Reduced beta cell function in offspring of mothers with young-onset type 2 diabetes

AIMS/HYPOTHESIS

Animal models indicate that even exposure to mild maternal hyperglycaemia in utero is detrimental to the beta cell function of the offspring, but evidence of this in humans is limited. In Europids who are diagnosed with type 2 diabetes before the age of 50 years, the risk of diabetes in the offspring of the diabetic mothers is greatly increased compared with the risk in those born to diabetic fathers. We hypothesised that offspring born to mothers with young-onset type 2 diabetes would have been exposed to mild hyperglycaemia in utero, so we studied the impact of this on their beta cell function.

SUBJECTS AND METHODS

We measured beta cell function using early insulin response (EIR) after oral glucose; insulin resistance using HOMA; and HbA(1c) in 568 non-diabetic adult offspring born to parents with type 2 diabetes (mean age 55.8 years), split according to which parent was affected (in 327 it was the mother) and parental age of diagnosis: <50 years (n=117) or > or =50 years. To reduce the impact of genetic susceptibility, the offspring of affected fathers were used as control subjects.

RESULTS

Offspring of mothers with young-onset type 2 diabetes had lower EIR (log EIR 4.32, 95% CI [4.14-4.51] vs 4.63 [4.43-4.83] p=0.02) and higher HbA(1c) (4.89% [4.79-4.99] vs 4.68% [4.57-4.79] p=0.02) than the offspring of fathers with young-onset type 2 diabetes. Insulin sensitivity was similar in the two groups. There were no differences in EIR or HbA(1c) between the offspring born to mothers and fathers who were diagnosed after the age of 50 years.

CONCLUSIONS/INTERPRETATION

We conclude that the offspring of mothers with young-onset type 2 diabetes have a reduction in beta cell function. This is consistent with exposure to mild maternal hyperglycaemia programming beta cell function.

Extraskeletal osteochondroma in the nape of the neck: a case report

Extraskeletal osteochondroma in the nape of the neck is rare and its pathological diagnosis is based on radiological and histopathological examination. It is vital that such a diagnosis be considered when a discrete, ossified mass is localised in soft tissues, even at atypical sites. Differential diagnoses include myositis ossificans, a lipomatous lesion, a pseudomalignant osseous tumour, an ossifying fibromyxoid tumour, an extraskeletal chondroma with endochondral ossification, synovial (osteo) chondromatosis, tumoural calcinosis, a synovial sarcoma, and an extraskeletal osteosarcoma. Clinical awareness of this benign entity is important as no malignant transformation or metastasis has been reported. Marginal excision with histopathological identification is the treatment of choice.

Prospective, long-term evaluation of steroid-induced glaucoma

PURPOSE

To evaluate the intraocular pressure (IOP) after cessation of steroid use in steroid-induced glaucoma and its control with medication or surgery.

METHODS

Thirty-four eyes of 34 patients having steroid-induced glaucoma were prospectively evaluated after cessation of steroid for IOP, visual acuity, and optic disc status at 3 months, and every 3 months for 18 months.

RESULTS

Topical steroid use (73.5%) was the most frequent cause for glaucoma. The baseline IOP was 35.47+/-12.59 mmHg. The baseline vertical cup-disc ratio correlated with duration of steroid use (P=0.014) and the baseline IOP (P<0.0001). In 25 patients (73.5%), IOP could be controlled by topical medications alone, whereas nine patients (26.5%) required surgery. The mean baseline IOP in eyes requiring surgery was 49.67+/-13.28 mmHg and in eyes managed medically, 30.36+/-7.51 mmHg (P=0.002). The vertical cup-disc ratio in surgically treated patient was 0.87+/-0.13:1 as compared to 0.71+/-0.15:1 (P=0.012) in the medically treated group. At 6, 12, and 18 months follow-up, 22 (64.7%), 33 (97.1%), and all 34 (100%) patients were off treatment, respectively.

CONCLUSIONS

Patients with steroid-induced glaucoma, who were <or=20 years old, with a higher IOP, and greater glaucomatous optic neuropathy, were more likely to need surgery. After cessation of steroid therapy, all eyes were off treatment at 18 months.

Efficacy of three doses of tramadol with bupivacaine for caudal analgesia in paediatric inguinal herniotomy

BACKGROUND

This study was designed to evaluate the analgesic efficacy of three doses of tramadol, administered caudally with bupivacaine, in providing postoperative pain relief in children.

