Identifying the culprit allergen in seasonal allergic rhinitis

Seasonal allergic rhinitis (SAR) is the main form of rhinitis in children whereas in adults it accounts for about a third of cases of rhinitis. It is a risk factor for the development of asthma and chronic rhinosinusitis. The most common allergic triggers are grass and tree pollens, allergy to moulds and weeds is less common. Identifying the months of the year when an individual is symptomatic will help define the culprit allergen. If there is a clear recurring seasonal history the diagnosis may be made on the strength of the history. Skin prick tests are available in specialist clinics and are a useful tool in differentiating SAR from non-allergic rhinitis and defining the culprit allergen(s). Specific IgE tests for suspected allergens can be performed if skin tests are not available. A positive specific IgE test to an allergen does not necessarily mean that clinical allergy is present, it may reflect sensitisation of the immune system. Although, in general, specific IgE tests have a high negative predictive value they are less sensitive than skin prick tests for grass pollen and moulds. Allergen avoidance is the first step in the management of any allergic rhinitis. Oral non-sedating antihistamines are recommended as first-line treatment for mild SAR, higher doses may be necessary in moderate to severe SAR. Intranasal corticosteroids should be used in moderate to severe forms of SAR and also in mild forms where treatment with antihistamines has failed. There are no major differences in terms of efficacy between different corticosteroid preparations. Long-term growth studies in children using fluticasone, mometasone and budesonide (but not beclometasone) have been reassuring.     

Capecitabine plus oxaliplatin (XELOX) versus 5‐fluorouracil/leucovorin plus oxaliplatin (FOLFOX‐6) as first‐line treatment for metastatic colorectal cancer

A regimen consisting of 5‐fluorouracil/leucovorin plus oxaliplatin (FOLFOX‐6) is widely used in France in the first‐line treatment of metastatic colorectal cancer (MCRC). The aim of our study was to demonstrate the non‐inferiority of capecitabine plus oxaliplatin (XELOX) versus FOLFOX‐6 for this indication. Patients were randomly assigned to receive XELOX or FOLFOX‐6 for 6 months. The primary endpoint was overall response rate (ORR) in the per‐protocol (PP) population; however, progression‐free and overall survival (OS), time to response and response duration were also assessed. A total of 306 patients were enrolled (XELOX n = 156; FOLFOX‐6 n = 150). ORR was 42 and 46% with XELOX and FOLFOX‐6, respectively, in the PP population. The difference between groups was 4.7%; the upper limit of the unilateral 95% confidence interval (14.4%) was below the non‐inferiority margin of 15%. In the intent‐to‐treat population, median progression‐free survival was 8.8 months with XELOX and 9.3 months with FOLFOX‐6, and median OS was 19.9 and 20.5 months, respectively. XELOX patients had significantly more grade 3/4 thrombocytopenia (12% vs. 5%) and diarrhoea (14% vs. 7%), but significantly less grade 3/4 neutropenia (5% vs. 47%), febrile neutropenia (0% vs. 6%) and neuropathy (11% vs. 26%) than FOLFOX‐6 patients. We conclude that XELOX is non‐inferior in terms of efficacy to FOLFOX‐6 in the first‐line treatment of MCRC, but has a different toxicity profile.     

Diverse roles of leptin in the gastrointestinal tract: modulation of motility, absorption, growth, and inflammation

Objective

Leptin was discovered in 1994 as a hormone produced by adipose tissue with a modulatory effect on feeding behavior and weight control. Recently, the stomach has been identified as an important source of leptin and growing evidence has shown diverse functions for leptin in the gastrointestinal tract.

Methods

Using leptin as a keyword in PubMed, more than 17 000 articles were identified, of which more than 500 articles were related to the role of leptin in the gastrointestinal tract. Available abstracts were reviewed and more than 200 original articles were reviewed in detail.

