GIANT CONGENITAL MELANOCYTIC NEVI – A RARE CASE REPORT

Giant congenital melanocytic nevi (GCMN) are the melanocytic lesions that arise due to the abnormal migration of melanoblasts during the embryogenesis, affecting approximately one in 500,000 live births. There is gain-of-function mutation in the NRAS gene is usually associated with GCMN, causing abnormal proliferation of embryonic melanoblasts that are usually present since birth with change in their morphological characteristics with time, and increasing in their size reaching upto a diameter ? 20 cm in adulthood. These are characterized by dark brown to black in color with irregular margins and having verrucous surfaces, with or without satellite lesions which are present beyond the periphery of the central lesion. Depending on their distribution these can be classified as bathing trunk, coat-sleeve, or stocking nevi. We hereby report a case of a sixteen year old female presenting with GCMN. The development of a malignant neoplasm on same lesion is only absolute indication for surgery in GCMN

Evaluation of Cardioprotective activity of Asparagus racemosus against Doxorubicin induced cardiotoxicity in albino rats: an experimental study

Background: Cardiotoxicity is one of the most feared side effects of anticancer agents like Doxorubicin. Asparagus racemosus is a widely used medicinal plant in Indian system of medicine known for its antioxidant activity. In certain studies ethanol extract of Asparagus racemosus has shown to possess cardioprotective activity in experimental animals while in some other studies cardioprotective potential of Asparagus racemosus has not been demonstrated. Therefore, due to the controversial action, the present study was designed to explore the cardioprotective effect of aqueous effect of Asparagus racemosus against doxorubicin induced cardiotoxity.Methods: Following approval from Institutional Animal Ethics Committee of L.L.R.M Medical College registered under CPCSEA, India, this study was conducted in which 30 rats were randomized into five groups of six rats each. Group I received 2 ml/kg b.w. normal saline p.o for 21 days, group II apart from receiving pellet diet and normal saline for 21 days were treated with Doxorubicin in a single dose of 20 mg/kg intraperitoneally on the 21st day, group III and group IV received aqueous extract of Asparagus racemosus in doses of 250 mg/kg/day and 500 mg/kg/day respectively p.o. for 21 days followed by administration of Doxorubicin (20 mg/kg i.p.) on the 21st day, Group V received Carvedilol in doses of 30 mg/kg/day p.o. for 21 days followed by administration of Doxorubicin (20mg/kg i.p) on the 21st day. Then they were anaesthetized and blood sample was collected from abdominal aorta for performing blood test i.e. Creatinine kinase MB fraction (CK-MB), Lactate dehydrogenase (LDH), Serum glutamate oxaloacetate transaminase (SGOT), Serum glutamate pyruvate transaminase (SGPT). After blood collection the animals were sacrificed and heart was dissected out for histopathological study. The data obtained was organized and analysed by suitable statistical methods i.e. ANOVA followed by Post Hoc test.Results: CK-MB, LDH, SGOT and SGPT levels were found to be significantly raised (p<0.001) in Doxorubicin treated group. Asparagus racemosus pretreated groups exhibited significant limitation (p<0.001) in rise in levels of CK-MB,LDH,SGOT and SGPT levels in a dose dependent manner following Doxorubicin administration which were comparable to the group treated with the standard cardioprotective drug Carvedilol. Histopathological changes further corroborated cardioprotective potential of Asparagus racemosus.Conclusions: The present study concluded that aqueous extract of Asparagus racemosus possess cardioprotective potential against Doxorubicin induced cardiotoxicity.

Evaluation of nephroprotective activity of Tinospora cordifolia against gentamicin induced nephrotoxicity in albino rats: an experimental study

