Partial Molar Ectopic Pregnancy: A diagnostic challenge.

Here, we present a rare case of a primigravida who presented to us with symptoms and signs suggestive of an ectopic gestation, which turned out to be a partial mole in histopathological examination. Since it is a very rare occurrence, we would like to publish the case details in this case report.

PD-L1 Expression in Colorectal Carcinoma Correlates with the Immune Microenvironment.

INTRODUCTION/BACKGROUND: Colorectal carcinoma (CRC) is a common malignancy, with its diverse clinical, pathological, and molecular features. The immune microenvironment of a tumor comprises of interplay between various cells and molecules, and has a significant role in deciding the tumor behavior and overall prognosis. PD-L1 (programmed cell death ligand-1) has been implicated in the regulation of the tumor immune microenvironment (TIME). There is limited data regarding the correlation of PD-L1 expression with immune cell profile in CRCs, especially in the Indian setting. The study aimed to assess the PD-L1 expression in CRC tumor cells and its association with TIME, mismatch repair (MMR), and various other clinicopathological parameters. METHODS: This is a hospital-based, cross-sectional observational study. PD-L1 expression was assessed at the protein level by immunohistochemistry and mRNA level by qRT-PCR. Immune cell markers (CD4, CD8, CD20, FOXP3, and CD163) were interpreted using the ImageJ Fiji platform. RESULTS: Of the 104 cases, 21% were PD-L1 positive and were more common in right-sided CRCs. PD-L1 positive cases showed significantly higher concentrations of all T-cell subsets (CD4+ , CD8+ , and FOXP3+), CD20+ B-cells, and CD163+ macrophages were noted. No statistical significance was seen between PD-L1 expression with clinical profile, pathological subtype, grade or stage, mismatch repair status (proficient vs deficient), and survival. CONCLUSIONS: The present study showed a relatively lower frequency of PD-L1 in CRC from the Eastern Indian cohort. The immune cell concentration in the present study was calculated using image analysis-based objectivised methods. Significant correlation of PD-L1 expression in tumor cells with the tumor-infiltrating immune cells indicated its crucial role in the pathobiology of CRC especially by regulating the TIME. Considering the therapeutic implication of PD-L1 in various malignancies, it may be one of the crucial therapeutic targets in a proportion of cases.

Cribriform Morular Thyroid Carcinoma: A Rare Case and Associated Uncommon Features.

Cribriform morular thyroid carcinoma has been added under tumors of uncertain histogenesis. Its peculiar clinical, histomorphological pattern, and immunohistochemical profile have been proved different from papillary thyroid carcinoma. A 59-year-old female patient had a lesion in the left lobe of the thyroid. Fine needle aspiration cytology was reported as medullary thyroid carcinoma. The total thyroidectomy specimen showed a predominantly solid tumor of size 9.5 cm in the left lobe. Microscopy showed a mixed growth pattern with the dominant cribriform and solid morular area. Nuclear features of papillary carcinoma were not seen. Squamoid morules had nuclear clearing. Marked stromal hyalinization and calcification were noted. Extrathyroidal extension, lymphovascular invasion, and lymph node metastasis were not identified. Immunohistochemically the tumor cells were diffuse and strong nuclear positive for ß-catenin, TTF1, PAX8, estrogen receptor, focal, and weak positivity for CD5. Synaptophysin, calcitonin, thyroglobulin, and CDX2 were negative. We report this rare cribriform morular thyroid carcinoma case with its associated uncommon histological and immunohistochemical features.

Alpha-Fetoprotein (AFP)-Negative Hepatoid Adenocarcinoma of the Stomach and its Associated Uncommon Features With a Review.

