The Human Microbiome and Recurrent Abdominal Pain in Children

This project explores the nature of the human intestinal microbiome in healthy children and children with recurrent abdominal pain. The overall goal is to obtain a robust knowledge base of the intestinal microbiome in children without evidence of pain or gastrointestinal disease and in those with recurrent abdominal pain (functional abdominal pain (FAP) and FAP associated with changes in bowel habits, i.e., irritable bowel syndrome or IBS). Specific aims include: 1. Characterize the composition of the gut microbiome in healthy children by DNA sequencing. 2. Determine the presence of disease-specific organism signatures of variable gut microbiomes in children with recurrent abdominal pain. 3. Perform functional gut metagenomics by evaluation of whole community gene expression profiles and discovery of disease-specific pathway signatures. Multiple strategies have been deployed to navigate and understand the nature of the intestinal microbiome in childhood. These strategies included 454 pyrosequencing-based strategies to sequence 16S rRNA genes and understand the detailed composition of microbes in healthy and disease groups. Microarray-based hybridization with the PhyloChip and quantitative real-time PCR (qPCR) probes were applied as complementary strategies to gain an understanding of the intestinal microbiome from various perspectives. Data collected and analyzed during the HMP UH2 Demo project, from a set of healthy and IBS children (7-12 yo) may enable the identification of core microbiomes in children, in addition to variable components that may distinguish healthy from diseased pediatric states. Twenty-two children with IBS and twenty-two healthy children were enrolled and analyzed in the UH2 phase of this study. The planned enrollment targets for the UH2/3 phases include 50 healthy children, 50 children with FAP and 50 children with IBS (minimum of 3 time points per child). We are currently analyzing the dataset for the presence of disease-specific signatures in the human microbiome, and correlating these microbial signatures with pediatric health or IBS disease status in addition to IBS subtype (e.g., diarrhea-vs constipation-predominant). In the next phase, whole genome shotgun sequencing and metatranscriptomics will be performed with a subset of children in each group. This study explores the nature of core and variable human microbiome in pre-adolescent healthy children and children with IBS. 
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Urological disorders and pregnancy: An overall experience

Aim: Pregnancy is an anatomical and physiological altered state and the presence of various urological problems not only aggravates the disease itself, but also results in unfavourable pregnancy outcome. Aim is to highlight obstetric outcome in pregnant women with urological problems. Materials and Methods: Longitudinal prospective cohort study conducted in tertiary care hospital, IPGME and R, Kolkata from Jan 2011 to Dec 2012. All pregnant women with urological problems were included as subjects. Results: A total of 33 subjects were followed up throughout their antenatal period. Among them majority (72.72%) presented with hydro nephrosis followed by hydroureter (60.6%), PUJ obstruction and pyelonephritis each with incidence of 15.15%, then urolithiasis (12.12%), nephrolithiasis (6.06%) and renal abscess (12.12%). Interventions required were DJ stenting (72.72%), pyeloplasty (15.15%) and others were RURSL, abscess drainage and ATT. The pregnancy outcome was complicated with preterm labor in majority of patients (45.45%), oligohydramnious (18.18%), PIH (9.09%) and still birth (6.06%). Twenty four live birth were there. Majority required NICU admissions as predominantly prematurity was an important concern. Majority women with hydronephrosis underwent DJ stenting. Conclusion: Preterm labor is an important obstetric concern. Vaginal delivery is the choicest mode of termination and LSCS can be reserved for obstetric reason. DJ stenting is safe and practical approach for continuation of pregnancy with hydronephrosis. Regular follow up, vigilant antenatal care and multidisciplinary approach from urologist, obstetrician and neonatologist will bring out successful pregnancy outcome

Predicting IUGR by Uterine and Umbilical doppler: Though Old but Gold

Introduction- The uterine and umbilical artery Doppler interrogation is an established non-invasive tool for evaluation of placental blood flow in pregnancy. The doppler studies have huge potential in detecting placental insufficiency which increases the risk of complications like preeclampsia, intrauterine growth-restriction (IUGR).This leads to early prediction and better surveillance, which ultimately results in reduction of maternal and perinatal mortality. Objective- This study was aimed to evaluate and compare the uterine and umbilical artery Doppler indices for early prediction of IUGR. Method- This prospective observational study was conducted over one year on 100 low-risk and 50 high-risk singleton pregnancies. All antenatal women were subjected to screening Doppler studies between 21-25 weeks and 31-35 weeks and followed up for subsequent development of IUGR and other pregnancy outcomes. Results: Out of the 150 study population, 19 mothers delivered IUGR fetus with incidence of 12.67% (5% in low-risk and 28% in high-risk women). 48 study participants had abnormal Doppler values; 43 had uterine artery and 17 had umbilical artery Doppler abnormality. 12 women had both uterine and umbilical artery Doppler abnormalities, out of these 9 developed IUGR. Out of 5 women who had bilateral persistent uterine artery diastolic notches, 3 delivered IUGR baby. For predicting IUGR in second trimester, the right uterine RI was most sensitive with highest NPV and right uterine PI was most specific. The PPV of PI of right uterine and umbilical artery was highest during the time. For IUGR prediction in third trimester, all Doppler parameters were highly specific and had good NPV. The sensitivity of all the parameters was low, the highest being 37% for left uterine RI and S/D. The PPV of umbilical artery RI (83%) was significantly higher than others. In both the trimesters the sensitivity, specificity and NPV of all the Doppler parameters was similar. The combined abnormal uterine and umbilical artery Doppler reveals a higher sensitivity (47.37%), NPV (92.81%) and PPV (75%), thus a better predictor of IUGR. Conclusion: The Doppler velocimetry is a useful tool for placental circulation surveillance especially in high-risk pregnancies. It is recommended to perform second trimester Doppler meticulously for early prediction and timely intervention in high-risk pregnancy. The second trimester uterine artery RI, persistent uterine artery diastolic notch, combined Doppler abnormalities of both arteries has good predictive value for growth restriction

