Platelet functions in lymphatic filariasis patients.

Filariasis is a chronic disease where parasitic worms survive in human hosts even for decades and lead to complications like lymphedema and elephantiasis. Despite the persistent existence of filarial parasites in human hosts, fatal and thrombotic complications are not known, unlike other parasitic diseases like malaria. This suggests that filarial parasites might be affecting the host's platelet functions. This study was conducted to examine platelet functions in confirmed filariasis patients and healthy controls. Results showed that filariasis patients had larger platelets, inhibited aggregation, and slower speed of aggregation, compared to controls. However, in vivo markers of platelet activation and degranulation (beta thromboglobulin and soluble P-selectin) were not affected. Observations suggested that there is increased platelet turnover, cellular apoptosis and inhibited platelet functions in filariasis patients compared to controls. Platelet function inhibition was not associated with the duration of disease, lymphedema-affected organs, or gender of patients. This study confirms that filarial parasites modulate platelet functions in human hosts.

Clinical Significance of Frequently Down-Regulated Phosphatidylethanolamine-Binding Protein-1 in Gallbladder Cancer.

BACKGROUND: Promoter hypermethylation of tumor suppressor genes has been demonstrated to be one of the major mechanisms of their epigenetic regulation in various reports. We have studied the promoter methylation status of PEBP1 and evaluated its correlation with gallbladder carcinogenesis. AIMS: PEBP1, an endogenous inhibitor of Raf/MEK/ERK signaling pathway, is a tumor suppressor gene. We aimed to study the expression profile of PEBP1 and understand the mechanism and significance of its deregulation in gallbladder cancer. METHODS: PEBP1 expression analysis and its promoter methylation status were investigated in 77 gallbladder carcinoma (GBC) and tissue biopsies from 28 patients of gallstone disease by RT-PCR and MS-PCR, respectively. RESULTS: Our results of the mRNA expression profiling demonstrate that PEBP1 is down-regulated in 62.3% (48/77), while 31.2% (24/77) of the gallbladder cancer biopsies show no significant change and 6.5% (5/77) show up-regulated expression compared to tissue samples of gallstone diseases. In GBC, 48.1% (N = 37) GBC biopsy samples exhibited significantly heterozygous promoter hypermethylation compared to tissue samples from gallstone diseases which show promoter hypermethylation in 3 (10.7%) samples only. In gallbladder cancer, the PEBP1 methylation is significantly associated with lymph node metastasis and shorter period of survival. CONCLUSION: PEBP1 is frequently down-regulated and hypermethylated in gallbladder cancer and its promoter hypermethylation is a frequent and early inactivating mechanism in GBC.

A case series analysis of spigelian hernia: A diagnostic dilemma and its successful laparoscopic repair.

ABSTRACT: A Spigelian hernia is an uncommon, atypical protrusion of the peritoneum or abdominal contents via a defect (Spigelian fascia), consisting of the internal oblique aponeuroses and the transversus abdominis. With a frequency ranging from 0.12% to 2% of all abdominal wall hernias, Spigelian hernias are extremely rare. It usually arises from a condition that increases intra-abdominal pressure, the degeneration of the abdominal aponeurotic layers or trauma to the abdominal wall. Herein, we present a case series of patients with varying presentations of Spigelian hernia who presented, who were promptly diagnosed and who were managed successfully with laparoscopic surgical repair.

Role of Bovine Colostrum Dressing on Chronic Non-Healing Wounds in Comparison to Conventional Dressing: A Case-Control Study.

Colostrum has been shown to be suitable for oral and/or topical applications. Colostrum decreases the amount of discharge from wounds and also accelerates healing, leading to a decrease in the number of dressings. In this study, 40 patients with chronic non-healing wounds were divided into two groups, considering the inclusion and exclusion criteria. Group I included 15 patients with conventional dressings, and Group II included 25 patients with added topical colostrum dressings. All patients were assessed at the time of presentation and after 21 days. The results of the present study indicate that colostrum powder dressings may be used as an adjunct in the management of chronic non-healing wounds.

Burden of Chronic Nonhealing Wounds: An Overview of the Worldwide Humanistic and Economic Burden to the Healthcare System.

