Self injurious behavior in temporal lobe epilepsy

Self-injurious behavior (SIB) or self-mutilating behavior (SMB) is rare but can occur in temporal lobe epilepsy. Such a behavior during seizures is not usually recalled by patient. Here is a case with self mutilating behavior in left temporal lobe epilepsy, presented because of its rare manifestation and diagnostic dilemma. A 19 year old unmarried Muslim student presented to emergency with SMB, guilty rumination and a persecutory delusion. The patient was intermittently confused about place and time. In subsequent assessments, he was found harboring death wishes and suicidal ideation. He transiently had auditory hallucination and thought broadcasting. He episodically tried to harm himself by severely biting only his left ring finger. It was difficult to influence him during such episodes. EEG revealed left temporal lobe seizure. Diagnosis of 'Epilepsy and Organic Psychosis' was made. The patient responded well to Antiepileptic and Antipsychotic medications.

NGF induced differentiated PC12 cells as in vitro tool to study 4-hydroxynonenal induced cellular damage

Investigations were carried out to examine the suitability of PC12 cells as an in vitro tool to examine 4-hydroxynonenal (4-HNE)-induced toxicity in nervous tissue. On day 8 of differentiation, markers of neural effects and oxidative stress were measured following exposure of PC12 cells to 1-50 microM 4-HNE for 1-8h. Endpoints included dopamine DA-D(2) receptor and glutathione S-transferase (GSTP1-1) protein levels, 4-HNE-protein binding, glutathione (GSH) concentrations and intracellular calcium levels. GSH levels were maximally depleted after 4h. 4-HNE also induced depletion of GSTP1-1 and increased intracellular Ca(++), with the latter seen as early as 1h after exposure. Responses at 8h were not greater than responses at earlier times. The experiments suggest that PC12 cells could be an in vitro tool for understanding toxicant-cell interactions, especially those that result in oxidative stress.

Differential protection of pre-, co- and post-treatment of curcumin against hydrogen peroxide in PC12 cells

Pharmacological potential of curcumin was assessed in PC12 cells against hydrogen peroxide (H(2) O(2)) exposure. In MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide] and lactate dehydrogenase (LDH) assays, 24-hour exposure of H(2)O(2) (0.5 mM and above) was found to be cytotoxic. A significant (p < 0.001) increase in percentage cell viability was recorded in PC12 cells pretreated with curcumin (25, 50 and 100 µg/mL) for 24 hours prior to H(2)O(2) (0.5 and 1 mM) exposure for 24 hours. Co-exposure to H(2)O(2) and curcumin was also found effective. However, a therapeutic treatment of curcumin for 24 hours after H(2)O(2) exposure to the cells was found ineffective. Differential response of PC12-H(2)O(2) model to curcumin in MTT and LDH assays suggests the utility of these endpoints to sort the drug candidates to study their antioxidant potential.

Improvised external fixator device to restore motion in a neglected elbow dislocation

Neglected posterior dislocation of the elbow is a common problem in developing countries. One acceptable form of treatment is open reduction and transarticular Steinmann pin fixation. However, this leads to a stable but stiff elbow. We used an improvised external fixator after open reduction in two cases, which allowed for early mobilisation with adequate stability. This option can be considered when modern implants are not available.

Oxygen glucose deprivation model of cerebral stroke in PC-12 cells: glucose as a limiting factor

Optimum time points for oxygen-glucose deprivation (OGD) and re-oxygenation have been identified to suggest the suitability of PC-12 cells as rapid and sensitive in vitro model of cerebral stroke. Further, the precise role of glucose as one of the limiting factors was ascertained. PC-12 cells were subjected to receive OGD of 1-8 h followed by re-oxygenation for 6 to 96 h in medium having glucose 0-10 mg/ml. Loss of cell viability was assessed using trypan blue dye exclusion and MTT assays. The significant (p < 0.05) reduction in percent viable cell count was started at 2 h of OGD (80.7 +/- 2.0) and continued in further OGD periods (3, 4, 5, 6, 7, and 8 h), i.e. 65.7 +/- 3.5, 59.7 +/- 4.6, 54.3 +/- 3.2, 44.7 +/- 2.9, 20.3 +/- 4.3, 5.7 +/- 2.0 of counted cells, respectively. Cells growing in glucose-free medium have shown a gradual (p < 0.001) decrease in cell viability throughout the re-oxygenation. Re-oxygenation of 24 h was found to be first statistically significant time point for all the glucose concentrations. Glucose concentration during re-oxygenation was found to be one of the key factors involved in the growth and proliferation in PC-12 cells. The OGD of 6 h followed by a re-oxygenation period of 24 h with 4-6 mg/ml glucose concentration could be recorded as optimum conditions under our experimental conditions.