Hepatoid adenocarcinoma of the stomach is a rare histologic subtype of gastric carcinoma. Morphologically, it shows hepatocyte-like features and the tumor cells can show the expression of alpha-fetoprotein (AFP) in the tumor cells as well as in serum. There are a few AFP-negative hepatoid adenocarcinoma tumors that have been reported in the literature. A 45-year-old male patient presented with abdominal pain. Endoscopy and radiological studies showed an ulceronodular thickening in the antropyloric thickening with lymphadenopathy. He underwent radical subtotal gastrectomy with lymph node dissection. Microscopic examination showed adenocarcinoma with hepatocytic morphology, the presence of lymphovascular and perineural invasion, prominent peritumoral lymphocytic infiltration, multiple metastatic tumor deposit involving regional lymoh nodes and omentum. Adjacent gastric mucosa showed Helicobacter pylori-associated chronic atrophic gastritis with intestinal metaplasia. On immunohistochemistry (IHC), tumor cells were immunopositive for keratin 7, CDX2, and HepPar-1, p53 (focal), and MUC5AC (focal) while immunonegative for AFP, SALL4, MUC2, CD10, and HER2 (ERBB2) was negative. We report this AFP-negative hepatoid adenocarcinoma with its associated uncommon features and discussed the literature review and diagnostic approach.

Inclusion of Perineural Invasion with AJCC-TNM Staging: Outcomes from a South Asian Cohort of Curatively Treated Gastric Cancer Patients.

BACKGROUND: The incidence of perineural invasion (PNI) in patients with gastric cancer (GC) is high, and patients with PNI positive disease have a poor prognosis compared to PNI-negative disease. The present study aims to study the incidence and evaluate the impact of PNI on the survival outcome of a cohort of South Asian GC patients. MATERIAL AND METHODS: All consecutive patients undergoing curative gastrectomy were included in the study. The incidence of PNI and correlation with different clinico-pathological features and overall survival was performed. RESULTS: A total of 59.54% had PNI-positive disease and the median OS of PNI + ve patients was 29.3 months, while it was not reached in PNI-ve patients. The PNI positivity was a significant prognostic factor for overall survival both on univariate and multivariate analysis. On TNM-PNI staging, those with TNM stage I/II patients with PNI + ve disease had similar OS to all stage III patients (p = 0.835) and were worse than that of PNI-ve patients (p < 0.05). CONCLUSION: The incidence of PNI in gastric cancer is high. The inclusion of PNI with AJCC-TNM staging may better stratify prognostic staging in curatively treated gastric cancer patients.

Angioleiomyoma of the uterus presenting as an endometrial polyp: An uncommon occurrence of two cases with a literature review.

ABSTRACT: Angioleiomyoma is a benign neoplasm that arises from vascular smooth muscle cells. Angioleiomyoma of the endometrium is very uncommon. The differential diagnoses of this entity are myopericytoma, angiomyofibroblastoma, endometrial stromal tumor, and perivascular epithelioid cell tumor. 31-year-old and 45-year-old patients presented with heavy menstrual bleeding, lower abdomen pain, and dysmenorrhea. Perspeculum and radiological investigations showed an endometrial polyp. They underwent diagnostic hysteroscopy, polypectomy, and endometrial biopsy. Polypectomy specimens of both cases revealed polypoidal lesions lined by the endometrium. The core of the polyp was arranged in long intersecting bundles of spindle cells and interconnecting anastomotic patterns with many intervening thick-walled blood vessels. These spindle cells have oval and cigar-shaped nuclei, fine chromatin, and a moderate amount of eosinophilic cytoplasm, resembling smooth muscle cells. These smooth muscle cells of the vessel wall were merging with the adjacent walls of the blood vessel. There was no nuclear atypia or necrosis. The mitotic rate was 0-1/10 HPF. Focal areas of hyalinization and adipocytic components were noted in one case. The endometrial glands did not show intraepithelial or invasive neoplasia. On immunohistochemistry (IHC), these spindle cells were diffuse and strongly immunopositive for SMA and Desmin. CD34 highlighted the endothelial lining of the prominent thick-walled blood vessels. By correlating with histomorphology and IHC positivity, a diagnosis of angioleiomyomatous polyp of endometrium was rendered. We report two uncommon cases of angioleiomyoma of the endometrium and discuss the differential diagnosis and literature review.

Invasive micropapillary urothelial carcinoma of the renal pelvis presenting as nonfunctional kidney: A unique presentation and review of the literature.

