Role of adipokines in obstructive airway disease and diabetes mellitus

This review summarizes the state of the current literature relating to the associations of lung disease and adipokines (proteins produced by adipose tissue) in humans. The mechanistic basis for these associations in humans is not established, although a possible role for adipokines has been invoked. Leptin, a pro-inflammatory adipokine, and adiponectin, an anti-inflammatory adipokine, are causally associated with asthma in mice. Although human studies are currently inconclusive, high-serum leptin and low-serum adiponectin concentrations predict asthma, independent of obesity, in select population groups, such as premenopausal women in the United States. In contradistinction, low-serum leptin and high-serum adiponectin concentrations are associated with stable COPD, although these associations are likely confounded by fat mass. Interestingly, leptin may promote systemic and airway inflammation in stable COPD patients. On the other hand, COPD may upregulate systemic and lung adiponectin expression. The precise mechanism and significance of the associations between these adipokines and lung disease at the current stage are confusing and frankly paradoxical in places. It is now known that adipose tissue is not an inert organ simply for energy storage, but regulates systemic inflammation via a variety of secreted proteins (called adipokines). While the associations of obesity and adipokines with cardiovascular, endocrine, and rheumatological diseases are well described, the respiratory effects of obesity and adipokines are less well known. This review will focus on the effect of obesity and adipokines on asthma and chronic obstructive pulmonary disease (COPD) in humans. This area of research needs additional study that may open up novel therapeutic strategies for these lung diseases.

Practice of self-medication among medical students in a region of northern state of India

Background: Self-medication usually leads to irrational drug utilization pattern leading to various issues like economic burden, incomplete treatment and antibiotic resistance. Self-medication is a common practice in developing countries and prevalent among medical students, influencing their future decision making as medical professional. The current study was carried out to determine the prevalence of self-medication among medical students and their attitude towards the same.Methods: A cross-sectional questionnaire based study was conducted in a tertiary care teaching hospital from July 2015 to Oct 2015. Structured and validated questions were used to collect information about knowledge, attitude and practice of self-medication among undergraduate medical students. The study included total of 328 participants. Data were collected from each participant and analyzed statistically by using SPSS version 20 for count and percentages.Results: A total of 328 subjects studying at a medical school were assessed regarding their practice, attitude and perception of self-medication behavior. Out of total recruited subjects, 53% were males and 47% were females. The prevalence of self-medication among recruited subjects was 89.9%. Symptoms like fever, Headache and weakness were the most common reasons of self-medication. The most commonly used drugs were antipyretic, analgesics (81.7%), antibiotics (51.2%). Approximately 15% subjects were not aware about the completion of the course of antibiotic treatment. Subjects obtained information and procured drugs from their family members, friends and pharmacist and the reasons for this were cited as lack of time, minor ailments and quick relief. Only 32.6% students opined that self-medication should be encouraged in future.Conclusions: Current study reveals that practice of self-medication is highly prevalent among medical students without adequate knowledge of drugs used. Students should be educated regarding advantages and disadvantages of self-medication.

Computer assisted learning module in experimental pharmacology for medical students: introduction and evaluation

Background: Animal experiments have been restricted due to strict Committee for the Purpose of Control and Supervision of Experiments on Animals (CPCSEA) rules and regulations for animal procurement and experimentation. At present, teaching is done by showing cards with tracings. This helps in the development of cognitive domain only. There is a need to change the traditional passive learning methodologies to an active technology based experimental learning methodology. Present educational interventional study is aimed at enhancing learning and making teaching interactive and interesting by introducing Computer Assisted Learning (CAL). Objectives of the study are to assess and evaluate the learning outcome of two methods (teaching by showing cards and computer assisted) in experimental Pharmacology and to assess the perception of students and faculty towards implementation of CAL.Methods: The study was conducted at Sarawathi Institute of Medical Sciences, Hapur, UP, India. A departmental meeting was organized to sensitize the faculty members. Test and feedback questionnaire were prepared. Participants were divided into two groups. One group was taught by cards and another by CAL. For second experiment students cross over was done. Students were assessed by post-test analysis. Feedback from the faculty and students were taken and analyzed.Results: There was improvement in knowledge of students as shown from results of post-test analysis. More than 86% of the faculty members and 80% of the students rated CAL methodology more than 3 at Likert scale.Conclusions: As compared to teaching by cards, the learning was enhanced by CAL. Students found CAL more enjoyable, interactive, comprehensible and easy to retain. In future, students would prefer CAL as an alternative method of learning in experimental laboratory.