Proteomics-based approach for identification and purification of human phosphate binding apolipoprotein from amniotic fluid

Human amniotic fluid is of both maternal and fetal origin; it protects the fetus and provides the environment for growth and development of the fetus. We used a proteomics-based approach for targeting and purifying human phosphate binding protein, a member of the DING family of proteins from amniotic fluid, using Blue Sepharose CL-6B, DEAE-Sephacel and gel filtration chromatography. The protein had earlier been reported to be serendipitously purified along with PON1 (paraoxonase 1). It was identified using electro-spray-ionization-time-of-flight mass spectrometry and was found to be human phosphate binding protein. Human phosphate binding proteins have been reported to play a role as phosphate scavengers and may have a protective function against phosphate-related disorders, such as atherosclerosis, diabetes and kidney stones.

The Effect of Surface Treatments on the Micro-shear Bond Strength of a Resin Luting Agent and Four All-ceramic Systems

The bond strength between ceramics and a resin luting agent is affected by the ceramic surface treatment, which is dependent on the ceramic composition.

Renal amyloidosis secondary to childhood tuberculosis: a report of two cases

Childhood renal amyloidosis is a rare entity and is mostly secondary in nature. We describe two cases of renal amyloidosis in association with childhood tuberculosis. The first case was a 10-year-old girl who presented with abdominal tuberculosis and nephrotic syndrome, while the second case was a 5-year-old boy who presented with disseminated tuberculosis and nephrotic syndrome. They were found to have amyloidosis on renal biopsy. The former was treated with anti-tubercular drugs, while the latter required anti-tubercular drugs and steroids. Both the cases showed clinical improvement with remission of nephrotic syndrome. Successful treatment of tuberculosis can result in remission of nephrotic syndrome due to secondary renal amyloidosis. It is important, especially in developing countries, to be aware that tuberculosis continues to be part of the differential diagnosis of amyloidosis in children.

Accumulation and distribution of toxic metals in wheat (Triticum aestivum L.) and Indian mustard (Brassica campestris L.) irrigated with distillery and tannery effluents

In the present study, accumulation and distribution of toxic metals (Cu, Cd, Cr, Zn, Fe, Ni, Mn, and Pb) and their biochemical effect on wheat and mustard plants irrigated with mixed distillery and tannery effluents are reported. Analyses of effluents and soil samples have shown high metal content than the permissible limit except Pb. Further, analyses of plant samples have indicated the maximum accumulation of Fe (340 mg kg(-1) in wheat root and 560 mg kg(-1) in mustard leaves) followed by Mn and Zn in root>shoot>leaves>seeds. Maximum increase in photosynthetic pigment was observed between 30 and 60 days while protein content was found maximum between 60 and 90 days of growth period in both plants. An increase in malondialdehyde, cysteine and ascorbic acid antioxidants content was also observed in root and leaves of treated plants upto 60 and 90 days of growth. Hence, wheat and mustard plants irrigated with effluents without adequate treatment are health hazards for environment, humans and animals.

Effect of synergist piperonyl butoxide (PBO) on the toxicity of some essential oils against mosquito larvae

Effect of a known synergist piperonyl butoxide on the toxicity of steam distillate essential oils of Jamarosa (Cymbopogan nardus), Pacholli (Pogostemon pacholli), Basil (Ocimum basilicum), and Peppermint (Mentha pipreta) plant species against Anopheles stephensi larvae were evaluated. The purpose of the present study was to identify the insecticidal potential of these oils against mosquito larvae. The Piperonyl Butoxide (PBO) was used to enhance the activity of these oils with the aim of developing essential oil based formulations. The bioassays of these oils with and without PBO were performed against late 3rd instar larvae of An. stephensi. The LC50 values against An. stephensi were 44.19 ppm for Ocimum basilicum oil, followed by, Mentha pipreta, Cymbopogan nardus, and Pogostemon pacholli oil which gave LC50 values above 250 ppm. Thus in the present study the Ocimum basilicum oil was found to be most effective, whereas Pogostemon pacholli oil was found to least effective against mosquitoes for larvicidal action. The effect of synergist PBO led to the enhancement of toxicity of oils, the LC50 value for Ocimum basilicum were reduced from 44.19 ppm to 23.87 ppm. Similarly the oil of Pogostemon pacholli showed most significant results where the LC50 value was > 250 ppm it was reduced to 50 ppm with PBO.

Prolactin inducible protein in cancer, fertility and immunoregulation: structure, function and its clinical implications

Prolactin inducible protein (PIP) is a 17- kDa single polypeptide chain, known by various names due to its versatile nature and function in human reproductive and immunological systems. It is expressed in several exocrine tissues such as the lacrimal, salivary, and sweat glands. Its expression is up regulated by prolactin and androgens, and estrogens down regulate it. Due to its over-expression in metastatic breast and prostate cancer, presently PIP is considered as a prognostic biomarker. Moreover, its aspartyl-proteinase nature suggests its role in tumor progression. PIP has unique features because it is small in size and plays multiple important functions. Its ability to bind potentially with CD4-T cell receptor, immunoglobulin G (IgG), actin, zinc alpha2-glycoprotein (ZAG), fibronectin and enamel pellicle, reveals its important biological functions. This is the first comprehensive review on the structure and functional analysis of PIP and its clinical applications.

