Clinical and endocrinological profile of children with precocious puberty at a tertiary care center

Introduction: Puberty is said to be precocious if it appears before chronological age of 8 years in girls and 9 years in boys. Untreated early puberty leads to early sexual maturation with growth and bone age advancement with early fusion, leading to the paradox of tall stature in childhood but short adult final height. Objective: The objective of this study was to study the profile of precocious puberty in children with respect to clinical and endocrinological outcome. Materials and Methods: This was a prospective study of 28 children (23 girls) who presented with precocious puberty in pediatric endocrine outpatient department. Presenting complaints, clinical findings including anthropometry, investigations (biochemical and radiological), treatment, and outcome with follow-up visits (every 3 monthly), were recorded. Results: Age at the presentation was 5.4±2.6 years. Most common presentation in girls was breast development (82.6%) followed by axillary hair development (39.13%), pubic hair development (30.43%), vaginal bleeding (13%), and clitoral hypertrophy (4.3%). History of recent height spurt was reported in 69.57% of girls. Boys presented with pubic hair growth and increased penile length (100%), change in voice (40%), seizures, or behavioral issues including aggressiveness. Etiology varied with the idiopathic cause constituting majority of the cases in girls (43.5%) with other causes being ovarian tumor (4.3%), adrenal adenoma (4.3%), and thelarche variant (4.3%). In boys, hypothalamic hamartoma (60%) was the most common cause followed by sex cord tumors (40%). The mean advancement in bone age on presentation was 3.4 years. Baseline luteinizing hormone (LH) was found to be high in patients with central causes like hypothalamic hamartomas than in children with other cause. Gonadotropin-releasing hormone (GnRH) stimulation test was positive (maximal stimulated LH after aqueous GnRH analog >3 mIU/ml by chemiluminescence immunoassay) in 61.5% of patients. Height velocity post-treatment showed a declining trend as compared to previous records before the onset of treatment and bone age advancement also slowed down. Conclusions: Increasing trend of precocious puberty and its adverse effect on final height and psychological profile of patients mandates the need for early referral and diagnosis and appropriate management

Development and Validation of Stability Indicating Reverse Phase High Performance Liquid Chromatographic Method for estimation of Donepezil HCl from bulk drug

Stability of Donepezil Hydrochloride(DONE) was investigated using stability indicating Reverse phase high performance liquid chromatography (RP-HPLC) utilizing C-18 column and mobile phase containing Acetonitrile:Water (pH 3.5)  in ratio of 40:60 at flow rate of 1 ml min-1. Peaks of donepezil and degradation products were well resolved at retention times < 7 min. Stability was performed in 0.1N hydrochloric acid, 0.1N sodium hydroxide, 3 % hydrogen peroxide, neutral, photolytic and dry heat conditions. Fast hydrolysis was seen in alkaline condition as compared to oxidative and neutral conditions. Methods was validated with respect to linearity, precision, accuracy, specificity and robustness LOQ and LOD. It was also found to be stability indicating, and therefore suitable for the routine analysis of Donepezil hydrochloride in the pharmaceutical formulation

Adolescent intermittent ethanol reduces serotonin expression in the adult raphe nucleus and upregulates innate immune expression that is prevented by exercise

Serotonergic neurons of the raphe nucleus regulate sleep, mood, endocrine function, and other processes that mature during adolescence. Alcohol abuse and binge drinking are common during human adolescence. We tested the novel hypothesis that adolescent intermittent ethanol exposure would alter the serotonergic system that would persist into adulthood. Using a Wistar rat model of adolescent intermittent ethanol (AIE; 5.0 g/kg, i.g., 2-day on/2-day off from postnatal day [P]25 to P55), we found a loss of dorsal raphe nucleus (DRN) serotonin (5-HT)-immunoreactive (+IR) neurons that persisted from late adolescence (P56) into adulthood (P220). Hypothalamic and amygdalar DRN serotonergic projections were reduced following AIE. Tryptophan hydroxylase 2, the rate-limiting 5-HT synthesizing enzyme, and vesicular monoamine transporter 2, which packages 5-HT into synaptic vesicles, were also reduced in the young adult midbrain following AIE treatment. Adolescent intermittent ethanol treatment increased expression of phosphorylated (activated) NF-κB p65 as well as markers of microglial activation (i.e., Iba-1 and CD11b) in the adult DRN. Administration of lipopolysaccharide to mimic AIE-induced innate immune activation reduced 5-HT+IR and increased phosphorylated NF-κB p65+IR similar to AIE treatment. Voluntary exercise during adolescence through young adulthood blunted microglial marker and phosphorylated NF-κB p65+IR, and prevented the AIE-induced loss of 5-HT+IR neurons in the DRN. Together, these novel data reveal that AIE reduces 5-HT+IR neurons in the adult DRN, possibly through an innate immune mechanism, which might impact adult cognition, arousal, or reward sensitivity. Further, exercise prevents the deleterious effects of AIE on the serotonergic system

