Background Although epidemiological studies have reported positive associations between circulating urate levels and cardiometabolic diseases, causality remains uncertain. Objective Through a Mendelian randomization approach, we assessed whether serum urate levels are causally relevant in type-2 diabetes (T2D), coronary heart disease (CHD), ischemic stroke and heart failure. Methods We investigated 28 SNPs known to regulate serum urate levels in association with a range of vascular and non-vascular risk factors to assess pleiotropy. To limit genetic confounding, 14 SNPs found exclusively associated with serum urate levels were used in a genetic risk score to assess associations with the following cardiometabolic diseases (cases/controls): T2D (26,488/83,964), CHD (54,501/68,275), ischemic stroke (14,779/67,312) and heart failure (4,526/18,400). As a positive control, we also investigated our genetic instrument in 3,151 gout cases and 68,350 controls. Results Serum urate levels, raised by 1 standard deviation (SD) due to the genetic score, were not associated with T2D (odds ratio [OR] 0.95, 95% CI, 0.86–1.05), CHD (OR. 1.02, 95% CI, 0.92–1.12), ischemic stroke (OR. 0.99, 95% CI, 0.88–1.12), or heart failure (OR. Q1.07, 95% CI, 0.88–1.30). These results were in contrast with previous prospective studies that observed increased risks of T2D (OR. 1.25, 95% CI, 1.13–1.37), CHD (OR. 1.06, 95% CI, 1.03–1.09), ischemic stroke (OR. 1.17, 95% CI, 1.00–1.37), and heart failure (OR. 1.19, 95% CI, 1.17–1.21) for an equivalent increase in circulating urate levels. However, a 1 SD increase in serum urate levels due to the genetic score was associated with increased risk of gout (OR. 5.84, 95% CI, 4.56–7.49), which was directionally consistent with associations observed in previous epidemiological studies Conclusions Evidence from this study does not support a causal role of circulating serum urate levels in T2D, CHD, ischemic stroke, or heart failure. Lowering serum urate levels may not translate into risk reductions for cardiometabolic conditions.

Choledochal cysts present differently in adults and children; whereas children present with the classic triad, adults present with common biliary or infective complications. Although the methods of detection and surgical treatment are similar for the two groups, the type IVa cyst typically seen in the adult group creates a marked deviation with respect to long-term complications such as ascending cholangitis, anastomotic strictures, stone formation, and development of cholangiocarcinoma. These are areas of grave concern that can be addressed to a large extent by providing an access loop during the initial surgery especially for type IVa cysts. The glaring differences in terms of presentation, histologic picture, and outcome urges us to consider choledochal cysts in children as a separate entity.

Ascariasis, a helminthic infection of humans, is the most common parasitic infestation of the gastrointestinal tract. It infects about 25% of the world's population; around 20 thousand deaths occur per year from an adverse clinical course of the disease. This review is focused on biliary ascariasis, examining in some detail the pathogenesis of the disease with special reference to postcholecystectomy ascariasis and related issues. Although an endemic disease of tropical and subtropical countries, increasing population migration facilitated by fast improving communication facilities demands that clinicians everywhere be familiar with the clinical profile and management of biliary ascariasis.

Although, out of 26 choledochoplasties, we encountered only one (3.84%) stump stone in a maximum follow-up period of 59 months, further long-term follow-up studies are required to prove the efficacy of the procedure.

BACKGROUND AND OBJECTIVES:Because breast cancer in men is rare, few patients are available for prospective studies. To learn more about its epidemiology, risk factors, clinical features, genetics and pathology in our country, we conducted a retrospective study of all cases seen in recent decades at our institution.PATIENTS AND METHODS:We identified each case of male breast cancer in the database at the Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India, between the years 1983 to 2007.RESULTS:We identified only 32 cases of male breast cancer over the 24-year period. Male breast cancer accounted for 32 (2.8%) of 1141 resected breast specimens, which included all breast lesions and 32 (4.1%) of 780 breast cancer cases. Of the 32 cases, 20 (62.5%) had various associated risk factors. Invasive ductal carcinoma was seen in 30 cases (93.7%). Of 20 cases that underwent molecular studies, 16 (80%) patients had estrogen receptor positivity whereas 14 (70%) had progesterone receptor positivity. Six cases (30%) overexpressed HER2 and p53. The BRCA2 mutation was observed in 4 cases (40%) while no patient presented with the BRCA1 mutation.CONCLUSION:An incidence of 4.1% for male breast cancer indicates that this disease is not as uncommon as presumed in this part of the world. Breast cancer in men seems more frequently to be hormone receptor positive and the BRCA2 mutation confers a significant risk to men.