METHODS

Eighty children, aged between 2 and 8 yr, undergoing inguinal herniotomy were randomly allocated to receive bupivacaine 0.25% 0.75 ml kg(-1) (Group B; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1 mg kg(-1) (Group BT1; n=20), bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 1.5 mg kg(-1) (Group BT1.5; n=20), or bupivacaine 0.25% 0.75 ml kg(-1) with tramadol 2 mg kg(-1) (Group BT2; n=20) by the caudal route immediately after induction of general anaesthesia. Heart rate, arterial pressure and oxygen saturation were monitored. Postoperative pain was assessed at regular intervals for 24 h using All India Institute of Medical Sciences pain score. Analgesia was supplemented whenever pain score was >or=4. Duration of analgesia and requirement for additional analgesics was noted.

RESULTS

Duration of analgesia was longer in Group BT2 [(mean (SD) 12 (0.9) h] compared with Group B [4 (1) h], Group BT1 [8 (0.9) h], or Group BT1.5 [11 (1) h]; all P<0.001. Total consumption of rescue analgesic was significantly lower in group BT2 compared with other groups (P<0.001). There were no significant changes in heart rate, arterial pressure and oxygen saturation between groups. Adverse effects were not observed.

CONCLUSIONS

Caudal tramadol 2 mg kg(-1), combined with bupivacaine 0.25% 0.75 ml kg(-1), provided longer duration of postoperative analgesia and reduced requirement for rescue analgesic compared with tramadol 1 mg kg(-1) or 1.5 mg kg(-1) in children undergoing inguinal herniotomy.

Recurrent epithelial ovarian cancer (EOC): What determines the outcome?

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Background: Recurrent EOC is a common clinical problem and treatment is not curative. We retrospectively analyzed the data on 354 patients with recurrent EOC to determine the impact of various prognostic factors on outcome. Methods: Between August, 1989 and June, 2005, 354 patients (median age 49 years, range, 28 to 80 years) were diagnosed as recurrent EOC. 259 patients received chemotherapy alone, 44 were treated with combination of secondary debulking surgery and chemotherapy or radiotherapy. Remaining 51 (14.4%) patients had no treatment. Main types of salvage chemotherapy included- cisplatin + cyclophosphamide (CP, n = 53), CP + adriamycin (CAP, n = 68), paclitaxel + carboplatin/cisplatin (TP, n = 78). 10 factors were analyzed for survival. Results: 56.5% of patients responded to chemotherapy; complete (CR)-34.2% and partial response (PR) in 22.3% of patients. 124 (35%) patients had no response or progressive disease. 10 (2.8%) died of chemo-toxicity and in remaining 20 status was not known. Median overall survival for patients who received treatment is 19 months vs 3 months for 51 patients who did not receive treatment, p < .001. Predictors of survival were - response to salvage chemotherapy (20 vs 8 months, p < .001), treatment-free interval (>6 months vs ≤ 6 months, 23 vs 9 months p < .001), site of relapse (single vs multiple, 22 vs 16 months, p < .001), Chemotherapy regimen (CP vs CAP vs Paclitaxel + carboplatin) p < .003 on univariate analysis. Age (≤50 years vs >50 years, p = 0.02), initial stage (I vs II vs III vs IV, p = 0.079), histology (serous vs others, p = 0.849), site of relapse (vault vs others, p = 0.156) were not significant predictors. On multivariate logistic regression analysis- response to salvage chemotherapy (HR 0.21, 95% CI 0.15–0.30), treatment-free interval (HR 0.36, 95% CI, 0.20–0.64), and site of relapse (vault vs others, HR 1.22, 95% CI 0.78–1.94) attained significance among 10 factors analyzed. Conclusions: Present study confirms that all patients with recurrent EOC should receive treatment. Response to salvage chemotherapy, a longer treatment-free interval (>6 months) and single site of metastasis are predictors of significantly superior outcome.

No significant financial relationships to disclose.

Neoadjuvant chemotherapy in advanced epithelial ovarian oancer (EOC): A phase III randomized study

