A clinical study of dermatoses in diabetes to establish its markers

Background:

Cutaneous manifestations of diabetes mellitus generally appear subsequent to the development of the disease, but they may be the first presenting signs and in some cases they may precede the primary disease manifestation by many years.

Aims:

The aim of our study was to study the spectrum of dermatoses in diabetics, to know the frequency of dermatoses specific to diabetes mellitus (DM), and to establish the mucocutaneous markers of DM.

Material and Methods:

The study was conducted at a diabetic clinic and our department between September 2008 and June 2010. Two hundred and twenty-four diabetic patients were included in the study group and those with gestational diabetes were excluded. Healthy age- and sex-matched individuals were taken as controls.

Results:

The male to female ratio was 1 : 1.21. Type 2 DM was seen in 89.7% and type 1 DM in 10.3% of the patients. Dermatoses were seen in 88.3% of the diabetics compared to 36% in non-diabetic controls (P<0.05). Cutaneous infections were the most common dermatoses followed by acanthosis nigricans and xerosis in diabetics. Type 2 DM was found to have an increased risk of complications than type 1 DM. Complications of diabetes were seen in 43.7% of the diabetic cases. Diabetic dermopathy, loss of hair over the legs, diabetic foot ulcer, and so on, were found to be the cutaneous markers of DM in our group of cases.

Conclusion:

Dermatoses were more common in diabetics than non-diabetics. Cutaneous infections formed the largest group of dermatoses in DM.     

Nails: diagnostic clue to genodermatoses

Nails are cutaneous appendages mostly involved in mechanical functions. However, nails may reflect presence of various systemic disorders evidenced by alteration of their shape, size, color or texture. Genodermatoses are multisystem disorders with cutaneous involvement. Many of the genodermatoses present with nail changes and some of these may be the clinical pointers to the diagnosis. Diagnostic clues to various genodermatoses derived from nail findings have been discussed.     

Central angiotensin converting enzyme facilitates memory impairment in intracerebroventricular streptozotocin treated rats

Preclinical and clinical studies indicated involvement of renin angiotensin system (RAS) in memory functions. However, exact role of RAS in cognition is still ambiguous. Our aim was to explore how angiotensin converting enzyme (ACE) modulates memory in experimental model of memory impairment. Memory deficit was induced by intracerebroventricular administration of streptozotocin (STZ, 3 mg/kg) in rats. Perindopril, an ACE inhibitor, was given for 21 days and memory function was evaluated by Morris water maze test. Cerebral blood flow (CBF) was measured by laser doppler flowmetry. The biochemical and expression studies were done in cortex and hippocampus of rat brain after the completion of behavioral studies. STZ caused impairment in memory along with significant reduction in CBF, ATP level and elevated oxidative and nitrosative stress. The activity and mRNA expression of acetylcholinesterase (AChE) and ACE were also increased in rat brain regions following STZ administration. However, serum ACE activity remained unaffected. Treatment with perindopril dose dependently improved memory by increasing energy metabolism and CBF. Perindopril also decreased oxidative and nitrosative stress, activity and mRNA expression of AChE and ACE in STZ treated rat. Further, ACE inhibition mitigated STZ induced neurodegeneration as observed in histopathological studies. Moreover, perindopril per se improved memory and CBF, decreased oxidative stress with no effect on AChE activity and expression. However, perindopril per se significantly reduced ACE activity but increased mRNA expression of ACE in rat brain. These results suggest that ACE occupies a pivotal role in STZ induced memory deficit thus implicating central RAS in cognition.     

