome formation, HMGB-1 extracellular release, and necrotic induction and viability rescue with necrostatin-1 and Ripk3-targeting siRNA. The necrosis-inducing capacity of SIM+MET may make these drugs a highly-effective treatment for apoptosis- and chemotherapy-resistant metastatic CRPC cells.

Measurement and modeling of phosphorous transport in shallow groundwater environments

Leaching of phosphorus (P) from agricultural soils, especially those that are sandy, is adversely impacting P-limited ecosystems like Florida's Everglades. A more developed understanding of P and water management strategies and their effects on P leaching is needed to achieve reductions in subsurface P losses, especially from intensively managed dual cropping systems under plastic mulch in shallow water regions. We compared the effects of conservation P and water management strategies with traditional practices on P transport to groundwater. A 3-year experiment was conducted on hydrologically isolated plots with plastic-mulched successive cropping systems to compare high (HEI) and soil test based recommended (REI) external input (water and fertilizer P) systems with traditional sub-irrigation (seepage), and REI with a potential water conservation subsurface drip irrigation system (REI-SD) with regard to groundwater P concentrations above and below the low conductivity spodic horizon (Bh). The REI treatments had higher available storage for rainfall and P than HEI. Use of both REI systems (REI=2098μg/L and REI-SD=2048μg/L) reduced groundwater P concentrations above the Bh horizon by 33% compared to HEI (3090μg/L), and results were significant at the 0.05 level. Although the subsurface drip system saved water, it did not offer any groundwater quality (P) benefit. Mixing and dilution of influent P below the low conductivity Bh horizon between treatments and with the regional groundwater system resulted in no significant differences in groundwater P concentration below the Bh horizon. Groundwater P concentrations from this study were higher than reported elsewhere due to low soil P storage capacity (SPSC), high hydraulic conductivity of sandy soils, and a high water table beneath crop beds. The HEI system leached more P due to ferilizer P in excess of SPSC and used higher irrigation volumes compared with REI systems. Despite a 40% difference in the average amount of added fertilizer P between HEI (187kg P2O5/ha) and REI (124kg P2O5/ha), soil Mehlich 1 P (M1P) values were similar for both systems while they received Pinput. Soil M1P for REI and REI-SD increased to a maximum of 55mg/kg while they received Pinput, and then gradually decreased after Pinput ceased. However, M1P for HEI increased steadily to a maximum of 145mg/kg by the end of the study with continued Pinput. Mehlich-1 P measured six years after the study still showed relatively high levels of P, a legacy effect of Pinput. The main factors influencing groundwater P concentration varied by seasons. During fall with frequent rainfall, the concentrations were influenced mainly by M1P and Pinput, and highlight a need for greater focus on Pinput management (vs. water management) during this season. However, during the dry period of spring, a greater focus on irrigation management is required since depth to water table and rainfall also become contributing factors. Three multivariate models (r(2)=0.67 to 0.93), for spring, fall, and annual periods, were developed for predicting groundwater P concentrations for a wide range of water and P inputs (0 to 191kg P2O5/ha of Pinput). The uniqueness of these models is that they use readily available hydrologic (rainfall and water table depth), management (Pinput), and soil (M1P) data commonly monitored by growers when managing water and nutrient inputs on agricultural landscapes. The development of similar models may not be necessary for other agro-ecosystems in similar regions since long-term data collected in these regions may be applied, with verification, to the models presented here.

A Type-II First Branchial Cleft Anomaly Presenting as a Post-Auricular Salivary Fistula: A Rare Presentation

First branchial cleft anomalies are rare with the average age of presentation as 19 years. There is an average delay of 3.5 years between initial presentation and adequate treatment due to diagnostic dilemma. A very rare variant of first branchial cleft anomaly presenting as a post-auricular salivary fistula is reported. A 12-year-old girl presented with a history of intermittent watery discharge, more so at the time of meals from a right post-auricular opening for last 3 years. Computed tomography sialography revealed a fistulous tract connecting the sub segmental duct of the parotid gland extending along the pre-tragus region in subcutaneous plane up to mastoid tip after passing inferior to external auditory canal. Superficial parotidectomy with identification of facial nerve branches was carried out for excision of the tract. Histopathology revealed sinus tract comprising of ectodermal components and acini of the parotid gland. We classified our case into work's type-2 based on anatomical location at an angle of mandible, its relationship to parotid gland and facial nerve and previous history of ear discharge. To the best of our knowledge, this is the first case of its type to be reported.

Pituitary tuberculoma

Tuberculosis of pituitary gland is rare. We report a case of tuberculosis of pituitary gland in a 68-year-old male presented with holocranial headache of four months duration with left temporal hemianopia, with visual acuity of 6/6, without any localizing sign. Magnetic resonance imaging showed a sellar ring enhancing mass with suprasellar extension. Patient was taken up for surgery and put on antitubercular treatment and hormone replacement therapy.

Unusual extensive physiologic melanin pigmentation of the oral cavity: a clinical presentation

Pigmented lesions are commonly found in the oral cavity. Oral pigmentations may be physiological or pathological in nature. It may represent as a localized anomaly of limited significance or the presentation of potentially life threatening multisystem disease. Oral pigmentation has a multifactorial etiology. Most of the oral pigmentations are physiologic. Evaluation of a patient with pigmented lesions should include a full medical and dental history, extraoral and intraoral examinations. In this article, we report a case of extensive physiologic pigmentation of the oral cavity in a 12 year old female patient, posing a diagnostic challenge.

