Association of MC4R (rs17782313) gene polymorphism with obesity measures in Western India

Background and aimsThe association of melanocortin receptor 4 (MC4R) gene with adiposity measures is widely studied in European populations. Only six studies have investigated the role of MC4R gene with adiposity measures among Indian populations. We have evaluated the role of MC4R (rs17782313) gene polymorphism in influencing adiposity measures in India among children and adults.Materials and methodsThe present population based cross sectional study was conducted among 303 individuals (208 children and 95 adults) of age group 10–30 years, belonging to Rajasthan. Somatometric measurements (standing height, weight, and waist and hip girths) and blood samples were taken after obtaining written informed consent. Genotyping of MC4R rs17782313 single nucleotide polymorphism was done using restriction fragment length polymorphism method for polymerase chain reaction ampli?ed fragments. We examined association between rs17782313 and different adiposity measures (height, weight, BMI, WHR, and waist and hip girths) using linear regression models.ResultsThe MC4R variant (rs17782313) predicted increased body weight (0.15 kg, S.E ± 0.076, P = 0.043) among children. In combined population, the rs17782313 variant was moderately associated with body weight (0.13 kg, S.E ± 0.070, P = 0.057). This variant was not found to be associated with any other adiposity measure.ConclusionFurther studies are needed to evaluate the association of MC4R variants through sequencing and functional genomics with different adiposity measures in Indian populations for understanding the genetic underpinnings of adiposity in India.     

Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature

BACKGROUNDPregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.CASE SUMMARYWe present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSIONMost patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.     

Laser-capture microdissection of plasma cells from subacute sclerosing panencephalitis brain reveals intrathecal disease-relevant antibodies

Increased IgG and oligoclonal bands are found in cerebrospinal fluid of humans with chronic infectious CNS disease. Studies have shown that these oligoclonal bands are antibodies directed against the agent that causes disease. Laser-capture microdissection was used to isolate individual CD38+ plasma cells from the brain of a patient with subacute sclerosing panencephalitis, and single-cell RT-PCR was used to analyze individual IgG heavy and light chains expressed by each cell. Based on overrepresented IgG sequences, we constructed functional recombinant antibodies (recombinant IgGs) and determined their specificities. Five of eight recombinant IgGs recognized measles virus, the cause of subacute sclerosing panencephalitis. These results demonstrate that overrepresented IgG sequences in postmortem brains can be used to produce functional recombinant antibodies that recognize their target antigens. This strategy can be used to identify disease-relevant antigens in CNS inflammatory diseases of unknown etiology.     

High sensitive C-reactive protein-Effective tool in determining postoperative recovery in lumbar disc disease

Background:

It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP) assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score.

Materials and Methods:

A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon.

Results:

The level of HSCRP in the study group was between 0.050– and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points).

Conclusion:

HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.     

Functional outcome following a large head total hip arthroplasty: A retrospective analysis of mid term results

Background:

One of the reasons that hip resurfacing and large head metal on metal (MOM) total hip arthroplasty (THA) became popular in Asia was the possible increased range of movement and thereby improved function of the hip joint. Due to concerns of MOM articulation an alternative bearing was sought. Hence, a shift from large head MOM to large head ceramic on ceramic (COC) was made. The aim of this study was to compare the functional outcome including range of motion (ROM) and dislocation rates following large head MOM and large head COC THA.

Materials and Methods:

Retrospectively, 39 primary THA with large head MOM with a mean age of 56 years (range 36-72 years) and average followup of 54 months (range 38-70 months) were compared with 23 primary THA with large head COC bearing with a mean age of 48 years (range 36-68 years) and an average followup of 18 months (range 12-26 months). Functional outcome was assessed using the Modified Harris Hip Score. Dislocation rate and ROM were compared.

Results:

Global ROM averaged 248 degrees with MOM group and 252 degrees with the COC group. One patient with metal bearing had dislocation at an average 3 year followup which required revision THA while there were no complications in the COC group. MHHS averaged 89 points in MOM and 94 in COC THR.

