Prevalence of Celiac Disease in Children with Unexplained Failure to Thrive

Background

Gluten sensitive enteropathy or celiac disease (CD) is a disorder of small bowel that occurs upon exposure to gluten. A total of 67 children of either sex in the age group of 1–12 years with unexplained failure to thrive were studied for the prevalence of CD.

Methods

This was a cross-sectional study. It included detailed history, clinical assessment, estimation of anti gliadin (AGA), tissue transglutaminase antibodies (tTGA) and duodenal biopsy. Treatment with gluten free diet and follow-up of diagnosed cases was done for one year.

Result

Sixteen cases (23.88%) had villous atrophy and positive serology, essential criteria for the diagnosis of CD. Forty six (69%) children were between 4–12 years of age. Male to female ratio was 2.3:1. Main symptoms were irritability (63%), diarrhea (56%) and weight loss (56%). Thirty seven (56%) children had weight less than 3^rd percentile. tTGA was 100% sensitive and 90.2% specific. Duodenal biopsy showed decreased villious-crypt ratio in 81.25% and intra epithelial lymphocytosis in 81% children (p<0.000001). All the confirmed cases were advised strict gluten free diet for one year. On follow-up at six months, all children showed improvement in their symptoms and weight gain.

Conclusion

CD is an important cause of unexplained failure to thrive in children.Key Words: Failure to thrive, Celiac disease     

To determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation

Background

Cross-sectional study was carried out to determine the frequency of subtelomeric abnormalities in children with idiopathic mental retardation (MR).

Method

Multiplex ligation-dependant probe amplification technique was used to detect subtelomeric abnormalities.

Results

Out of 35 children, 21 (60%) were males. Family history of MR was present in 23%. Main clinical features included speech delay in all motor delay cases (83%) and non-specific dysmorphic features (77%).

Conclusion

Associated clinical features were more in children with intelligence quotient (IQ) < 50 (P < 0.05). Subtelomeric deletion (4q35) was observed in one child.     

Role of prophylactic surfactant in preterm infants

Background

Respiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. The physiological function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread. A wide variety of surfactant products have been formulated and studied in clinical trials. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity.

Methods

This was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. One hundred preterm newborns (controls) less than 34 weeks gestation were managed in the conventional manner as per the existing protocols in the neonatal intensive care unit. Twenty-five consecutively delivered preterm newborns less than 34 weeks gestation were administered surfactant. Data regarding clinical outcomes including mortality and morbidity profile was collected and analysed.

Results

The mean duration of ventilation in the ventilated babies in the control group and the surfactant group was 129.8 ± 43 hours and 85.7 ± 46 hours, respectively; the difference being statistically significant. In the surfactant group, four babies (16%) died and in the control group, 27 babies (27%) died. The difference was not statistically significant. The number of babies developing retinopathy of prematurity and needing laser treatment for retinopathy of prematurity was greater in the surfactant group.

Conclusion

Prophylactic administration of surfactant in preterm newborns of gestational age <34 weeks is associated with a significant decrease in mean duration of ventilation and an increase in the incidence of retinopathy of prematurity.     

Augmenting BMI and Waist-Height Ratio for Establishing More Efficient Obesity Percentiles among School-going Children

Research Questions:

1. Are all the existing methods for estimating the obesity and overweight in school going children in India equally efficient? 2. How to derive more efficient obesity percentiles to determine obesity and overweight status in school-going children aged 7-12 years old?

Objectives:

1. To investigate and analyze the prevalence rate of obesity and overweight children in India, using the established standards. 2. To compare the efficiency among the tools with the expected levels in the Indian population. 3. To establish and demonstrate the higher efficiency of the proposed percentile chart.

Study Design:

A cross-sectional study using a completely randomized design.

Settings:

Government, private-aided, unaided, and central schools in the Thrissur district of Kerala.

Participants:

A total of 1500 boys and 1500 girls aged 7-12 years old.

