Association of endothelial nitric oxide synthase gene T-786C promoter polymorphism with gastric cancer

AIM: To investigate the role of endothelial nitric oxide synthase -786T > C promoter polymorphism in the etiology of gastric cancer (GC).METHODS: A total of 150 GC patients and 150 control subjects were included in the study. The information on demographic features was elicited with an informed consent from all the patients and control subjects using a structured questionnaire. Helicobacter pylori (H. pylori) infectivity status was tested in antral biopsies from all the subjects by rapid urease test following the method of Vaira et al. Genomic DNA was isolated from whole blood samples following the salting out method of Lahiri et al. Genotype analysis of the rs2070744 polymorphism was carried out by allele-specific polymerase chain reaction method. The genotypes were determined based on the appearance of bands on an agarose gel stained with ethidium bromide under ultraviolet gel documentation with the help of 100 bp ladder. Odds ratios and corresponding 95%CIs were determined using java stat online software.RESULTS: There was a significant difference in the distribution of C allele (C vs T; P = 0.000, OR = 5.038) in patient group compared to the control subjects exhibiting a fivefold increased risk for GC. When the T/T and C/C genotypes were compared, there was an enhanced GC risk for individuals with C/C genotype (T/T vs C/C; P = 0.000). Among the demographic factors, smoking and alcoholism were the common risk factors in patients compared to the control subjects (P < 0.05). Patients with smoking and alcoholism developed cancer even in heterozygous T/C condition (smoking: P = 0.020 and alcoholism: P = 0.005). Individuals with H. pylori infection showed seven fold increased risk for cancer. All the patients with C/C genotype revealed a significant association between H. pylori infection and GC. Among the patients 2.4% of them revealed familial incidence of GC. No significant difference was noticed between cases and controls with regard to consanguinity (P = 0.473).CONCLUSION: The Present data suggest that eNOS-786 C/C genotype and C allele may be considered as potential risk factors in patients with GC.     

<Emphasis Type="Italic">Salmonella typhimurium</Emphasis> Meningitis in an Infant Presenting with Recurrent Meningitis

Salmonella typhimurium meningitis in infancy is very uncommon and does not respond to usual duration of empirical antibiotic therapy. A 5-mo-old infant presented with clinical picture of acute pyogenic meningitis and was treated with empirical antibiotic therapy for 14 d. But, 2 wk after the discharge, the child presented again with similar complaints. CSF culture had grown Salmonella typhimurium following which dual antibiotic therapy was given for 6 wk.     

Impact of parent and teacher concordance on diagnosing attention deficit hyperactivity disorder and its sub-types

Objective  This study examines the extent to which parents and teachers agree on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and its subtypes, as per the DSM IV criteria. It assesses whether the extent of agreement between informants improves by making the ADHD criteria more flexible. Methods  Parents and teachers of 119 clinic-referred sample of children (mean age=8.4 years, S.D= 2.48) with disruptive behavioral symptoms completed the Vanderbilt Attention Deficit Hyperactivity Disorder Diagnostic Parent and Teacher Rating Scales, respectively. Concordance of parent and teacher reports for the presence or absence of diagnosis of ADHD and type of ADHD was examined by percent agreement and the kappa statistics. Results  Of the 119 children referred for disruptive behavior disorders, 96 (80.6%) met criteria for any type of ADHD according to the parents’ report; and only 68 (57.1%) met criteria according to the teachers’ report. Parent and teacher agreement for the diagnosis of any type of ADHD was only 52% :(k= .11, n.s); and the agreement regarding diagnosis of sub-type was even poorer. Making the criteria more flexible vis-à-vis impairment or number of symptoms did not improve agreement between the informants. Conclusion  Clear guidelines are needed to reconcile the differences between informants in order to promote uniform diagnostic practices among clinicians working with children having ADHD.     

Full Outline of Unresponsiveness score and the Glasgow Coma Scale in prediction of pediatric coma

BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) as predictors of outcome in children with impaired consciousness.     

Pediatric Moyamoya Disease: Clinical Profile, Literature Review and Sixteen Year Experience from a Tertiary Care Teaching Institute

Objective

To assess the clinical spectrum and outcome of pediatric moyamoya disease (MMD) in Indian sub-continent.

Methods

The authors retrospectively analysed data of 23 patients, diagnosed with pediatric moyamoya disease from a single center during the period of 1996–2011.

Results

There were 18 boys and 5 girls. Mean age at onset of symptoms was 3.8?±?2.2 y. All patients presented with cerebral ischemic events. Recurrent stroke was the presenting feature in 12(52.2 %) patients. Twenty one patients were definitive case of moyamoya disease and two were probable case of moyamoya disease. Posterior circulation was involved in 26.1 % patients. Three patients underwent indirect surgical revascularisation procedure and rest were managed conservatively. On follow up 66.6 % patients had residual neurological deficit.

Conclusions

Heightened awareness of this entity among pediatric neurologists is required for early diagnosis of pediatric moyamoya disease.     

Comparison of customized and cohort-based birthweight standards in identification of growth-restricted infants in GUSTO cohort study

Background: The aim was to evaluate the ability of customized and cohort birthweight standards in discriminating intrauterine growth retardation (IUGR).

Methods: Birthweights (BWs) of GUSTO singleton infants born at gestational age (GA) 35–41 weeks were converted using two standards: (a) GUSTO cohort-based BW centile adjusted for GA and baby gender; (b) customized BW percentile calculator adjusted for maternal height and weight, race, parity, GA and gender. Infants were classified into three groups: (1)?<?10th BW centile by customization– customized-SGA, (2)?<?10th BW centile by GUSTO– GUSTO-SGA; and (3)?>?10th BW centile by both standards – BOTH-non-SGA.

Results: Of the 1011 infant–mother dyads, 68 were customized-SGA and 104 were GUSTO-SGA, with concordance of 61% (n?= 63) for SGA. While 5 (7%) of customized-SGA were not SGA by GUSTO-charts, 41 (39%) of GUSTO-SGA were not SGA by customized-charts. Customized-SGA had significantly the least growth in abdominal circumference (AC) and highest head circumference (HC): AC growth ratio between second and third trimester; and the lowest mean BW, ponderal index and placental weight than other groups.

Conclusion: Customized-SGA standard was a better discriminator of pathologic fetal growth based on AC growth. It improved strength of association with pathology and in our population reduced false positives (41/104?=?39%) in the assessment of SGA.     

Targeting pancreatic ductal adenocarcinoma: New therapeutic options for the ongoing battle

Pancreatic ductal adenocarcinoma(PDAC),the most commonly reported form of pancreatic cancer,is a lethal malignancy that con-tributes to the global cancer burden with high morbidity and mor-tality[1].It has a poor 5-year survival mainly because PDAC poses a significant diagnostic challenge,has a high metastatic rate at di-agnosis and is stubbornly resistant to therapy[2].     

A Comparative Study of Feto-Maternal Outcome in Instrumental Vaginal Delivery

Objective

To compare maternal and neonatal outcomes of vacuum versus forceps application in assisted vaginal delivery.

Material and Method

Women in labor with vertex presentation were delivered by vacuum and forceps. A total of 120 cases were included in this prospective study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum hemorrhage, Apgar score, instrumental injuries, NICU admissions PNM etc. χ² test was used to analyze the data.

Observations

Maternal morbidity viz. episiotomy extension as well as first and second degree perineal tear were significant in the forceps group (P = 0.0001 and P = 0.02, respectively). With regards to neonatal morbidity, no statistically significant difference was noted.

Conclusion

Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no fetal distress) as it is significantly less likely to injure the mother.