Chronic wounds have long been a significant public health concern, but the true impact of these wounds is unknown since research designs and measuring techniques vary, leading to inconsistent estimates. The definition of a wound is a loss of epithelial continuity caused by damage to the tissue. The following conditions can cause chronic wounds: panniculitis, pyoderma gangrenosum, traumatic, neurological, metabolic, hematologic, neoplastic, or infection-related. The growing global incidence of diabetes and the aging population necessitate greater attention to chronic wounds. Regrettably, it is sad that significant healthcare institutions have overlooked wound research. The study of health-related illnesses and occurrences in particular populations, including their distribution, frequency, and determinants, and the application of this research to control health problems.

Clinical Significance of Overexpression of Oct4 in Advanced Stage Gallbladder Carcinoma.

BACKGROUND: Oct4 has critical role in maintaining pluripotency, proliferative potential, and self-renewal capacity in embryonic stem and germ cells. Although Oct4 has been shown to be upregulated in many cancers, its clinical significance in gallbladder carcinoma is poorly understood. METHODS: We studied the expression profile of Oct4 in 61 GBC and 30 chronic cholecystitis (as control) using real time RT-PCR, western blotting, and immunohistochemistry. The expression data was correlated with clinico-pathological parameters. The diagnostic utility was assessed through ROC curve, and prognostic value was analyzed by Kaplan-Meier method. RESULTS: Oct4 was significantly upregulated at mRNA as well as protein levels. The higher mRNA expression shows significant association with late stage, late T stage, and higher grade of tumor. A significant positive correlation was also observed with stage, T stage, and tumor grade. Sum score analysis of protein expression shows positive correlation with stage and the presence or absence of gallstone in tumor samples. The ROC curve analysis revealed the moderate diagnostic potential of Oct4. Kaplan-Meier analysis showed that patients having higher expression of Oct4 were having low mean survival compared with the patients with lower Oct4 expression. CONCLUSION: In conclusion, our data suggests that higher expression of Oct4 may serve as potential biological indicator for tumor aggressiveness and poor prognosis of GBC.

Effect of negative pressure wound therapy on wound thermometry in diabetic foot ulcers.

Background: Negative pressure wound therapy (NPWT) is the treatment of choice for diabetic foot ulcers (DFUs), and the role of NPWT in the management of DFU is limited. The aim of the study was to compare the effects of NPWT versus conventional dressing (CD) on wound healing in DFU. Materials and Methods: A total of 55 patients were included and divided into two groups: 23 patients were treated with NPWT and 32 patients with CD. The NPWT dressings were changed every 7 days, while the CDs were changed daily. Wound culture sensitivity, wound size, granulation tissue, and pain evaluation (assessed by Visual Analog Scale) were all measured at the start and 3 weeks or until the ulcer was healed. The wound margin temperature was measured at four random sites for thermometric evaluation, and normal limb temperature was also measured for comparison. Patients' satisfaction and treatment costs were also compared. Results: On days 14 and 21, the wound size was reduced significantly in the NPWT group (P < 0.001 and P < 0.001, respectively). The percentage reduction in wound size from baseline to days 7, 14, and 21 was significantly higher in the NPWT group (P = 0.013, P = 0.001, and P = 0.029, respectively). On days 7, 14, and 21, the granulation tissue score was significantly higher in the NPWT group (P = 0.001, P = 0.001, and P < 0.001, respectively). On days 14 and 21, the mean VAS score was significantly low in the NPWT group (P < 0.001 and P < 0.001, respectively). The majority of wounds in the NPWT group were sterile on day 21 compared to those in the CD group (P = 0.008). The majority of patients in the NPWT group had excellent patient satisfaction (P < 0.001). The average material cost was significantly higher in the NPWT group (P = 0.001). The mean wound temperature of the affected limb was significantly higher compared to that of the unaffected limb (P < 0.001). Conclusion: In terms of early formation of granulation tissue, faster wound size reduction, less discomfort, and patient satisfaction, the study indicated that NPWT appeared to be superior. An initial rise in temperature in a DFU may indicate the presence of a pre-ulcerative lesion.

Frequent promoter hypermethylation and down regulation of BNIP3: An early event during gallbladder cancer progression.

