Hypertrophic neuropathy in Noonan syndrome with multiple lentigines

RASopathies comprise several genetic syndromes with mainly cardio–facial–cutaneous manifestations. We report a patient with Noonan syndrome with multiple lentigines (NSML) due to a PTPN11 (p.Thr468Met) mutation associated with hypertrophic neuropathy of lumbar plexus in an adult woman, initially referred for neuropathic pain. Differential diagnosis of neurofibromatosis type 1 (NF1) and other RASopathies is difficult without molecular testing. © 2016 Wiley Periodicals, Inc.

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Modeling fear-conditioned bradycardia in humans

Abstract

Across species, cued fear conditioning is a common experimental paradigm to investigate aversive Pavlovian learning. While fear-conditioned stimuli (CS+) elicit overt behavior in many mammals, this is not the case in humans. Typically, autonomic nervous system activity is used to quantify fear memory in humans, measured by skin conductance responses (SCR). Here, we investigate whether heart period responses (HPR) evoked by the CS, often observed in humans and small mammals, are suitable to complement SCR as an index of fear memory in humans. We analyze four datasets involving delay and trace conditioning, in which heart beats are identified via electrocardiogram or pulse oximetry, to show that fear-conditioned heart rate deceleration (bradycardia) is elicited and robustly distinguishes CS+ from CS−. We then develop a psychophysiological model (PsPM) of fear-conditioned HPR. This PsPM is inverted to yield estimates of autonomic input into the heart. We show that the sensitivity to distinguish CS+ and CS− (predictive validity) is higher for model-based estimates than peak-scoring analysis, and compare this with SCR. Our work provides a novel tool to investigate fear memory in humans that allows direct comparison between species.

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Selectivity of conditioned fear of touch is modulated by somatosensory precision

Abstract

Learning to initiate defenses in response to specific signals of danger is adaptive. Some chronic pain conditions, however, are characterized by widespread anxiety, avoidance, and pain consistent with a loss of defensive response specificity. Response specificity depends on ability to discriminate between safe and threatening stimuli; therefore, specificity might depend on sensory precision. This would help explain the high prevalence of chronic pain in body areas of low tactile acuity, such as the lower back, and clarify why improving sensory precision may reduce chronic pain. We compared the acquisition and generalization of fear of pain-associated vibrotactile stimuli delivered to either the hand (high tactile acuity) or the back (low tactile acuity). During acquisition, tactile stimulation at one location (CS+) predicted the noxious electrocutaneous stimulation (US), while tactile stimulation at another location (CS−) did not. Responses to three stimuli with decreasing spatial proximity to the CS+ (generalizing stimuli; GS1–3) were tested. Differential learning and generalization were compared between groups. The main outcome of fear-potentiated startle responses showed differential learning only in the hand group. Self-reported fear and expectancy confirmed differential learning and limited generalization in the hand group, and suggested undifferentiated fear and expectancy in the back group. Differences in generalization could not be inferred from the startle data. Specificity of fear responses appears to be affected by somatosensory precision. This has implications for our understanding of the role of sensory imprecision in the development of chronic pain.

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Sero-prevalence of vitamin D deficiency among pediatric subjects visiting central railway hospital, Byculla, Mumbai, India: a cross sectional study

2016-03-07T03-00-57Z
Source: International Journal of Contemporary Pediatrics
Ajay B. Kale, Mohd Haseeb, Dipti Jain, Bharat Jain, Apurva Deshmukh.
Background: Vitamin D deficiency leads to improper bone mineralization and causes rickets in children. Recently role of vitamin D has been found in a wide range of physiological functions, including cell differentiation, immune function and insulin production. Methods: This study was hospital-based cross-sectional study. Participants were recruited from population of young children aged 6 months to 15 years attending Dr. Babasaheb Ambedkar central railway hospital at Byculla, Mumbai, India. Sample size was 150 subjects. Study duration was May 2012 to May 2013. Vitamin D levels were measured by electrochemiluminescent immunoassay. Vitamin D deficiency was defined as levels


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The study of prevalence of hyperuricemia and metabolic syndrome in type 2 diabetes mellitus