Gemcitabine in brief versus prolonged low-dose infusion, both combined with carboplatin for advanced non-small cell lung cancer

PURPOSE

Gemcitabine in low-dose prolonged infusion is a treatment with documented activity against a variety of tumors. The present study was conducted to evaluate the efficacy and safety of the combination of gemcitabine at a low-dose prolonged infusion in comparison with standard dose gemcitabine with carboplatin in chemonaive patients with advanced non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS

Sixty chemonaive patients with stage IIIB or IV NSCLC were included. Patients were randomly assigned 1:1 to receive 350 mg/m 2 gemcitabine in a 6-h infusion on days 1 and 8 and carboplatin area under the serum concentration time curve (AUC) 5 on day 1 versus gemcitabine 1,000 mg/m 2 on days 1 and 8 and carboplatin AUC 5 on day 1 (3-week cycle both). A total of 118 chemotherapy cycles, with a median of 4 cycles per patient (range 2-6), and 134 chemotherapy cycles, with a median of 4.47 cycles per patient (range 3-6) were administered in standard and low infusional dose arm, respectively.

RESULTS

Among patients in the standard arm, 40% had overall response rate (ORR), 33.3% had stable disease and 26.6% had progressive disease, while in low-dose infusional arm, 36.6% had ORR, 36.3% had stable disease and 26.6% had progressive disease (P = 0.992). Median progression-free survival was 5.5 months and 5.4 months, median overall survival was 9.7 months and 10.7 months, and 1-year survival was 33.7% and 36.6% in standard arm and low-dose infusion arm, respectively. Grade 3/4 toxicity was rare.

CONCLUSION

In NSCLC, gemcitabine low-dose prolonged infusion with carboplatin has low toxicity, especially thrombocytopenia, and has an activity comparable with gemcitabine given in higher dose in standard infusion.

Processing fly ash stabilized hydrogen titanate nano-sheets for industrial dye-removal application

We report a new method for the processing of fly ash (FA) stabilized hydrogen titanate nano-sheets in the form of aggregated microspheres. The industrial silica-based FA has been utilized for this purpose which has been surface-modified by coating with the anatase-titania (TiO(2)) via sol-gel. The anatase-TiO(2) coated FA particles are subjected to the hydrothermal treatment in an autoclave under high temperature and pressure conditions in a highly alkaline solution. The hydrothermal conditions cause dissolution of silica resulting in the disintegration of other constituents of FA which are adsorbed in ionic and/or oxidized form on the surface of intermediate product of the hydrothermal treatment of anatase-TiO(2), specifically the hydrogen titanate. The adsorption of FA constituents has resulted in the stabilization of hydrogen titanate in the nano-sheet morphology instead of nanotubes. The FA stabilized hydrogen titanate nano-sheets exhibit higher specific surface-area than that of the hydrogen titanate nanotubes and have been successfully utilized for the removal of an organic synthetic-dye from an aqueous solution via surface-adsorption, involving the electrostatic-attraction and ion-exchange mechanisms operating, in the dark-condition.

Fictitious pseudo Meig’s syndrome: A medical emergency

The present case scenario deals with an acute on chronic symptomatology, and collapsed state of the patient with poor vitals on admission in casualty. Clinical work up pointing to an elevated serum CA 125 levels and USG pelvis suggesting peritoneal adhesions with cystic to firm mass in left ovary and minimal free fluid in abdomen and cul de sac, X Ray chest suggesting right sided Pleural effusion. It was after careful evaluation of the case, with past and present history along with signs, symptommatology and intraoperative findings that differentials like Chronic granulomatous lesions, endometriosis, Neoplastic lesions with metastasis and Meig’s syndrome or Pseudo Meig’s were evaluated. Finally, a diagnosis of genital tuberculosis with enodmetriosis was confirmed on histopathological evaluation. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5975 JCMSN 2011; 7(1): 57-64

Synthesis, characterization and antiproliferative activity of 1,2-naphthoquinone and its derivatives

In the present study substituted 1,2-naphthoquinones were synthesized, purified and characterized by spectroscopic studies (UV, FT-IR, ¹H NMR, ¹³ C NMR and elemental analysis). These compounds were evaluated for cytotoxicity against a panel of human cancer cell lines (Hep-G₂ for liver sarcoma, MG-63 for osteosarcoma and MCF-7 for human breast cancer). The cells were dosed with these ortho-naphthoquinone derivatives at varying concentrations, and cell viability was measured by a 3-(4,5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay with doxorubicin as positive control. Significant anticancer activities were observed in vitro for some members of the series, and compounds 1,2-naphthoquinone 2-thiosemicarbazone, 1,2-naphthoquinone-2-semicarbazone, 4-amino-1,2-naphthoquinone 2-thiosemicarbazone and 4-amino-1,2-naphthoquinone-2-semicarbazone are active cytotoxic agents against different cancer cell lines with IC₅₀ values in the range of 5.73-17.67 μM. The obtained data suggested that better anticancer activity was linked with introduction of thiosemicarbazone and semicarbazone moiety in 1,2-naphthoquinone ring system. Outcomes of experimentation also reveal that incorporation of amino group in 1,2-naphthoquinone moiety contributes positively for cytotoxic action of compounds. Docking experiments showed a good correlation between their calculated interaction energies with the topoisomerase-II and the observed IC₅₀ values of all these compounds.