Conclusion:

This study has shown that large head ceramic on ceramic THA is a good alternative to large head metal on metal THA with comparable dislocation rates and range of movements and without complications of metallosis in Asian patients.     

“Dynamic” liver retraction at laparoscopy: An easy and effective technique

Liver retraction is an essential step during any laparoscopic upper gastrointestinal operation, especially during dissection at the oesophageal hiatus. However, the generally employed Nathanson retractor may cause significant postoperative liver dysfunction secondary to congestion of the liver.1,2 It may be technically cumbersome to systematize its frequent use intraoperatively and it may not be readily available at large. Furthermore, the unabated pressure it inflicts on the left lobe of the liver, especially during prolonged surgeries, may lead to hepatic ischaemic necrosis, gangrene, or even unexpected mortality.1 While few recently developed innovative liver retraction techniques seem useful in this context, 2-5 they tend to offer a “static” liver retraction. In this paper, we describe an easy-to-use method of laparoscopic liver retraction wherein any 5mm laparoscopic instrument can be used to manipulate the “heavy” liver so as to provide a “dynamic” counter-traction at will.     

The J-wave: A new electrocardiographic sign of an occult cardiac injury

Background

The aim of this study was to determine the sensitivity and specificity of a J wave on the electrocardiogram (ECG) to detect an occult cardiac injury in patients following penetrating chest trauma.

Method

A prospective study conducted on patients admitted to the Groote Schuur Hospital Trauma Centre following penetrating chest trauma during the period of 1st October 2001 and 28th February 2009, who did not have an indication for emergency surgery and that underwent an ECG and later a subxiphoid pericardial window (SPW) for a potential cardiac injury. All the patients were easily resuscitatable with less than 2 l of crystalloid. A standard 12-lead ECG was performed shortly after admission. A J wave was defined as the small positive reflection on the R-ST junction.

Results

There were 174 patients where an ECG was performed and the patient underwent SPW for a possible cardiac injury. The mean age of the patients was 28 years (range 11–65). The mechanism of injury was stab wounds in 167 patients and 7 low velocity gunshot wounds. A J-wave was present on the ECG in 65 (37%) of the 174 patients with a possible cardiac injury. The sensitivity of a J wave to detect a hemopericardium was 44%, specificity was 85%, and positive predictive value of 91% (p < 0.001).

Conclusion

The presence of a ‘J’ wave on ECG signifies a significant risk of an occult cardiac injury after penetrating thoracic trauma.     

Is ADHD a risk for posttraumatic stress disorder (PTSD)? Results from a large longitudinal study of referred children with and without ADHD

Objectives. Preclinical studies link prenatal nicotine exposure with the development of both ADHD-like phenotype in rodents and blockade of extinction learning in a fear conditioning paradigm, a preclinical model of posttraumatic stress disorder (PTSD). While these findings suggest that either ADHD, prenatal nicotine exposure, or both could be a risk factor for PTSD, such associations have not been investigated in humans. Methods. Subjects were ascertained from family-genetic, longitudinal studies of paediatrically and psychiatrically referred children with and without ADHD of both sexes and their siblings followed for 10 years from childhood into adulthood (n = 403 probands; n = 464 siblings; mean age at follow-up of probands and siblings = 22.0 years). All subjects were comprehensively evaluated with structured diagnostic interviews that included questions regarding prenatal use of cigarettes. Results. A total of 12% (104/867) of the sample had been exposed to maternal smoking during pregnancy. There was no interaction effect between maternal smoking during pregnancy and ADHD (z = 0.01, P = 0.99). Maternal smoking during pregnancy and ADHD were independent, significant risk factors for PTSD at the 10-year follow-up (odds ratio = 3.58 [1.35,9.48], z = 2.57, P = 0.01 and odds ratio = 2.23 [1.06,4.69], z = 2.11, P = 0.04, respectively). Conclusions. These results suggest that both maternal smoking during pregnancy and ADHD are significant predictors of PTSD in humans.