Spectrum of Manifestations of Carcinoma Stomach: An Institutional Evaluation

INTRODUCTION: Despite a major decline in incidence and mortality over several decades, stomach cancer is still the fourth most common cancer and the second most common cause of cancer death in the world. There is a 10-fold variation in incidence between populations at the highest and lowest risk. The incidence is particularly high in East Asia, Eastern Europe, and parts of Central and South America, and it is about twice as high among men than among women. Prognosis is generally rather poor, with 5-year relative survival below 30% in most countries. AIM OF THE STUDY: 1. To study the epidemiology of cancer stomach. 2. To assess the influence of risk factors in the causation of cancer stomach. 3. To correlate the clinical features of cancer stomach with the site of lesion. 4. To assess the commonest anatomical site of lesion in cancer stomach. 5. To assess the incidence of operability of tumour at the time of presentation. 6. To assess the role of CECT in staging the cancer stomach. MATERIALS AND METHODS: Patients included in the study were recruited from the Department of Digestive Health and Diseases, Government Peripheral hospital, Anna Nagar, Chennai. The study period was from January 2008 to December 2009. Consecutive patients diagnosed to have cancer stomach were included in the study group. Only biopsy proven adenocarcinomas, were included in the study. A detailed proforma was compiled for the patients with cancer stomach. A detailed history about dietary habits, social habits such as smoking, alcohol, previous gastric surgery, previous history of gastric ulcer and family history of gastric cancer were recorded. Clinical history about dyspepsia, pain abdomen, anorexia and weight loss, vomiting, dysphagia and upper GI bleed were obtained and thorough clinical examination was done. Body mass index was calculated for all. Appropriate investigations such as haemoglobin, erythrocyte sedimentation rate, X ray chest, U G I Scopy & biopsy and CECT scan of the upper abdomen were done. Histopathological grading was done by the pathologist. Treatment was individualized according to the stage of the disease during presentation. STATISTICAL ANALYSIS: The statistical analysis of the data was done using SSPS 11. ‘ p’ value of < 0.05 was considered to be statistically significant. The p value was calculated using chi square test. Percentage calculation and cross analysis were done to identify significant data. RESULTS: During the study period of two years, a total number 12800 patients attended OPD. Endoscopy was performed for 5842 cases (31%). Among those, biopsy proven adenocarcinomas was 172. This accounts to 3% of total endoscopy and 1% of total OPD cases. Of these 172 cases, males were 72% and females 28% constituting a ratio of 3 : 1. The incidence of cancer stomach in patients below the age of 40 years was 13.95%. It slowly increased and reached a maximum in the 5th decade and then slowly declined. The incidence was 13.3% in patients above the age of 70. The mean age of the patient was 55.76. The minimum age was 28yrs and the maximum age was 77 years. Most of them were from places in & around Chennai (88%). Many of them were farmers and labourers. About 80% of the female patients were housewives. Majority of the patients were Hindus (89.5%), followed by Muslims (6%) and Christians (4.5%). CONCLUSION: Mean age of the patients with cancer stomach is 56 years. • Males outnumbered female cases probably due to increased smoking and alcohol consumption. • People with Low intake of vegetables and fruits and those who had no refrigerators lead to a higher risk of developing cancer stomach in both sexes. • Past history of gastric surgery still continues to be a risk factor. And gastric ulcer is not a significant risk factor. • Pain abdomen is the commonest presenting symptom. • Significant number of patients with Ball Rolling Movement were found to be operable in the pre-operative evaluation. • Dysphagia and vomiting immediately after taking food along with loss of appetite commonly present as OG Junction growth. • Cutaneous markers of intra abdominal malignancy are extremely rare. • Antral growth is more common than OG Junction growth. • Antral growth presents earlier and more amenable to surgery compared to OG Junction and diffuse gastric cancer. • Blood group “A” is a significant risk factor for cancer stomach particularly for diffuse gastric cancer and OG Junction growth. • CT Scan is a valuable modality of investigation preoperative evaluation. • Two thirds of patients were found to be inoperable during the time of diagnosis and hence underwent only palliative treatment

Advanced ovarian malignancy in pregnancy mimicking ovarian hyperstimulation syndrome: a case report

Advanced ovarian malignancy is a rare occurrence in pregnancy. Here we report a case of primary infertility presenting in early pregnancy following invitro fertilization with features of Ovarian hyperstimulation syndrome unresponsive to treatment. Further evaluation revealed advanced ovarian malignancy. She was treated with chemotherapy followed by staging surgery at the time of elective cesarean at 35 weeks gestation. This case outlines the difficulties in diagnosis of ovarian cancer during pregnancy

Biorational management of maize fall armyworm, Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) using Bacillus thuringiensis (Berliner) enriched with chemical additives

An invasive pest, fall armyworm, Spodoptera frugiperda (J.E.Smith) (Lepidoptera: Noctuidae) attacks maize at every stage of development, from seedling emergence up to cob formation. Early instar larvae were seen mostly on leaves of maize with characteristics pin or shot hole symptoms. Later instar larvae were confined to deep whorls, leaving typically ragged like appearance and fed on the reproductive stage of the crop especially tassels and developing cobs resulting in quality and quantity loss of maize produce. The effect of commercially available Bacillus thuringiensis subsp. kurstaki product, Dipel® against the second instar larvae of Fall Armyworm (FAW )was not promising under laboratory conditions. Hence, an effort was made to add an adjuvant along with B. thuringiensis to increase the virulence of commercially available B. thuringiensis.The Laboratory bioassays with B. thuringiensis and seven chemical additives ( T1- Bt + Boric acid, T2- Bt + Zinc oxide, T3- Bt + Sodium nitrate, T4- Bt + Peptone, T5- Bt + Urea, T6- Bt + EDTA, T7- Bt + Citric acid &amp; T8-  Bt alone T9- Control) were tested against second instar larvae of Spodoptera frugiperda larvae. The results showed that B. thuringiensis plus sodium nitrate (T3) promoted maximum mortality 82.2 per cent with a minimum LC50 value of 54.620 mg/l. Sodium nitrate boosted B. thuringiensis activity at a concentration of 0.05 per cent by 2.128-fold than B. thuringiensis alone. Overall, sodium nitrate improved the efficacy of B. thuringiensis spray at the maximum level followed by boric acid, urea, EDTA and peptone