ABSTRACT: Micropapillary urothelial carcinoma of the renal pelvis is a rare and aggressive variant and poses a diagnostic challenge, especially related to the site and histomorphology of the tumor. A 60-year-old female presented with right pelvic-ureteric junction obstruction and a nonfunctioning right kidney. She underwent a simple right nephrectomy. The microscopy examination revealed a high-grade tumor of the renal pelvis, predominant micropapillary architecture. The tumor infiltrated into the kidney, renal sinus, perinephric fat, adrenal gland, and Gerota's fascia. Extensive lymphovascular and perineural invasions were also noted. On immunohistochemistry, tumor cells were positive for GATA-binding protein 3, cytokeratin 7, and cytokeratin 20, while negative for paired box gene 8, cluster of differentiation 10, mammaglobin, and alpha-methylacyl-CoA racemase. The p63 was positive in the conventional areas and negative in the micropapillary pattern. We reported an additional case of micropapillary urothelial carcinoma of the renal pelvis, literature review, and discussed the differential diagnosis. Immunonegativity of p63 in the micropapillary component was an additional finding.

Effect of intra-nasal nitrilotriacetic acid trisodium salt in lowering elevated calcium cations and improving olfactory dysfunction in COVID-19 patients.

PURPOSE: An association between COVID-19 and olfactory dysfunction has been noted in many patients worldwide. The olfactory adaptation process leads to an increase in intracellular calcium cation levels. Nitrilotriacetic acid trisodium salt has high selective chelation for calcium cations from olfactory mucus. The aim of this work is to test the effect of an intranasal nitrilotriacetic acid trisodium salt to lower the elevated calcium cations in COVID-19 patients with relevant symptoms of olfactory dysfunction. METHODS: Fifty-eight COVID-19 adult patients with relevant symptoms of olfactory dysfunction were enrolled in a prospective randomized controlled trial. They received a nasal spray containing either 0.9% sodium chloride or 2% nitrilotriacetic acid trisodium salt. Olfactory function was assessed before and after treatment using the Sniffin' Sticks test. Quantitative analysis of calcium cation concentration in nasal secretions was performed using a carbon paste ion-selective electrode. RESULTS: After the application of nitrilotriacetic acid trisodium salt compared to sodium chloride, a significant improvement from functional anosmia to healthy normosmia with significant decrease in calcium cation concentration was observed. CONCLUSIONS: Further collaborative research is needed to fully investigate the effect of an intranasal nitrilotriacetic acid trisodium salt in the treatment of olfactory disorders.

Quantitative Spectrophotometric Analysis of Celecoxib and Tramadol in Their Multimodal Analgesia Combination Tablets.

BACKGROUND: Pain is a global, complex health problem that includes physical, emotional, and social components. The pain management process has many goals, including patient satisfaction, reducing clinical complications, and lowering costs. The physician describes pain medications in terms of the proven cause and classification of the severity of the pain. The combination of celecoxib and tramadol was recently approved by the Food and Drug Administration (FDA) in October 2021 for the treatment of acute pain in adults. OBJECTIVE: This paper presents the first published quantitative analytical methods for celecoxib and tramadol. METHODS: The UV absorption spectra of celecoxib and tramadol showed strong overlap. Mathematical simultaneous equation and ratio difference methods were developed to resolve the spectral overlap and quantify the drugs in the combination mixture. In the simultaneous equation method, the absorbance and absorptivity values at 252 and 217 nm were used to construct two mathematical equations that were used for the simultaneous mathematical quantification of the above drugs. The mathematical manipulation of the ratio difference based on the calculation of the differences in the amplitude values between 250 and 280 nm enabled the quantitative analysis of celecoxib, and the differences in the amplitude values between 221 and 272 nm enabled the quantitative analysis of tramadol. RESULTS: The proposed methods were successfully applied to the selective quantitative analysis of celecoxib and tramadol in the synthetic mixtures and in the pharmaceutical tablets without interference from the tablet additives. CONCLUSIONS: The applied methods demonstrated good linearity in the concentration range of 1-20 µg/mL and 3-45 µg/mL for celecoxib and tramadol, respectively, with acceptable accuracy and precision. The methods were found to be sensitive with LOD values of 0.183 µg/mL and 0.626 µg/mL for celecoxib and tramadol, respectively, in simultaneous equation method and of 0.275 µg/mL and 0.772 µg/mL for celecoxib and tramadol, respectively, in ratio difference method. HIGHLIGHTS: The first established simple and validated UV spectrophotometric methods were described for concurrent quantification of the celecoxib and tramadol in their recently approved pharmaceutical formulation.

