Outcomes in pituitary adenoma causing acromegaly following endoscopic endonasal transsphenoidal surgery.

Objectives: The objectives of the study were to study the analysis of outcomes after endoscopic endonasal transsphenoidal surgery (EETSS) in acromegaly in terms of surgical complications, clinical improvement, endocrinological remission, achievement of prognostically critical growth hormone (GH) level, and requirement of additional treatment. Materials and Methods: The study included 28 acromegaly patients, who underwent EETSS. A 2010 consensus criterion was used for defining remission. Assessment of prognostically critical GH level (random value <2.5 ng/ml), the extent of resection and additional treatment, was done at post-operative week (POW) 12. Results: All adenomas were macroadenomas; with a mean volume of 16.34 cm3 (range, 0.4-99 cm3). Most adenomas had high-grade extensions. Most common suprasellar, infrasellar, anterior, and posterior extension grades were 3 (n = 13), 1 (n = 16), 1 (n = 14), and 0 (n = 20), respectively. Knosp Grade 3 was common on both sides (right, n = 9 and left, n = 8). One patient had already been operated on with EETSS, 1.5 years back from current surgery. Sixteen patients were on hormonal support, preoperatively. Four patients died during follow-up. Post-operative common complications were diabetes insipidus (DI, n = 18), cerebrospinal fluid rhinorrhea (n = 10), surgical site hematoma (n = 3), meningitis (n = 3), hydrocephalus (n = 2), and syndrome of inappropriate antidiuretic hormone (n = 1). The mean hospital stay was 11.62 days and 12.17 months were the mean follow-up period. At 12 POW, no improvement was seen in body enlargement and visual complaints, but all other complaints improved significantly except perspiration. Adenomas were decreased in all extensions except posterior and mean adenoma volume was reduced from 16.34 cm3 to 2.92 cm3 after surgery. Sub-total resection (STR, n = 10), near-total resection (NTR, n = 7), gross-total resection (GTR, n = 5), and partial resection (PR, n = 2) were achieved. Endocrinological remission and prognostically critical GH levels were attained in 29.17% (n = 7) and 66.67% (n = 16), respectively. NTR, GTR, STR, and PR were associated with 57.14%, 40%, 10%, and 0% endocrinological remission, respectively. Additional treatment was required in a total of 17 patients, three in GTR, nine in STR, three in NTR, and two in PR. Ten were treated with Gamma Knife radiosurgery along with medical treatment and seven with medical treatment alone. Conclusion: A successful EETSS can reduce adenoma volume to achieve clinical improvement, endocrinologic remission, and prognostically critical GH level with some complications related to surgery. Pre-operative larger volume and higher extension grades affect these outcomes adversely.

Impact of lifestyle modifications on snoring and mild sleep apnoea patients.

OBJECTIVE: Behavioural modification through increasing nutritional awareness, along with customised dietary changes and education about physical inactivity, for obese snorers and mildly sleep apnoeic patients would help improve their quality of life. METHODS: A one-year prospective interventional study enrolled snorers and/or mild obstructive sleep apnoea sufferers, with 36 patients each in the test group and control group. Nutritional information and tailor-made diet charts were given to the 36 test subjects. The severity of snoring and daytime sleepiness after 6 and 12 months was compared using the Epworth Sleepiness Scale and Thornton Snoring Scale as measures of quality of life. RESULTS: Subjective scores on both scales showed highly significant improvement (p ≤ 0.001) in the test group. No significant improvement was seen in the control group. CONCLUSION: Awareness of basic nutrition and customised diet plans help to achieve behavioural modification in the long term, resulting in a better quality of life.

The ancient practice of sutra neti leading to velopharyngeal stenosis: case report.

BACKGROUND: An ancient yoga technique called sutra neti, which is extensively used in India to keep the sinuses healthy, led to complete velopharyngeal stenosis in a 67-year-old male patient who presented with bilateral nasal obstruction, mouth breathing, anosmia and a change in voice. METHOD: The patient was diagnosed by nasal endoscopy using a zero-degree Hopkins rod endoscope, and adhesions were released using coblation. RESULTS: The patient had post-operative alleviation of symptoms and a patent velopharyngeal inlet on examination. CONCLUSION: Vigorous sutra neti can lead to velopharyngeal stenosis. Release of the stenosis is then required to cure the nasal blockade.