Effect of ageing on in vitro true seed and in vivo drupe germination and its dormancy mechanism in teak (Tectona grandis Linn.f)

The germination percentage of teak seed is generally very poor due to its higher percentage of empty seed and poor seed viability. The viable seeds exhibit protracted germination behaviour due to their inherent seed dormancy and other physiochemical characteristics. Hence establishing a teak nursery for largescale plantation activities is a challenging task. This study was undertaken to study the effect of ageing on in vitro true seed and in vivo drupe germination and its dormancy mechanism in teak. Fresh, one-year and two-year stored drupes were used to represent different levels of ageing. Under in vivo conditions, poor drupe germination was observed in fresh drupes (3%) and germination percentage was increased when the drupes were subjected to ageing for one year (17%) or two years (32%). When true seeds separated from fresh drupes and germinated under in vitro conditions, enhanced germination (58.3%) was observed. Biochemical analysis showed that indole-3- acetic acid, indole butyric acid, abscisic acid and coumarin are not present in fresh, one year and two-year-old true seeds. The gibberellic acid was increased with an increase in ageing, but the GA3 did not influence the germination percent under in vitro conditions. Scanning electron microscope (SEM) image of fresh teak true seed showed that embryo tip was shrivelled, whereas one and two-year-old true seed embryo tip bulged; this was confirmed that one and two-year-old true seed embryos were matured and satisfied the after-ripening requirement. Nursery studies revealed that one and two-year-old drupes recorded the highest germination compared to fresh drupes.                

Cn-AMP2 from green coconut water is an anionic anticancer peptide

Globally, death due to cancers is likely to rise to over 20 million by 2030,which has created an urgent need for novel approaches to anticancer therapies such as the development of host defence peptides. Cn-AMP2 (TESYFVFSVGM), an anionic host defence peptide from green coconut water of the plant Cocos nucifera, showed anti-proliferative activity against the 1321N1 and =U87MG human glioma cell lines with IC50 values of 1.25 and 1.85mM, respectively. The membrane interactive formof the peptide was found to be an extended conformation, which primarily included β-type structures (levels>45%) and random coil architecture (levels>45%). On the basis of these and other data, it is suggested that the short anionic N-terminal sequence(TES) of Cn-AMP2 interacts with positively charged moieties in the cancer cell membrane. Concomitantly, the long hydrophobic C-terminal sequence (YFVFSVGM) of the peptide penetrates the membrane core region, thereby driving the translocation of Cn-AMP2 across the cancer cell membrane to attack intracellular targets and induce anti-proliferative mechanisms. This work is the first to demonstrate that anionic host defence peptides have activity against human glioblastoma, which potentially provides an untapped source of lead compounds for development as novel agents in the treatment of these and other cancers. Copyright © 2014 European Peptide Society and John Wiley & Sons, Ltd

'Diastereoselective Carbocyclization of 1,6-Heptadienes Triggered by Rhodium-Catalyzed Activation of an Olefinic C-H Bond'

The use of α,ω‐dienes as functionalization reagents for olefinic carbon–hydrogen bonds has been rarely studied. Reported herein is the rhodium(I)‐catalyzed rearrangement of prochiral 1,6‐heptadienes into [2,2,1]‐cycloheptane derivatives with concomitant creation of at least three stereogenic centers and complete diastereocontrol. Deuterium‐labeling studies and the isolation of a key intermediate are consistent with a group‐directed C-H bond activation, followed by two consecutive migratory insertions, with only the latter step being diastereoselective

Co-Creation of Breast Cancer Risk Communication Tools and an Assessment of Risk Factor Awareness: A Qualitative Study of Patients and the Public in India.

BACKGROUND: Low awareness of BC and its associated risk factors causes delays in diagnosis and impacts survival. It is critical to communicate BC risk to patients in a format that they are easily able to understand. Our study aim was to develop easy-to-follow transmedia prototypes to communicate BC risk and evaluate user preferences, alongside exploring awareness of BC and its risk factors. METHODS: Prototypes of transmedia tools for risk communication were developed with multidisciplinary input. A qualitative in-depth online interview study was undertaken using a pre-defined topic guide of BC patients (7), their relatives (6), the general public (6), and health professionals (6). Interviews were analyzed using a thematic approach. FINDINGS: Most participants preferred pictographic representations (frequency format) of lifetime risk and risk factors and storytelling using short animations and comic strips (infographics) for communicating genetic risk and testing: "In a short time, they explained it very well, and I liked it". Suggestions included minimizing technical terminology, decreasing the delivery speed, "two-way dialogue", and using local "language for different locations". There was low awareness of BC, with some understanding of age and hereditary risk factors but limited knowledge of reproductive factors. INTERPRETATION: Our findings support use of multiple context-specific multimedia tools in communicating cancer risk in an easy-to-understand way. The preference for storytelling using animations and infographics is a novel finding and should be more widely explored

Synthesis of the originally proposed structures of elatenyne and an enyne from Laurencia majuscula

A bidirectional synthesis of the originally proposed structures for the natural products elatenyne and a chloroenyne from Laurencia majuscula is described along with a reassessment of the structures of the halogenated enynes based upon a C-13 NMR chemical shift/structure correlation