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Sunday, April 20, 2014

Absence of Izumo-Juno Protein pairing may cause Infertility, even all other Factors remaining Normal

Posted by Prahallad Panda on 8:21 AM Comments

Till now, it is a standard teaching that sperm moves ahead to fertilize ovum, but how it is attracted has been found recently.
Researchers at the Wellcome Trust Sanger Institute have discovered interacting proteins on the surface of the sperm and the egg essential for conjugation. The protein attract egg and sperm towards each other.

English: Electron microscope image of sperm.
English: Electron microscope image of sperm. (Photo credit: Wikipedia)
Japanese researchers identified a protein in 2005 and named Izumo after a Japanese marriage shrine, which is displayed on the surface of sperm that recognizes egg. But its mate on the egg has remained a mystery till now.
The researchers have identified a single protein that paired with Izumo and is necessary for fertilization. The protein is named Juno after the Roman Goddess of fertility and marriage.
The team developed mice that lacked the Juno protein on the surface of their eggs. These mice were infertile and their eggs did not fuse with normal sperm, highlighting that the Juno protein is essential for fertility in female mice. In the same way, male mice lacking the Izumo protein are also infertile, highlighting its essential role in male fertility.
The team discovered that after about 40 minutes of the initial fertilization step, there is a sudden loss of the Juno protein from the surface of the egg. This may explain why the egg, once fertilized by the first sperm cell, shuts down its ability to recognize further sperm. This prevents the formation of embryos with more than one sperm cell that would otherwise have too many chromosomes and die.
The team is now screening infertile women to understand whether defects in the Juno receptor are a cause of infertility. If it is, then a simple genetic screening test could help inform the appropriate treatment for women struggling to conceive naturally by reducing the expense and stress often involved in assisted fertility treatments.
The article published in The ScienceDaily can be viewed here.
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Tuesday, January 14, 2014

High up Caecum and Difficult Appendicectomy

Posted by Prahallad Panda on 9:13 PM Comments

Pain, fever and nausea/vomiting, Murphy’s triad points to appendicitis; an ultrasonogram supports the provisional diagnosis. Through Lanz (R) incision abdomen opened; usually a finger should be able to feel the appendix in abdomen. If, not felt, a portion of colon is brought out and traced to the coalescence of the all three tinea coli to the base of appendix.

English: A cat scan demonstrating acute append...
English: A cat scan demonstrating acute appendicitis (note the appendix has a diameter of 17.1mm) (Photo credit: Wikipedia)
 All went in vain, became frustrated, not to find the one; saw an enlarged right ovary that was mentioned to be normal in the ultrasonogram. But, I was after appendix. A little confusion, is the enlarged ovary the cause of pain, not appendix?
To my good luck, thought came to mind to feel upwards, high up, towards Gall Bladder, some structure similar to the feeling of a diseased appendix was felt, raising some hope and apprehension. Apprehension is that, is it something else? Not viewable, manipulated by one finger, together with the retraction of wound upwards by assistant, saw something that raised hope, still not very much forth coming.
Anyway, able to saw it at last; applied bob cocks and went for retrograde appendicectomy. Turned my view to the enlarged right ovary, on holding it with allies forceps, all watery fluid came out. Marsupialized and arrested all oozing.
Ohh, relieved.  At one time, was contemplating to open the abdomen fully in lower right paramedian plane.
Every case is a new case for a doctor. Appendicitis, both easy and difficult to diagnose; and the same is true for appendicectomy too.

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Sunday, December 29, 2013

Cinnamon may be Beneficial for Control of Bad Fats and Diabetes

Posted by Prahallad Panda on 12:25 PM Comments

The beneficial effect of cinnamon was being studied in the recent years. A double blind, placebo controlled study has shown that the consumption of 1.5 gms (Half a teaspoonful) of cinnamon powder daily, physical activity and balanced diet may reduce insulin resistance in diabetics and lower the bad fats (LDL) level.
English: Cinnamon
English: Cinnamon (Photo credit: Wikipedia)

Cinnamon may help remedy lipid profiles and have therapeutic benefits in patients with nonalcoholic fatty liver disease (NAFLD), according to a new Iranian trial. The trial was conducted by Dr. Hekmatdoost and colleagues of the Shahid Beheshti University of Medical Sciences, Tehran and was published online in the Nutrition Research on 9th December, 2013.
It was found that 12 weeks consumption of 1.5 grams (half of a teaspoon) cinnamon per day plus a balanced diet improves insulin resistance and eases Non-Alcoholic Fatty Liver Disease (NAFLD) by lowering the LDL (Low density Lipoprotein) level. The effect may be due to the anti-oxidant and insulin-sensitizer properties of cinnamon.
The researchers studied 50 patients who were randomized to two 750 mg capsules of cinnamon or placebo daily for 12 weeks. All patients were given advice on how to integrate a balanced diet and physical activity into their daily lives.
In both groups, LDL cholesterol dropped significantly but there was no significant change in serum HDL cholesterol levels. After 12 weeks, LDL levels were 55.8 mg/dL in the treatment group and 90.3 mg/dL in the placebo group (p=0.032).
In the active treatment group there were also significant decreases in the HOMA (Homeostatic Model Assessment) index, fasting blood glucose, total cholesterol, triglyceride; and liver enzymes like alanine aminotransferase and aspartate aminotransferase. This was also true of gamma glutamine transpeptidase and high-sensitivity C-reactive protein (hs-CRP).
The researchers note that although the study was small, the findings are in line with those of other studies and confirm their hypothesis that cinnamon supplementation can reduce the main characteristics of NAFLD, including insulin resistance, liver enzymes, and the inflammatory marker hs-CRP.
More studies are needed, they conclude, but it appears that cinnamon "could be a good adjuvant therapeutic option for this disease."