Background: Gentamicin induced nephrotoxicity is a major contributor to Acute Kidney Injury (AKI) resulting from free radicals induced oxidative stress. Tinospora cordifolia is an Indian medicinal plant, widely used because of its antioxidant activity. Due to limited scientific literature exploring its nephroprotective potential, the present study was designed to investigate the nephroprotective effect of aqueous extract of Tinospora cordifolia against gentamicin induced nephrotoxicity in albino rats.Methods: The study was commenced following approval from Institutional Animal Ethical Committee of L.L.R.M. Medical College, Meerut (UP). Twenty four rats were randomised into four groups of six animals each. Total duration of study was 21 days. Group I received normal saline p.o., group II received normal saline along with gentamicin on last 5 days, group III and IV received Tinospora cordifolia in graded doses p.o. along with gentamicin on last 5 days. Injection gentamicin (40mg/kg) i.p. was given once daily for last 5 days to induce nephrotoxicity in rats of groups II, III and IV. The rats were sacrificed under anaesthesia, blood samples analysed for blood urea nitrogen (BUN) and serum creatinine levels and histopathological changes were studied. Statistical analysis was done using ANOVA followed by post hoc test.Results: Tinospora cordifolia pre-treated groups exhibited significant (p<0.001) limitation in rise in levels of BUN and serum creatinine in a dose dependent manner. Histolopathological observations further corroborated the biochemical findings.Conclusions: The present study concluded that aqueous extract of Tinospora cordifolia possesses nephroprotective potential against gentamicin induced nephrotoxicity.

Evaluation of cardioprotective effect of Aegle marmelos on doxorubicin induced cardiotoxicity: an experimental study

Background: Aegle marmelos (A. marmelos), a medicinal herb, is widely used in the Indian system of medicine for treatment of various ailments. The methanolic extract of A. marmelos leaves had shown antioxidant effect. However, so far aqueous extract of A. marmelos is not scientifically evaluated for its cardio protective potential. Hence the present study was designed to find out cardio protective role of A. marmelos against doxorubicin induced cardiotoxicity.Methods: Thirty rats were randomized into five major groups (n=6). Group I received only 2ml/100g/day normal saline p.o., group II received 2ml/100g/day of normal saline p.o. followed by doxorubicin on 21st day, group III received carvedilol 30 mg/kg/day p.o., Group IV received A. marmelos 250mg/kg/day p.o. and Group V received A. marmelos 500mg/kg/day p.o. for 21days. Doxorubicin 20mg/kg i.p. single dose was given to induce cardiotoxicity in rats of group II, III, IV and V respectively on last day of experiment. Animals were sacrificed 48 hours after doxorubicin administration. Cardiac serum markers creatinine phosphokinase MB, lactate dehydrogenase, serum glutamate oxaloacetate transaminase and serum glutamate pyruvate transaminase were analysed biochemically. Histopathological changes were studied under light microscope.Results: All cardiac serum marker levels were found significantly (p<0.001) increased in doxorubicin group while A. marmelos pre-treated group displayed significant (p<0.001) reduction in rise of these parameters in a dose dependent manner indicating cardio protection. Histological observations further correlated the cardio protective effect of A. marmelos.Conclusions: The present study concluded that aqueous extract of A. marmelos possesses cardio protective potential against doxorubicin induced cardiotoxicity.

Aceclofenac Induced Stevens Johnson Syndrome: A Rare Case Report

Aceclofenac is commonly used Non Steroidal Anti-Inflammatory Drugs (NSAIDs) for musculoskeletal pain. Though mostly it is a safe drug but there were some spurious reports of Adverse Drug Reaction (ADR) by this drug. Here we report a rare occurrence of Stevens-Johnson syndrome (SJS) / Toxic Epidermal Necrolysis (TEN) after the use of Aceclofenac. An elderly female presented to dermatology OPD with complaints of eye discharge, blackish disclouration and oedema around both the eyes and lips and a rapidly evolving rash over face and bullaes and blisters all over the body. On taking history patient stated that she is taking Tab. Aceclofenac 100 mg BD since 2 days for sprain in her Right Foot. It was diagnosed as a case of drug induced SJS and Naranjo score for this adverse drug event was six, thereby making it a

Histone deacetylase inhibitors: pharmacotherapeutic implications as epigenetic modifier.