Effects of Dim Light at Night and Di-(2-Ethylhexyl) Phthalate on Locomotor Rhythms and Feeding Behavior

The circadian system is an organism’s internal biological clock, responsible for regulating physical and behavioral activities that follow a daily 24-hour cycle such as sleep patterns, feeding habits, and hormone release. These rhythms are controlled by the suprachiasmatic nucleus, housed in the brain’s hypothalamus. Circadian disruption occurs due to an interruption in the daily cycle. In humans, circadian disruption is caused by several factors, including light at night, shift work, and jet-lag. This creates problems in the synchronization of behavioral and physical activities and can lead to long-term health conditions. Furthermore, di-(2-ethylhexyl) phthalate (DEHP) is a ubiquitous chemical that has been shown to induce endocrine disruption, which may further modify circadian disruption. This study aims to test the connection between circadian and endocrine disruption. We expect to find abnormal locomotor activity and feeding behavior changes in both the circadian and endocrine disrupted groups. In the combined disruption group, we expect to see an additive effect of the two models of disruption.Ope

Evaluation of Available Medical Interpretation Resources Available to Spanish-Speaking Patients in NJ AHEC Counties

According to the US Census Bureau Spanish is the most common non-English language spoken in the US. Despite the growing population of Spanish-speaking individuals, most healthcare providers can only communicate in English. Linguistic differences between patients and providers have been identified to impact the quality of care received, therefore, it is not surprising that Spanish-speaking patients have been found to be less satisfied with healthcare. Language barriers in healthcare lead to poor compliance and underuse of services which eventually negatively impact health outcomes. Several studies found that the most effective communication tools are often underutilized, with healthcare providers relying on untrained interpreters instead, oftentimes leading to medical errors, incorrect treatment and misdiagnosis. The purpose of this study is to investigate the availability of interpretation services offered by New Jersey healthcare providers in Camden, Gloucester, Atlantic, Salem, and Cumberland County and increase awareness of interpretation services available in these healthcare settings

Genetic contribution of the leukotriene pathway to coronary artery disease

We evaluated the genetic contribution of the leukotriene (LT) pathway to risk of coronary artery disease (CAD) in 4,512 Caucasian and African American subjects ascertained through elective cardiac evaluation. Of the three previously associated variants, the shorter “3” and “4” alleles of a promoter repeat polymorphism in ALOX5 increased risk of CAD in African Americans (OR = 1.4, 95% CI 1.0–1.9; p = 0.04), whereas a haplotype of LTA4H (HapK) was associated with CAD in Caucasians (OR = 1.2, 95% CI 1.01–1.4; p = 0.03). In Caucasians, first-stage analysis of 254 haplotype-tagging SNPs in 15 LT pathway genes with follow-up of 19 variants in stage 2 revealed an LTA4H SNP (rs2540477) that increased risk of CAD (OR = 1.2, 95% CI 1.1–1.5; p = 0.003) and a PLA2G4A SNP (rs12746200) that decreased risk of CAD (OR = 0.7, 95% CI 0.6–0.9; p = 0.0007). The PLA2G4A rs12746200 variant also decreased risk of experiencing a major adverse cardiac event (MACE = myocardial infarction, stroke, or death) over 3 years of follow-up (HR = 0.7, 95% CI 0.5–0.9; p = 0.01), consistent with its cardioprotective effect. Functional experiments demonstrated that stimulated monocytes from carriers of LTA4H variants HapK or rs2540477 had 50% (p = 0.002) and 33% (p = 0.03) higher LTB4 production, respectively, compared to non-carriers. These ex vivo results are consistent with LTB4 being the direct product of the reaction catalyzed by LTA4H and its role in promoting monocyte chemotaxis to sites of inflammation, including the artery wall of atherosclerotic lesions. Taken together, this study provides additional evidence that functional genetic variation of the LT pathway can mediate atherogenic processes and the risk of CAD in humans