Is Hypoglycemia Secondary to Metastatic Retroperitoneal Sarcoma - A Therapeutic Challenge? Case Report and Review of Literature.

Most soft tissue sarcomas afflict the extremities; however, the retro peritoneum can also be affected rarely. Retroperitoneal sarcomas are relatively asymptomatic. Although tumor-induced hypoglycemia is rare in tumors other than insulinomas, extrapancreatic tumors are a subset that displays this phenomenon. The occurrence of hypo-insulinemic hypoglycemia with low GH and IGF-1 should prompt consideration of the secretion of a hypoglycemic substance impeding the secretion of insulin and GH, such as IGF-2 or one of its related substances. The present case report is of a 38-year-old male with retroperitoneal round cell sarcoma with liver metastasis with severe symptomatic hypoglycemia who was managed with multipronged symptomatic therapy and oncological management after which he had shown significant improvement in hypoglycemic episodes and symptom profile. A literature review revealed our case report to be the first reported case of a young male (preponderance in the older population) with hypoglycemia associated with retroperitoneal sarcoma which presented with liver metastasis and the only one treated with Gemcitabine /Docetaxel. The presence of these features might point toward a poorer prognosis in a disease with an already dismal course. All these points towards the need for further research regarding intensified oncological treatment after evidence-based prognostication of high-risk groups and modalities for the management of symptomatic hypoglycemia such as Somatostatin analogs and glucagon which aid in symptom control.

Utilization of health care services by elderly for respiratory diseases including TB - Challenges.

Progressive functional decline of all body organ systems in association with decreased immunity makes elderly vulnerable to all types of diseases including respiratory diseases. Advances in medical fields have resulted in increasing proportion of elderly globally. Healthcare demands of elderly population are complex. Provision of healthcare services for this continuously increasing population subgroup & ensuring their adequate utilization is full of challenges. These are demographic, socioeconomic, financial, physical accessibility, quality of healthcare services, attitudinal & transportation related. Large size of this subgroup with special healthcare needs in context of limited available resources of middle income country like India is the biggest challenge. Poor educational status & socioeconomic condition of Indian elderly, dependence on family, absence of formal social security & healthcare security complicates situation further. Condition of elderly females is particularly worse. In view of poor physical ability with often associated physical disability makes accessibility of healthcare services also significant factor. Overcoming negative attitudinal factors prevalent in Indian elderly & make them utilize available healthcare services is another huge challenge. Quality of healthcare services in form of availability of required expertise & equipments, attitude of healthcare providers towards elderly patients & convenience in utilization of these services also play an important role. Special provisions in TB control program for elderly in view of their complex needs, high prevalence, morbidity & mortality are also required.

Complementary Proteomics, Genomics approaches identifies potential pathogenicity/virulence factors in Tilletia indica induced under the influence of host factor.

Karnal bunt disease of wheat is incited by quarantine fungal pathogen T. indica. Till date, there is little information on the pathogenic mechanisms involved in Karnal bunt. In order to understand the molecular mechanisms of disease pathogenesis, highly aggressive T. indica TiK isolate was cultured in the presence of host factor extracted from developing spikes of wheat variety WH-542. Modulation in protein profile of mycelial proteins and secretome from TiK cultured in the absence and presence of host factor was analyzed by 2-DE. Fifteen and twenty nine protein spots were up-regulated/differentially regulated in the proteome of mycelial and secreted proteins, respectively and identified using MALDI-TOF/TOF. Identified proteins are involved in suppression of host defense responses, lignin degradation of plant cell wall, penetration, adhesion of pathogen to host tissues, pathogen mediated reactive oxygen species generation, hydrolytic enzymes, detoxification of host generated reactive oxygen species. Further, integration of proteomic and genomic analysis has led to candidate pathogenicity/virulence factors identification. They were functionally annotated by sequence as well as structure based analysis. In this study, complementation of proteomics and genomics approaches resulted in novel pathogenicity/virulence factor(s) identification in T. indica.

Innovative Economical Surgical Suture Board.

The aim of this study is to develop an economical suture board for practising suturing skills and techniques. Suture boards were made by using local electric boards, small leather patch, four suction buttons, six screws and a hook. These suture boards are multipurpose boards which are economical and available all the time in department for practicing. This board can also be placed in endotrainer for laparoscopic suturing skills. This economical suture board is cheap, easily available and helps in practicing various suturing and knot tying techniques.

Predictive distribution modeling and population status of the endangered Macaca munzala in Arunachal Pradesh, India.

The present study reports the population of Macaca munzala in Tawang and West Kameng districts and its predictive distribution range in Arunachal Pradesh, estimated using ecological niche modeling. Environmental variables and occurrence data from a preliminary survey were used in the MaxEnt modeling, a statistical model to know the potential distribution area of the enigmatic species in Arunachal Pradesh. Later, a population survey was carried out in Tawang and West Kameng districts of the state following existing trails and paths. The distribution model revealed that only 2.4% of the total landmass of the state is potential distribution habitat range for M. munzala, whereas 10.19% of the total area of the two districts were shown to be potential habitat of the species. A total number of 971 individuals (including two solitary males) comprising 41 troops of M. munzala were recorded during the population survey. The mean troop size was 23.63 ± 1.21 individuals per troop ranging from 12 to 44 individuals. On average, M. munzala troops were comprised of juveniles (30.37%), adult females (23.83%), infants (18.22%), adult males (11.53%), sub-adult females (9.81%), and sub-adult males (6.23%). Our observed population size of M. munzala is higher in Tawang and West Kameng districts when compared with the earlier available records. This study showed the potential distribution of M. munzala based on environmental variables and the present population status in Tawang and West Kameng districts of Arunachal Pradesh, India.