Comparison of basal lamella relaxing incision and combined conventional medialisation and controlled synechiae in functional endoscopic sinus surgery: a randomised prospective study.

OBJECTIVES: To compare combined conventional Freer medialisation and controlled synechiae, performed for middle meatal access (during the initial steps of functional endoscopic sinus surgery) and post-operative middle turbinate medialisation, with basal lamella relaxing incision, the latter of which is a single step for achieving both middle meatal access and post-operative medialisation. The study also compared the effects of controlled synechiae and basal lamella relaxing incision on post-operative olfaction. METHOD: A randomised prospective study was performed on 52 nasal cavity sides (32 patients). Only basal lamella relaxing incision was performed in one group, and both conventional medialisation and controlled synechiae were performed in the other. Intra-operative and post-operative photography was used to measure the middle meatal area. A pocket smell test was used to assess olfaction. RESULTS: There were no significant differences in operative middle meatal access and post-operative medialisation of the middle turbinate. Post-operative olfaction was affected more in the combined conventional medialisation and controlled synechiae group, compared to the basal lamella relaxing incision group, but this finding was not statistically significant. CONCLUSION: Basal lamella relaxing incision is an effective single-step technique for achieving adequate middle meatal access and post-operative medialisation, with no significant effect on olfaction.

Loss of LZAP inactivates p53 and regulates sensitivity of cells to DNA damage in a p53-dependent manner.

Chemotherapy and radiation, the two most common cancer therapies, exert their anticancer effects by causing damage to cellular DNA. However, systemic treatment damages DNA not only in cancer, but also in healthy cells, resulting in the progression of serious side effects and limiting efficacy of the treatment. Interestingly, in response to DNA damage, p53 seems to play an opposite role in normal and in the majority of cancer cells-wild-type p53 mediates apoptosis in healthy tissues, attributing to the side effects, whereas mutant p53 often is responsible for acquired cancer resistance to the treatment. Here, we show that leucine zipper-containing ARF-binding protein (LZAP) binds and stabilizes p53. LZAP depletion eliminates p53 protein independently of its mutation status, subsequently protecting wild-type p53 cells from DNA damage-induced cell death, while rendering cells expressing mutant p53 more sensitive to the treatment. In human non-small-cell lung cancer, LZAP levels correlated with p53 levels, suggesting that loss of LZAP may represent a novel mechanism of p53 inactivation in human cancer. Our studies establish LZAP as a p53 regulator and p53-dependent determinative of cell fate in response to DNA damaging treatment.

Langerhans Cell Histiocytosis of the Temporal Bone with Otic Capsule Involvement.

INTRODUCTION: This study is conducted to demonstrate that destructive lesions of the otic capsule by Langerhans cell histiocytosis (LCH) causing both radiographic and audiologic findings can be completely reversed with adequate treatment. Retrospective case review and analysis of clinical and imaging data were obtained as part of the diagnosis and treatment of patients with LCH of the temporal bone. METHODS: With Institutional Review Board (IRB) approval, cases of LCH involving the temporal bone were searched for within the institutional databases. Criteria for inclusion was histologic diagnosis of LCH and pretreatment computed tomography (CT) demonstrating temporal bone and/or otic capsule involvement and posttreatment follow-up CT/magnetic resonance imaging (MRI) scans obtained at least 6 months after starting treatment. RESULTS: We report eight cases of LCH of the temporal bone with three demonstrating otic capsule involvement radiographically and/or clinically. Review of posttreatment imaging revealed all three patients had complete restoration of the bony labyrinthine architecture and near or complete restoration of their hearing. CONCLUSIONS: Though LCH of the temporal bone is a common site within the spectrum of the disease, involvement of the otic capsule remains rare. Here, we report the largest series of otic capsule involvement by LCH and investigate whether both architecture and hearing are recovered with appropriate treatment. Lastly, restoration of the bony architecture of the labyrinth suggests the mechanism of LCH is demineralization and not ablative.

Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ear: a prospective study.

