Young onset colorectal cancer: How does it differ from its older counterpart.

BACKGROUND: Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group. MATERIALS AND METHODS: Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young‑onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years). RESULTS: Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (P = 0.02) and obstruction at time of presentation (P = 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (P = 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (P = 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65 P = 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39 P = 0.02). The survival was similar among the two groups. CONCLUSIONS: Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.

Laboratory Abnormalities in Patients with Organophosphorous Poisoning.

Organophosphorous (OP) poisoning is an ever increasing and troublesome situation in the developing countries and is a major health care challenge in the 21st century. Hundred patients who attempted suicide with organophosphates, admitted to the emergency services were included in the study. They were graded (grade 0,1,2,3) according to clinical findings and examined for parameters like RBS, serum urea, serum creatinine, liver function tests, serum amylase, serum cholinesterase and LDH . The APACHE (II) of the cases were determined and correlated with severity of the clinical manifestations. A significant decline in serum cholinesterase (ChE) with increasing grades of intoxication(p <0.05) was observed along with raised levels of random blood sugar, serum urea, creatinine, hepatic enzymes and amylase. APACHE(II) score, showed a significant rise with severity of the degree of intoxication (p<0.001) and a negative correlation with serum cholinesterase. The findings of this study highlighted usefulness of biochemical and clinical indices in the management of organophosphorous poisoning thereby recognizing the complications early and facilitating early management.

Ecological problems of tree species in protected ecosystems of Orissa, India.

The tree layer vegetation of two protected ecosystems i.e. Similipal Biosphere Reserve (SBR) and Bhitarkanika National Park (BNP) of eastern ghat was analysed for structure, composition and diversity. With respect to the tree species composition the two protected ecosystems were differed from each other at the family, genera and species level. About 117 tree species representing 85 genera and 42 families were recorded in SBR. The average number of species per hectare was 32.5. However, a total of 29 tree species representing 22 genera and 16 families were recorded in BNP with an average number of species per hectare of 24.17. Species dominancy of the two protected areas was also different due to their difference in habitat condition. In SBR Shorea robusta was the most dominant species while in BNP Excoecaria agallocha was the most dominant species. Shannon-Wiener species diversity was 3.15 for Similipal and 2.314 for Bhitarkanika indicating that Similipal was highly diverse than Bhitarkanika. In general both the protected ecosystems of Orissa are highly rich in biodiversity and are characteristics of good ecological wealth of eastern ghat. Thus conservation and management practices are essential for the sustainability of their biodiversity.

Prevalence of hepatitis C virus genotypes and impact of T helper cytokines in achieving sustained virological response during combination therapy: A study from Central India.

Characterisation of host immune response to hepatitis C virus (HCV) genotypes may have an important prognostic and therapeutic implication. Genotype-3 was more prevalent in the examined cohort and demonstrated a significantly higher response to combination therapy than genotype-1. Sustained virological response (SVR) was 94.74% in genotype-3 and 45.45% in genotype-1. The patients who achieved SVR reported higher levels of circulating T helper 1 cytokines in comparison to subjects with no SVR in both the studied groups. Besides providing local prevalence, our study might also assist in understanding the host immune mechanisms involved to achieve SVR during combination therapy in chronic HCV patients.

Resuscitation of asphyxiated newborns with room air or 100% oxygen at birth: a multicentric clinical trial.