Cyproheptadine adverse drug interaction with anti-epileptic drugs

Cyproheptadine is a H1 and 5- HT1/2 receptor antagonists, impairing the anticonvulsant activity of antiepileptic drugs and reduces threshold, increases severity of seizures, when administered chronically. Anuj a 13 years old male from Delhi, known case of SSPE stage-III with epilepsy, on oral anti-epileptic drug has seizure induction followed the use of oral cyproheptadine. Stopping cyproheptadine, patient didn’t sustain any further seizures.

Pre-treatment effect of myo-inositol and l-5, methyltetrahydrofolate in ovulation induction oocyte quality and pregnancy outcome in clomiphene resistance polycystic ovarian disease

Background: This study was designed to assess the treatment effect of myo-inositol and l-5, methyltetrahydrofolate in oocyte quality, pregnancy outcome in clomiphene citrate resistance PCOS cases.Methods: Authors conducted prospective open label, randomized, parallel group study in SIMS Hapur, U.P. Eligible patients full filling inclusion criteria were randomized into two groups having 25 patients in each group using myo-inositol 580mg and l-5, methyltetrahydrofolate 800mcg in treatment group and tab folic acid 400mcg in placebo group for 12 weeks. The follow-up visits are on weeks 4, 8 and 12.Results: 12 weeks later, 21 patients in treatment group restored one spontaneous menstrual cycle and 19 patients maintained the normal ovulatory activity in follow up cycle. Ovulation induction done in 18 patients with clomiphene citrate at the dose of 50mg during treatment out of which 10 conceive, as compared with only 9 women out of the 25 women (36 percent) in the placebo group ovulate (P>0.001) out of which 4 conceived. There was significant decrease in Sr. testosterone, DHEA and AMH level and estradiol level, while statically significant increase in Sr. SHBG and FSH level seen in treatment group(p<0.001).Conclusions: In the study, more number of studied patients get back to normal menstrual cyclicity, insulin-lowering activity and its intracellular role in oocyte maturation. Significant Dec seen in serum estradiol level at the day of HCG administration.

Phytochemical, Antimicrobial and Anti-Adherence Analysis of Plant and Ayurvedic Extracts.

The incessant and vital need to discover new antimicrobial compounds with diverse chemical structures and novel mode of action is stimulated by the increasing failure of chemotherapeutics and expanded antibiotic resistance exhibited by pathogenic agents. In the present research work, antimicrobial activity of few plant extracts and ayurvedic samples were screened against bacteria. Phytochemical analysis of active plant extracts showed the presence of triterpenes, glycosides and flavonoids. Both aqueous and acetone extracts of Holoptelia integrifolia leaf and Barringtonia acutangula flower; and methanolic extract of Glycyrrhiza glabra and Meera powder exhibited activity against S. aureus. Aqueous mortar pestle and soxhlet extracts of B. acutangula flower exhibited activity against both P. aeruginosa and E. coli. Further, the ability to adhere and build biofilm was assessed in few biofilm formers at sub-MIC concentrations using the Microtiter plate assay and the Coverslip assay. Aqueous soxhlet and mortar pestle extract of B. acutangula flower and acetone overnight extract of H. integrifolia leaf exhibited antibiofilm activity against these organisms.

Correlation of gallstone characteristics with mucosal changes in gall bladder.