Effect of synergist piperonyl butoxide (PBO) on the toxicity of some essential oils against mosquito larvae

Effect of a known synergist piperonyl butoxide on the toxicity of steam distillate essential oils of Jamarosa (Cymbopogan nardus), Pacholli (Pogostemon pacholli), Basil (Ocimum basilicum), and Peppermint (Mentha pipreta) plant species against Anopheles stephensi larvae were evaluated. The purpose of the present study was to identify the insecticidal potential of these oils against mosquito larvae. The Piperonyl Butoxide (PBO) was used to enhance the activity of these oils with the aim of developing essential oil based formulations. The bioassays of these oils with and without PBO were performed against late 3rd instar larvae of An. stephensi. The LC50 values against An. stephensi were 44.19 ppm for Ocimum basilicum oil, followed by, Mentha pipreta, Cymbopogan nardus, and Pogostemon pacholli oil which gave LC50 values above 250 ppm. Thus in the present study the Ocimum basilicum oil was found to be most effective, whereas Pogostemon pacholli oil was found to least effective against mosquitoes for larvicidal action. The effect of synergist PBO led to the enhancement of toxicity of oils, the LC50 value for Ocimum basilicum were reduced from 44.19 ppm to 23.87 ppm. Similarly the oil of Pogostemon pacholli showed most significant results where the LC50 value was >250 ppm it was reduced to 50 ppm with PBO.

Prevalence & risk factors of pre-hypertension & hypertension in an affluent north Indian population

BACKGROUND & OBJECTIVES

Urban Indians have a high prevalence of insulin resistance, hypertension and cardiovascular disease. We studied the prevalence of pre-hypertension and hypertension, as well their association with cardiovascular risk factors, in a north Indian upper socio-economic population.

METHODS

A total of 1746 adults (age >or=30 yr) residing in an urban colony of high-income group residents in the city of Lucknow, north India, were invited to be enrolled for the study. The response rate was 64 per cent (n=1112). Blood pressure, anthropometry, plasma glucose in response to oral glucose tolerance test and lipids were measured. The variables contributing significantly to pre-hypertension and hypertension were analyzed by multiple logistic regression analysis.

RESULTS

The age and sex adjusted prevalence of hypertension was 32.2 per cent and pre-hypertension was 32.3 per cent. In contrast to hypertension, which was highest in the age group 60-69 yr (64%), prehypertension was highest (36%) in the group 30-39 yr. There was a high prevalence of cardiovascular risk factors in the general population [central obesity (86.7%), elevated LDL cholesterol (22.8%), abnormal glucose tolerance (41.6%) and smoking (20.3% of males)]. Two or more of the cardiovascular risk factors were present in a higher proportion of hypertensive [66%, odds ratio (OR) 3.0, P<0.0001] and pre-hypertensive, (56%, OR 2.0, P<0.0001) compared to normotensive subjects (39%). Subjects with pre-hypertension had body mass index, waist-hip ratio and frequency of glucose intolerance, which was intermediate between normotensive and hypertensive subjects. In multiple logistic regression analysis, increasing age, body mass index, waist hip ratio and impaired glucose tolerance/diabetes were independent risk factors for both hypertension and pre-hypertension.

INTERPRETATION & CONCLUSION

A high prevalence of pre-hypertension and hypertension were noted in affluent urban north Indians. Increasing age, body mass index, central obesity and impaired glucose tolerance/diabetes were significantly associated with both hypertension and pre-hypertension. Pre-hypertension was associated with an increased prevalence of cardiovascular risk factors.

Bacterial pretreatment enhances removal of heavy metals during treatment of post-methanated distillery effluent by Typha angustata L

A combination of bacterial pretreatment followed by free water surface flow through wetland plants was investigated to determine its effect on removal of heavy metals in bioremediation of post-methanated distillery effluent (PMDE). The bacterial pretreatment was intended to transform the metal complexes and organic pollutants into simpler, biologically assimilable molecules. The 10% and 30% v/v concentrations of PMDE favored luxuriant bacterial growth; the 50% concentration supported less growth, whereas the undiluted effluent (i.e., 100%) supported very little bacterial growth. The use of bacterial pretreatment combined with the constructed wetland system greatly increase the overall bioaccumulation of all heavy metals by the plants compared with the control treatment. However, the integration of bacterial pretreatment of PMDE with the Typha angustata resulted in enhanced removal of Cd (34.02-61.50% increase), Cr (35.90-57.60% increase), Cu (32.88-54.22% increase), Fe (32.50-51.26% increase), Mn (35.99-82.85% increase), Ni (35.85-59.24% increase), Pb (33.45-59.51% increase) and Zn (31.95-53.70% increase) compared with a control that lacked this pretreatment. In addition to the bioaccumulation of these heavy metals, several physico-chemical parameters also improved at the 30% effluent concentration: color, BOD, COD, phenol and total nitrogen decreased by 98.33%, 98.89%, 98.50%, 93.75% and 82.39%, respectively, after 7 days of free water surface flow treatment. The results suggest that bacterial pretreatment of PMDE, integrated with phytoremediation will improve the treatment process of PMDE and promote safer disposal of this waste.