Peripartum cardiomyopathy coexistent with human immunodeficiency virus: A substantial obstetric jeopardy

Peripartum cardiomyopathy (PPCM) is a rare cause of pregnancy-related heart failure, which affects a woman during the last months of pregnancy or first months of parturition. Its etiopathogenesis is still unclear. Coexistence of PPCM with human immunodeficiency virus (HIV) has been scarcely analyzed. A low CD4 count is proposed to be one of the predictors of dilated cardiomyopathy in HIV. Here, a pregnant woman with HIV presented with signs of congestive heart failure for the first time during her last trimester. Echocardiography revealed a dilated cardiomyopathy with ejection fraction of 34% which proved the diagnosis of PPCM. She underwent cesarean section for impending previous scar rupture. Her status deteriorated subsequently in spite of all efforts and she succumbed due to ventricular tachycardia. This case necessitates an awareness regarding coexistence of HIV with PPCM and dreaded clinical sequences. Patients suffering from HIV should be treated well and their CD4 count should be improved before conception to avoid such complications in pregnancy

Correlation of BMI and serum albumin with c-reactive protein in male patients with stable chronic obstructive pulmonary disease

Background: There is growing consensus that chronic obstructive pulmonary disease (COPD), a chronic inflammatory disease of the airways and lung parenchyma is associated with low grade systemic inflammation even in stable COPD, which increases during acute exacerbation. It is still debated whether the inflammation is a spill-over from the lung or the lung bears the share of systemic inflammation in COPD. There is systemic manifestation in COPD which is responsible for its severity in individual cases, but it is not clearly known whether the systemic inflammation give rise to systemic manifestations.Methods: In this background we measured serum C-reactive protein (CRP) level in 53 stable COPD patients and 32 age/sex matched control without known ischemic heart disease (IHD)/ diabetes mellitus (DM)/ peripheral arterial disease and normal chest X-ray and tried to find out any correlation of serum CRP level (marker of systemic inflammation) with BMI and serum albumin (marker of nutritional abnormality).Results: The study found that serum CRP level was significantly higher in stable COPD patient in comparison to healthy control. (6.226±3.9 vs 1.31±0.53).Though serum CRP level did not significantly increase with increasing severity of the disease, but serum CRP level was significantly increased in COPD patients with low BMI and low serum albumin (9.10±3.14 vs 4.01±2.90 p value <0.001 and 8.51±3.5 vs 3.59±2.5 with p value <0.001 respectively for BMI and serum albumin).Conclusions: So, the study concluded that stable COPD is associated with increased systemic inflammatory markers than normal control, correlates significantly with nutritional parameters in COPD like BMI and serum albumin level and may be an indicator of malnutrition regardless of lung function impairment

Partial Invasive Molar Pregnancy –2 Case Reports

Gestational trophoblastic disease encompasses several entities like complete mole , partial mole , invasive mole , gestational trophoblastic carcinoma and trophoblastic carcinoma from implantation site . These entities are different from each other by their origins , morphology , their evolution and their treatment. Among all components partial mole is very common (90%) and triploid genetically. This is one of the important causative factors of miscarriages. Very rarely (2-4%) partial mole can develop into invasive one presenting with features of incomplete abortion , missed abortion and sometimes as obstetric emergencies like intra peritoneal hemorrhage and torrential vaginal bleeding .So proper diagnosis and timely intervention can prevent mortality and reduce morbidity of the patients. Here we report two such cases of partial invasive molar pregnancies with varied picture

A Forward Genetic Approach to Mapping a P-Element Second Site Mutation Identifies DCP2 as a Novel Tumor Suppressor in Drosophila melanogaster

The use of transposons to create mutations has been the cornerstone of Drosophila genetics in the past few decades. Second-site mutations caused by transpositions are often devoid of transposons and thereby affect subsequent analyses. In a P-element mutagenesis screen, a second site mutation was identified on chromosome 3, wherein the homozygous mutants exhibit classic hallmarks of tumor suppressor mutants, including brain tumor and lethality; hence the mutant line was initially named as lethal (3) tumorous brain [l(3)tb]. Classical genetic approaches relying on meiotic recombination and subsequent complementation with chromosomal deletions and gene mutations mapped the mutation to CG6169, the mRNA decapping protein 2 (DCP2), on the left arm of the third chromosome (3L). Thus the mutation was renamed as DCP2l(3)tb. Fine mapping of the mutation further identified the presence of a Gypsy-LTR like sequence in the 5′UTR coding region of DCP2, along with the expansion of the adjacent upstream intergenic AT-rich sequence. The mutant phenotypes are rescued by the introduction of a functional copy of DCP2 in the mutant background, thereby establishing the causal role of the mutation and providing a genetic validation of the allelism. With the increasing repertoire of genes being associated with tumor biology, this is the first instance of mRNA decapping protein being implicated in Drosophila tumorigenesis. Our findings, therefore, imply a plausible role for the mRNA degradation pathway in tumorigenesis and identify DCP2 as a potential candidate for future explorations of cell cycle regulatory mechanisms