Role of Nuclear Morphometry in the Cytologic Evaluation of Benign and Malignant Breast Lesions.

Breast cancer is the most common diagnosed cancer in female over the world. It is the most important cause of 'cancer death' among female. For diagnosis of breast masses the Fine needle aspiration cytology (FNAC) is applied as the primary tool. Though it is an easy, rapid and comparatively minimally invasive and inexpensive procedure for quick diagnosis, it is largely a subjective tool. Computer-assisted image morphometry provides a new influential method for high-precision measurement of nuclear features and can help to differentiate between benign and malignant breast aspirates. Therefore, the aim of study was to evaluate computer assisted semi-automatic nuclear morphometry on cytology of breast lesions to differentiate benign and malignant lesions of breast. Total 70 cases were included in this cross sectional study, performed in the department of Pathology, Mymensingh Medical College, Mymensingh, Bangladesh from March 2019 to February 2021. Morphometric analysis was done on images captured from FNAC slides of the selected cases. Image J Morphometric Software was used for image analysis. Statistical analysis was done by using SPSS 26.0 version. On analysis of morphometry, four nuclear size parameters, two nuclear shape parameters and one nuclear chromasia parameter were measured. The cut-off values with sensitivity and specificity between benign and malignant category for mean nuclear area were 61.54µm², 91.0%, 97.0%, for mean maximum feret diameter 10.89µm, 94.0%, 95.0%, for mean minimum feret diameter 7.71µm, 94.0%, 97.0% and for mean nuclear perimeter 33.32µm, 94.0%, 95.0% respectively. So, in this observation, morphometry is adjunctive tools which may overcome the limitations of inter observer agreement, improve diagnostic accuracy and avoid unnecessary repeat Fine Needle Aspiration (FNA) in breast aspirates.

Vascular Endothelial Growth Factor Expression in Colorectal Adenocarcinoma of Resected Samples and its Association with Histological Grade and Pathological Stage.

Colorectal carcinoma (CRC) is one of the major public health problems. Vascular endothelial growth factor (VEGF) is an effective angiogenic factor and plays a pivotal role in the development, progression and metastasis of CRC. It also could further help in selecting patients of high risk of disease progression for adjuvant therapy. Therefore, this study was undertaken to reveal the importance of angiogenic factor (VEGF) as an adjunctive tool with histologic parameters of CRC. Total 45 cases were included in this cross-sectional observational study, performed in the department of Pathology, Mymensingh Medical College, Mymensingh and Immunohistochemistry was done in the department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from March 2019 to February 2021. All the cases were evaluated for VEGF immunohistochemical expression. Majority of cases were low grade adenocarcinoma (86.9%) and most common stage was stage III (48.9%). Among 45 cases collectively 13 (4-negative + 9-weak positive) cases were low for VEGF expression and 32 (22-moderate positive + 10-strong positive) cases were high for VEGF expression. Statistically significant association was found with VEGF expression and increasing tumor stage as well as with lymph node metastasis (p<0.05). VEGF had positive significant correlation with stage (r=0.322; p=0.031) of tumor. However, no correlation with VEGF expression and grade (r=0.219; p=0.149) and other clinicopathological parameters of tumor was seen.

Impact of the calcium form of ß-hydroxy-ß-methylbutyrate upon human skeletal muscle protein metabolism.

BACKGROUND & AIMS: ß-hydroxy-ß-methylbutyrate (HMB) is purported as a key nutritional supplement for the preservation of muscle mass in health, disease and as an ergogenic aid in exercise. Of the two available forms of HMB (calcium (Ca-HMB) salt or free acid (FA-HMB)) - differences in plasma bioavailability have been reported. We previously reported that ∼3 g oral FA-HMB increased muscle protein synthesis (MPS) and reduced muscle protein breakdown (MPB). The objective of the present study was to quantify muscle protein metabolism responses to oral Ca-HMB. METHODS: Eight healthy young males received a primed constant infusion of 1,2 13C2 leucine and 2H5 phenylalanine to assess MPS (by tracer incorporation in myofibrils) and MPB (via arterio-venous (A-V) dilution) at baseline and following provision of ∼3 g of Ca-HMB; muscle anabolic (MPS) and catabolic (MPB) signalling was assessed via immunoblotting. RESULTS: Ca-HMB led a significant and rapid (<60 min) peak in plasma HMB concentrations (483.6 ± 14.2 µM, p < 0.0001). This rise in plasma HMB was accompanied by increases in MPS (PA: 0.046 ± 0.004%/h, CaHMB: 0.072 ± 0.004%/h, p < 0001) and suppressions in MPB (PA: 7.6 ± 1.2 µmol Phe per leg min-1, Ca-HMB: 5.2 ± 0.8 µmol Phe per leg min-1, p < 0.01). Increases in the phosphorylation of mTORc1 substrates i.e. p70S6K1 and RPS6 were also observed, with no changes detected in the MPB targets measured. CONCLUSIONS: These findings support the pro-anabolic properties of HMB via mTORc1, and show that despite proposed differences in bioavailability, Ca-HMB provides a comparable stimulation to MPS and suppression of MPB, to FA-HMB, further supporting its use as a pharmaconutrient in the modulation of muscle mass.