Epigenetic modifications such as acetylation and deacetylation of histone proteins play a decisive role in transcriptional alteration and expression of genes. Acetylation is catalysed by the histone acetyl transferases enzymes and activates expression of genes by converting chromatin into a less compact, transcriptionally active state. Histone deacetylases enzymes catalyze deacetylation that condenses chromatin into a closed structure .Consequently transcriptional factors are unable to access DNA and gene expression is suppressed. Balanced activity of HATs and HDACS is essential for normal gene expression. Increased HDAC activity can lead to imbalance in protein acetylation resulting in hypoacetylation, tight chromatin structure and suppression of various genes. This aberrant suppression of genes is the hallmark of several malignant and other diseases including neurodegenerative disorders. Histone Deacetylase Inhibitors (HDACIs) have potential to restore the balance of histone acetylation that reverses the silencing of pathological genes. Thus HDACIs modify expression of genes without affecting sequence of DNA and act as epigenetic modifiers. Vorinostat and romidepsin are FDA approved HDACIs. Valproic acid, belinostat and many others are in different phases of clinical trials. This review article explores the target based epigenetic mechanisms as well as existing and potential therapeutic role of HDACIs in various malignant and non-malignant diseases. Data sources were articles published in medical journals and bibliographic database Medline.

Advances in genetics and molecular breeding of three legume crops of semi-arid tropics using next-generation sequencing and high-throughput genotyping technologies.

Molecular markers are the most powerful genomic tools to increase the efficiency and precision of breeding practices for crop improvement. Progress in the development of genomic resources in the leading legume crops of the semi-arid tropics (SAT), namely, chickpea (Cicer arietinum), pigeonpea (Cajanus cajan) and groundnut (Arachis hypogaea), as compared to other crop species like cereals, has been very slow. With the advances in next-generation sequencing (NGS) and high-throughput (HTP) genotyping methods, there is a shift in development of genomic resources including molecular markers in these crops. For instance, 2,000 to 3,000 novel simple sequence repeats (SSR) markers have been developed each for chickpea, pigeonpea and groundnut. Based on Sanger, 454/FLX and Illumina transcript reads, transcriptome assemblies have been developed for chickpea (44,845 transcript assembly contigs, or TACs) and pigeonpea (21,434 TACs). Illumina sequencing of some parental genotypes of mapping populations has resulted in the development of 120 million reads for chickpea and 128.9 million reads for pigeonpea. Alignment of these Illumina reads with respective transcriptome assemblies have provided >10,000 SNPs each in chickpea and pigeonpea. A variety of SNP genotyping platforms including GoldenGate, VeraCode and Competitive Allele Specific PCR (KASPar) assays have been developed in chickpea and pigeonpea. By using above resources, the first-generation or comprehensive genetic maps have been developed in the three legume speciesmentioned above. Analysis of phenotyping data together with genotyping data has provided candidate markers for drought-tolerance-related root traits in chickpea, resistance to foliar diseases in groundnut and sterility mosaic disease (SMD) and fertility restoration in pigeonpea. Together with these traitassociated markers along with those already available, molecular breeding programmes have been initiated for enhancing drought tolerance, resistance to fusarium wilt and ascochyta blight in chickpea and resistance to foliar diseases in groundnut. These trait-associated robust markers along with other genomic resources including genetic maps and genomic resources will certainly accelerate crop improvement programmes in the SAT legumes.

Comparative Evaluation of Glycemic Control & Changes in Lipid Profile with Combined Oral Hypoglycemics (A Sulfonylurea Plus Pioglitazone Versus a Sulfonylurea Plus Metformin) in Patients with Type 2 Diabetes Mellitus.

Emerging datas have shown a high failure rate of longterm monotherapy in preventing the vascular complications of DM II. It establishes the significance of meal time hyperglycemia and the role of post-prandial glucose excursions in the development and progression of vascular complications. This prospective, randomized, open parallel group study was conducted on patients selected from those who were attending O.P.D. of Department of Endocrinology and Human Metabolism of SVBP Hospital, L.L.R.M. Medical College, Meerut. The study have demonstrated that the combination therapy with Sulfonylurea plus Pioglitazone (SUP) is an effective regimen for patients who are insufficiently treated with Sulfonylurea mono-therapy. This regimen may provide a possible positive effect on other coronary risk factors/ dyslipidemias associated with the type 2 Diabetes.

Limnological investigations of Texi Temple pond in district Etawah (U.P.).

Present investigations were carried out on the limnological aspects of Texi temple pond in district Etawah. Many of the parameters were found below the permissible limits for drinking water as suggested by WHO. A total of 18 parameters were analysed and their seasonal variations in the year 2003 were discussed.

Concomitant gout and rheumatoid arthritis--a case report.

We report a case of definite rheumatoid arthritis and co-existing gout. Although gout and rheumatoid arthritis are relatively common entities individually, the co-existence of these two conditions is rare.