OBJECTIVE: This study aimed to compare the success rate of type I tympanoplasty in active (wet) and inactive (dry) mucosal chronic otitis media. METHODS: A prospective study was performed of 35 patients each with dry ear and wet ear undergoing type I tympanoplasty in the Otolaryngology Department, Postgraduate Institute of Medical Education and Research, India. All patients underwent type I tympanoplasty between January 2010 and June 2011 by the post-auricular approach. Samples of the remnant tympanic membrane were sent for histopathological examination. RESULTS: After a minimum follow up of one year, the success rate was 88.6 per cent for dry ears and 80 per cent for wet ears. Neither the type (p = 0.526) nor the presence (p = 0.324) of discharge influenced the success rate. Histopathological examination of the tympanic membrane margins was performed for 46 patients: of these, 19 showed evidence of vascularity and 27 did not. There was no significant difference in success rate between groups (p = 0.115). CONCLUSION: The success rate was not influenced by the presence of ear discharge at the time of surgery, and tympanic membrane vascularity did not influence graft uptake.

The clock gene Per2 links the circadian system to the estrogen receptor.

Circadian rhythms regulate diverse physiological processes including homeostatic functions of steroid hormones and their receptors. Estrogen receptor-alpha (ERalpha) is essential for normal mammary gland physiology and is a prognostic marker for the treatment of breast cancer. We report that Per2, a core clock gene, links the circadian cycle to the ERalpha signaling network. Binding of enhances ERalpha degradation, while suppression of Per2 levels leads to ERalpha stabilization. In turn, Per2 itself is estrogen inducible in these cells, suggesting a feedback mechanism to attenuate stimulation by estrogen. In addition, overexpression of Per2 in breast cancer cells leads to significant growth inhibition, loss of clonogenic ability and apoptosis. Taken together, these results further support a critical role for peripheral circadian regulation in tissue homeostasis and suggest a novel role for clock genes in estrogen receptor-positive breast cancer.

MATERNAL RISK FACTORS AS DETERMINANTS OF LOW BIRTH WEIGHT AMONG ARMED FORCES FAMILIES.

Low birth weight (LBW) is responsible for a significant proportion of child morbidity and mortality apart from its possible role in the occurrence of chronic disease in adult life. This study highlights the overall low incidence of LBWs at 13.6% among the Armed Forces families. The Other Ranks had a proportionally higher incidence of LBW at 24.14%. 82.14% of the LBWs occurred in the age group of 20-29 yrs, with only 6.93% of the births being teenage pregnancies. Primiparous women accounted for 54.95% of births but 75% of the LBWs. Smoking was not a significant factor. The findings underscore the need for special attention to other rank families and primiparas. A continued effort at updating the health care facilities provided to the Armed Forces families, and a concerted health and dietary advice by the authorised medical attendants, directed at the primiparous women, will further help lower the incidence of LBWs. The National LBW target of less than 10% by 2000 AD is definitely achievable by the Armed Forces.

SEXUAL BEHAVIOUR AS A RISK FACTOR IN THE TRANSMISSION OF HIV INFECTION AMONG ADOLESCENTS AND YOUNG MALES IN INDIA.

In order to understand the beliefs and behaviour related to sexual perception and activity of young male adults a multi-centric study was conducted using a structured proforma for a face to face interview. A total of 9845 subjects in the age group 18-25 years were interviewed. 73.78% of the respondents believed that sex with a commercial sex worker (CSW) is an acceptable way of satisfying sex. Sex with an Amateur was considered acceptable by 57.21% of the subjects. Knowledge about condom use was inadequate among 23.67% of the subjects. An information education and communication (IEC) intervention programme with a school set up and peer network education is recommended for developing safe sex practices. Aggressive social marketing for condom usage will reduce the rate of infection and probability of transmission of HIV/AIDS.

Effect of vitamin B-6 supplementation on fuels, catecholamines, and amino acids during exercise in men.