2016-03-07T02-20-22Z
Source: International Journal of Advances in Medicine
Sanjay A. Mundhe, Dinkar R. Mhasde.
Background: Type 2 diabetes mellitus (Type 2 DM) is associated with cardiovascular complications, of which metabolic syndrome plays a prominent role. The metabolic syndrome is a cluster of cardiovascular risk factors characterized by central obesity, insulin resistance, dyslipidemia and hypertension. Hyperuricemia is gaining importance as cardiovascular risk factor and has role in renal and metabolic diseases. Our study was aimed to find out the prevalence of hyperuricemia and metabolic syndrome in type 2 DM and to evaluate association of hyperuricemia with metabolic syndrome. Methods: This observational longitudinal study was carried out on 150 patients of type 2 DM patients for determination of hyperuricemia and components of metabolic syndrome. Results: Metabolic syndrome was diagnosed in 68 patients (45.3%) with higher prevalence in males (53.4%) than females (33.9%). Hyperuricemia was found in 38 patients (25.3%) with higher prevalence in males (33%) than females (14.5%). Hyperuricemia and metabolic syndrome was found in 32 (21.3%) patients with higher prevalence among males (27.3%) than females (12.9%). The patients with hyperuricemia and metabolic syndrome compared to those without hyperuricemia and metabolic syndrome had higher mean age (63.16 versus 55), mean FBS (139.31 versus 117.23), mean duration of diabetes (12.66 versus 5.64), mean BMI (28.71 versus 24.61), systolic BP (128.50 versus 122.12), diastolic BP (80.63 versus 74.27), TG (176.28 versus 141.69) and lower HDL (39.63 versus 52.03). Conclusions: Prevalence of hyperuricemia is higher in patients of type 2 diabetes with metabolic syndrome and is positively correlated with BMI, blood pressure and triglycerides and negatively correlated with HDL-C.


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Validity of Jones criteria for diagnosis of rheumatic fever and rheumatic heart disease

2016-03-07T02-20-22Z
Source: International Journal of Advances in Medicine
Brijesh Kumar, Mukesh Rana.
Background: Acute rheumatic fever (ARF) remains one of the major causes of cardiovascular disease burden throughout the world particularly among the young. Availability of echocardiography / Doppler adds a different angle to the diagnosis of ARF and RHD in India. Methods: The present one year cross-sectional study was conducted on patients of rheumatic fever (RF) and rheumatic heart disease (RHD) of age group of 5-15 years from in and around Kanpur, India to test the validity of Jones criteria. Results: Out of 950 patients, majority had arthralgia (85%) and fever (82%). Nearly 23% had arthritis, 67% patients had an increased PR interval in ECG and increased ASO titre was seen in 93% of patients. Only1% was having subcutaneous nodules, 2% had Erythema marginatum and no patient had chorea while 24 % had a positive throat swab culture. Conclusions: Jones criteria can be made more simple and easy to apply. The two diagnostic features of RF and RHD were arthritis/arthralgia and carditis. The other major as well as minor criteria had no importance for diagnosis of new cases.


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Understanding the degree of awareness among medical professionals regarding the ethics of pharmaceutical marketing activities in context of revised MCI code of ethics

2016-03-07T01-15-08Z
Source: International Journal of Basic & Clinical Pharmacology
Renuka H. Munshi, Kanchan R. Singh, Astha D. Thakkar.
Background: Pharmaceutical marketing activities are regarded as ethically challenging by most medical professionals. This study was planned to understand the extent of the interaction of pharmaceutical companies with healthcare providers & to determine the level of awareness about the Medical Council of India (MCI) Code of Ethics. Methods: A questionnaire based survey was conducted among 100 consultants and residents. The questionnaire mainly dealt with ethical issues about accepting free gifts, medicines and other sponsorships from pharmaceutical representatives, interactions and expectations from representatives of pharmaceutical companies by doctors and ascertaining among them the level of awareness about the MCIs code of ethics. Results: 59.4% residents and 58.8% consultants do not consider small gifts (stationery/books/drug samples) as ethically problematic. 88% residents and 85% consultants felt that offers should be limited. 72% of consultants were aware of the revised MCI code of ethics as compared to 28% of residents. Conclusions: Most physicians do maintain a code of ethics with regards to accepting gifts and they felt that inexpensive gifts do not influence clinical judgment. Consultants were of the view that amended MCI code of ethics would not affect their clinical practice significantly.