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Background: We compared upfront surgery to upfront chemotherapy in patients with advanced EOC (stage IIIC and IV (pleural effusion only). Factors- optimum debulking (residual disease ≤1cm) rate, surgical morbidity, chemotherapy toxicity, survival and quality of life (QOL) were analyzed. Methods: Between Oct.2001 and Oct. 2005, 90 newly diagnosed patients with advanced EOC have been randomized to upfront surgery followed by six cycles of paclitaxel + carboplatin (TC) (Arm A) or upfront chemotherapy - 3 cycles (TC) followed by surgery then 3 more cycles of TC. Eligibility criteria included- age 18 to 65 years, biopsy or cytological proven diagnosis of EOC and adequate hematological, renal, liver and cardiac functions. Upper and lower GI endoscopy and serum CEA was done in all patients to rule out GIT primary. QOL was assessed using FACT-O questionnaire at baseline, postop, post 3 cycles and post 6 cycles chemotherapy. Results: 78 of 90 patients have completed the treatment. Among 74 evaluable patients, optimal debulking rate was higher in the neoadjuvant chemotherapy arm (83% vs 13%, p < .001). Blood loss during surgery (340 ml vs.485 ml, p < . 008), mean operating time (69 minutes vs. 77 minutes, p = 0.22), post op infection rate (3% vs 17.5%, p < .07), & hospital stay (9 days vs. 12.4 days, P = 0.04) were lower in the chemotherapy arm. Operative mortality was higher in upfront surgery arm (7.7% vs 3.3%, p = .38). QOL score was higher post 3 cycles and post 6 cycles in the upfront chemotherapy arm (p < . 0001). Grade III-IV GI toxicity (4.5% vs 3.8%) and myelo-suppression (7% vs 9%) was similar in two arms. At a median follow up of 33 months, Overall (41 vs 42 months) & progression-free survival (35.3 vs 29 months,p = ns) are not significantly different in upfront chemotherapy vs upfront surgery arms, respectively. Conclusions: Upfront chemotherapy in advanced EOC results in significantly higher optimum debulking rate with reduced surgical morbidity and mortality, Quality of life score was also higher. Present study favors role of “upfront chemotherapy” in patients likely to have residual disease >1cm and higher morbidity with upfront surgery.

No significant financial relationships to disclose.

Ultrasound Therapy in Tendinous Injury Healing in Goats

The effect of ultrasound therapy on tendon injury healing was studied on 12 locally available non-descript adult goats of either sex divided equally in two groups (I and II) consisting of six animals each. The superficial digital flexor tendon (SDFT) was transected and immediately repaired with nylon (2/0) using a locking loop suture pattern under atropine-triflupromazine-lignocaine epidural analgesia and strict aseptic condition. A full limb plaster of Paris cast was applied to immobilize the operated limb for 3 days. Postoperative care was similar in both the groups. In group I, the operated limb was allowed to heal without ultrasound therapy. In group II, pulsed ultrasound therapy was started 3 days after repair of tendinous injury at an intensity of 1 W/cm(2) for 10 min daily for 10 consecutive days. The animals of both groups were evaluated clinically and haemato-biochemically on days 1, 3, 7, 15, 20 and 30 postoperatively. Air tendonograms and ultrasonography were performed on days 0, 10, 20 and 30 post-tenorrhaphy. Histopathological examination of tendon biopsy samples was performed on day 30 post-tenorrhaphy. Resolution of inflammatory swelling, pain, weight bearing and tendon gliding movement was earlier in the test group than control. Rectal temperature, total leucocyte count and differential leucocyte count did not vary significantly at various stages of observation in both the groups. Serum glucose, cortisone and serum alkaline phosphatase levels increased significantly after tendon injury repair in all the animals and decreased slowly at all subsequent intervals in control group, whereas, it was near normal in the treatment group on day 30 post-tenorrhaphy. Air tendenograms and ultrasonography examinations in the test group revealed that there was a marked regression of peritendinous adhesion between the tendon and skin on day 30 post-tendon injury repaired and the tendon at the reconstructive site attained near normal thickness and density. Adhesions were present in the reconstructed site of SDFT in all animals of the control group. Histopathologically, the granulation tissue was comparatively bettered organized at the healing site in the ultrasound-treated animals.

Study on oxidative stress in patients with abdominal trauma

Reactive oxygen species have been implicated in the etiology of multiple organ dyspepsia syndrome and infection's complications in patients with trauma. But the oxidative stress and antioxidants levels in abdominal trauma have not yet been studied. Therefore, this study was planned to measure lipid peroxidation for oxidative stress and reduced glutathione, catalase and superoxide dismutase (SOD) for antioxidant levels in plasma & heamolysate of 30 patients with abdominal trauma and 30 controls. From this study we can summarize that there was an increase in oxidative stress and decrease in antioxidant levels (causing oxidative stress) on day zero in patients with abdominal trauma. This oxidative stress on day zero was not related to the development of complications. There was no significant difference in oxidative stress between patients with solitary and multiple abdominal organ injury and also between patients with hollow viscus injury and solid organ injury on day zero. From this study, we conclude that in patients with abdominal trauma there was increase in oxidative stress and decrease in antioxidant levels on day zero.

Choroidal detachment in perforated corneal ulcers: frequency and management

AIMS

To determine the frequency of choroidal detachment (CD) in eyes with non-traumatic corneal ulcer perforation and, also, to assess the efficacy and safety of cyanoacrylate glue in sealing corneal perforations.