BACKGROUND: Epigenetic alterations have been reported as one of the risk factors of gallbladder cancer. Promoter hypermethylation is associated with high incidence and poor prognosis of GBC. Bcl-2/adenovirus E1B 19 kDa interacting protein 3 is a pro-apoptotic protein member of Bcl-2 family. AIMS: Present study was aimed to investigate expression profile and promoter methylation status of BNIP3 in GBC and its correlation with clinico-pathological parameters. METHODS: The expression analysis and methylation status of BNIP3 was performed by semi-quantitative reverse transcription polymerase chain reaction and Methylation-specific polymerase chain reaction respectively in 84 GBC patients and 29 gallstone tissues (used as normal controls). RESULTS: We demonstrate down regulation of BNIP3 in 56% of the GBC samples. BNIP3 promoter is also frequently hypermethylated (69%) in GBC samples. Interestingly, we found that 69% (40/58) of the BNIP3 promoter hypermethylated samples had also reduced expression of BNIP3. Our data demonstrate significant correlation of the mRNA expression and promoter hypermethylation with late stage and nodal metastasis. Hypermethylation of BNIP3 promoter is associated with low overall survival period. CONCLUSION: Our results suggest that promoter hypermethylation is an early event and can be a frequent mechanism for downregulation of BNIP3 in GBC.

Vulvar aggressive angiomyxoma: a surgical challenge.

Aggressive angiomyxoma is a rare and locally aggressive mesenchymal tumour, predominantly occurring in women of reproductive age group. The term aggressive is attributed to the infiltrative nature and frequent local recurrences. They arise commonly from the vulvovaginal region, perineum or pelvis and are usually misdiagnosed as other common entities in these regions. Radiological investigations aid in the diagnosis and planning of surgery. However, the final diagnosis in most of the cases is established by histopathological examination. We herein report a case of a middle-aged woman presenting with recurrent large right vulvar mass highlighting the surgical challenges posed by its intrapelvic extension.

Color Doppler ultrasound as an objective assessment tool for chemotherapeutic response in advanced breast cancer.

BACKGROUND: In our part of the world, the majority of the patients with breast cancer present with locally advanced disease and require neo-adjuvant chemotherapy as the primary treatment modality. It is essential to monitor the response to chemotherapy in these patients. Clinical examination as the sole criterion of response assessment is entirely subjective and fallacious. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are expensive. The role of Doppler ultrasonography as an imaging modality for this purpose is therefore being evaluated. METHODS: A prospective study was undertaken of 25 cases of locally advanced breast carcinoma (LABC) and Color Doppler sonography was used for the sequential assessment of chemotherapeutic response. The response assessed on the basis of clinical examination and Color Doppler was compared with the histological response. The parameters assessed on color Doppler were a change in the number of flow signals, maximum flow velocity (Vmax), pulsatility index (PI) and resistivity index (RI). Responses were analysed statistically using the Pearson correlation coefficient and Kappa statistics (kappa). The sensitivity, specificity, positive predictive & negative predictive values for predicting complete histological response were calculated. RESULTS: Color Doppler showed a sensitivity of 88.88 % for predicting complete histological response. The negative predictive value of color Doppler was 92.3 %. A significant correlation was obtained between color Doppler and histopathological response. CONCLUSIONS: Color Doppler was found to be an objective and effective tool or modality compared with clinical evaluation in sequential response assessment, especially for predicting complete histological response.

Pain in acute and chronic wounds: a descriptive study.

The significance of pain in wound healing is much neglected because of biases against pain management in general, a lack of knowledge of available analgesics, and difficulties associated with pain measurement. To assess pain in patients suffering from acute and chronic wounds, a 1-day descriptive study was conducted involving 50 patients, 26 with acute wounds and 24 with chronic wounds, served by the wound clinic of a university hospital. Patients responded to questions regarding onset, location, type, and intensity of pain using the Visual Analog and Visual Reporting Scales and to statements about aggravating and relieving factors and overall impact on their quality of life using a 5-point scale where 5 = totally agree and 1 = completely disagree. Results showed pain was commonly mild to moderate (41 patients, 88%), located in and around wound (43 patients, 93.5%), occurred most frequently during dressing change (30 patients, 65%), and was relieved by medications (39 patients, 84.8%) and positioning (17 patients, 37%). The most commonly affected quality of life variables were physical activity (40 patients, 87% of patients) and social functioning (23 patients, 50%). Controlling wound pain can play a major role in improving patient quality of life.

Cholecysto-hydatid cyst fistula.

A 27-year-old woman developed recurrent hydatid of liver. CT scan showed unilocular cysts in segments IV and VII. Intraoperatively, there was a fistulous communication between the gall bladder and the cyst in segment IV. Partial pericystectomy along with cholecystectomy was done for the segment IV cyst; percutaneous aspiration, instillation and re-aspiration using hypertonic saline was done for the cyst in segment VII. This was followed by albendazole treatment.