Comparative evaluation of different mathematical models for simultaneous UV spectrophotometric quantitative analysis of velpatasvir and sofosbuvir.

Velpatasvir and sofosbuvir are new drugs prescribed in a combined pharmaceutical dosage form that pose a new challenge for the treatment of chronic hepatitis C. In this work, a comparative evaluation of the classical mathematical model, simultaneous equations, and the advanced mathematical model, partial least squares, for the spectrophotometric quantitative analysis of velpatasvir and sofosbuvir in bulk powder and in the new combined pharmaceutical dosage form was presented. The mathematical simultaneous equation method was used to resolve the overlap between velpatasvir and sofosbuvir. The absorbance and absorbativity values at 255 and 244.8 were used to construct two mathematical equations required for spectrophotometric quantitative analysis of the drugs under study. Partial least squares, an advanced mathematical tool dealing with the full spectral data of velpatasvir and sofosbuvir, was also introduced. An experimental design for the calibration sets and validation sets for the binary mixture of the drugs under study were created. The model was optimized based on a five-level, two-factor experimental design. Pre-processing of the spectral data was applied and resulted in the exclusion of the spectral region from 200 to 230 nm due to noise. The described methods were successfully applied to the spectrophotometric quantitative analysis of velpatasvir and sofosbuvir in Epclusa® tablets.

Improving the Quality of Medical Documentation in Orthopedic Surgical Notes Using the Surgical Tool for Auditing Records (STAR) Score.

Aims Due to the significant value held by medical records in terms of influencing patient care and medico-legal cases, this study aimed to investigate the quality of surgical notes and their improvement through periodic auditing during a six-year period at a major tertiary hospital. Methodology This study retrospectively evaluated surgical records of patients undergoing elective orthopedic surgeries at Jordan University Hospital from 2016 to 2021 using the Surgical Tool for Auditing Records (STAR) validated questionnaire. This questionnaire is composed of six distinct sections aimed to quantify the quality of medical records and demonstrate their associated deficiencies. Pre- and post-audit STAR scores were analyzed using the two independent sample t-test on Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp. Armonk, NY). Results A total of 454 records were randomly selected and evaluated using the STAR questionnaire. There was an overall significant trend of improvement in the quality of records in all evaluated years compared to the 2016 baseline. The most pronounced improvements were in the records of 2021 as compared to the 2016 baseline (97.4 ± 0.7 vs. 94.3 ± 1.6; p:<0.05), in which the Initial Clerking, Subsequent Entries, and Operative Record domains had the most significant magnitude of change. The Consent and Anesthesia domains plateaued over the study's period in terms of overall quality. The most improved STAR domain was the Discharge Summary domain, in which four subsections (follow-up, diagnosis, complications, and medications on discharge) had significant STAR score increases (all; p:<0.05). Conclusion Our study implies that simple measures, including personnel education and training and periodic auditing, are effective measures in increasing the quality of surgical records. High-quality medical records need to be sustained and continuously improved, as they contribute to better health care, promote research, and contribute to economic gains through cost-effective practices.

Prevalence and associated factors of stress among primary health care nurses in Saudi Arabia, a multi-center study.

BACKGROUND: Nursing practice has been identified as one of the most stressful professions within the healthcare systems. The current study aimed to determine the prevalence of stress and its associated factors among primary healthcare nurses. MATERIALS AND METHODS: This analytical cross-sectional study was conducted among 200 Saudi nurses in the government primary health care centers in Medina city, Saudi Arabia. Stress was measured by the stress subscale of the 21-Item Depression, Anxiety and Stress Scale. Sources of stress were assessed by 15 items. RESULTS: The majority were females (68.0%) and aged less than 40 years (72.5%). Thirty percent had severe or very severe stress. Stress was associated significantly with the presence of chronic diseases (P = 0.037) and with working in night shifts (P = 0.042). All sources of stress in the workplace were associated significantly and positively with stress (P < 0.01). CONCLUSION: About one-third of the participants had stress. Improving work conditions and minimizing stress in the workplace should be a priority in the primary health care setting.