Non-small cell lung cancer with distal cutaneous metastases in a patient with a previously treated colorectal carcinoma.

Cutaneous manifestations of visceral carcinomas are scarce, occurring in around 0.7-12% of internal malignancies. Lung cancer is one of the most common sources of skin metastasis, particularly in male patients. We present a case of cutaneous metastasis in a man with concurrent lung lesions and a previously treated colorectal carcinoma. Immunohistochemistry markers for both skin and lung lesions were strongly positive for carcinoembryonic antigen and cytokeratin 20, suggesting an intestinal primary tumour. However, colonoscopy excluded new and metastatic bowel lesions. After multidisciplinary team meetings, which reviewed the clinical, radiological and immunohistochemistry findings, it was concluded to be a non-small cell lung cancer with skin metastasis. This case presented an interesting diagnostic challenge, and highlighted the importance of cross-specialty liaison and investigation to reach the correct diagnosis.

Effects of leucine and its metabolite ß-hydroxy-ß-methylbutyrate on human skeletal muscle protein metabolism.

Maintenance of skeletal muscle mass is contingent upon the dynamic equilibrium (fasted losses-fed gains) in protein turnover. Of all nutrients, the single amino acid leucine (Leu) possesses the most marked anabolic characteristics in acting as a trigger element for the initiation of protein synthesis. While the mechanisms by which Leu is 'sensed' have been the subject of great scrutiny, as a branched-chain amino acid, Leu can be catabolized within muscle, thus posing the possibility that metabolites of Leu could be involved in mediating the anabolic effect(s) of Leu. Our objective was to measure muscle protein anabolism in response to Leu and its metabolite HMB. Using [1,2-(13)C2]Leu and [(2)H5]phenylalanine tracers, and GC-MS/GC-C-IRMS we studied the effect of HMB or Leu alone on MPS (by tracer incorporation into myofibrils), and for HMB we also measured muscle proteolysis (by arteriovenous (A-V) dilution). Orally consumed 3.42 g free-acid (FA-HMB) HMB (providing 2.42 g of pure HMB) exhibited rapid bioavailability in plasma and muscle and, similarly to 3.42 g Leu, stimulated muscle protein synthesis (MPS; HMB +70% vs. Leu +110%). While HMB and Leu both increased anabolic signalling (mechanistic target of rapamycin; mTOR), this was more pronounced with Leu (i.e. p70S6K1 signalling 90 min vs. 30 min for HMB). HMB consumption also attenuated muscle protein breakdown (MPB; -57%) in an insulin-independent manner. We conclude that exogenous HMB induces acute muscle anabolism (increased MPS and reduced MPB) albeit perhaps via distinct, and/or additional mechanism(s) to Leu.

Percutaneous nephrolithotomy--a versatile technique for both simple and complex renal stone.

Percutaneous Nephrolithotomy is currently the preferred first line treatment for simple & complex renal calculi. The technique also being used increasingly for smaller stones that have failed ESWL. Aim of the study is to share our experience in PCNL in course of time. This study was conducted from January 2009 to December 2012, 131 patient's with 142 renal units of 5-75 yrs of age, PCNL were performed in NIKDU, BSMMU & JBFH. Stone were classified into simple (isolated renal pelvis or isolated calyceal stones) or complex (partial or complete staghorn stones, renal pelvic stone with accompanying calyceal stones). The stone size was 1.5-5cm approximately. We asses our initial puncture technique, need for multi-tract, supra 12th rib access, stone free rate, operative duration, postoperative complication, number of transfusion and hospital stay. Operative durations were 60 min -180 minutes. Puncture technique improved in course of time. 14 patients need multi-puncture and tract, all are supra 12th access. Out of 142 renal units 120 (83%) were stone free after first procedure, another 22 need and auxiliary procedure, (5 2nd look PCNL, 6 URS, 11 ESWL) to become stone free result in a 95% stone free rate. Complications occurred in 17 procedures which dealt accordingly. This study revealed PCNL is an effective, versatile safe and cosmetically acceptable procedure for all age groups in simple and complex renal stone.