Background and aim: Gallstones are known to produce diverse histopathological changes in the gall bladder. Our aim was to correlate various gallstone characteristics (number, size, weight, volume and morphological type) with the type of mucosal response in gall bladder (inflammation, hyperplasia, metaplasia and carcinoma). Methods: The study was conducted on 330 open cholecystectomy specimens with complete gallstones. The stones were assessed for various parameters i.e. number, size, weight, volume and morphological type. For microscopy, sections were obtained from the fundus, body and neck of the gallbladder. Additional sections were taken from abnormal looking areas. Results: Out of the 330 cases, 194 (59%) had mixed stones, 84 (25%) combined, 30 (9%) pigment and 22 (7%) had cholesterol stones. Number of stones varied from a single calculus in 131 (39.6%) cases, double in 29 (8.8%) and multiple in the remaining 170 (51.6%) cases. Cholecystitis, hyperplasia, metaplasia and carcinoma were more commonly seen with mixed and multiple stones. The average weight of calculi in cholecystitis was 2.551 gm, in hyperplasia 3.619 gm, metaplasia 4.549 gm and 17.96 gm in cases with carcinoma. Similarly, average volume of the stone(s) was 2.664 ml in cholecystitis, 3.742 ml in hyperplasia, 4.532 ml in metaplasia and 19.178 ml in carcinoma. The average calculus size (2.147 cm) was found to be maximum in cases with carcinoma, followed by hyperplasia (1.187 cm), metaplasia (1.145 cm) and cholecystitis (1.136 cm). Conclusion: As the weight, volume and size of the stone increases the changes in the gall bladder mucosa changes from cholecystitis, hyperplasia, metaplasia, dysplasia, to carcinoma.

Profile of Erythroblastopenia in Childhood.

Bone marrows of hospitalized children with anaemia were examined to study the incidence and profile of erythroblastopenia in childhood. Forty children aged between 7 months to 12 years with anaemia, reticulocytopenia and isolated erythroblastopenia on Bone marrow aspiration were evaluated during 2 years duration. Depending on duration of illness and their recovery the disease was categorized into acute, subacute and chronic erythroblastopenia. The disease was found to be associated with PEM and nutritional anaemia (55%), gastroenteritis (12.5%) and respiratory tract infections (12.5%) amongst others.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Heterotopic Triplet Pregnancy: Bilateral Tubal Pregnancy and an Intrauterine Pregnancy.

Heterotopic gestation, although common with assisted reproductive techniques, is very rare in natural conception. We report a rare case of heterotopic pregnancy, resulting from spontaneous conception, in a 30-year old woman with no known risk factors for heterotopic pregnancy. Emergency laparotomy followed by right salpingectomy, left salpingostomy and evacuation of non-viable intrauterine pregnancy contributed towards saving the patient's life.

Fetus-in-fetu presenting as acute intestinal obstruction.

Fetus-in-fetu is a rare condition in which a fetiform calcified mass is often present in the abdomen of its host; a newborn or infant. We present the case of a three-month-old male baby with acute intestinal obstruction and abdominal mass. X-ray abdomen and ultrasonogram revealed a cystic mass with calcification. On laparotomy, a well encapsulated retroperitoneal mass causing high intestinal obstruction was identified. Total excision of the mass was done. Diagnosis of fetus-in-fetu was confirmed on histopathology. Postoperative recovery was uneventful.

Inflammatory psuedo-tumor of the spleen.

Inflammatory pseudo-tumor of spleen, a benign reactive lesion of unknown etiology and pathogenesis, is extremely rare with isolated case reports in literature. These are usually misdiagnosed preoperatively, both clinically and radiologically; metastasis or lymphoproliferative disorders with pathological studies allow reliable diagnosis of the disease. We report the unusual occurrence of this lesion in the spleen.

HER-2/neu expression in lesions of uterine cervix: Is it reliable and consistent.