Evaluation of PGE2 gel for cervical ripening and induction of labour.

In a prospective study a single dose PGE2 gel 0.5 mg was given in 97 Low Bishop Score subjects, 12 hrs prior to indicated oxytocin or PGE2 tab induction for cervical ripening. Analysis of 97 subjects shows that it is very highly effective. 56 primi and 21 multi delivered spontaneously with gel administration only while 4 primi and 2 multi delivered vaginally following oxytocin and 3 more cases delivered vaginally following PGE2 tab administration and fewer caesarian section (11) were performed. The endo cervical administration of PGE2 was well tolerated and systemic PGE2 effects were minimal.

Surface epithelial tumours of the ovary.

Surface epithelial tumours (SET) constituted 65.7% of all the ovarian tumours. Benign tumours were 182 (71.9%), of low malignant potential (LMP) 11 (4.4%) and frank malignant 60 (23.7%). Maximum number of cases, 102 (40.3%) belonged to 3rd decade. Mean age for serous cystoma was 31.5% years as compared to 30.8 years for mucinous cystoma. The commonest presenting feature was the abdominal lump observed in 182 cases (71.9%) and pain in abdomen in 120 (47.4%).Serous cystomas were t he most frequent tumours and comprised of 32.21% of all the ovarian tumours or 46.01% of all the SET or 65.56% of all the cystic SET. Seventeen (11.7%) of serous tumours were bilateral. Mucinous cystomas constituted 14.55% of all the ovarian tumours or 30.8% of all the SET. These tumours were bulky (78.6%; 15 cm diameter) and multilocular (83.9%).Mucinous cystadenocarcinoma was the commonest malignant epithelial tum our (36.6%). Endometroid carcinoma comprised 3.65% of all the SET or 8.4% of all the ovarian malignancy. Squamous metaplasia was seen in one case whereas 2 cases were of mesodermal mixed tumour with heterologous element as rhabdomyosarcoma. Clear cell carcinoma, Brenner tumour and unclassified group constituted 0.79%, 1.18% and 1.58% of all SET respectively.

Solid tumours of the ovary.

One hundred seventeen solid ovarian tumours, diagnosed histologically during the period between 1971 and 1990, were studied. The overall incidence of solid ovarian tumours was 23.4% of all the ovarian tumours (500 cases) studied. Of 117 solid ovarian tumours 19 (16.2%) were benign and the rest 98 (83.8%) were malignant. Epithelial tumours were the commonest (28.2%) followed by germ cell tumours (22.2%), sex cord stromal tumours (21.4%), metastatic tumours (19.7%) and non-specific tumours (8.5%). The average age (26.8 years) was comparatively low for germ cell tumours otherwise in other groups it ranged between 42 and 45 years. Below 15 years immature teratoma was diagnosed in 4 cases and granulosa cell tumour in 2 cases. Bilateral tumours were seen in 22 cases (23.2%) out of 95 cases observed. Pain and fullness in the pelvic region were observed in 94.9% cases. Varied morphological picture was seen in 6 cases of endometrioid carcinoma. Dysgerminoma constituted 6.8% of solid ovarian tumours. Gliomatosis peritonei was noticed in one case of immature teratoma. Granulosa cell tumour accounted for 11.1% of solid ovarian tumours. Of 23 cases of metastatic tumours, Krukenberg tumour was noticed in 88.9% cases. Diagnostic problems as well as prognostic factors of solid ovarian tumours have been discussed.

Intracardiac blood flow velocities and cardiac output in normal fetuses: a prospective pulsed Doppler echocardiographic study.

Two dimensional and pulsed Doppler echocardiographic studies were performed in human fetuses with the aim to establish normal values for blood flow velocities and cardiac output in Indian subjects. Thirteen pregnant mothers were prospectively followed up at 4 weeks interval from 19 to 40 weeks of gestation. Blood flow velocity spectra across aortic, pulmonary, mitral and tricuspid valves were analyzed to obtain peak flow velocity (cm/sec) and velocity time integral. Aortic and pulmonary diameters were measured at the valve level from two dimensional echocardiographic images and ventricular stroke volume calculated. The values were plotted against fetal age (weeks) and fetal weight (gms). Our results showed that there is a linear increase of the measured Doppler data, with increasing gestational age and weight. These values may be used as a reference for the Indian population.