METHODS

18 eyes of 17 patients were studied. Inclusion criterion was any patient with a non-traumatic perforated corneal ulcer. All patients had a thorough history taken and complete ophthalmic examination including B-scan ultrasonography. Patient demographics, presence of CD, and efficacy of corneal gluing were assessed.

RESULTS

Eight of the 18 eyes (44%) were documented to have a CD. Among perforations of >2 mm2, six eyes (75%) were documented to have CD compared with two eyes (20%) with perforations of <or=2 mm2 (p = 0.054). No correlation could be determined between perforation duration and incidence of CD. Of the 15 eyes that underwent gluing, there were 13 successes (87%) and two failures (13%). Within the successes four patients (27%) required re-gluing because of infection (one patient) or progression of melt and glue loosening (three patients). Failure was the result of severe progression of melting (one patient) and a very large perforation (one patient).

CONCLUSION

Choroidal detachment following corneal ulcer perforation is common and is more likely in larger corneal perforations. Preoperative B-scan should be considered in cases of large corneal perforations requiring therapeutic keratoplasty to document choroidal detachment, which if large may require drainage. Cyanoacrylate glue is an effective and safe method for sealing small corneal perforations. A vigil must be maintained for infection while the glue and bandage contact lens are in situ.

Hypomagnesaemia masquerading as hypoparathyroidism

Magnesium deficiency is a common clinical problem. Dietary malabsorption and renal wasting are the commonest causes. Hypomagnesemia induces a state of functional hypoparathyroidism due to decreased secretion of parathormone (PTH) as well as resistance to its action. Contrary to typical autoimmune hypoparathyroidism, it is associated with decreased levels of serum phosphate. We report a patient who presented with hypocalcemic tetany associated with hypomagnesaemia due to renal wasting. Subsequently, he improved with magnesium supplementation of therapy.

Ageing and circadian variation in cardiovascular events

INTRODUCTION

Circadian variation in cardiovascular events is well recognised in vascular events. This study aims to observe any significant difference in circadian variability in geriatric patients when compared to their younger counterparts.

METHODS

This prospective study was conducted at medical emergency at the Government Medical College and Hospital, Chandigarh, India. All the patients attending medical emergency with symptoms suggestive of coronary artery disease were included. The time of occurrence of first symptom and subsequent symptoms was noted. Electrocardiography, cardiac enzymes and echocardiography were performed to establish the diagnosis of acute coronary syndrome. The 24-hour day was divided into 12 equal parts of two hours each. For the final analysis, the two-hour periods were grouped into six equal periods of four hours each and four quarters of six hours each.

RESULTS

We studied 559 patients, out of whom 459 were 65 years old or younger, and 100 patients were older than 65 years old. 459 patients had 498 episodes in all. 100 patients above the age of 65 years had 104 episodes. Both the groups had peaking of acute myocardial infarction in the early morning hours with patients older than 65 years of age having a slightly early peak. However, there was considerable variability for peaking of unstable angina and non-Q myocardial infarction. In patients older than 65 years, early morning peaking of events was noted whereas in 65 years or younger, the peaking of events was noted in the evening hours.

CONCLUSION

Circadian variability exists in occurrence of acute coronary events and is variable in geriatric patients when compared to their younger counterparts.

Acute toxicity and cardio-respiratory effects of 2-deoxy-D-glucose: a promising radio sensitiser

OBJECTIVE

To evaluate the acute toxicity of 2-deoxy-D-glucose (2DG) by oral (p.o.) and intravenous (i.v.) routes, and also the cardio-respiratory effects following high doses of 2DG in animal models.

METHODS

The LD50 of 2DG (in water) was determined in rats and mice by p.o. route and in mice by i.v. route. The effect of 2-DG (250 mg/kg, 500 mg/kg, and 1000 mg/kg, i.v.) was studied on various cardio-respiratory parameters viz., mean arterial blood pressure, heart rate and respiratory rate in anaesthetised rats. The effect of 2DG (500 mg/kg, 1000 mg/kg, and 2000 mg/kg, p.o.) was also studied on various respiratory parameters viz., respiratory rate and tidal volume in conscious rats and mice using a computer program.