Results

The available literature demonstrated that leptin can modulate several important functions of the gastrointestinal tract. Leptin interacts with the vagus nerve and cholecystokinin to delay gastric emptying and has a complex effect on motility of the small bowel. Leptin modulates absorption of macronutrients in the gastrointestinal tract differentially in physiologic and pathologic states. In physiologic states, exogenous leptin has been shown to decrease carbohydrate absorption and to increase the absorption of small peptides by the PepT1 di-/tripeptide transporter. In certain pathologic states, leptin has been shown to increase absorption of carbohydrates, proteins, and fat. Leptin has been shown to be upregulated in the colonic mucosa in patients with inflammatory bowel disease. Leptin stimulates gut mucosal cell proliferation and inhibits apoptosis. These functions have led to speculation about the role of leptin in tumorigenesis in the gastrointestinal tract, which is complicated by the multiple immunoregulatory effects of leptin.

Conclusion

Leptin is an important modulator of major aspects of gastrointestinal tract functions, independent of its more well-described roles in appetite regulation and obesity.     

Synthesis, glucose uptake activity and structure-activity relationships of some novel glitazones incorporated with glycine, aromatic and alicyclic amine moieties via two carbon acyl linker

Three series of novel glitazones were designed and prepared by using appropriate synthetic schemes to incorporate glycine, aromatic and alicyclic amines via two carbon linker. Compounds were synthesized both under conventional and microwave methods. Nineteen out of twenty four synthesized compounds were evaluated for their in vitro glucose uptake activity using isolated rat hemi-diaphragm. Compounds, 6, 9a, 13a, 13b, 13c, 13f and 13h exhibited significant glucose uptake activity. Illustration about their synthesis and in vitro glucose uptake activity is described along with the structure-activity relationships.     

Sexual dimorphism of the index to ring finger ratio in South Indian adolescents

Sex determination from prepubertal human remains is a challenge for forensic experts and physical anthropologists worldwide as definitive sexual traits are not manifested until after the full development of secondary sexual characters that appear during puberty. The research was undertaken in 350 South Indian adolescents to investigate sexual dimorphism of the index and ring finger ratio. The index finger length (IFL) and the ring finger length (RFL) were measured in millimeters in each hand and the index and ring finger ratio was computed by dividing the index finger length by the ring finger length. Mean RFL was greater than mean IFL in both males and females. Mean RFL was significantly higher in males. The index and ring finger ratio showed a statistically significant difference between males and females (p ≤ 0.001). The index and ring finger ratio was found to be higher in females (0.99) when compared to their male counterparts (0.95). The index and ring finger ratio thus shows sexual dimorphism in the South Indian adolescents that may prove useful to determine the sex of an isolated hand when it is subjected for medicolegal examination. The study suggests that a ratio of 0.97 and less is suggestive of male sex, while a ratio of more than 0.97 is suggestive that the hand is of female origin among South Indian adolescents.     

Prevalence and correlation of oral lesions among tobacco smokers, tobacco chewers, areca nut and alcohol users

Introduction: The incidence of oral premalignant and malignant lesions is on the rise due to an increasednumber of people taking in tobacco and alcohol related habits. Material and Methods: 1028 patients withtobacco, alcohol and areca nut habits attending our Department of Oral Medicine and Radiology formed thestudy sample. An interviewer based questionnaire was used to record the habit details. All the patients werethen examined clinically for the presence of lesions. Chi square and Fisher exact tests were used to assess thestatistical significance of the study parameters. Results: Males had a higher prevalence and comprised 87.9%of the sample. The commonest habit in this study sample was smoking (39.2%) followed by smokeless tobaccouse (28.1%). Out of the 1028 patients with habits 40% had no clinically detectable changes in their mucosa.Of the mucosal changes leukoplakia (14%) was the commonest. Conclusions: This study provided informationabout the habit trends in the patients visiting this institution. The study may serve as a useful tool in educatingthe patients about the deleterious effects of oral tobacco, alcohol and betel exposure.