Simultaneous spectrophotometric quantitative analysis of elbasvir and grazoprevir using assisted chemometric models.

Artificial neural networks and genetic algorithm artificial neural networks, chemometric assisted spectrophotometric models, were developed for the quantitative analysis of elbasvir and grazoprevir in their newly FDA approved pharmaceutical dosage form. The UV absorption spectra of elbasvir and grazoprevir show severe degree of overlap which caused difficulty for selecting certain spectrophotometric method with advantage of simultaneous quantitative analysis of the cited drugs. After extensive study and many experimental trials, artificial neural networks and genetic algorithm artificial neural networks were the suitable models for the quantitative analysis of studied drugs in their binary mixture. Experimental design and constructing the calibration and validation sets of the binary mixture were achieved to implement the proposed models. The models were optimized with the aid of five-levels, two factors experimental design. The designed models were successfully applied to the quantitative analysis of Zepatier® tablets. The results were statistically compared with another reported HPLC quantitative analytical method with no significant difference by applying Student t-test and variance ratio F-test.

Application of different chemometric assisted models for spectrophotometric quantitative analysis of velpatasvir and sofosbuvir.

Four chemometric assisted spectrophotometric models were developed for the quantitative analysis of velpatasvir and sofosbuvir, in their newly FDA approved pharmaceutical dosage form. Due to the existed overlap of the scanned absorption spectra between velpatasvir and sofosbuvir, this resulted in degree of difficulty of the possibility of the conventional spectrophotometric methods to quantify and analyze the cited drugs simultaneously. Classical least squares, principal component regression, partial least squares and genetic algorithm partial least squares were designed and compared for the quantitative analysis of velpatasvir and sofosbuvir in their binary mixture. Experimental design for different concentrations of the studied drugs was done based on the spectral sensitivity of velpatasvir and sofosbuvir and the confirmed ratio of the two drugs in the commercial pharmaceutical dosage form. Optimization of the described models was adopted with the aid of five-levels, two factors experimental design. Successfully quantitative assay of the drugs in Epclusa® tablets was done by the proposed models. Statistically comparative analysis for the obtained models results with another published capillary electrophoresis quantitative analytical method was performed. It is noteworthy mentioning that there was no significant difference between the proposed models and the published method with respect to the accepted statistical parameters.

Different chemometric assisted approaches for spectrophotometric quantitative analysis of lesinurad and allopurinol.

Three chemometric assisted spectrophotometric approaches were designed for precise quantitative analysis of lesinurad and allopurinol, in their recently FDA approved combination pharmaceutical dosage form. By utilizing the recorded absorption spectral data of lesinurad and allopurinol mixtures, principle component regression, partial least squares and genetic algorithm partial least squares were developed and compared for the spectrophotometric quantitative analysis of the cited drugs in their binary mixture. Experimental design for different concentrations of the studied drugs was done based on the spectral sensitivity and the commercial ratio of the two drugs in the combined pharmaceutical dosage form. Optimization of the described models was done using five-levels, two factors experimental design principle. Quantitative assay of the two drugs in Duzallo® tablet was successfully done and the data obtained was statistically compared with the results of another published HPLC quantitative analytical method.

Simultaneous spectrophotometric quantitative analysis of velpatasvir and sofosbuvir in recently approved FDA pharmaceutical preparation using artificial neural networks and genetic algorithm artificial neural networks.