Results:

BMI percentiles, waist circumference percentiles, and waist to height ratio are the ruling methodologies in establishing the obese and overweight relations in school-going children. Each one suffers from the disadvantage of not considering either one or more of the obesity contributing factors in human growth dynamics, the major being waist circumference and weight. A new methodology for mitigating this defect through considering BMI and waist circumference simultaneously for establishing still efficient percentiles to arrive at obesity and overweight status is detailed here. Age-wise centiles for obesity and overweight status separately for boys and girls aged 7-12 years old were established. Comparative efficiency of this methodology over BMI had shown that this could mitigate the inability of BMI to consider waist circumference. Also, this had the advantage of considering body weight in obesity analysis, which is the major handicap in waist to height ratio. An analysis using a population of 1500 boys and 1500 girls has yielded 3.6% obese and 6.2% overweight samples, which is well within the accepted range for Indian school-going children.

Conclusion:

The percentiles for school-going children based on age and sex were derived by comparing all other accepted standards used for measurement of obesity and overweight status. Hence, augmenting BMI and waist to height ratio is considered to be the most reliable method for establishing obesity percentiles among school-going children.     

Neural stem cell markers, nestin and musashi proteins, in the progression of human glioma: correlation of nestin with prognosis of patient survival

BACKGROUND: The IF protein nestin and the RNA-binding protein musashi are expressed by neural progenitor cells during CNS development. Their expression in glial tumors was evaluated by immunohistochemistry, and the histopathological scores correlated with levels of cysteine cathepsins that are known prognostic markers in several tumors. METHODS: The levels of nestin, musashi, and cathepsins B and L were assessed by immunohistochemical analysis of biopsies from 87 patients with primary CNS tumors. To confirm the immunohistochemical data, nestin expression was analyzed by real-time PCR in 12 brain tumor biopsies. The exact location of nestin-positive cells was determined by mapping the distribution of nestin in a highly invasive human glioma xenograft model. RESULTS: Immunostaining revealed nestin to be expressed in 95.8% and musashi in 80% of the patient biopsies. The total IHC score for nestin was significantly higher in high- than in low-grade tumors (P < .0001). No difference was observed for musashi (P = .11). Real-time PCR of nestin expression confirmed the immunohistochemical data. Nestin expression was shown to be a strong prognostic marker for decreased overall survival (P = .0001), whereas musashi expression has no prognostic significance. Moreover, nestin was shown by Cox regression analysis to be a stronger prognostic marker than cathepsins B and L. IHC staining of nestin in a xenograft model showed that its expression is localized mainly in the invasive tumor cells at the tumor periphery. CONCLUSIONS: Nestin is shown to be a strong prognostic marker for glioma malignancy. The presented data links the invasive glioma cells to CNS precursor cells, indicating that the most malignant cells in the gliomas may well be closely related to the glioma stem cells.     

Suppression of mouse skin tumor promotion and induction of apoptosis in HL-60 cells by Alpinia oxyphylla Miquel (Zingiberaceae)

There have been considerable efforts to search for naturally occurring substances for the intervention of carcinogenesis. Many components from dietary or medicinal plants have been identified that possess substantial chemopreventive properties. An example is curcumin (Curcuma longa Linn., Zingiberaceae), which has been shown to inhibit tumor promotion in experimental carcinogenesis. Alpinia oxyphylla Miquel, another plant of the ginger family used in oriental herbal medicine, contains diarylheptanoids whose structures are analogous to that of curcumin. In the present study, we have tested A.oxyphylla for its ability to suppress tumor promotion. Thus, topical application of the methanolic extract of dried fruits of A.oxyphylla significantly ameliorated 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced skin tumor promotion as well as ear edema in female ICR mice. In another study, treatment of HL-60 cells with the methanolic extract of A.oxyphylla significantly reduced the viability of the cells and also inhibited DNA synthesis. Microscopic examination of the treated cells showed characteristic morphology of apoptosis. Furthermore, cells treated with the extract of A.oxyphylla exhibited internucleosomal DNA fragmentation in time- and concentration-dependent manners. TPA- stimulated generation of superoxide anion in differentiated HL-60 cells was also blunted by A.oxyphylla. Taken together, these findings suggest that A.oxyphylla possesses potential chemopreventive and antitumorigenic activities.