Huge Nevus Lipomatosus Cutaneous Superficialis on Back: An Unusual Presentation

Nevus lipomatosus cutaneous superficialis (NLCS) is a benign dermatosis, histologically characterized by the presence of mature ectopic adipocytes in the dermis. We hereby report a case of a 10-year-old boy who presented with multiple huge swellings on the scapular regions and lower back. The lesions were surmounted by small papules, along with peau-d orange appearance at places. Histology showed features consistent with NLCS. The case is being reported for the unusual clinical presentation.     

Limb lead interchange in thorough QT/QTc studies

The investigators analyzed 85,133 electrocardiograms (ECGs) recorded in 484 subjects from 5 thorough QT/QTc studies (3 using Holter devices, 2 using 12-lead ECGs) for inadvertent limb lead interchanges using a dedicated quality control process in a central ECG laboratory. Limb lead interchanges were present in 2919 (3.4%) ECGs in 17.9% of subjects and were more frequent with Holter devices (7.5% vs 0.8%, P < .0001), where leads remain connected for prolonged periods, affecting data from several time points. Left arm-left leg interchange was seen in 54% of 12-lead ECGs and right arm-left arm interchange in 38%. The ECG device itself could identify 21.7% of interchanges, whereas experienced readers blinded to subject and visit identified 79% of interchanges; 21% of interchanges were identified only during the quality control process. If correctly identified, QT measurement could be performed in a precordial lead. If undiagnosed, incorrect QT interval measurements and morphological diagnosis may confound results.     

Development of an antigen heterologous enzyme linked immunosorbent assay for measurement of corticosterone in rat serum

Homologous and heterologous combinations of enzyme conjugate and antibody in steroid enzyme immunoassay (EIA) influences unlabeled steroid recognition by antibody that affects sensitivity of the assay. To develop corticosterone enzyme linked immunosorbent assay (ELISA), antibodies were generated against corticosterone-3-carboxymethyloxime-bovine serum albumin (corticosterone-3-CMO-BSA) and corticosterone-21-hemisuccinate-bovine serum albumin (corticosterone-21-HS-BSA). Four horseradish peroxidase (HRP) enzyme conjugates were prepared using two corticosterone derivatives (corticosterone-3-CMO and corticosterone-21-HS) and two cortisol derivatives (Cortisol-3-CMO and Cortisol-21-HS). Eight combinations of homologous and heterologous assays were evaluated. The use of antigen heterologous combination resulted in development of assay. The developed assay is simple, direct, and convenient to use, as it permits the direct addition of the serum sample in to the assay, and it requires only 1.5 hours to complete.     

Smoking Is Underrecognized as a Risk Factor for Chronic Pancreatitis

Background/Aims: Smoking is an established risk factor for chronic pancreatitis (CP). We sought to identify how often and in which CP patients physicians consider smoking to be a risk factor. Methods: We analyzed data on CP patients and controls prospectively enrolled from 19 US centers in the North American Pancreatitis Study-2. We noted each subject's self-reported smoking status and quantified the amount and duration of smoking. We noted whether the enrolling physician (gastroenterologist with specific interest in pancreatology) classified alcohol as the etiology for CP and selected smoking as a risk factor. Results: Among 382/535 (71.4%) CP patients who were self-reported ever smokers, physicians cited smoking as a risk factor in only 173/382 (45.3%). Physicians cited smoking as a risk factor more often among current smokers, when classifying alcohol as CP etiology, and with higher amount and duration of smoking. We observed a wide variability in physician decision to cite smoking as a risk factor. Multivariable regression analysis however confirmed that the association of CP with smoking was independent of physician decision to cite smoking as a risk factor. Conclusions: Physicians often underrecognize smoking as a CP riskfactor. Efforts are needed to raise awareness of the association between smoking and CP.     

Evaluation of delirium in elderly: A hospital‐based study

Aim: The study aimed to study the prevalence, etiologies, clinical profile and outcome of delirium in hospitalized elderly in medicine wards. Methods: Four hundred elderly patients of more than 60 years of age admitted with delirium in the emergency and medicine wards of Sir Sunderlal Hospital Varanasi, India, were evaluated and managed. The Hindi version of the Mini‐Mental Status Examinations, a vernacular (Hindi) version of the Mini‐Mental State Examination, was used for evaluation of cognitive function status of patients and Confusion Assessment Method (CAM), a screening instrument based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders was used for diagnosis of delirium. Results: A total of 400 hospitalized elderly delirious patients were included in the study aged 61–105 years. The mean age of the subjects was 70.87 ± 9.26 years and 70.81 ± 8.4 years amongst males and females, respectively. The mortality rate was 14.75%. Out of nine CAM features, all the cases had all three essential features, 78.75% had four features, 58.5% had five features, 44.5% had six features and 9.25% had all nine features. There was a high prevalence of hypoactive delirium (65%) as compared to hyperactive (25%) or mixed (10%). Most common etiologies were sepsis followed by metabolic abnormalities. 70% had 2 or more etiologies. Conclusion: Sepsis and metabolic abnormalities were the most common etiologies of delirium in this study. The maximum patients had more than one etiology and this emphasizes the multifactorial nature of delirium and need for thorough evaluation to unravel them. Most of the causes were treatable and have favorable outcome (83% recovered). Geriatr Gerontol Int 2011; 11: 467–473.     