How good are we at fine needle aspiration cytology?

OBJECTIVES: To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology. DESIGN: Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals. MAIN OUTCOME MEASURES: Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound. RESULTS: Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance. CONCLUSION: Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.

Purification, characterization and toxic profile of two toxins isolated from puffer fish Tetraodon patoca, available in Bangladesh.

Among the marine toxins related to human intoxication, tetrodotoxin has been known as one of the most prejudicial. Two tetrodotoxins, namely PFT-1 and PFT-2 were isolated and purified from liver of puffer fish by thin layer chromatography. The structure of both the toxins was elucidated by means of IR, 1H-NMR and 13C-NMR and mass spectroscopy. Sub acute toxicity study showed that both the toxins had pronounced effects on total RBC, WBC, platelet and ESR. Further serum levels of SGPT, SGOT, SALP, bilirubin, creatinine and urea are also affected by the toxins. The histopathological examinations showed that all the tissues such as liver, lung, heart and kidney of rat were severely changed after treatment with the toxins. The toxicity of the purified compounds, PFT-1 and PFT-2 were also performed by brine shrimp lethality bioassay.

Study on Mycobacterium tuberculosis: the primary drug resistance pattern.

The study was carried out to investigate the primary drug resistance pattern of tubercle bacilli isolated from the pulmonary tuberculosis patient attended in Shyamoli TB clinic, Dhaka. Sputum from 961 suspected tuberculous patients were randomly collected and stained by Ziehl-Neelsen (Z.N) stain. 135 were microscopically positive for Acid Fast Bacilli (AFB). Among them 30 patients were excluded from the study as they received antitubercular treatment before. So only 105 microscopically positive cases were cultured on Lowenstein-Jensen (L-J) media and 100 showed pure growth and rest 5 were contaminated with fungus. These 100 cases were studied on 4 antitubercular drugs. Out of these 100 isolates, 91 were M. tuberculosis and rest 9 in the nonchromogen group of mycobacteria other than tuberculosis (MOTT) species. Among 91 M. tuberculosis species, 89 (97.80%) to Isoniazid (INH), 73 (80.21%) to Rifampicin (RMP) and 91 (100%) to Streptomycin (SM) and Ethambutol (ETHM) were sensitive. Of the 9 MOTT species, 4 (44.44%) to SM, 7 (77.78%) to ETHM were sensitive and all (100%) were resistant to INH and RMP. Among the 100 isolates, 27 (18 M. tuberculosis and 9 MOTT) were resistant to 4 drugs either single or in combination. Of the 18 (66.67%) M. tuberculosis species, 16 (59.26%) to RMP, and 2 (7.41%) to RMP and INH were resistant. Of the 9 (33.33%) MOTT species, 4 (14.81%) to RMP and INH, 3 (11.11%) to RMP, INH and SM and 2 (7.41%) to RMP, INH, SM and ETHM were resistant.

Serum immunoglobulin profiles of septicemic versus healthy neonates.

We studied 125 clinically suspected septicemic neonates (Patient) aged from 1 to 28 days and 25 healthy neonates (control) of comparable age and sexes. Cultures of blood were done and serum immunoglobulins (IgG, IgA) were estimated in all the subjects. Blood cultures were found positive in 45 (36%) patients. Preterm patients showed significantly higher number of positive blood cultures as compared to term patients. The mean serum IgG level in patients was found significantly lower than that of the controls. The serum IgG levels were also found significantly lower in 75 preterm as compared to 50 term, and in 45 blood culture positive patients as compared to 80 blood culture negative patients. On the other hand, the mean serum IgM level in patients was found significantly higher as compared to controls. Similarly, serum IgM levels were found higher in preterm patients as compared to term patients and in blood culture positive patients as compared to blood culture negative patients. No significant difference of mean serum IgA level was found among the subjects. It is evident from our study, that blood culture positive patients were mostly preterm, in whom transplacental passage of IgG is insufficient and due to low IgG level, preterm baby cannot counteract bacterial invasion and as such, suffer from septicemia more frequently. Septicemic neonates as a rule showed higher level of serum IgM due to synthesis by themselves in primary response to infection.

Detection of early xerophthalmia by impression cytology and rose Bengal staining--a comparative study.

