Opportunities and challenges for biomarker discovery using electronic health record data

Electronic health records (EHRs) have become increasingly relied upon as a source for biomedical research. One important research application of EHRs is the identification of biomarkers associated with specific patient states, especially within complex conditions. However, using EHRs for biomarker identification can be challenging because the EHR was not designed with research as the primary focus. Despite this challenge, the EHR offers huge potential for biomarker discovery research to transform our understanding of disease etiology and treatment and generate biological insights informing precision medicine initiatives. This review paper provides an in-depth analysis of how EHR data is currently used for phenotyping and identifying molecular biomarkers, current challenges and limitations, and strategies we can take to mitigate challenges going forward.

Characteristics of Electrical Synapses, C-terminals and Small-conductance Ca2+ activated Potassium Channels in the Sexually Dimorphic Cremaster Motor Nucleus in Spinal Cord of Mouse and Rat

Sexually dimorphic motoneurons (MNs) located in lower lumbar spinal cord are involved in mating and reproductive behaviours and are known to be coupled by electrical synapses. The cremaster motor nucleus in upper lumbar spinal cord has also been suggested to support physiological processes associated with sexual behaviours in addition to its thermoregulatory and protective role in maintaining testes integrity. Using immunofluorescence approaches, we investigated whether cremaster MNs also exhibit features reflecting their potential for electrical synaptic communication and examined some of their other synaptic characteristics. Both mice and rats displayed punctate immunolabelling of Cx36 associated with cremaster MNs, indicative of gap junction formation. Transgenic mice with enhanced green fluorescent protein (eGFP) reporter for connexin36 expression showed that subpopulations of cremaster MNs in both male and female mice express eGFP, with greater proportions of those in male mice. The eGFP+ MNs within the cremaster nucleus vs. eGFP- MNs inside and outside this nucleus displayed a 5-fold greater density of serotonergic innervation and exhibited a paucity of innervation by C-terminals arising from cholinergic V0c interneurons. All MNs within the cremaster motor nucleus displayed prominent patches of immunolabelling for SK3 (K+) channels around their periphery, suggestive of their identity as slow MNs, many though not all of which were in apposition to C-terminals. The results provide evidence for electrical coupling of a large proportion of cremaster MNs and suggest the existence of two populations of these MNs with possibly differential innervation of their peripheral target muscles serving different functions.

Expression of the gap junction protein connexin36 in small intensely fluorescent (SIF) cells in cardiac parasympathetic ganglia of rodents

In mammals, several endocrine cell types are electrically coupled by connexin36 (Cx36)-containing gap junctions, which mediate intercellular communication and allow regulated and synchronized cellular activity through exchange of ions and small metabolites via formation of intercellular channels that link plasma membranes of apposing cells. One cell type thought to be endocrine-like in nature are small intensely fluorescent (SIF) cells that store catecholamines in their dense-core vesicles and reside in autonomic ganglia. Here, using immunofluorescence approaches, we examined whether SIF cells located specifically in cardiac parasympathetic ganglia of adult and neonatal mice and adult rats follow patterns of Cx36 expression seen in other endocrine cells. In these ganglia, SIF cells were identified by their distinct small soma size, autofluorescence at 475 nm, and immunolabelling for their markers tyrosine hydroxylase and vesicular monoamine transporter-1. SIF cells were often found in pairs or clusters among principal cholinergic neurons. Immunofluorescence labelling of Cx36 occurred exclusively as fine puncta that appeared at contacts between SIF cell processes and somata or at somato-somatic appositions of SIF cells. These puncta were absent in cardiac parasympathetic ganglia of Cx36 null mice. Transgenic mice expressing enhanced green fluorescent protein reporter for Cx36 expression displayed labelling for the reporter in SIF cells. The results suggest that Cx36-containing gap junctions electrically couple SIF cells, which is consistent with previous suggestions that these may be classified as endocrine-type cells that secrete catecholamines into the bloodstream in a regulated manner.