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Comparison of conventional and sustained-release formulation of metformin in type 2 diabetics

2016-03-07T01-15-08Z
Source: International Journal of Basic & Clinical Pharmacology
Vishal V. Ghorpade, Rajesh S. Hiray, Bharti R. Daswani, Balasaheb B. Ghongane.
Background: To investigate the effects of metformin sustained-release (MSR) compared with metformin immediate-release (MIR) on glycaemic control, blood pressure, lipid profile and metabolic parameters like weight, waist circumference in type 2 diabetes. Methods: A prospective, randomized, double blind study was conducted at tertiary healthcare and teaching hospital at Pune, Maharashtra. After obtaining institutional ethical committee approval and written informed consent, 40 newly diagnosed type 2 diabetic patient were randomly assigned to receive metformin immediate release formulation (MIR) 500 mg once 1 week and then twice daily and metformin sustained release formulation (MSR) 500 mg once 1 week and then 1000mg once daily for 18 weeks. Fasting and post prandial blood glucose level (BGL), HbA1c, blood pressure, lipid profile, weight and waist circumference, were recorded at the start and end of study. Results: Both MIR and MSR significantly decreased fasting; post prandial BGL and HbA1c at 18 weeks. But no significant difference was seen between two groups. Study did not show any effect on blood pressure and on lipid profile. Both formulations decreased obesity as evident by significant reduction in weight and waist circumference. All patients tolerated both formulations of metformin. Though overall incidences of adverse effects are less with sustained release formulation, difference was not significant between two groups. Conclusions: To conclude, both metformin immediate release and sustained release formulations achieved comparable glycaemic control and sustained release formulation would be as effective as immediate release formulation with advantage of being reduce daily intake of tablets.


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Prevalence, risk factors, management, and treatment outcomes of first-line antituberculous drug-induced liver injury: A prospective cohort study

Pharmacoepidemiology and Drug Safety

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Extra-hepatic manifestations of hepatitis C — a meta-analysis of prevalence, quality of life, and economic burden

Gastroenterology

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Surgeon volume and cancer esophagectomy, gastrectomy, and pancreatectomy: A population-based study in England

Annals of Surgery

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Sorafenib with or without everolimus in patients with advanced hepatocellular carcinoma (HCC): A randomized multicenter, multinational phase II trial

Annals of Oncology

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Cost of ambulatory care for the pediatric intestinal failure patient: One-year follow-up after primary discharge

Journal of Pediatric Surgery

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A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis

Alimentary Pharmacology and Therapeutics

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Glycosyltransferases and non-alcoholic fatty liver disease

World Journal of Gastroenterology

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Sofosbuvir-containing regimen for HCV infection in hemodialysis patients: 400 mg daily or only on the day of hemodialysis

Journal of Hepatology

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Potential market size and impact of hepatitis C treatment in low- and middle-income countries

Journal of Viral Hepatitis

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Tenofovir-based antiretroviral therapy in HBV–HIV coinfection: Results from the TREAT Asia HIV Observational Database

Antiviral Therapy

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Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis

Annals of Surgery

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Folate and inflammatory markers moderate the association between Helicobacter pylori exposure and cognitive function in US adults

Helicobacter

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Association of preoperative narcotic use with postoperative complications and prolonged length of hospital stay in patients with Crohn's disease

JAMA Surgery

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Efficacy and safety of daikenchuto (TJ-100) in pregnant women with constipation

Taiwanese Journal of Obstetrics and Gynecology

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Exploring faecal incontinence in nursing home patients: A cross-sectional study of prevalence and associations derived from the Residents Assessment Instrument for Long-Term Care Facilities

Journal of Advanced Nursing

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Bone and celiac disease

Current Osteoporosis Reports

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HLA typing using buccal swabs as accurate and non-invasive substitute for venipuncture in children at risk for celiac disease

Journal of Gastroenterology and Hepatology

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Similar rebleeding rate in 3-day and 7-day intravenous ceftriaxone prophylaxis for patients with acute variceal bleeding

Journal of the Formosan Medical Association

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Polyprotein-driven formation of two interdependent sets of complexes supporting hepatitis C virus genome replication

Journal of Virology

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Histologic inflammatory activity of the rectal margin as a predictor of postoperative complication in ileoanal anastomosis (J-pouch) procedure in children with refractory ulcerative colitis

Journal of Pediatric Surgery

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