Seasonal variations in extrathyroidal conversion of thyroxine to tri-iodothyronine and migratory disposition in redheaded bunting

Thyroid gland has been shown to be involved in the migratory disposition in redheaded bunting, Emberiza bruniceps, (Chandola & Pathak, 1980 a,b; Pathak & Chandola, 1982). Extrathyroidal conversion of thyroxine (T4) to triiodothyronine (T3) was now studied in thyroidectomised buntings by measuring the appearance of plasma T3 (RIA) 4h after an injection of 2.5ug I-T4 during non-migratory (January), spring pre-migratory (March) and post-migratory (June) periods of the year. A significantly high peripheral conversion of T4-T3 was recorded during pre-migratory period compared to non-migratory and postmigratory periods. This suggests that the increase in circulating $\text{T3}\text{T4}$ ratio observed in buntings prior to spring migration could be to a certain extent, the result of an enhanced peripheral monodeiodination of T4.The inhibition of extrathyroidal conversion of exogenously administered I-T4 into T3 in thyroidectomised buntings (by propylthiouracil) prevented the T4-induced fattening significantly during non-migratory period (January). Same dose of PTU failed to inhibit T4-induced fattening as well as peripheral monodeiodination of T4 in thyroidectomised birds in spring premigratory period. This indicates that the T4-effects on fattening may be brought about by its conversion to T3, and also that the peripheral deiodinating enzyme systems in this bird may be comparatively more active during spring premigratory period than that during nonmigratory period.The results argue for a role of T3 in premigratory fattening, a characteristic of migratory disposition in birds. Also the seasonal variations in peripheral conversion of T4-T3 may be of great adaptive significance in seasonal breeders where energy requiring events like migratory fattening (and reproduction and molting-all influenced by thyroid status) must be temporally spaced across the year.     

Primary malignant melanoma of oral cavity —Ultrastructure with review of literature

Primary Malignant Melanoma of Oral Cavity is a rare Neoplasm. Here a case of this condition is reported in light of existing review of Literature and Ultrastructural study.     

Pulmonary edema associated with subarachnoid hemorrhage. Evidence for a cardiogenic origin

A 56-year-old woman with no history of cardiac disease developed acute pulmonary edema following a subarachnoid hemorrhage. A constellation of findings, including elevated creatine kinase MB isoenzyme activity in the absence of electrocardiographic or scintigraphic evidence of acute myocardial infarction, elevated pulmonary artery wedge pressure, segmental wall motion abnormalities, and depressed ejection fraction of the left ventricle demonstrated by two-dimensional echocardiography and radionuclear ventriculography, pointed to a direct myocardial injury leading to cardiac failure. The evidence for cardiogenic origin of pulmonary edema provided by this case is in contrast to the belief that "neurogenic" pulmonary edema is of noncardiac origin.     

Clinical Profile of Scrub Typhus in Pregnancy in Sub-Himalayan Region

Background

Scrub typhus is rare in pregnancy, but it has now become an important cause of febrile illness in pregnancy in sub-Himalayan region of India. Only a few case reports have been published so far, and they show adverse maternal and fetal outcomes. No consensus has been reached till now regarding treatment.

Methodology

All the pregnant patients irrespective of period of gestation admitted with febrile illness with positive IgM ELISA for scrub typhus with or without eschar were included. The clinical profile was observed using a detailed history of symptoms, travel, recreation, agricultural activities, treatment record prior to admission, and a detailed examination, and the treatment outcome was noted. Fever workup including cultures, CXR, CSF analysis, serology for scrub was done. IgM scrub typhus was done by kit method manufactured by InBios Intertational, Inc.

Results

We observed in total 14 pregnant patients out of which eight were in the the second trimester and six were in the third trimester. The clinical features of the disease observed for pregnant females were the same as for nonpregnant females. There was no difference in the severity of scrub typhus between pregnant and nonpregnant women. No mortality was found in these patients. On follow-up, they had normal peripartum and postpartum periods. All were treated with azithromycin 500 mg once a day for 5 days.

Conclusion

Although rare, scrub typhus should be considered in differential diagnosis of fever in pregnant patients especially in scrub season. Azithromycin should be the drug of choice in pregnancy as it has no adverse effect on fetus and pregnancy outcome.

     

Assessing Trends in Palliative Surgery for Extrahepatic Biliary Malignancies: A 15-Year Multicenter Study

Introduction

Extrahepatic biliary malignancies are often diagnosed at an advanced stage. We compared patients with unresectable perihilar cholangiocarcinoma (PHCC) and gallbladder cancer (GBC) who underwent a palliative procedure versus an aborted laparotomy.

Methods

Seven hundred seventy-seven patients who underwent surgery for PHCC or GBC between 2000 and 2014 were identified. Uni- and multivariable analyses were performed to identify factors associated with outcome.