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Sunday, December 8, 2013

Prevention and Treatment of Steroid Induced Osteoporosis in SLE in a nutshell

Posted by Prahallad Panda on 5:25 PM Comments

Long term glucocorticoid (GC) therapy may cause osteopenia or osteoporosis in patients suffering from SLE (Systemic Lupus Erytematosus). Osteopenia and osteoporosis are conditions, where there occurs rarification of bone due to less availability of calcium for bone health. In other wards the bone mass is decreased.
The frequency of osteoporosis in SLE ranges from 4.0 to 48.8% and that of osteopenia from 1.4 to 68.7%.
There are several ways in which this can happen:
1.       Inhibiting calcium absorption from the gastrointestinal track.
2.       Decreasing the renal tubular reabsorption of calcium and consequent secondary hyperparathyroidism.
3.       Glucocorticoids reduce growth hormone (GH) secretion and may alter the GH/insulin‐like growth factor (IGF)‐I axis. But, this may play a minor role.
4.       There is also an alteration in hypothalamic gonadotrophin‐releasing hormone secretion with subsequent reduction in serum testosterone and oestradiol levels.
5.       Inhibiting IGF‐I transcription in osteoblasts (Bone forming cells).
6.       Reducing the replication, differentiation and function of osteoblasts and increase the apoptosis rates of mature cells, thereby depleting the osteoblastic cell population and inhibiting the function of mature cells.
7.       In the presence of GCs, bone marrow stromal cells do not differentiate into osteoblasts; instead, these cells differentiate toward an adipocyte cell lineage.
8.       GCs increase the expression of macrophage colony stimulating factor (M‐CSF) and receptor activator of Nuclear factor kappa beta ( NF‐kB) ligand (RANK‐L).
9.       In addition, GCs decrease the expression of osteoprotegerin in stromal and osteoblastic cells.
Through these mechanisms, GCs can induce the formation of osteoclasts (Act opposite Osteoblasts) to and favour bone resorption. GCs also reduce the rate of apoptosis among mature osteoclasts.
Bone mineral density (BMD) can be tested by DXA (Dual-energy X-rays Absorptiometry). Results are scored compared with the BMD of young, healthy people and is expressed in a measure called a T-score. The scoring is as follows:

Dual-energy X-ray absorptiometry (DEXA) assess...
Dual-energy X-ray absorptiometry (DEXA) assessment of bone mineral density of the femoral neck (A) and the lumbar spine (B): T scores of - 4.2 and - 4.3 were found at the hip (A) and lumbar spine (B), respectively in a 53 year-old male patient affected with Fabry disease. Courtesy: Dr Caroline LEBRETON, CHU Raymond Poincaré, Garches, France. (Photo credit: Wikipedia)
DXA T-Score
Bone Mineral Density (BMD)
Not lower than –1.0
Between –1.0 and –2.5
Osteopenia (mild BMD loss)
–2.5 or lower
To prevent osteopenia and osteoporosis in the first place, some preventive measures can be taken.
  • Be physically active and do weight-bearing exercises, like walking, most days of each week.
  • Change lifestyle choices that raise your risk of OP, such as quitting smoking.
  • Implement strategies to help decrease your risk of falling, which raises the risk of fractures.
  • Get DXA testing of your BMD.
Treatment of established osteoporosis:
Vitamin D increases intestinal calcium absorption and increases its reabsorption in distal renal tubules. Serum levels of at least 30 ng/mL (82 nmol/L), and optimally of 40–60 ng/mL, of 25‐hydroxyvitamin D should be the target treatment regimen for GIO management. To achieve these levels, 1,000 to 2,000 IU of oral vitamin D daily or 50,000 to 60,000 IU per week may be necessary.
Bisphosphonates are indicated for the prevention and treatment of GIO (Glucocorticoid Induced Osteoporosis) and most guidelines recommend the use of these drugs. The prevention and treatment goals of bisphosphonate use are stabilizing or increasing bone mineral density, as well as reducing frequency of fractures.
Currently, alendronate (70 mg/week or 10 mg/day) and risedronate (35 mg/week or 5 mg/day) are the some of the oral antiresorptive drugs that are recommended in GIO. Zoledronic acid, in injection form had been approved for the prevention and treatment of GIO.
Caution needs to be exercised when considering the use of bisphosphonates in women of childbearing age with GIO, given that bisphosphonates have an extended half‐life and may cross the placenta with potentially unfavourable effects on foetal skeletal development. The adverse effect like osteonecrosis of jaw (ONJ) has to be kept in mind, while prescribing it.
Teriparatide a synthetic parathormone had also been approved by USFDA for treatment of GIO. It is taken as subcutaneous injection daily. It may not be continued for more than 2 years at a time. The injection comes in pre-filled syringes containing 30 doses.
In a randomized multicenter trial, it had been seen that subcutaneous teriparatide (20 µg/day) is more effective in comparison to the use of oral alendronate (10 mg/day) over 18 months in patients with established GIO.
The key to prevent and treat Glucocorticoid Induced Osteoporosis are adequate weight bearing physical exercise, calcium and vitamin D intake in adequate doses.  
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