High prevalence of type 2 diabetes mellitus in affluent urban Indians

The highest prevalence of type 2 diabetes mellitus in developing countries occurs in the upper socio-economic group, but this has not been well documented in Indians. The age and sex standardized prevalence of diabetes in 1112 affluent adult Indian subjects was 21.1%. This is the highest prevalence of diabetes reported from India.

Human milk fortification and gastric emptying in the preterm neonate

Fortification of expressed breast milk (EBM) is widely recommended for preterm feeding. Fortification of EBM results in increased caloric density and osmolarity, both of which may retard gastric emptying. As gastric emptying is a major determinant of feed tolerance, we investigated the effect of fortification (with Lactodex HMF) of EBM on gastric emptying in preterm neonates. The half gastric emptying time was measured using real time ultrasonography in 25 consecutive preterm neonates first on EBM alone, then on EBM + Lactodex HMF. Each baby served as its own control. The students t-test was used for statistical analysis. The mean gestation age was 34.48 +/- 0.77 weeks. The mean birth weight was 1.92 +/- 0.14 kg. The mean half gastric emptying time at an age of 5.4 +/- 0.86 days on EBM was 24.00 +/- 5.00 min and 24.40 +/- 5.06 min on EBM + human milk fortifier (HMF). The same at 2nd assessment (15.2 +/- 1.79 days), with EBM was 22.80 +/- 4.58 min vs. 23.60 +/- 4.89 min when given EBM + HMF. These differences were not statistically significant. Fortification of EBM with Lactodex HMF does not affect the gastric emptying in preterm neonates and therefore is unlikely to affect feed tolerance in them.

Effects of cross-link breakers, glycation inhibitors and insulin sensitisers on HDL function and the non-enzymatic glycation of apolipoprotein A-I

AIMS/HYPOTHESIS

Hyperglycaemia, a key feature of diabetes, is associated with non-enzymatic glycation of plasma proteins. We have shown previously that the reactive alpha-oxoaldehyde, methylglyoxal, non-enzymatically glycates apolipoprotein (Apo)A-I, the main apolipoprotein of HDL, and prevents it from activating lecithin:cholesterol acyltransferase (LCAT), the enzyme that generates almost all of the cholesteryl esters in plasma. This study investigates whether the glycation inhibitors aminoguanidine and pyridoxamine, the insulin sensitiser metformin and the cross-link breaker alagebrium can inhibit and/or reverse the methylglyoxal-mediated glycation of ApoA-I and whether these changes can preserve or restore the ability of ApoA-I to activate LCAT.

METHODS

Inhibition of ApoA-I glycation was assessed by incubating aminoguanidine, pyridoxamine, metformin and alagebrium with mixtures of methylglyoxal and discoidal reconstituted HDL (rHDL) containing phosphatidylcholine and ApoA-I, ([A-I]rHDL). Glycation was assessed as the modification of ApoA-I arginine, lysine and tryptophan residues, and by the extent of ApoA-I cross-linking. The reversal of ApoA-I glycation was investigated by pre-incubating discoidal (A-I)rHDL with methylglyoxal, then incubating the modified rHDL with aminoguanidine, pyridoxamine or alagebrium.

RESULTS

Aminoguanidine, pyridoxamine, metformin and alagebrium all decreased the methylglyoxal-mediated glycation of the ApoA-I in discoidal rHDL and conserved the ability of the particles to act as substrates for LCAT. However, neither aminoguanidine, pyridoxamine nor alagebrium could reverse the glycation of ApoA-I or restore its ability to activate LCAT.

CONCLUSIONS/INTERPRETATION

Glycation inhibitors, insulin sensitisers and cross-link breakers are important for preserving normal HDL function in diabetes.

Chemical composition and larvicidal activities of the essential oil of Zanthoxylum armatum DC (Rutaceae) against three mosquito vectors

BACKGROUND & OBJECTIVES

In view of the recently increased interest in developing plant origin insecticides as an alternative to chemical insecticide, this study was undertaken to assess the larvicidal potential of the essential oil from the seeds of Zanthoxylum armatum DC [syn. Z. alatum Roxb] (Rutaceae) against three medically important species of mosquito vectors, Aedes aegypti, Anopheles stephensi and Culex quinquefasciatus.