RESULTS

The p.o. LD50 of 2DG was found to be >8000 mg/kg in mice and rats, and at this dose no death was observed. The LD50 in mice by i.v. route was found to be 8000 mg/kg. At this dose 2 out of 4 mice died and the death occurred within 6 h. A significant increase in the body weight was observed after p.o. administration of 2DG in rats at 500 mg/kg, 1000 mg/kg, and 2000 mg/kg doses. There was no significant change in the body weight at 4000 mg/kg and 8000 mg/kg by the p.o. route in rats and up to 8000 mg/kg by p.o. as well as i.v. routes in mice. Intravenous administration of 2DG (250 mg/kg, 500 mg/kg, and 1000 mg/kg) in anaesthetised rats showed a time-dependent decrease in the mean arterial blood pressure. There was no change in the heart rate in any of the treatment groups. The tidal volume was not changed significantly by p.o administration in conscious rats, but a significant decrease in the respiratory frequency at 500 mg/kg and 1000 mg/kg doses was observed. In the mice also there was no change in the tidal volume after p.o, administration, but the respiratory frequency decreased significantly at 2000 mg/kg dose.

CONCLUSION

2DG is a safe compound but can cause a fall in the blood pressure and a decrease in respiratory frequency at high doses.

A First-Principles Study of the Electronic Structure and Stability of a Lithium Aluminum Hydride for Hydrogen Storage

LiAlH4 holds great promise for reversible hydrogen storage, where a fundamental understanding of hydrogen interaction with the metal elements is essential to further improve its properties. The present paper reports a first-principles study of its stability and electronic structure, using a full potential linearized augmented plane wave (FLAPW) method within the generalized gradient approximation (GGA) for high accuracy. The theoretically calculated heat of formation agrees well with experiment. The electronic structures show that the H atoms bond nonequivalently with the Al in the [AlH4]- ligand, which leads to complex dehydrogenation characteristics of LiAlH4.

Characterization of antimicrobial-resistant Salmonella isolated from imported foods

Two-hundred eight Salmonella isolates recovered from over 5,000 imported foods entering the United States in 2001 were tested for antimicrobial susceptibilities and further characterized for quinolone resistance mechanisms, integron carriage, and genetic relatedness. Salmonella Weltevreden (20%), Salmonella Newport (6%), Salmonella Lexington (5%), and Salmonella Thompson (4%) were the four most common serotypes recovered. Twenty-three (11%) isolates were resistant to at least one antimicrobial, and seven (3.4%) to three or more antimicrobials. Resistance was most often observed to tetracycline (9%), followed by sulfamethoxazole (5%), streptomycin (4%), nalidixic acid (3%), and trimethoprim/sulfamethoxazole (2%). One Salmonella Schwarzengrund isolate recovered from squid imported from Taiwan exhibited resistance to eight antimicrobials, including ampicillin, chloramphenicol, gentamicin, kanamycin, nalidixic acid, sulfamethoxazole, tetracycline, and trimethoprim/sulfamethoxazole. Six isolates (Salmonella Bareilly, Salmonella Derby, Salmonella Ohio and three Salmonella Schwarzengrund) contained class 1 integrons, which carried several resistance genes including dhfrI/dhfrXII, aadA, pse-1, and sat1, conferring resistance to trimethoprim/sulfamethoxazole, streptomycin, ampicillin, and streptothricin, respectively. Five of six nalidixic acid-resistant isolates possessed DNA point mutations at either Ser83 or Asp87 in DNA gyrase. One ciprofloxacin-resistant isolate possessed double mutations in DNA gyrase at positions Ser83 and Asp87 as well as a single mutation at Ser80 in parC. The top three serotypes identified, Salmonella Weltevreden (n = 41), Salmonella Newport (n = 13), and Salmonella Lexington (n = 11), were further characterized for genetic relatedness by pulsed-field gel electrophoresis. Fifty-five distinct pulsed-field gel electrophoresis patterns were observed among the 65 isolates, indicating extensive genetic diversity among these Salmonella serotypes contaminating imported foods.

Measles, mumps and rubella -- the urologist's perspective

In recent years there has been a decline in the uptake of the MMR vaccine and a significant increase the number of reported case of mumps. This condition has number of important extrasalivary manifestations including mumps epididymo-orchitits. The article reviews the pathophysiology, clinical symptoms, diagnosis, and long-term sequelae of this increasingly prevalent condition and provides a reference for all practising urologists treating this disease.

Non-hyperinsulinemic hypoglycemia in a patient with a gastrointestinal stromal tumor

One of the authors (JvD) recently reported a case of non-islet cell tumor hypoglycemia caused by the production of "big" IGF-II by a gastrointestinal stromal tumor (GIST). Here, we report a patient with a GIST in whom non-hyperinsulinemic hypoglycemia was not attributable to aberrant tumoral IGF-II processing, but instead was caused by a combination of cachexia, renal and hepatic dysfunction, and tumoral glucose consumption.