OBJECTIVE: To compare the short-term efficacy of room air versus 100% oxygen for resuscitation of asphyxic newborns at birth. DESIGN: Multicentric quasi randomized controlled trial. SETTING: Teaching hospitals. INCLUSION CRITERIA: Asphyxiated babies weighing greater than 1000 grams, with heart rate less than 100 per min and/or apnea, unresponsive to nasopharyngeal suction and tactile stimuli and having no lethal abnormalities. INTERVENTION: Asphyxiated neonates born on odd dates were given oxygen and those on even dates room air for resuscitation. OUTCOME MEASURES: Primary: Apgar score at 5 minutes; Secondary: Mortality and Hypoxic ischaemic encephalopathy (HIE) during first 7 days of life. RESULTS: A total of 431 asphyxiated babies, 210 in the room air and 221 in 100% oxygen group were enrolled for the study. Both the groups were comparable for maternal, intrapartum and neonatal characteristics. The heart rates in room air and 100% oxygen groups were comparable at 1 minute (94 bpm and 88 bpm), 5 minutes (131 bpm and 131 bpm) and 10 minutes (135 bpm and 136 bpm). Median apgar scores at 5 min [7 versus 7] and 10 minutes [8 versus 8 ], in the room air and oxygen groups respectively, were found to be comparable. Median time to first breath (1.5 versus 1.5 minutes) was similar in the room air and oxygen group. Median time to first cry (2.0 versus 3.0 minutes) and median duration of resuscitation (2.0 versus 3 minutes) were significantly shorter in the room air group. The number of babies with HIE during first seven days of life in the two treatment groups (35.7% babies in room air and 37.1% in the 100% oxygen group) were similar. There was also no statistically significant difference in the overall and asphyxia related mortality in the two treatment groups (12.4% and 10.0% in room air versus 18.1% and 13.6% in oxygen group). CONCLUSION: Room air appears as good as 100% oxygen for resuscitation of asphyxic newborn babies at birth.

Demasking of subclinical left ventricular dysfunction in anemic children.

OBJECTIVE: To study subclinical left ventricular dysfunction in anemic children. SETTING: Hospital. SUBJECTS: The study population consisted of 52 cases of anemia (16 mild, 14 moderate, 22 severe) and 20 normal age and height matched children aged between 7-12 years. METHODS: These children were subjected to Echocardiography on Ascuson XP model using 3.5 MHz Transducer during rest and immediately after maximum tolerated exercise on Quniton Model Q-5000 treadmill using modified Naughton protocol. Left ventricular end diastolic dimensions, left ventricular systolic dimension, fractional shortening, left ventricular end diastolic volume, systolic volume, stroke volume and ejection fraction were studied on M-mode echocardiography, and E/A ratio on doppler mode. RESULTS: Significant differences were observed in resting heart rate, gain in heart rate at peak exercise compared to basal values and double product, total exercise duration and metabolic equivalents at peak exercise in controls and anemic subjects. Left ventricular dysfunction was present in all severely anemic subjects after maximum tolerated exercise on treadmill. The only evidence of left ventricular diastolic dysfunction was in form of decreased left ventricular end diastolic volume after exercise in moderate and severely anemic subjects. CONCLUSIONS: Exercise is helpful in demasking subtle left ventricular dysfunctions in anemic subjects that are not detected during rest.

Anticonvulsant and proconvulsant roles of nitric oxide in experimental epilepsy models

The effect of acute (120 mg/kg) and chronic (25 mg/kg, twice a day, for 4 days) intraperitonial injection of the nitric oxide (NO) synthase (NOS) inhibitor N(G)-nitro-L-arginine (L-NOARG) was evaluated on seizure induction by sound drugs such as pilocarpine and pentylenetetrazole (PTZ) and by stimulation of audiogenic seizure-resistant (R) and audiogenic seizure-susceptible (S) rats. Seizures were elicited by a subconvulsant dose of pilocarpine (100 mg/kg) only after NOS inhibition. NOS inhibition also simultaneously potentiated the severity of PTZ-induced limbic seizures (60 mg/kg) and protected against PTZ-induced tonic seizures (80 mg/kg). The audiogenic seizure susceptibility of S or R rats did not change after similar treatments. In conclusion, proconvulsant effects of NOS inhibition are suggested to occur in the pilocarpine model and in the limbic componentes of PTZ-induced seizures, while an anticonvulsant role is suggested for the tonic seizures induced by higher doses of PTZ, revealing inhibitor-specific interations with convulsant dose and also confirming the hypothesis that the effects of NOS inhibitors vary with the model of seizure.

Immunological profile in neonatal hyperbilirubinemia.

Thirty cases of neonatal hyperbilirubinemia of varying etiology, severity and duration; and twenty six normal healthy newborns were subjected to various tests of cellular and humoral immunity. The results revealed a significant depression of all the parameters of cellular immunity in neonatal hyperbilirubinemia of greater than or equal to 10 mg/dl as compared to the control values. The depression of immunological profile in these newborns was seen to be more pronounced with increasing duration and severity of jaundice. A limited assessment of the humoral immunity by the B cell count and serum immunoglobulin IgG levels, however, showed no significant difference from the control.