Results

Utilization of preoperative imaging increased over time (CT use, 80.1 % pre-2009 vs. 90 % post-2009) (p?<?0.001). The proportion of the patients undergoing curative-intent resection also increased (2000–2004, 67.0 % vs. 2005–2009, 74.5 % vs. 2010–2014, 78.8 %; p?=?0.001). The planned surgery was aborted in 106 (13.7 %) patients and 94 (12.1 %) had a palliative procedure. A higher incidence of postoperative complications (19.2 vs. 3.8 %, p?=?0.001) including deep surgical site infections (8.3 vs. 1.1 %), bleeding (4.8 vs. 0 %), bile leak (6.0 vs. 0 %) and longer length of stay (7 vs. 4.5 days) were observed among the patients who underwent a palliative surgical procedure versus an aborted non-therapeutic, non-palliative laparotomy (all p?<?0.05). OS was comparable among the patients who underwent a palliative procedure (8.7 months) versus an aborted laparotomy (7.8 months) (p?=?0.23).

Conclusion

Increased use of advanced imaging modalities was accompanied by increased curative-intent surgery. Compared with patients in whom surgery was aborted, patients who underwent surgical palliation demonstrated an increased incidence of postoperative morbidity with comparable survival.

     

Frequency,spectrum, and factors associated with fecal evacuation disorders among patients with chronic constipation referred to a tertiary care center in northern India

Background

Data on fecal evacuation disorder (FED) causing chronic constipation (CC) is scanty in India.

Methods

Prospectively maintained data of 249 consecutive patients with CC (Rome III) referred for investigations were retrospectively analyzed.

Results

Of 249 patients (43.7?±?16.2 years, 174 males), 135/242 (55.8 %), 57/249 (22.9 %), and 83/136 (61.0 %) had abnormal balloon expulsion test (>200 g), anorectal manometry [>100 mmHg resting pressure (n?=?4), >167 mmHg squeeze pressure (n?=?46), and both (n?=?7)], and defecography (anorectal angle not opening by >15° during defecation, perineal descent ≥4 cm, and/or rectocele), respectively. Though 181/249 (72.6 %) had one test abnormality, 86/249 (34 %) had FED (greater than or equal to two abnormalities), 44/65 (67.6 %) of whom had a defecation index ≤1.4. Rome III criteria for irritable bowel syndrome were equally fulfilled by patients with and without FED [74/83 (89 %) vs. 117/144 (81.2 %); p = ns]. On univariate analysis, straining duration, prolonged straining [≥30 min; 21/39 (53.8 %) vs. 15/65 (23.1 %); p?=?0.002], incomplete evacuation [75/77 (97.4 %) vs. 95/114 (83.3 %); p?=?0.004], and >3 stools/week [60/75 (80 %) vs. 76/128 (60 %); p?=?0.004] were commoner among the FED patients though age, gender, symptom duration, mucus, manual evacuation, and stool forms were comparable. Resting and squeeze pressures and balloon volume at maximum tolerable limit were higher, and the sphincter tended to be shorter in FED. Prolonged straining, incomplete evacuation, and squeeze pressure were significant on multivariate analysis. Manometry and defecography abnormalities were commoner among the female FED patients.

Conclusion

FED is not uncommon, which fulfills the Rome III criteria for IBS, and prolonged straining may be suggestive; abnormal defecography and manometry are commoner in female.

     

Prevalence of Nutrition and Health-Related Claims on Pre-Packaged Foods: A Five-Country Study in Europe

This study is part of the research undertaken in the EU funded project CLYMBOL (“Role of health-related CLaims and sYMBOLs in consumer behaviour”). The first phase of this project consisted of mapping the prevalence of symbolic and non-symbolic nutrition and health-related claims (NHC) on foods and non-alcoholic beverages in five European countries. Pre-packaged foods and drinks were sampled based on a standardized sampling protocol, using store lists or a store floor plan. Data collection took place across five countries, in three types of stores. A total of 2034 foods and drinks were sampled and packaging information was analyzed. At least one claim was identified for 26% (95% CI (24.0%–27.9%)) of all foods and drinks sampled. Six percent of these claims were symbolic. The majority of the claims were nutrition claims (64%), followed by health claims (29%) and health-related ingredient claims (6%). The most common health claims were nutrient and other function claims (47% of all claims), followed by disease risk reduction claims (5%). Eight percent of the health claims were children’s development and health claims but these were only observed on less than 1% (0.4%–1.1%) of the foods. The category of foods for specific dietary use had the highest proportion of NHC (70% of foods carried a claim). The prevalence of symbolic and non-symbolic NHC varies across European countries and between different food categories. This study provides baseline data for policy makers and the food industry to monitor and evaluate the use of claims on food packaging.     

Autosomal recessive osteopetrosis: case report of two siblings

Malignant osteopetrosis is a rare congenital disorder of bone resorption, occurring in less than 1 in 200 000 births. It is caused by the failure of osteoclasts to resorb immature bone. We report on two siblings with autosomal recessive osteopetrosis. The prominent clinical features were short stature, progressive blindness, defective development of primary and permanent teeth, and anemia.