Prevalence & pattern of respiratory diseases including Tuberculosis in elderly in Ghaziabad - Delhi - NCR.

Elderly population is continuously increasing all over the world including India. Old age is associated with significant prevalence of chronic illnesses. Population based study to find prevalence & pattern of respiratory diseases in elderly in India is difficult to find. Present study was done in an urban locality of Ghaziabad inhabited mainly by low socio - economic status population. Two part questionnaire was used as main tool. Through part one 1522 elderly were screened for respiratory disease. Respiratory disease was confirmed & diagnosed by part two of questionnaire, physical examination & necessary investigations. Prevalence of respiratory diseases was 18.8% in this study. Prevalence of respiratory diseases was almost double in elderly males as compared to females. COPD was most prevalent respiratory disease followed by Bronchial asthma.

Combined potentiating action of phytochemical(s) from Cinnamomum tamala and Aloe vera for their anti-diabetic and insulinomimetic effect using in vivo rat and in vitro NIH/3T3 cell culture system.

The present investigation was undertaken to analyze the ethanolic extracts of leaves of Cinnamomum tamala and Aloe vera for their anti-diabetic and insulinomimitic effect by determining the levels of blood sugar, glycosylated hemoglobin, and serum lipid profile (total cholesterol, triglycerides, high density lipoprotein (HDL), and low density lipoprotein (LDL)) after daily administration of each alone and in combined at 250 mg/kg in alloxan (ALX)-induced diabetic rats. Treatment of diabetic rats with the extracts restored the elevated biochemical parameters significantly. The anti-diabetic effect further potentiated the insulin signaling pathway by co-administration of both extracts. The molecular mechanisms of modulating gene expression and cellular signaling through the insulin receptor were also evaluated on specific targets of the insulin signaling pathway, including insulin receptor substrate (IRS), phosphatidylinositol 3-kinase (PI3-K), AKT, and the glucose transporter (GLUT4) on NIH/3T3 cell line by western blotting, ELISA, semiquantitative RT-PCR, and real-time PCR. The active principle of both extracts revealed insulin mimicking effect as indicated by increased expression of pIRS1 and pAKT in time-dependent manner. There was no significant difference in PI3-K content between unchallenged and challenged groups. Enhanced expression of GLUT-4 transcript further suggested that the Cinnamomum and Aloe phytochemicals could serve as a good adjuvant in the present armamentarium of anti-diabetic drugs by either mimicking or improving insulin action. This study reveals that ethanolic extracts of C. tamala and A. vera have potent therapeutic efficacy and prospect for the development of phytomedicine for diabetes mellitus.

Direct analysis in real time by mass spectrometric technique for determining the variation in metabolite profiles of Cinnamomum tamala Nees and Eberm genotypes.

Cinnamomum tamala Nees & Eberm. is an important traditional medicinal plant, mentioned in various ancient literatures such as Ayurveda. Several of its medicinal properties have recently been proved. To characterize diversity in terms of metabolite profiles of Cinnamomum tamala Nees and Eberm genotypes, a newly emerging mass spectral ionization technique direct time in real time (DART) is very helpful. The DART ion source has been used to analyze an extremely wide range of phytochemicals present in leaves of Cinnamomum tamala. Ten genotypes were assessed for the presence of different phytochemicals. Phytochemical analysis showed the presence of mainly terpenes and phenols. These constituents vary in the different genotypes of Cinnamomum tamala. Principal component analysis has also been employed to analyze the DART data of these Cinnamomum genotypes. The result shows that the genotype of Cinnamomum tamala could be differentiated using DART MS data. The active components present in Cinnamomum tamala may be contributing significantly to high amount of antioxidant property of leaves and, in turn, conditional effects for diabetic patients.

Spatial distribution pattern analysis of Dof1 transcription factor in different tissues of three Eleusine coracana genotypes differing in their grain colour, yield and photosynthetic efficiency.

In the present study Dof1 gene of finger millet was cloned and sequenced. In silico analysis reveals 61% identity with the Sorghum bicolor and 57% identity with the Oryza sativa Dof1 sequence. A comparative analysis of gene sequences from different crops and three finger millet genotypes {Brown (PRM-1), Golden (PRM-701) and White (PRM-801)} differing in grain colour, yield and photosynthetic efficiency showed a high degree of sequence identity of Dof1 sequence gene ranging from 22 to 70% as evident from distance matrix of the built phylogenetic tree showing two major clusters. A total of five conserved motifs were observed in Dof1 sequences of different cereals. Motif 1 with multilevel consensus sequence CKNCRRYWTKGGAMRNVPVG contains zinc finger Dof domain. Motif 3 and motif 5 contains protein kinase phosphorylation site. Motif 2 contains Dof domain and zinc finger N-glycosylation site while motif 4 is involved in Zinc finger type profiling. Further, we studied the spatial distribution of Dof1 gene in three vegetative tissues (root, stem and flag leaf) as well as four stages of developing spikes (S1, S2, S3 and S4) of the three finger millet genotypes using qualitative and quantitative PCR based approaches. Physiological parameters (plant height, leaf area, chlorophyll content, SPAD value and photosynthetic efficiency) at the time of flowering was found to be highest in white (PRM-801) genotype followed by golden (PRM-701) and brown (PRM-1) genotype. Semi-quantitative RT-PCR and quantitative real-time PCR analysis revealed that the expression of Dof1 is highest in leaves and lowest in roots, which suggests its role in regulation of photosynthesis-related genes and carbon skeleton synthesis. Also at grain maturity stage, expression of Dof1 was higher in white (PRM-801) genotype followed by golden (PRM-701) and brown (PRM-1) genotype. The result is suggestive of Dof1 role in the accumulation of grain protein and yield attribute through regulation of key enzymes involved in source to sink relationship during grain filling stage.