This study was conducted to evaluate the expression of HER-2/neu oncogene in the lesions of the uterine cervix and to determine its correlation with histological type of malignancy, grade and clinical stage of presentation. One hundred cervical specimens were included in this study. These comprised cases with diagnosis of benign epithelial lesions, squamous cell carcinoma, adenocarcinoma, carcinoma cervix with glandular differentiation and cervical intraepithelial neoplasia. HER-2/neu immunostaining was performed by streptovidin-biotin peroxidase method. Higher expression of HER-2/neu was noted in malignant lesions as compared to benign lesions. Intensity of staining also correlated with clinical stage of presentation, lymph node metastasis and presence of parametrial extension. The over-expression of HER-2 oncoprotein is associated with poor prognosis, metastatic potential and aggressive biological behavior.

Thymic atypical carcinoid.

Only 2% of carcinoids originate from the thymus with an estimated incidence of 1.5 to 3 per 10,000,000 persons per year. We present the case of a 30-year-old female patient in whom the diagnosis was confirmed by a fine needle aspiration cytology of a large mediastinal mass.

Prostatic stromal proliferation of uncertain malignant potential (PSPUMP): a case report.

Proliferative lesions of specialized prostatic stroma are rare with only few isolated case reports documented in literature. These lesions are histologically characterized by exuberant proliferation of prostatic stroma with variable number of normal and hyperplastic glands. Recently this group of tumors have been labeled as prostatic stromal proliferations of uncertain malignant potential (PSPUMP). We report a case of PSPUMP in a 72 years old male who underwent radical prostatectomy for a mass in pelvis. Based on histological appearance and immunohistochemistry, a diagnosis ofPSPUMP was made.

Immunohistochemical study of the expression of HER-2/neu oncogene in ovarian lesions.

To evaluate the expression of HER-2/neu in various ovarian lesions, 75 cases of ovarian tissues (25 cases of benign lesions and 50 cases of carcinoma) were studied in the department of pathology, Pt. B.D. Sharma PGIMS, Rohtak. Besides conventional H&E staining, representative sections were processed for immunohistochemical staining for HER-2/neu detection. Two (8%) of benign cases were 1+ positive and 19 (38.0%) of malignant lesions were positive for HER-2/neu staining with intensity 1+/2+ in 16 cases (32.0%), 3+ in 2 cases (4%) and 4+ in 1 case (2%). It was observed that HER-2/neu expression was significantly associated with high grade ovarian tumours, however intensity of positivity did not correlate with the grade of tumour.

Transferrin receptor expression in reactive and neoplastic lesions of lymphnodes.

Transferrin, the major iron binding protein in human plasma transports iron to various tissues. The first step in cellular iron uptake is binding of transferrin complex to the cell surface membrane by specific molecule known as transferrin receptors. Transferrin receptors are found in limited sites in normal tissues, in contrast, the receptors are widely distributed in majority of carcinomas and sarcomas. Presence of increased transferrin receptors implies a stage of moderate or less differentiation corresponding to elevated proliferative activity and therefore, has a prognostic value. Demonstration of transferrin receptors and its distribution pattern within a tumour as well as its quantitative determination can provide data helpful for, both, an additional understanding of tumour biology and as an approach for planning therapy. In present study, we analysed 60 cases, 30 each of reactive lymphadenitis and lymphomas for transferrin receptors using immunohistochemical technique (DAKO, Code-K0673). Grade II and Grade III intensity was recorded in the germinal centers and the histiocytes in sinus histocytosis indicating the proliferating cells and activated histocytes. Most of the low grade non-Hodgkin lymphomas (83.66%) showed weak (Grade I) positivity for transferrin receptors. Intermediate grade lymphomas showed moderate (Grade II) to high intensity (Grade III) for transferrin receptors (57.14% and 42.85%) respectively. Seventy five percent of high grade lymphomas showed strong (Grade III) positivity. All the 9 cases of Hodgkin lymphoma (100%) showed grade III positivity. Proportion of the cells within a tumour expressing transferrin receptors in high density are therefore likely to represent the growth fraction of the tumour.