METHODS

Essential oil was hydro distilled in the laboratory from the seeds obtained from the market and the chemical constituents of the oil were determined using GC/GC-MS. Bioefficacy of the essential oil was evaluated under laboratory conditions using III instar mosquito larvae.

RESULTS

Among the three mosquito species tested, Cx. quinquefasciatus was the most sensitive (LC50 = 49 ppm) followed by Ae. aegypti (LC50 = 54 ppm) and An. stephensi (LC50 = 58 ppm). GC-MS analysis of the oil revealed at least 28 compounds, consisting mainly of oxygenated monoterpenes (75%) and monoterpenes (22%). Linalool though constituted a major part (57%), failed to produce any appreciable mortality when tested alone.

INTERPRETATION & CONCLUSION

From the results it can be concluded that the larvae of the three mosquito species were susceptible to the essential oil composition. Such findings would be useful in promoting research aiming at the development of new agent for mosquito control based on bioactive chemical compounds from indigenous plant sources as an alternative to chemical larvicides.

Mini-implants for retraction, intrusion and protraction in a Class II division 1 patient

This case report demonstrates the clinical utility and versatility of mini-implants in carrying out different types of tooth movement in a 14-year-old boy with a 'severe' Class II division 1 malocclusion. Mini-implants were placed for 'en masse' retraction and intrusion of maxillary anterior teeth and for lower molar protraction. More than 11 mm of maxillary incisor retraction was achieved together with 3 mm of intrusion. There was significant reduction in the dentoalveolar protrusion and retraction of the upper lip, which resulted in decreased mentalis strain and improved chin projection. Cephalometric superimposition and panoramic radiographs showed no anchorage loss and good occlusion at the end of treatment.

Impact of timing of initiation of adjuvant chemotherapy on survival after resection of colorectal cancer

4054

Background: Based on the results of intergroup trials, adjuvant chemotherapy has become the standard of care for patients with Duke stage C colon and Duke stages B and C rectal cancer. Although initiation of adjuvant chemotherapy soon after recovery from surgery is desirable, only few studies have examined whether a delay in starting adjuvant chemotherapy affect clinical outcomes. Our objective in this study is to determine the impact of timing of adjuvant chemotherapy on survival after resection of Duke stage C colon and Duke stages B and C rectal cancer. Methods: Study involves use of the information available from patients chart review in the province of Saskatchewan, Canada. Patients 18 years of age and older (median age 66 years), diagnosed with Duke Stage C colon and Duke stages B and C rectal cancer between 1993 and 2000 were included. Median followup was 54.8 months. All patients with rectal cancer received radiation treatment as per institution policy. Cox proportional hazards models were used to analyze the impact of timing of adjuvant chemotherapy on survival. Results: Among 701 patients eligible for study, 453 (64.6%) patients received adjuvant chemotherapy within 56 days of surgery (group I) and 248 patients (35.3 %) received adjuvant chemotherapy after 56 days of surgery (group II). Median time interval between surgery and the initiation of adjuvant chemotherapy in group I, and II were 41 days and 70 days respectively. Five year DFS for group I was 39% as compared to 37% for group II (HR 0.94, CI 0.76–1.16, p = 0.58). Median OS for group I was 97.5 months as compared to 68.9 months (HR 1.08, CI 0.85–1.37, p= 0.54). Age, histology and number of lymph nodes analyzed, were identified as independent prognostic factors in multivariate analysis. Conclusions: In this study, patients with Duke stage C colon and Duke stages B and C rectal cancer who received adjuvant chemotherapy within 56 days of resection has similar outcomes as compared to patients who received adjuvant chemotherapy after 56 days of resection.

[Table: see text]

Prognostic importance of primary tumor resection in patients with advanced colorectal cancer (CRC): A Canadian province’s experience