Two chemometric assisted spectrophotometric models were applied for the quantitative analysis of velpatasvir and sofosbuvir in their newly FDA approved pharmaceutical dosage form. The UV absorption spectra of velpatasvir and sofosbuvir showed certain degree of overlap which exhibited degree of difficulty for the choice of certain method provides simultaneous quantitative analysis of the cited drugs. Artificial neural networks and genetic algorithm artificial neural networks were the suitable model for the quantitative analysis of velpatasvir and sofosbuvir in their binary mixture. Experimental design and building the calibration set for the binary mixture were achieved to implement the described models. The proposed models were optimized with the aid of five-levels, two factors experimental design. Spectral region of 380-400 nm was rejected which resulted in 181 variables. GA reduced absorbance matrix to 72 and 36 variables for velpatasvir and sofosbuvir respectively. The models succeeded to estimate the studied drugs with acceptable values of root mean square error of calibration and root mean square error of prediction. The developed models were successfully applied to the quantitative analysis of the two drugs in Epclusa® tablets. The results were statistically compared with another published quantitative analytical method with no significant difference by applying Student t-test and variance ratio F-test.

Burnout among nurses working in the primary health care centers in Saudi Arabia, a multicenter study.

BACKGROUND: Burnout is a common psychosocial phenomenon among nursing. It has been attributed to prolonged exposure to stress in the work place. This study aimed to determine the prevalence and associated factors of burnout among nurses in the primary health care centers in Saudi Arabia. METHODS: This cross-sectional study was conducted among 200 nurses by using a self-administered questionnaire. Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout. RESULTS: Most participants were females (73.0%) and aged ≤35 years (52.0%). About 39% had high emotional exhaustion, 38% had high depersonalization and 85.5% had low personal accomplishment. About 89% (178) scored high at least on one subscale of burnout. Burnout was associated with age, educational level and sources of stress in the workplace. CONCLUSION: Level of burnout among nurses was high and was associated mainly with stressors in the workplace. Improving work environment and management of stress in the workplace should be a priority to minimize burnout among nurses.

Study on Liver Dysfunction in Type 2 Diabetic Patients in Bangladesh.

AIM: Diabetes mellitus (DM) represents one of the major lifestyle-related pathological conditions; the incidence and prevalence of DM have reached an epidemic level around the world. Diabetes mellitus is usually associated with obesity, coronary diseases, and cerebral pathologies. However, more insights are required to evaluate a temporal relation between DM and hepatic functions. This study assesses whether and to what extent liver functions are modified in DM patients. MATERIALS AND METHODS: A total of 100 patients with type 2 DM and 100 normal healthy controls were enrolled in this study following proper scrutiny of inclusion and exclusion criteria. Different parameters of liver function tests were measured in patients in the two groups. Data were analyzed to assess the extent and magnitude of abnormal liver functions in DM. RESULTS: The levels of bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, and prothrombin time were 0.737 ± 0.311 mg/dL, 39.00 ± 24.21 IU/L, 26.42 ± 10.40 IU/L, 4.10 ± 0.513 g/dL, and 16.46 ± 2.78 seconds in patients with DM and 0.506 ± 0.183 mg/dL, 28.26 ± 6.67 IU/L, 18.90 ± 4.75 IU/L, 4.12 ± 0.277 g/dL, and 14.23 ± 1.04 seconds in control subjects. Statistical analyses revealed that most of these parameters of liver function test were significantly different in DM patients compared to control subjects (p < 0.05). Serum alkaline phosphatase level was 89.61 ± 25.59 mg/dL in type 2 DM patients and 96.83 ± 16.34 mg/dL in control subjects (p > 0.05). The prevalence of abnormal values of serum bilirubin, ALT, AST, prothrombin time, and albumin were 5.17, 31.03, 5.17, 5.17, 43.10, and 10.34% respectively in type 2 DM patients and 0, 2, 0, 2, 3, and 0% respectively in control subjects, indicating high prevalence of DM patients with abnormal liver functions. CONCLUSION: Abnormal liver functions of different extents and magnitudes have been found in type 2 DM patients, and the impact of abnormal liver function should be considered during the management of DM patients and also to assess their long-term follow-up prognosis. HOW TO CITE THIS ARTICLE: Rashid MHO, Haque MZ, Rahman MK, Khan MMR, Rahman ASMM, Al-Mahtab M, Rahman MS, Roy PK, Islam MN. Study on Liver Dysfunction in Type 2 Diabetic Patients in Bangladesh. Euroasian J Hepato-Gastroenterol 2016;6(1):1-4.