Immunohistochemical and molecular genetic study on epithelioid glioblastoma: Series of seven cases with review of literature

Epithelioid glioblastoma (e-gbm) is a recently described variant of glioblastoma (GBM) which is associated with short survival and now added as a provisional entity to WHO 2016 classification of CNStumors. About half of these tumors show characteristic BRAF-V600E mutation. However, unlike conventional GBMs, e-gbm lack specific diagnostic and prognostic markers. Hence, we aimed to molecularly characterize these tumors. An extensive review of literature was performed.In a multi-institutional effort, all the cases of glioblastoma of year 2017 were reviewed. Cases with predominant epithelioid morphology were analysed. Seven cases of e-gbm (adults:4 and pediatric: 3) were identified. Duration of symptoms varied from 2 weeks to one month. Radiologically, all cases were supratentorial, contrast enhancing with solid and cystic appearance. Majority of the cases were immunopositive for GFAP (71%), EMA (71%), S100 (71%) and vimentin (85%). All the cases showed ATRX, INI-1 and H3K27me3 expression. BRAFV600Emutation was seen in 28% of cases. TERT mutation was seen in 40% cases, while one case showed EGFR amplification. H3F3A mutations and PTEN deletions were seen in none. Although e-gbms are rare, epithelioid morphology of a CNS tumor in a young adult or children with areas of necrosis needs thorough histomorphological and genetic workup.     

Horizontal transmission of novel H1N1/09 influenza virus in a newborn: Myth or fact?

Horizontal transmission of H1N1/09 virus infection is very common however; transmission through this route has not been reported in newborns. To our knowledge, this is the first case report of newborn who acquired infection of novel H1N1/09 virus horizontally through asymptomatic family members or hospital staff during epidemic period in Kolkata, India. Baby recovered without antiviral therapy but received antibiotic for bacterial co-infection.     

Psychiatric Morbidity,Social Support,and Coping in Wives of Alcohol and Opioid Dependent Men

The study aimed to ascertain the psychiatric morbidity in wives of substance dependent men and to assess social support and coping as its correlates. It was carried out at the Drug De-addiction and Treatment Centre of Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Two groups of substance dependent men (alcohol and opioid) and their wives were recruited (n = 50 in each group). The subjects were assessed for relevant socio-demographic and clinical variables, dependence severity measures, psychiatric morbidity (GHQ 12 and MINI), coping, and social support. Patients and spouses in the opioid dependent group were of younger age and had a lesser duration of marriage than those of alcohol dependent group. In both groups, more than 70 percent of the spouses had scores above the cutoff in GHQ-12. The psychiatric diagnosis was present in 16 percent and 20 percent of the wives in alcohol and opioid dependence groups, respectively, depression and dysthymia being the commonly encountered diagnoses. Social support was comparable across both groups. The most common coping mechanisms utilized were those of denial and internalization. On multivariate logistic regression, GHQ-12 scores were the predictors of MINI diagnosis. Psychological morbidity is common in wives of patients with substance use disorders. Attention to the mental health issues can relieve the distress in this vulnerable population.     

The Role of Health Literacy in Predicting Multiple Healthcare Outcomes Among Hispanics in a Nationally Representative Sample: A Comparative Analysis by English Proficiency Levels

Health literacy (HL) research among Hispanics currently focuses on individuals with limited English proficiency but impacts of HL on healthcare outcomes among other English language proficiency groups is relatively unknown. Regression models assessed associations between HL and healthcare outcomes for Hispanics overall (n = 4013) and for proficiency level sub-populations using the 2007 Pew Hispanic Health Survey. Overall, Hispanics with adequate HL percieved US medical care as “excellent,” were more satisfied with their doctor’s help, and reported “excellent” overall health. In the sub-population analysis, “excellent” perception of US healthcare was associated with HL among the Spanish and English dominant groups. Among bilinguals, adequate HL was associated with decreased use of traditional medicine. The effect of adequate HL varied within English proficiency groups. HL research that focuses only on Spanish dominant speakers can exclude a substantial percentage of English proficient or bilingual populations who have low HL.     

Comparative study of efficacy and tolerability of flupirtine versus tramadol in non-steroidal anti-inflammatory drug intolerant mechanical low back pain

BackgroundMechanical low back pain (MLBP) is a commonly encountered entity in clinical practice. Pain relief and restoration of functional capacity are management goals.Aims and objectivesTo compare the efficacy and tolerability of flupirtine, a selective neuronal potassium channel-opener (SNEPCO), with tramadol, a widely-used opioid analgesic, in MLBP.MethodsThis randomized, single-blinded, intention to treat (ITT) trial started with 240 non-steroidal anti-inflammatory drug (NSAID) intolerant patients who were prescribed either tablet flupirtine (100 mg twice daily) or capsule tramadol (50 mg twice daily), for 4 weeks. Follow-up was done on days 14, 28 and 4 weeks after treatment completion. Assessment of improvements in Indian Health Assessment Questionnaire Disability Index (Indian HAQ-DI), Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and measurement of Pain Relief Rate (PRR) were performed. Adverse events were recorded.ResultsOne hundred and seven patients receiving flupirtine and 103 receiving tramadol were analyzed on an ITT basis. Scores in Indian HAQ-DI, VAS and NRS improved significantly in both groups in the last visit, but more so with flupirtine. PRR was reasonably higher with flupirtine, [59 (55.14%)] patients experiencing significant to complete pain relief at the end of the study, compared to tramadol [41 (39.81%)]. Adverse effects were less with flupirtine [26 (24.30%) versus 41 (39.81%), p < 0.05], minimizing drop-outs.ConclusionFlupirtine has better sustained efficacy and tolerability than tramadol in MLBP.