14529

Background: Surgical resection (SR) of primary tumor in patients with newly diagnosed advanced CRC remains controversial. Limited data is available regarding potential benefit of resection in these patients. We performed a population-based study to determine the prognostic value of SR of primary tumor in patients with metastatic CRC. Methods: Medical records of patients with metastatic CRC diagnosed between 1991–2000 in the province of Saskatchewan were reviewed. Patients with unresectable T4M0 disease were excluded. A multivariate analysis was performed using Cox regression model and various clinicopathologic variables were tested for their prognostic significance. Kaplan-Meier curves were used to determine survival. A preliminary analysis of data of 212 eligible patients diagnosed between 1998–2000 is presented here. Results: Patients median age was 71 yrs (33–94) and M:F was 1:0.77. One hundrad thirty one (62%) patients underwent SR for the primary tumor. Among 131 patients, 76 (58%) were operated for tumor related symptoms (36% obstruction, 14% perforation, and 9% bleeding). Six percent patients died of postoperative complications. Of 212 patients, 36% received 5FU-based chemotherapy (46% patients with SR) and 17% received a second line therapy. Median overall survival (OS) of all patients was 6.7 months. Patients who underwent SR of primary tumor had a significantly better median OS of 11 months compared with 3 months in patients who did not have surgery (HR 0.47; 95% CI 0.29–0.76). Patients who underwent SR and had received chemotherapy had a median OS of 14.8 months compared with median OS of 6 months if they did not receive chemotherapy (HR, 0.29; 95% CI 0.15–0.55). In addition to 5FU-based chemotherapy and SR of primary tumor; metastectomy, age >65 yrs, elevated alkaline phosphatase level and thrombocytosis were other important variables that were correlated with survival in patients with advanced CRC. Conclusions: SR of primary tumor has been associated with significant improvement in survival independent of systemic chemotherapy in patients with advanced CRC. Further analysis of data in patients diagnosed between 1991–2000 is planned to confirm these findings in a larger group of patients.

No significant financial relationships to disclose.

Isolation and Characterization of an Indian Orf Virus from Goats

Isolation and characterization of an orf virus has been described here. The virus was isolated from an outbreak of 'scabby mouth' in goats in Northern India. Viral morphology from the scab biopsy revealed typical ovoid-shaped particles characteristic of Parapoxvirus. Virus was isolated from sonicated scab suspension and characterized by restriction enzyme (RE) analysis and sequencing of full-length GM-CSF- and interleukin-2 inhibitory factor (GIF) gene. RE pattern of the virus did not show close resemblance to most of the orf viruses published earlier. However, it showed high sequence identity and closer phylogenetic relationship with previously published ORFV-SA00 strain, as evident from the nucleotide and deduced amino acid sequence of GIF gene.

Insulin therapy

Optimal glycemic control in type 1 diabetes mellitus (T1DM) requires Intensive Insulin Therapy. Implementation of intensive therapy should be early and prolonged as suggested by the results of Diabetes control and complications trial and Epidemiology of Diabetes Interventions and Complications (EDIC) study. Proper implementation of intensive therapy requires a course teaching flexible intensive insulin treatment combining dietary freedom and insulin adjustment as shown by the Dose adjustment for normal eating (DAFNE) randomized controlled trial. Pen injectors appear to be feasible for routine use although pumps may be required in special situations. Various types of insulin are available in the market, including newer analogs (Iispro, aspart, glargine). Although insulin analogs seem to be more physiological, controlled studies suggested either similar efficacy to regular insulin or only a minor benefit in favor of insulin analogs. The primary concern in developing countries like India is the cost-benefit ratio of short acting insulin analogs in the treatment of diabetic children but this still remains unclear. It would be premature to recommend switching patients to newer analogs especially those who are well controlled, especially when the long-term data is still awaited. The choice of post-meal short acting insulin in toddlers may be decided by the care provider if deemed appropriate. Noninvasive insulin deliveries are now in development. It does appear that the most clinically viable non-invasive system to date may be pulmonary delivery.

Oral squamous cell carcinoma: etiology, pathogenesis and prognostic value of genomic alterations

Tumours of the head and neck comprise an important group of neoplasia, the incidence of which is increasing in many parts of the world. This increase remains high, despite all the advances in modern medicine. This malignancy is more prevalent in the developing world and unfortunately, has not received satisfactory attention as the more prevalent cancers of the developed world, like lung, breast, or colon cancer. Recent advances in diagnosis and therapeutic techniques of these lesions have yielded novel molecular targets, uncovered signal pathway dominance and advanced early cancer detection. This review covers recent advances in our understanding of the etiology, molecular changes and the possible role that genomic and proteomic research might play in the diagnosis and effective cure of this modern-day scourge.

Discordence of HER-2/neu overexpression and estrogen receptor between the primary breast cancer and axillary lymph node with metastasis