PURPOSE: In two separate but identical studies, the effect of vitamin B-6 supplementation was examined on plasma energy substrates, catecholamines, and 13 amino acid concentrations during exercise. METHODS: Eleven trained men performed two separate exhaustive exercise tests at 71.0+/-4.6% VO2max during two separate 9-d controlled diet periods. Exercise test 1 (T1C) occurred following a control diet, and test 2 (T2B6) occurred following a vitamin B-6 supplemented diet (20 mg PN.d(-1)). Blood was drawn pre, during (60 min), post, and post-60 min of exercise, and plasma was analyzed for glucose, lactate, glycerol, free fatty acids (FFA), catecholamines (N = 5), and amino acids (N = 5). RESULTS: Mean FFA concentrations changed over time in both tests (P < 0.001) and were lower in T2B6 compared to T1C at pre (P = 0.03), during (P = 0.05), and post-60 min (P = 0.04) of exercise. Mean lactate, glycerol, and catecholamine concentrations only changed over time (P < 0.0001). The only significant changes in amino acid concentrations were for lower tyrosine (P = 0.007) and methionine (P = 0.03) concentrations in T2B6 relative to TIC at post-60 min of exercise and postexercise, respectively. No differences were observed in exercise times to exhaustion between TIC (108+32.6 min) and T2B6 (109+51.2 min). CONCLUSIONS: These results indicate that vitamin B-6 supplementation can alter plasma FFA and amino acid concentrations during exhaustive endurance exercise without affecting endurance.

HIV SEROPREVALENCE AMONG ADOLESCENTS AND YOUNG ADULT MALES IN INDIA: A LARGE COMMUNITY BASED EPIDEMIOLOGICAL STUDY.

A large number of HIV seroprevalence studies have been conducted on the high-risk groups. However there seems to be a paucity of such studies undertaken in the general population. This study was directed towards the adolescents and young Indian male adults. A representative samples of 19,436 were tested, out of which nine were positive for HIV, thereby giving a HIV seroprevalence rate of 0.46 per 1000 with a clustering of the positive subjects towards the North East of India followed by the Southern states. Those from the North East were younger than those from the South. This calls for a targeted information, education and communication (IEC) programme aimed at the younger group in the East with known greater risk potential for intravenous drug abuse, and older adults in the South. The study also provides an insight for HIV/AIDS mapping and possible future direction of the epidemic in India.

SALT IODINE MONITORING IN THE ARMED FORCES.

Iodine deficiency is the most commonly implicated nutritional factor responsible for preventable mental deficiency in India and the world. The Government of India aims to control this through the supply of Iodised salt as the primary intervention strategy. Monitoring of the salt supplied, therefore becomes essential to ensure quality control. This study undertaken to assess the status of Iodised salt in the Armed Forces in the Pune-Kirkee complex found a great variation in the iodine content ranging from 10.6 ppm to 150.1 ppm. High levels of Iodine are potentially harmful. This calls for stringent quality assurance and monitoring as a cost effective long term measure in the Armed Forces.

ARE DOCTORS EFFECTIVE MEDICAL TEACHERS? RESULTS OF A CROSS-SECTIONAL STUDY AT ARMED FORCES MEDICAL COLLEGE, PUNE.

Medical education remains the onerous responsibility of the senior medical fraternity. Not being formally trained calls for periodic introspection to be more effective teachers. This study, involving the fourth year medical students revealed a great need for self-reflection to improve the Style of teaching, ensuring greater involvement of the students and teaching what is appropriate to the stage of study. Aggressive behaviour was inimical to good learning. A better student teacher communication and the ability to run the session' are important indicators of good teaching. A continued self-evaluation by teachers will improve student learning and medical education.

NUTRITIONAL STATUS OF THE UNDER FIVE CHILDREN OF ARMED FORCES PERSONNEL.

Three hundred and one underfive children belonging to Armed Forces families were studied for their anthropometric and haemoglobin status. Their weights, MUAC and haemoglobin were superior as compared with the children in the general civil population as reported in various studies. 82.39% had weights above 80% of Harvard median. Chest circumference and head circumference crossing took place between 12-23 months. 69.56% had MUAC within normal limits and 59.81% had haemoglobin levels of 11 gm/dl or more. The healthier nutritional status of the underfives in the Armed Forces population is attributable to a healthier environment and an easy access to comprehensive health care facilities made available to them. It can be further improved by augmenting and modernising the MCH services with a view to provide quality care.