Advanced metastatic pancreatic neuroendocrine tumor treated successfully with peptide receptor radionuclide therapy: a case report

Neuroendocrine tumor (NET) is a rare tumor that has been observed in different sites such as lungs and throughout the gastrointestinal tract. Clinical features are usually non-specific and vary considerably depending upon the location of the tumor. Symptoms are similar to those of common conditions such as peptic ulcer disease, gastritis, irritable bowel syndrome, asthma, etc. Thus, an initial diagnosis of a NET usually occurs at an advanced stage. This report describes a case of pancreatic NET (PNET, grade 2) with liver metastasis in a 37-year-old male which was found to be inoperable due to extensive direct involvement of the proximal jejunal branches and superior mesenteric vein. Peptide receptor radionuclide therapy (PRRT) with lutetium-177 dotatate (177Lu-DOTATATE) was administered due to the inoperability of primary PNET. Complete resolution of symptoms occurred with three cycles of PRRT.

Serum Glutamic Oxaloacetic Transaminase - Predictor in Detection of Early Neurological Deterioration in Acute Ischemic Stroke

In 20-40 percent of stroke patients, symptoms evolve during initial hours, resulting in rise of mortality. Early Neurological Deterioration (END) is now an emerging entity. In acute ischemic stroke, it results in increased mortality and functional disability. The incidence rates of early neurological deterioration is 13-37 percent of ischemic stroke. Ischemic stroke is associated with release of glutamate in brain. Serum glutamic oxaloacetic transaminase (SGOT) is the enzyme that metabolise glutamate and facilitates in lowering its level, but its significance is poorly understood. So, SGOT has been studied as predictor in detection of early neurological deterioration of acute ischemic stroke.

MATERIAL

This was an observational prospective study in 100 in acute ischemic stroke patients with the age more than 18 years and presenting with in 24 hours after symptom onset. Detailed history of the patients was noted and detailed examination was carried out. National Institute of Health Stroke Scale (NIHSS) score was calculated at admission, at 24 hours and at 72 hours to see change in score and detect the early neurological deterioration. Early neurological deterioration was defined by change in the NIHSS Score of 2 or more than 2 with in 72 hours of stroke onset. SGOT level was sent within 24 hours of admission and studied as a contributing marker in detection of Early neurological deterioration.

OBSERVATION

Among 100 patients enrolled in our study, there were more male patients (82%) with mean age of the 59.8 years. 72% of patients were diabetic and 84% were non alcoholic. Increase in SGOT value was found to be associated with early neurological deterioration(p <0.01). END in stroke patients were found to have SGOT > 40 IU/ml (p= 0.05). Higher level of SGOT (>40 IU/m) l had association with NIHSS at admission (p =0.07), at 48 hours (p=0.04) and at 72 hours (p= 0.03) with mean of 9.66,10.45,11.45 respectively. Positive correlation had been there between SGOT with NIHSS at admission, at 48 hours and at 72 hours .

CONCLUSION

The increase in SGOT levels during stroke is associated with neurological deterioration. Hence, SGOT may be utilised as predictor in detection of END in acute ischemic stroke as high values of SGOT positively correlated with NIHSS at admission, at 48 hours and 72 hours.

Association of IFNG gene polymorphism with asthma in the Indian population

Epidemiologic studies in India show that the prevalence of asthma is increasing, but no genetic studies have been reported on the Indian population thus far. We selected the IFNG locus on 12q21 as a candidate gene for asthma on the basis of its role in pathophysiology and positive linkage demonstrated in other populations. The aim of this study was to investigate association of a CA-repeat marker in this gene with asthma and total serum IgE levels in the North Indian population. The repeat region was PCR-amplified from patients and control subjects and analyzed through use of GeneScan. The distributions of allele sizes were found to be significantly different between patients and control subjects (Kolmogorov-Smirnov test, P < 10(-6)). Alleles 10 and 11 were found to be overrepresented in individuals with asthma, whereas alleles 13 and 15 were less likely in asthmatic individuals. We found that the CA-repeat polymorphism in the IFNG gene was significantly associated with total serum IgE levels (ANOVA, P < 10(-4) for control subjects and P =.0036 for patients). Furthermore, a previously reported promoter polymorphism at the -333 base pair position was not detected in our population. This is the first report on the association of a candidate gene with asthma from the Indian subcontinent.