20106

Background: Adjuvant hormonal therapy and trastuzumab are known to be associated with a significant reduction in cancer-related mortality in a subset of women with breast cancer. The treatment decision is usually based on immunohistochemistry (IHC) staining of the primary tumor. We reported here a case of discordance of HER-2/neu overexpression and estrogen receptor status between the primary breast cancer and axillary lymph node with metastasis. Methods: IHC and fluorescence in situ hybridization (FISH) analysis was perfromed for the assessment of HER-2/neu. E-cadherin staining was done on the primary tumor and lymph node with metastasis. Results: A 52 year old woman presented with right breast lump. The imaging studies showed a 5 × 5 cm speculated mass. No other abnormalities were noted. An excision biopsy revealed 3 cm moderately differentiated invasive lobular carcinoma. Subsequently a wider excision and axillary lymph node dissection was done. 2/20 lymph nodes were involved by the cancer. IHC was done in the primary tumor and the lymph node with metastasis. IHC of the primary tumor revealed less than 1% nuclei positive for estrogen receptor (ER), 0% nuclei positive for progesterone receptor (PR), and no HER-2/neu overexpression. IHC of the lymph nodes with metastasis revealed 80% nuclei positive for ER, less than 1% nuclei positive for PR, and equivocal HER-2/neu overexpression. FISH analysis for HER-2/neu gene was done on the primary tumor which revealed no amplification in the tumor nuclei (Her2/CEP17 ratio was 3.6/2.7 = 1.3) whereas FISH analysis on the lymph node section revealed amplification in tumor nuclei (Her2/CEP 17 ratio of 7.3/1.9 = 3.9). E-cadherin staining of the primary breast tumor as well as the lymph node with metastasis revealed no membrane staining of the malignant cells in either section. Conclusions: The unusual occurrence of a divergent IHC profile and FISH analysis results between the primary carcinoma and metastatic carcinoma may be due to a subselection of a malignant clone which were not represented in the section of primary tumor chosen for IHC. Future studies are required to determine the utility of IHC staining of metastatic cells involving the lymph nodes if primary tumor is negative for HER-2/neu & ER.

No significant financial relationships to disclose.

Gemcitabine-related thrombocytosis: Does it increase the risk of thrombosis?

6091

Background: Gemcitabine is an antimetabolite agent that has demonstrated activity in various solid and hematological malignancies. Although thrombocytopenia is a known side effect, gemcitabine-related thrombocytosis has been uncommonly reported. Chemotherapy increases the risk of thrombo-embolism in patients with cancer. The study aimed to identify the incidence of gemcitabine-related thrombocytosis and to determine whether it has been associated with an increased risk of thrombo-embolism. Methods: Medical records of 175 consecutive adults patients with a malignant disease who received gemcitabine at Saskatoon Cancer Center were reviewed. Patients with history of prior thrombo-embolism or with baseline thrombocytosis were excluded. Fisher’s Exact test was done for statistical analysis. Results: 149 eligible patients with median age of 62 (26–83) and M:F of 1.01:1 were identified. 141 (95%) patients had advanced malignancy and 61 (41%) had received prior chemotherapy. 106 (71%) patients received combination of chemotherapy and 95% of those patients received gemcitabine in combination with a platinum compound. Median number of cycle was 3 (1–8). Median platelets count prior to commencement of gemcitabine was 285 × 109 (44–449). 83 (56%) patients experienced thrombocytopenia whereas 69 (46%) patients experienced thrombocytosis within 3 weeks of treatment with gemcitabine. Median post-gemcitabine platelet count in patients with thrombocytosis was 622 × 109 (457–1385). 15 (10%) patients experienced thrombocytosis with each cycle of gemcitabine. Median duration of thrombocytosis was 2 weeks (0.5−5). 13 (9%) of 149 patients experienced a vascular event (venous, n=9; arterial, n=4) within 6 weeks of treatment with gemcitabine. Median platelet count prior to the vascular event was 268 × 109 (79–669). All except one patient had advanced malignancy and 85% had received combination of chemotherapy. 5 of 69 (7%) patients with thrombocytosis experienced a vascular event compared with 8 of 80 (10%) patients without thrombocytosis (p=0.77). Conclusions: Gemcitabine has been associated with an increased incidence of thrombocytosis. However gemcitabine-related thrombocytosis is a transient phenomenon and has not been associated with an increased risk of a vascular event.

No significant financial relationships to disclose.

Forced Uptake of Trivalent and Pentavalent Methylated and Inorganic Arsenic and Its Cyto-/genotoxicity in Fibroblasts and Hepatoma Cells

Mammals are able to convert inorganic arsenic to mono-, di-, and trimethylated metabolites. In previous studies we have shown that the trivalent organoarsenic compounds are more toxic than their inorganic counterparts and that the toxicity is associated with the cellular uptake of the arsenicals. In the present study, we investigated cyto-/genotoxic effects of the arsenic compounds arsenate [As(i)(V)], arsenite [As(i)(III)], monomethylarsonic acid [MMA(V)], monomethylarsonous acid [MMA(III)], dimethylarsinic acid [DMA(V)], dimethylarsinous acid [DMA(III)], and trimethylarsine oxide [TMAO(V)] after an extended exposure time (24 h) and compared the uptake capabilities of fibroblasts (CHO-9 cells: Chinese hamster ovary) used for genotoxicity studies, with those of hepatic cells (Hep G2: hepatoma cell-line). To find out whether the arsenic compounds are bound to membranes or if they are present in the cytosol, the amount of arsenic was measured in whole-cell extracts and in membrane-removed cell extracts by inductively coupled plasma-mass spectrometry (ICP-MS). In addition, we forced the cellular uptake of the arsenic compounds into CHO-9 cells by electroporation and measured the intracellular arsenic concentrations before and after this procedure. Our results show that organic and inorganic arsenicals are taken up to a higher degree by fibroblasts compared to hepatoma cells. The arsenic metabolite DMA(III) was the most membrane permeable species in both cell lines and induced strong genotoxic effects in CHO-9 cells after an exposure time of 24 h. The uptake of all other arsenic species was relatively low (<1% by Hep G2 and <4% by CHO cells), but was dose-dependent. Electroporation increased the intracellular arsenic levels as well as the number of induced MN in CHO-9 cells. With the exception of As(i)(III) and DMA(III) in CHO-9 cells, the tested arsenic compounds were not bound to cell membranes, but were present in the cytosol. This may indicate the existence of DMA(III)-specific exporter proteins as are known for As(i)(III). Our results indicate that the uptake capabilities of arsenic compounds are highly dependent upon the cell type. It may be hypothesized that the arsenic-induced genotoxic effects observed in fibroblasts are due to the high uptake of arsenicals into this cell type. This may explain the high susceptibility of skin fibroblasts to arsenic exposure.