Design and Development of a Heart Rate Variability Analyzer

Heart rate variability (HRV), analysis gives an insight into the state of the autonomic nervous system which modulates the cardiac activity. Here a digital signal controller based handy device is developed which acquires the beat to beat time interval, processes it using techniques based on non-linear dynamics, fractal time series analysis, and information theory. The technique employed, that can give reliable results by assessing heart beat signals fetched for a duration of a few minutes, is a huge advantage over the already existing methodologies of assessing cardiac health, those being dependant on the tedious task of acquiring Electro Cardio Gram(ECG) signals, which in turn requires the subject to lie down at a stretch for a couple of hours. The sensor used, relies on the technique of Photoplethysmography, rendering the whole approach as noninvasive. The device designed, calculates parameters like, Largest Lyapunov Exponent, Fractal dimension, Correlation Dimension, Approximate Entropy and α-slope of Poincare plots, which based on the range in which they fall, the cardiac health condition of the subject can be assessed to even the extend of predicting upcoming disorders. The design of heart beat sensor, the technique used in the acquisition of heart beat data, the relevant algorithm developed for the analysis purpose, are presented here.     

A Genome-Wide Association Study Identifies Novel Loci for Paclitaxel-Induced Sensory Peripheral Neuropathy in CALGB 40101

PURPOSE: Sensory peripheral neuropathy is a common and sometimes debilitating toxicity associated with paclitaxel therapy. This study aims to identify genetic risk factors for the development of this toxicity. EXPERIMENTAL DESIGN: A prospective pharmacogenetic analysis of patients with primary breast cancer, randomized to the paclitaxel arm of CALGB 40101, was used to identify genetic predictors of the onset and severity of sensory peripheral neuropathy. A genome-wide association study in 855 subjects of European ancestry was conducted and findings were replicated in additional European (n = 154) and African American (n = 117) subjects. RESULTS: A single nucleotide polymorphism in FGD4 was associated with the onset of sensory peripheral neuropathy in the discovery cohort [rs10771973; HR, 1.57; 95% confidence interval (CI), 1.30-1.91; P = 2.6 × 10(-6)] and in a European (HR, 1.72; 95% CI, 1.06-2.80; P = 0.013) and African American (HR, 1.93; 95% CI, 1.13-3.28; P = 6.7 × 10(-3)) replication cohort. There is also evidence that markers in additional genes, including EPHA5 (rs7349683) and FZD3 (rs10771973), were associated with the onset or severity of paclitaxel-induced sensory peripheral neuropathy. CONCLUSIONS: A genome-wide association study has identified novel genetic markers of paclitaxel-induced sensory peripheral neuropathy, including a common polymorphism in FGD4, a congenital peripheral neuropathy gene. These findings suggest that genetic variation may contribute to variation in development of this toxicity. Validation of these findings may allow for the identification of patients at increased risk of peripheral neuropathy and inform the use of an alternative to paclitaxel and/or the clinical management of this toxicity. Clin Cancer Res; 18(18); 5099-109. ?2012 AACR.     

Bladder Carcinoma after ABVD Chemotherapy for Hodgkin's Lymphoma: A Case Report

The treatment of lymphomas may result in the development of second malignancies, as evident by the numerous reports in the literature. Treatment with cyclophosphamide-based chemotherapy regimens may lead to bladder lesions such as haemorrhagic cystitis and also to carcinoma of the urinary bladder. Previous pelvic radiotherapy treatment is also implicated as a cause for local second cancers. We present the case of a patient treated for Hodgkin''s lymphoma, who was diagnosed with transitional cell carcinoma of the bladder soon after treatment completion. On completion of 6 cycles of ABVD chemotherapy the patient was on follow-up. Two months after treatment completion the patient complained of dysuria and was investigated for a suspected urinary tract infection. Urine microscopy did not reveal any abnormality. Symptomatic treatment was prescribed and cystoscopy was arranged. The cystoscopic findings suggested an irregular growth overlying the trigone and the biopsy reported it as transitional cell carcinoma. This case report demonstrates that symptoms attributed to common medical causes in patients treated for cancer may be a sign of second malignancy. This case report also demonstrates the need for a thorough evaluation of patients’ complaints during follow-up, although the likelihood for the occurrence of a second malignancy may be low. The assumption that these symptoms were due to a commonly occurring urinary tract infection would have had serious implications leading to a delay in the treatment of the bladder cancer.Key words: Hodgkin''s lymphoma, ABVD, Chemotherapy, Bladder carcinoma