Progression to end Stage Renal Disease in Poststreptococcal Glomerulonephritis (PSGN) - Chandigarh Study

193 patients (142 adults and 51 children) with acute PSGN were followed long term. Sixty percent had elevated serum creatinine and 14% had nephrotic range proteinuria at the onset. By two years 28 patients (14%) had died from uremia, and 19 were lost to follow up. Amongst the remainder, 8 patients (4%) had developed mild to moderate renal insufficiency, 12% were hypertensive, and 22% had urinary abnormalities. Of the 146 patients alive at 2 years, 107 were followed up to 10 years (mean 4.8 years). In addition to the 8 patients with renal insufficiency at 2 years, another 7 developed renal failure subsequently. Four out of these 15 patients progressed to uremia within 4 to 10 years after the onset of disease. Hypertension and persistent urinary abnormalities were present in 15% and 24% respectively. Progression to uremia occurred in 6% of children and 20% of adults. Nephrotic range proteinuria, renal insufficiency at the onset, and crescents in more than one third of glomeruli indicated a poor prognosis.

Acute Renal Failure Amongst Children in a Tropical Environment

The pathogenetic factors leading to acute renal failure (ARF) in 223 children between the ages of 20 days and 14 years were studied. Diarrhoeal diseases were responsible for ARF in 49.8%, acute glomerulonephritis in 34.1%, drug induced intravascular hemolysis in glucose -6-phosphate dehydrogenase deficiency in 4.5%, snake bite in 4%, hemolytic uremic syndrome in 2.2%, and miscellaneous causes in 5.4%. Dialysis was instituted in 178 children and the others were treated conservatively. Renal histology in 39 out of 76 children who presented with an acute nephritic illness revealed acute endocapillary proliferative glomerulonephritis in 27 and crescentic glomerulonephritis in 12. The histology in 79 out of 147 remaining patients showed acute tubular necrosis in 64, acute cortical necrosis in 13, and acute interstitial nephritis in 2. Overall mortality was 27.4%. This high incidence of ARF due to infective diarrhoeas and dysentery reflects poor socio-economic and hygienic conditions, inadequate facilities in rural areas, delays in seeking medical advice, and lack of knowledge about fluid and electrolyte therapy amongst the staff.

Tiered approaches to chromatographic bioanalytical method performance evaluation: recommendation for best practices and harmonization from the Global Bioanalysis Consortium harmonization team

The A2 harmonization team, a part of the Global Bioanalysis Consortium (GBC), focused on defining possible tiers of chromatographic-based bioanalytical method performance. The need for developing bioanalytical methods suitable for the intended use is not a new proposal and is already referenced in regulatory guidance language. However, the practical implementation of approaches that differ from the well-established full validation requirements has proven challenging. Advances in technologies, the need to progress drug development more efficiently, and emerging new drug compound classes support the use of categorized tiers of bioanalytical methods. This paper incorporated the input from an international team of experienced bioanalysts to surmise the advantages and the challenges of tiered approaches and to provide recommendations on paths forward.

Naso-oropharyngeal rhinosporidiosis: Endoscopic removal

Rhinosporidiosis is a chronic infestation by the fungus Rhinosporidium seeberi, which predominantly affects the mucus membranes of the nose and nasopharynx. We report a case of rhinosporidiosis with presentation as an oropharyngeal mass and a discusion about its endoscopic removal.

Fabricating feeding plate in CLP infants with two different material: a series of case report

Feeding is a family's biggest concerns when a child is born with cleft lip and/or palate. The goal for that child is to have as near normal feeding as possible. This report presents fabrication of feeding plates in two infants born with cleft lip and palate using two different materials.

A rare case report of orofacial granulomatosis in a pediatric patient

Orofacial granulomatosis comprises a group of diseases characterized by noncaseating granulomatous inflammation affecting the soft tissues of the oral and maxillofacial region. The most common clinical presentation is persistent swelling of one or both lips. It is important to establish the diagnosis accurately because this condition is sometimes a manifestation of Crohn's disease or sarcoidosis. This article describes a case of orofacial granulomatosis.

