Diagnostic Utility of NLR, PLR and MLR in Early Diagnosis of Gastric Cancer: an Analytical Cross-Sectional Study.

PURPOSE: Inflammatory markers such as neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) are linked with the pathogenesis of gastric cancer (GC). However, the clinical significance of the combination of these markers is unclear. Hence, this study was carried out to determine the individual and combined diagnostic accuracy of NLR, PLR and MLR among patients with GC. METHODS: In this prospective, cross-sectional study, patients were recruited into three groups, GC, precancerous lesions and age and gender-matched controls. The primary outcome was to determine the diagnostic accuracy of inflammatory markers in the diagnosis of GC. The secondary outcome was to determine the correlation of inflammatory markers with the stage of gastric cancer, nodal involvement and metastasis. RESULTS: A total of 228 patients, 76 in each group, were enrolled. The cut-off value of NLR, PLR and MLR were 2.23, 146.8 and 0.26, respectively, for the diagnosis of GC. The diagnostic abilities of NLR, PLR and MLR were significantly high at 79, 75 and 68.4, respectively, to predict GC compared to precancerous and control groups. All the models of inflammatory markers showed excellent discrimination between GC and the controls with an AUC > 0.7. The models also showed acceptable discrimination between GC and the precancerous lesion group with AUC between 0.65 and 0.70. No significant difference was found in correlating inflammatory markers with clinicopathological features. CONCLUSION: The discrimination capacity of the inflammatory markers could be used as screening biomarkers in diagnosing GC, even in its early stages.

Analysis and Characterization of Lactobacillus paragasseri and Lacticaseibacillus paracasei: Two Probiotic Bacteria that Can Degrade Intestinal Oxalate in Hyperoxaluric Rats.

In the present study, we characterized the probiotic properties of two commercially available bacterial strains, Lactobacillus paragasseri UBLG-36 and Lacticaseibacillus paracasei UBLPC-87, and evaluated their ability to degrade oxalate in vitro and in a hyperoxaluria-induced nephrolithiasis rat model. UBLG-36 harboring two oxalate catabolizing genes, oxalyl coenzyme A decarboxylase (oxc) and formyl coenzyme A transferase (frc), was previously shown to degrade oxalate in vitro effectively. Here, we show that UBLPC-87, lacking both oxc and frc, could still degrade oxalate in vitro. Both these strains harbored several potential putative probiotic genes that may have conferred them the ability to survive in low pH and 0.3% bile, resist antibiotic stress, show antagonistic activity against pathogenic bacteria, and adhere to epithelial cell surfaces. We further evaluated if UBLG-36 and UBLPC-87 could degrade oxalate in vivo and prevent hyperoxaluria-induced nephrolithiasis in rats. We observed that rats treated with 4.5% sodium oxalate (NaOx) developed hyperoxaluria and renal stones. However, when pre-treated with UBLG-36 or UBLPC-87 before administering 4.5% NaOx, the rats were protected against several pathophysiological manifestations of hyperoxaluria. Compared to the hyperoxaluric rats, the probiotic pre-treated rats showed reduced urinary excretion of oxalate and urea (p < 0.05), decreased serum blood urea nitrogen and creatinine (p < 0.05), alleviated stone formation and renal histological damage, and an overall decrease in renal tissue oxalate and calcium content (p < 0.05). Taken together, both UBLG-36 and UBLPC-87 are effective oxalate catabolizing probiotics capable of preventing hyperoxaluria and alleviating renal damage associated with nephrolithiasis.

Combined effect of polyacrylic acid and vitamin E in preventing calcium oxalate crystal deposition in the kidneys of experimental hyperoxaluric rats.

Our study explores the combined effect of polyacrylic acid and vitamin E as prophylactic and curative agent against ethylene glycol (EG) induced calcium oxalate stone formation in Wistar rats. Male Wistar rats (54) were divided into nine groups, including control. The experimental groups were equally segregated into two for preventive study (4) and curative study (4). Urolithiasis was induced with 0.75% (v/v) EG in drinking water. Polyacrylic acid (10 mg/kg) and vitamin E (300 IU/day) were supplemented from day 1 for preventive and day 30 for curative studies. Restoration of urinary lithogenic factors (calcium, oxalate, phosphate, citrate and magnesium) and renal function (urea and creatinine in serum) by intervening agents were accomplished compared to urolithic rats (P < .001). Abnormal localization and increased expression of Tamm-Horsfall Protein, osteopontin and transferrin were observed in the kidneys of urolithic rats (P < .001) from immunohistochemistry and immunoblotting analysis. Polyacrylic acid and vitamin E supplementation have regulated the expression of the urinary macromolecules. Pro-inflammatory cytokines in kidney were significantly reduced (P < .001) by the intervening agents compared to urolithic rats. Therefore, polyacrylic acid and vitamin E in combination could be a potential formulation for better management of urolithiasis.

Acute kidney injury in patients hospitalized with febrile urinary tract infections: A prospective observational study.