Recent Advances in the Epidemiology of Alcoholic Pancreatitis

Clinical observation has defined the medical profile of alcoholic pancreatitis, but its low incidence and prevalence has limited characterizing the disease at a population level, the contribution of environmental exposures, and a clear picture of its natural history. Recent studies have defined the impact of alcohol use and smoking on disease risk, and a threshold for alcohol consumption has been identified. Recurrent attacks of acute pancreatitis have been linked with continued alcohol consumption, and aggressive alcohol intervention has been shown to decrease recurrence. Progression from alcoholic acute pancreatitis to chronic pancreatitis is now believed to occur infrequently, and factors associated with progression have been identified. Alcoholic pancreatitis reduces lifespan in these patients, and the economic impact of pancreatitis is substantial. Efforts are needed to increase awareness of the impact of alcohol consumption and smoking on risk for pancreatitis and the benefits of cessation for primary and secondary prevention.     

The liver function test enzymes and glucose level are positively correlated in gallbladder cancer: A cancer registry data analysis from north central India

Aim of Study: To investigate the trend of expression of liver function test enzymes and other biochemical changes during gallbladder carcinogenesis. Materials and Methods: Eight hundred and seventy-eight gallbladder disease patients were selected to study the liver function test enzymes and routine blood biochemical changes in the last five years (2004-08). Statistical analysis was performed using Graph Pad prism? 5.02 software. Results: The liver function test enzymes showed significant correlations among themselves, and with glucose in gallbladder cancer and gallstone disease patients (N = 878). Out of 878 gallbladder cases, 46 (5.24%) showed significantly higher glucose level of 216.66 mg/dL (P < 0.0001). All the three pathological conditions of gallbladder, gallbladder cancer with stones (GBCS), gallbladder cancer without stones (GBC) and calculus cholecystitis (CC), showed highly significant positive correlation (Pearson) between Serum Glutamic Oxaloactetic Transaminase (SGOT) and Serum Glutamic Pyruvic Transaminase (SGPT) [P < 0.0001, (GBCS); P < 0.0001, (GBC), and P < 0.0001, (CC)]. SGOT and SGPT also showed positive correlation with higher glucose level independently, in both GBCS and CC (P < 0.0001 and P < 0.0001), respectively. Conclusion: Simultaneous elevation of glucose and liver function test enzymes in GBC makes the diagnosis complex. Any patient of gallbladder diseases with higher level of glucose may have the possibility of developing gallbladder cancer.     

ATM inhibitor KU-55933 increases the TMZ responsiveness of only inherently TMZ sensitive GBM cells

Ataxia telangiectasia mutated (ATM) kinase is critical in sensing and repairing DNA double-stranded breaks (DSBs) such as those induced by temozolomide (TMZ). ATM deficiency increases TMZ sensitivity, which suggests that ATM inhibitors may be effective TMZ sensitizing agents. In this study, the TMZ sensitizing effects of 2 ATM specific inhibitors were studied in established and xenograft-derived glioblastoma (GBM) lines that are inherently sensitive to TMZ and derivative TMZ-resistant lines. In parental U251 and U87 glioma lines, the addition of KU-55933 to TMZ significantly increased cell killing compared to TMZ alone [U251 survival: 0.004?±?0.0015 vs. 0.08?±?0.01 (p?<?0.001), respectively, and U87 survival: 0.02?±?0.005 vs. 0.04?±?0.002 (p?<?0.001), respectively] and also elevated the fraction of cells arrested in G2/M [U251 G2/M fraction: 61.8?±?1.1?% vs. 35?±?0.8?% (p?<?0.001), respectively, and U87 G2/M fraction 25?±?0.2?% vs.18.6?±?0.4?% (p?<?0.001), respectively]. In contrast, KU-55933 did not sensitize the resistant lines to TMZ, and neither TMZ alone or combined with KU-55933 induced a G2/M arrest. While KU-55933 did not enhance TMZ induced Chk1/Chk2 activation, it increased TMZ-induced residual ??-H2AX foci in the parental cells but not in the TMZ resistant cells. Similar sensitization was observed with either KU-55933 or CP-466722 combined with TMZ in GBM12 xenograft line but not in GBM12TMZ, which is resistant to TMZ due to MGMT overexpression. These findings are consistent with a model where ATM inhibition suppresses the repair of TMZ-induced DSBs in inherently TMZ-sensitive tumor lines, which suggests an ATM inhibitor potentially could be deployed with an improvement in the therapeutic window when combined with TMZ.