Association of methylenetetrahydrofolate reductase gene polymorphisms & colorectal cancer in India.

Background & objectives: Methylenetetrahydrofolate reductase (MTHFR) is a critical enzyme in folate metabolism and involved in DNA synthesis, DNA repair and DNA methylation. The two common functional polymorphisms of MTHFR, 677 C→T and 1298 A→C have shown to impact several diseases including cancer. This case-control study was undertaken to analyse the association of the MTHFR gene polymorphisms 677 C→T and 1298 A→C and risk of colorectal cancer (CRC). Methods: One hundred patients with a confirmed histopathologic diagnosis of CRC and 86 age and gender matched controls with no history of cancer were taken for this study. DNA was isolated from peripheral blood samples and the genotypes were determined by PCR-RFLP. The risk association was estimated by compounding odds ratio (OR) with 95 per cent confidence interval (CI). Results: Genotype frequency of MTHFR 677 CC, CT and TT were 76.7, 22.1 and 1.16 per cent in controls, and 74, 25 and 1.0 per cent among patients. The ‘T’ allele frequency was 12.21 and 13.5 per cent in controls and patients respectively. The genotype frequency of MTHFR 1298 AA, AC, and CC were 25.6, 58.1 and 16.3 per cent for controls and 22, 70 and 8 per cent for patents respectively. The ‘C’ allele frequency for 1298 A→C was 43.0 and 45.3 per cent respectively for controls and patients. The OR for 677 CT was 1.18 (95% CI 0.59-2.32, P = 0.642), OR for 1298 AC was 1.68 (95% CI 0.92-3.08, P = 0.092) and OR for1298 CC was 0.45 (95% CI 0.18-1.12, P = 0.081). The OR for the combined heterozygous state (677 CT and 1298 AC) was 1.18 (95% CI 0.52-2.64, P =0.697). Interpretation & conclusion: The frequency of the MTHFR 677 TT genotype is rare as compared to 1298 CC genotype in the population studied. There was no association between 677 C→T and 1298 A→C polymorphisms and risk of CRC either individually or in combination. The homozygous state for 1298 A→C polymorphism appears to slightly lower risk of CRC. This needs to be confirmed with a larger sample size.

Comparative study of the radial and femoral artery approaches for diagnostic coronary angiography

Femoral artery access is the standard approach for coronary procedures; however, the radial approach has gained sound recognition as an alternative to femoral access. We present our early experience with the transradial approach. A prospective, non-randomised study of 221 candidates for diagnostic coronary angiography was carried out at Sultan Qaboos University Hospital, Oman between December 2008 and April 2009. The patients had their procedure performed from radial or femoral access according to operator discretion and the results were compared. Femoral and radial groups included 116 and 105 patients respectively. Results: Radial access was associated with a significantly higher rate of procedural failure [17.1%] versus 0% in femoral group [p=0.001]. There were no local vascular complications in the radial group as opposed to 12.1% in the femoral group [p < 0.01]. Hospital length of stay was significantly reduced in the radial group [4.06 versus 23.5 hours, p < 0.01]. Total procedure time was longer in the radial group [23.7 +/- 13.7 min versus 20.1 +/- 7.4 min, p < 0.001], but radiation exposure was similar in both groups. There was a trend for a higher risk of major adverse cardiac events noticed in the femoral group; however, it did not reach statistical significance. The transradial approach for coronary angiography is associated with significantly reduced local vascular complications and shorter hospital stays. The femoral approach is the standard access site for coronary angiography; however, interventional cardiologists should acquire experience in the radial approach as an alternative in specific situations