BACKGROUND: Febrile urinary tract infection (fUTI) can be associated with acute kidney injury (AKI). We aimed to study the risk factors for AKI, its pathophysiological categories, and the role of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in differentiating these categories in patients hospitalized with fUTI. MATERIALS AND METHODS: We prospectively studied patients with fUTI admitted to the Department of Medicine of a tertiary care hospital in southern India from January 2017 to December 2018. Clinical evaluation, renal imaging, and estimation of fractional excretion of sodium (FeNa) and uNGAL were done at baseline. AKI was defined as ≥ 0.3 mg/dL rise in serum creatinine (SCr) within 48 hours during hospital stay (KDIGO criterion) or discharge SCr value 0.5 mg/dL or less compared to peak SCr after admission. RESULTS: We studied 100 patients. Their mean age was 52 (± 14) years; 45 were men. In all, 52 had AKI: pre-renal in 11 (21%), intrinsic renal in 24 (47%), post-renal in 16 (31%), and missing data 1 patient. uNGAL levels were significantly higher in the AKI group compared to the no-AKI group (median [IQR] 91.1 [13.2 - 188] vs. 264.9 [115.2 - 355.2] ng/mL; p < 0.001). On multivariable analysis, male sex (adjusted odds ratio, aOR [95% CI] 2.8 [1.09 - 7.14]), hypertension (4.12 [1.24 - 13.7]) and hydroureteronephrosis (7.82 [1.55 - 39.4]) were independently associated with AKI. There was an increasing trend of uNGAL across the three categories of AKI (pre-renal 106.1 [14.6 - 261.7] ng/mL, intrinsic renal 210.8 [8.5 - 353.8] ng/mL, and post-renal 335.5 [269.2 - 692.8] ng/mL; p = 0.001). Patients with pre-renal AKI had significantly lower levels of uNGAL compared to the other two categories combined (106.1 [14.6 - 261.7] vs. 284.6 [179 - 434.4] ng/mL; p = 0.016). CONCLUSION: Hospitalized fUTI patients should be evaluated for AKI, and obstructive uropathy should be ruled out in those with AKI. uNGAL levels may help in differentiating the pre-renal type of AKI from the other two categories.

Disseminated Kaposi's sarcoma as a presenting sign of HIV in an Indian male: A case report with dermoscopic findings.

Kaposi's sarcoma (KS) is one of the AIDS-defining illnesses, which tends to occur at low CD4 count. It is the most common malignancy associated with HIV disease. Yet, there is a paucity of Indian case reports of KS in the English literature. We report the case of a 45-year-old HIV-positive heterosexual male with an unusual presentation of KS in the form of unilateral lymphedema mimicking cellulitis. We also describe the dermoscopic findings of the same.

A novel approach to decalcification in histopathology laboratory: An adaptation from the Hammersmith protocol.

AIM: Utility of modified Hammersmith protocol in the deacalcification and/or softening of tissues and samples in a histopathology laboratory were studied. The object of the study was to prepare a novel method for softening/decalcifying tissue for histopathology. MATERIALS AND METHODS: All the hard tissues received in the histopathology section were received in 10% neutral buffered formalin and then placed in freshly prepared combination of 10 mL of concentrated formaldehyde and 5 mL of 10% formic acid in 85 mL distilled water was used for decalcification. The tissue was checked for evidence of adequate decalcification/softening every 6 hours. Those which were decalcified/softened were sent for routine tissue processing and staining, while those which were not, were again placed in formalin. The process was repeated until the tissue was ready for further processing. The routine sections of these slides were reviewed for morphology and stain quality along with special stains and immunohistochemistry performed. The time taken for decalcification, the variables most likely to affect decalcification, the morphology and staining characteristics were documented. Statistical analysis was done to determine the effect of softening/decalcification process on each variable. RESULTS: A total of 201 blocks in 119 specimens from humans including 61 males and 58 females were studied. Time taken was found to have a significant correlation only with the nature of the tissue (bone vs nonbone) and not with any other parameter viz. age, gender, specimen size, type of bone, and nature of pathology. CONCLUSION: This novel and modified method has circumvented the common problems of overdecalcification, preserved morphology, and produced consistent results without interfering with special stains and immunohistochemistry.

Haemolytic uraemic syndrome with peripheral gangrene and Kawasaki disease in a 15-month-old child.

A 15-month-old boy presented with atypical haemolytic uraemic syndrome (HUS) (without antecedent diarrhoea or dysentery) following a gluteal abscess and subsequently developed digital gangrene. During plasma infusion therapy for HUS, the clinical features of Kawasaki disease (KD) evolved. Intravenous immunoglobulin and aspirin therapy led to resolution of the KD. The case is notable for development of digital gangrene, a rare phenomenon described with HUS, as well as the development of features of KD. This is the first report of atypical HUS in association with peripheral gangrene and KD. The possible pathophysiological mechanisms are discussed.

Severe acute kidney injury in children owing to infective endocarditis-associated immune complex glomerulonephritis: a report of two cases.