Effect of lindane on hepatic and brain cytochrome P450s and influence of P450 modulation in lindane induced neurotoxicity

Oral administration of lindane (2.5, 5, 10 and 15 mg/kg, body weight) for 5 days was found to produce a dose-dependent increase in the activity of P450 dependent 7-ethoxyresorufin-O-deethylase (EROD), 7-pentoxyresorufin-O-dealkylase (PROD) and N-nitrosodimethylamine demethylase (NDMA-d) in rat brain and liver. A significant increase in the hepatic and brain P450 monooxygenases was also observed when the duration of exposure of low dose (2.5 mg/kg) of lindane was increased from 5 days to 15 or 21 days. As observed with different doses, the magnitude of induction in the activity of P450 monooxygenases was several fold higher in liver microsomes when compared with the brain. Western blotting studies have indicated that the increase in the P450 enzymes could be due to the increase in the expression of P450 1A1/1A2, 2B1/2B2 and 2E1 isoenzymes. In vitro studies using organic inhibitors specific for individual P450 isoenzymes and antibody inhibition experiments have further demonstrated that the increase in the activity of PROD, EROD and NDMA-d are due to the increase in the levels of P450 2B1/2B2, 1A1/1A2 and 2E1 isoenzymes, respectively. Induction studies have further shown that while pretreatment of 3-methylcholanthrene (MC), an inducer of P4501A1/1A2, did not produce any significant effect in the incidence of lindane induced convulsions, pretreatment with phenobarbital (PB), an inducer of P450 2B1/2B2 or ethanol, an inducer of P450 2E1 catalysed reactions, significantly increased the incidence of lindane induced convulsions. Similarly, when the P450-mediated metabolism of lindane was blocked by cobalt chloride incidence of convulsions was increased in animals treated with lindane indicating that lindane per se or its metabolites formed by PB or ethanol inducible P450 isoenzymes are involved in its neurobehavioral toxicity.

Cyclo-oxygenase 2 inhibitors: emerging roles in the gut

BACKGROUND AND AIMS

Discovery of an isoform of Cyclo-oxygenase (COX) 1, the inducible COX-2, has made it possible to avoid some side effects of non-specific COX inhibitors. The COX-2 gene is over-expressed in reflux oesophagitis, Barrett's oesophagus, gastric and colon cancer, familial adenomatous polyposis, pancreatic cancer, hepatocellular carcinoma, hepatotoxicity, cirrhosis, and inflammatory bowel disease, and specific COX-2 inhibitors have been tried experimentally and clinically and found effective.

METHODS

A Medline search was performed of English-language experimental studies and controlled clinical trials from January 1980 to January 2002, and relevant citations were noted.

RESULTS

Review of available literature shows that sulindac and COX-2 inhibitors are effective in preventing as well as regressing familial adenomatous polyposis. However, they have not been shown to prevent cancer in these patients. Studies evaluating NSAIDs and COX-2 inhibitors in carcinogen-induced and genetically manipulated animal models of various cancers have been promising especially in conditions such as Barrett's oesophagus, oesophageal and hepatocellular carcinoma and pancreatic cancer. COX-2 inhibitors may be of value in the treatment of reflux oesophagitis, pancreatitis and hepatitis, although carefully planned randomized controlled clinical trials demonstrating their efficacy need to be conducted. At present NSAIDs and COX-2 inhibitors cannot be recommended for average-risk individuals or for those with sporadic colorectal neoplasia (or other forms of cancers) as chemo-preventive agents.

CONCLUSION

COX-2 inhibitors may open up a new therapeutic era in which these drugs can be used for chemo-prophylaxis. However, COX-2 selective inhibitors retain renal adverse effects of the non-selective inhibitors and the concern regarding the pro-thrombotic potential of COX-2 inhibitors will limit their value as chemo-preventive agents.