Sizing of balloons in balloon mitral valvotomy.

In twenty six consecutive patients who underwent balloon mitral valvotomy (BMV) by the transseptal double balloon technique, the mitral valve area (MVA) increased from 0.78 +/- 0.1 cm2 to 1.80 +/- 0.3 cm2, (p < 0.001). Effective balloon dilating area (EBDA) of each combination of balloons used was calculated using a standard formula. Patients were classified into 4 subgroups with approximate EBDAs of 3.3, 4.0, 4.9 and 5.7 cm2 and they had mean post-BMV MVAs of 1.28, 1.78, 1.89 and 1.98 cm2 respectively (ANOVA F = 3.32, p < 0.05). Patients were reclassified after normalisation of EBDA and post-BMV MVA to square metre of body surface area. Three subgroups with mean normalised EBDAs of 2.32, 2.96 and 3.62 cm2/m2 had mean normalised post-BMV MVAs of 0.99, 1.17 and 1.40 cm2/m2 respectively (ANOVA F = 6.85, p 0.01). A trend towards increasing mitral regurgitation with increasing balloon size was noted. Three cases of mitral regurgitation including one case of severe mitral regurgitation occurred in the subgroup of 9 patients with largest normalised EBDAs. The overall correlation between normalised EBDAs and normalised post BMV MVA was strong r = 0.67, p < 0.01). The optimal normalised EBDA for Indian patients undergoing BMV is around 3.6 cm2/m2. Balloons used should be sized accordingly.

An indirect fluorescent antibody (IFA) test for the serodiagnosis of Kala-Azar.

The IFA test developed using Leishmania donovani promastigote and amastigote antigens showed very high antibody titre in clinically and parasitologically established cases (30) of kala-azar, the geometrical mean reciprocal titre (GMRT) being 870 +/- 5.4 and 5370 +/- 1.80 respectively with the two antigens. In contrast, the GMRT of normal subjects of endemic area was only 12.44 +/- 6.19 and 80.35 +/- 1.66 respectively with these antigens. None of the subjects from non-endemic area suffering with other parasitic diseases, such as malaria, filaria, amoebiasis, leprosy or tuberculosis (20 cases each) gave a positive response to any of the antigen. The test holds promise in the diagnosis of Kala-azar.

Tetralogy of Fallot with absent pulmonary valve: diagnostic features and management.

Tetralogy of Fallot with absent pulmonary valve is a rare congenital malformation. The diagnostic features and surgical management in ten patients with this malformation have been described. There were five male and five female patients, (age 3 1/2 to 26 years). The common symptoms were recurrent respiratory tract infection and cyanosis. Examination revealed hyperdynamic precordial pulsations, single second heart sound and an early diastolic murmur along the left sternal border in all. Electrocardiograms were indistinguishable from typical tetralogy of Fallot. Chest X-ray revealed cardiomegaly, prominent pulmonary conus and dilated pulmonary arteries in all cases, lung vascularity being variable. Echocardiographic findings were diagnostic and are discussed in detail. Cardiac catheterization and angiocardiography revealed annular stenosis in all, along with aneurysmal dilatation of main and branch pulmonary arteries. Eight patients underwent intracardiac repair. There was no perioperative mortality. All patients have been followed up for 350 months (mean 29 months).

Beneficial effects of Allium sativum, Allium cepa and Commiphora mukul on experimental hyperlipidemia and atherosclerosis--a comparative evaluation.

Oral administration of petroleum ether extract of Allium sativum, Allium cepa and ethylacetate extract of Commiphora mukul in albino rats significantly prevented rise in serum cholesterol and serum triglyceride level, caused by atherogenic diet. All the three agents were also found to confer significant protection against atherogenic diet induced atherosclerosis.

Effect of pinealectomy on daily rhythm of blood glucose in rabbits.

Daily rhythm of blood glucose was studied in superior cervical ganglionectomized (SCGX), sham operated and normal rabbits. A typical daily rhythm was observed in normal animals which was not influenced by surgical procedures. However, ganglionectomy, which tantamount to physiological elimination of pineal gland, caused complete reversal of this rhythm. Probable role of pineal gland in controlling blood glucose daily rhythm is suggested.