Population dynamics of a parasite Pallisentis in two species of fish Channa punctatus and Channa striatus

In an aquatic environment, there is a profound and inverse relationship between environment quality and disease status of fish. Parasites are one of the most serious limiting factors in aquaculture. Therefore, the present investigation has been undertaken to sort out the population dynamics of Pallisentis (Acanthocephala), in relation to host sex from freshwater fishes, Channa of Rohilkhand region. A total of 517 fishes (Channa punctatus, n = 198 and C. striatus, n = 319) were examined regularly from August 2006 to February 2010. Overall prevalence of Pallisentis in C. striatus was higher in females (67.78%) as compared to males (63.52%). In case of C. punctatus, overall prevalence of Pallisentis was higher in males (53.77%) as compared to females (52.17%) whereas, relative density was higher in females (61.41%) than in males (52.72%). Intensity (2-3 parasite/host, in both sexes), density (1.36 in males and 1.69 in females) and infection index (0.73 in males and 0.88 in females) were recorded.

Peripheral osteoma in a young patient: a marker for precancerous condition?

Osteoma is a benign osteogenic tumor arising from the proliferation of cancellous or compact bone. The osteoma can be central, peripheral, or of an extraskeletal type. Peripheral type of osteoma is most common in the lower jaws, which occurs at the surface of the cortical bone and is sessile or pedicled. The overall incidence of osteoma is low, affecting 0.01-0.04% of the population; osteomas comprise 12.1% of benign bone tumors and 2.9% of all bone tumors. Most of the osteomas occurring in the mandible are dense osteomas, and the cancellous osteoma is comparatively rare. Maxillofacial osteoma associated with cutaneous sebaceous cysts, multiple supernumerary teeth, and colorectal polyposis is known as Gardener's syndrome. However, in some cases, maxillofacial osteomas with multiple impacted and supernumerary teeth are not accompanied by a fixed complex of symptoms. We report one such case in a 15-year-old female patient.

Cemento-ossifying fibroma of maxillary antrum in a young female patient

The cemento-ossifying fibroma is classified as a fibro-osseous lesion of the jaws. It commonly presents as a progressively growing lesion that can attain an enormous size with resultant deformity if left untreated. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of controversy regarding terminology and the criteria for its diagnosis. This case report describes a female patient with cemento-ossifying fibroma involving maxillary antrum. The clinical, radiographic and histological features as well as the surgical findings are presented.

Lingual thyroid in children

Lingual thyroid is a rare embryological anomaly and originates from failure of the thyroid gland to descend from the foramen caecum to its normal eutopic pre-laryngeal site. The ectopic gland located at the base of the tongue is often asymptomatic but may cause local symptoms such as dysphagia, dysphonia with stomatolalia, upper airway obstruction and haemorrhage, often with hypothyroidism. One case is presented, in a 5 year-old girl patient, who complained of sensation of a foreign body and progressive dysphagia and dyspnoea caused by ectopic lingual thyroid. The diagnosis of lingual thyroid is usually made clinically and radionuclide scanning is used to confirm the diagnosis. In this case report, presentation, diagnosis and management of this condition is highlighted.

Safe and rapid resolution of severe hypertriglyceridaemia in two patients with intravenous insulin

AIM

To rapidly reduce serum triglyceride to a safe serum level. Severe hypertriglyceridaemia is associated with uncontrolled diabetes, obesity and poor physical activity. Even moderate increases in triglyceride levels (> 5mmol/L) confer an increased risk of pancreatitis and coronary artery disease. We present two patients with diabetes and serum triglyceride levels of greater than 85mmol/L despite polypharmacy intervention.

METHOD

72-hour intravenous insulin infusion was administered.

RESULTS

Serum triglyceride levels fell to 9.4 and 4.6 mmol/L respectively, without adverse events and sustained effect over several months.

CONCLUSION

We suggest the use of intravenous insulin infusion where lifestyle and oral drug therapies have failed can impact on severe hypertriglyceridaemia.