Renal involvement in infective endocarditis (IE) may manifest with different clinical patterns, including diffuse proliferative glomerulonephritis and crescentic glomerulonephritis, which may lead to haematuria and/or proteinuria. However, severe acute kidney injury (AKI) in such cases is extremely uncommon and is reported mostly in adults. Two children with rheumatic heart disease and a peri-membranous ventricular septal defect, respectively, who developed haematuria, proteinuria and severe AKI in association with IE are reported. The first case had diffuse proliferative glomerulonephritis with 10% cellular crescents, and made a complete renal recovery with antibiotics and intravenous methylprednisolone followed by oral prednisolone. However, the second case had severe crescentic glomerulonephritis which led to residual renal injury despite intravenous methylprednisolone and cyclophosphamide in combination with antibiotics. The cases illustrate that crescentic glomerulonephritis or severe diffuse proliferative glomerulonephritis should be considered as possible complications in children presenting with haematuria, proteinuria and severe AKI. Renal biopsy along with antibiotic therapy and prompt immunosuppressive therapy should be considered for the management of this potentially life-threatening condition.

Lipoblastoma presenting as a rapidly growing paravertebral mass and masquerading as myxoid liposarcoma on fine needle aspiration cytology.

Lipoblastoma is a peculiar variant of lipoma occurring almost exclusively during infancy and early childhood. It is found most commonly in the upper and lower extremities; less common sites are head and neck, trunk, mediastinum, and retroperitoneum. It has a greater predilection for boys and commonly presents as a slowly growing soft-tissue mass. We present here the case of a five- year old female child with a lipoblastoma presenting as a paravertebral mass in the right lower back which progressed rapidly in the previous six months causing diagnostic difficulty on fine needle aspiration cytology.

Immunoglobulin A nephropathy in association with generalized inflammatory peeling skin syndrome.

We describe an 8-year-old girl born to second-degree consanguineous parents with complaints of recurrent episodes of hematuria for 6 months. She had generalized peeling of the skin since birth and recurrent purulent cutaneous infections. The clinical presentation and histopathology of the skin biopsy specimen were consistent with the inflammatory variant of peeling skin syndrome (PSS). She also had a single ventricle with pulmonary stenosis, for which a bidirectional Glenn shunt had been placed. The renal biopsy specimen showed immunoglobulin A (IgA) nephropathy. She responded well to enalapril and steroids, with a decrease in proteinuria. IgA nephropathy has not been previously reported in PSS. Complications such as IgA nephropathy in children with PSS would help to further delineate the diverse clinical presentations and the clinical course of this rare dermatosis. We discuss the mechanisms that could explain this hitherto unreported association.

Sub-chronic toxicological evaluation of cleistanthin A and cleistanthin B from the leaves of Cleistanthus collinus (Roxb.).

OBJECTIVE: To investigate the toxicological effects of cleistanthin A and cleistanthin B using sub-chronic toxicity testing in rodents. METHOD: Cleistanthins A and B were isolated from the leaves of Cleistanthus collinus. Both the compounds were administered orally for 90 days at the concentration of 12.5, 25 and 50 mg/kg, and the effects on blood pressure, biochemical parameters and histology were assessed. The dose for sub-chronic toxicology was determined by fixed dose method according to OECD guidelines. RESULT: Sub-chronic toxicity study of cleistanthins A and B spanning over 90 days at the dose levels of 12.5, 25 and 50 mg/kg (once daily, per oral) revealed a significant dose dependant toxic effect in lungs. The compounds did not have any effect on the growth of the rats. The food and water intake of the animals were also not affected by both cleistanthins A and B. Both the compounds did not have any significant effect on liver and renal markers. The histopathological analysis of both cleistanthins A and B showed dose dependent morphological changes in the brain, heart, lung, liver and kidney. When compared to cleistanthin A, cleistanthin B had more toxic effect in Wistar rats. Both the compounds have produced a dose dependent increase of corpora amylacea in brain and induced acute tubular necrosis in kidneys. In addition, cleistanthin B caused spotty necrosis of liver in higher doses. CONCLUSION: The present study concludes that both cleistanthin A and cleistanthin B exert severe toxic effects on lungs, brain, liver, heart and kidneys. They do not cause any significant pathological change in the reproductive system; neither do they induce neurodegenerative changes in brain. When compared to cleistanthin A, cleistanthin B is more toxic in rats.

Basal like carcinoma of breast in patient with neurofibromatosis I: an association or co-existence?

Neurofibromatosis I (NF I), an autosomal dominant disorder is associated with increased risk of benign and malignant peripheral nerve sheath tumors and central nervous system tumors. There are only few case reports of breast carcinoma in known patients of NF I. We report a case of basal like carcinoma of the breast in a 69-year-old lady who had NF I. Considering the rare association of carcinomas with NF I and finding that both the NF I gene and a breast cancer pre-disposition gene, BRCA 1 are located in close proximity on chromosome 17q makes the association of these two conditions intriguing.