Tooth brushing skills for the children aged 3-11 years

OBJECTIVES

The objective of this study was to evaluate tooth brushing management and ability of children in relation to age and gender.

MATERIALS AND METHODS

The study population consisted of 45 children, who attended Department of Pedodontics and Preventive Dentistry at V.S Dental College and Hospital Bangalore. Children were divided into three groups according to age: Group I: 3-5 years, Group II: 6-8 years, and Group III: 9-11 years. Each child selected his/her favorite toothbrush and brushed his/her teeth under supervision of one instructor. The grip type during tooth brushing was recorded on a videotape and duration of tooth brushing also was noted. The data were analyzed in relation to the age and gender using the chi-square test. ANOVA was used to find if there is any significant difference between the mean brushing times in the different groups.

RESULTS

The results of statistical analysis showed that in all cases P> 0.05 for grip preferences and P.

CONCLUSION

The required manual dexterity for tooth brushing was present in younger age groups.

Pregnancy and sexually transmitted viral infections

Viral infections in pregnancy are a major cause of morbidity and mortality for both mother and fetus. Viral STIs occur as surface infection and then gradually infect immunologically protected sites. Therefore, these are asymptomatic, hidden and hence underdiagnosed, persistent and difficult to treat. HSV, HPV, HBV, HIV and CMV (cytomegalovirus) are the common ones. Most of these are transmitted during intrapartum period. Proper screening, identification and treatment offered during prenatal period may help in preventing their complications. Twenty five percent of women with a history of genital herpes have an outbreak at some point during the last month of pregnancy. Acyclovir is the accepted efficacious and safe therapy for HSV in pregnancy. Globally, HPV infection is the most common sexually transmitted infection. Neonatal transmission can occur in the absence of clinically evident lesions. HPV 6 or 11 may lead to Juvenile Onset Recurrent Respiratory Papillomatosis (JORRP). TCA, liquid nitrogen, laser ablation or electrocautery can be used to treat external genital HPV lesions at any time during pregnancy. Cesarean section is recommended only if the lesions are obstructing the birth canal. Mother to child transmission (MTCT) in HIV accounts for 15-30% during pregnancy and delivery, and a further 5-20% of transmission occurs through breastfeeding. HBV infection during pregnancy does not alter the natural course of the disease. In women who are seropositive for both HBsAg and HBeAg, vertical transmission is approximately 90%. Pregnancy is not a contraindication for HBV vaccination. Cytomegalovirus (CMV) is the most common intrauterine infection. Cytomegalic inclusion disease (CID) is the most severe form of congenital CMV infection. Treatment is supportive.

Intrapericardial Haematoma: A Rare Cause of Congestive Cardiac Failure After Three Years of Coronary Artery Bypass Grafting

We present a rare case of organised intrapericardial haematoma after three years of coronary artery bypass grafting. Delayed cardiac tamponade after open heart surgery usually occurs within first few weeks of surgery. Intrapericardial organised haematoma causing localised compression of cardiac chambers after three years of open heart surgery is very rare. Under cardiopulmonary bypass and cardioplegic cardiac arrest, we removed the haematoma. It is difficult to make a clinical diagnosis. However once diagnosis is made and haematoma removed, it gives good symptomatic relief to the patient.

Ascending aortic tear with severe aortic regurgitation following rugby injury

Blunt ascending aortic injuries are rare in clinical practice. Aortic valve regurgitation is an uncommon consequence of closed chest injury. It is caused by either ruptured valve cusp or when subadventitial rupture of the ascending aorta causes prolapse of subjacent valve cusp. Most of the blunt aortic injuries are secondary to high speed motor vehicle accident or falls from significant height. We report on a 33-year-old man who sustained an injury during a rugby game and presented with severe aortic regurgitation secondary to subadventitial rupture of ascending aorta on a background of asymptomatic dilated aortic root. He underwent emergency operation for torrential aortic regurgitation and severe left ventricular failure.