Twenty two cases were studied for early detection of Xerophthalmia by impression cytology and Rose Bengal staining. Patients were below 6 years of age and admitted in the paediatric ward of Dhaka Medical College Hospital. Assessment were done by conjunctival impression cytology and staining with 1% Rose Bengal dye. Estimation of serum retinol level was done by HPLC to correlate conjunctival findings with biochemical status. The mean age of the subjects were 3.15 +/- 1.75. Rose Bengal staining was positive in 40% cases and impression cytology was in 60% cases. The mean serum retinol level of the diseased children were 10.5 +/- 3. ug/dl. The sensitivity of Rose Bengal staining was 53.3% and that of impression cytology was 80% in detecting vitamin A deficiency when compared with serum retinol level. The specificity of Rose Bengal staining was 40% and that of impression cytology was 100%. Sensitivity of impression cytology was 100% in patient with retinol level 10 ug/dl.

Clinical and morphometric results of penetrating keratoplasty with one-piece anterior-chamber or suture-fixated posterior-chamber lenses in the absence of lens capsule.

The clinical records and serial corneal endothelial images of 25 acapsular, pseudophakic eyes with Kelman-style, one-piece, anterior-chamber intraocular lenses and 24 acapsular, pseudophakic eyes with suture-fixated, posterior-chamber intraocular lenses following penetrating keratoplasty were reviewed to determine clinical success and endothelial survival after 1 year. Twenty-two (88%) of 25 grafts in the anterior-chamber intraocular lens group and 23 (96%) of 24 grafts in the sutured posterior-chamber intraocular lens group were clear after 1 year; best corrected visual acuity of 20/40 or better was noted in 25% of the eyes in the anterior-chamber intraocular lens group and 29% of the eyes in the sutured posterior-chamber intraocular lens group. The mean intraocular pressure for the anterior-chamber intraocular lens group was significantly lower than for the sutured posterior-chamber intraocular lens group at 3 months (17 +/- 4 vs 21 +/- 7 mm Hg) and at 6 months (17 +/- 3 vs 20 +/- 5 mm Hg); but did not differ at 1 year. The mean percent of endothelial cell loss after 1 year did not differ between the anterior-chamber intraocular lens group (32% +/- 26%) and the sutured posterior-chamber intraocular lens group (27% +/- 26%). No clinical or endothelial morphometric advantages were noted after 1 year for the suture-fixated, posterior-chamber intraocular lens over the Kelman-style, one-piece anterior chamber, intraocular lens following pseudophakic penetrating keratoplasty; however, a long-term, prospective, randomized study of these two intraocular lens types is recommended.

Brain trace elements in Alzheimer's disease.

Instrumental neutron activation analysis has been used to determine the concentrations of 16 elements in selected brain regions and separated gray- and white-matter specimens from histologically verified Alzheimer's disease (AD) and age-matched control patients. Significantly different (p less than 0.05) mean concentrations of Br, Cl, Cs, Hg, N, Na, P, and Rb were observed in AD bulk brain samples compared to controls, while no significant differences were observed for Ag, Co, Cr, Fe, K, Sb, Sc, and Se. The differences that are most persistent and largest in magnitude for the pooled bulk samples, males and females, left and right hemispheres, and separated gray and white matter are the elevation of Br and Hg and the depletion of Rb in AD compared to controls. Significant interelement correlations for the latter elements in both AD and control brains are also documented. Based on these studies, the possibility of an etiological role for trace elements in AD clearly deserves further investigation.

Brain trace elements in Pick's disease.

The trace element content of the brain of two patients with Pick's disease examined postmortem was studied using instrumental neutron activation analysis. Results showed significant increases in chlorine, iron, manganese, sodium, and phosphorus and significant decreases in chromium, cesium, rubidium, and selenium and in the mean freeze-dried to wet-weight ratio for patients with Pick's disease compared with control patients. Brain zinc content was not elevated in the two patients, a finding that fails to support the hypothesis that elevated zinc levels play a role in the pathogenesis of Pick's disease.

Brain manganese concentrations in human aging and Alzheimer's disease.

Manganese levels have been measured in various brain regions in Alzheimer's disease (AD) and aging using instrumental neutron activation analysis. Mn grand mean for all regions was 0.261 micrograms/g for adult controls and 0.245 micrograms/g for AD and the differences were not statistically significant (p less than 0.05). Highest Mn levels were found in the basal ganglia in controls and AD. No significant alterations in Mn were found with advancing age suggesting that the brain has an efficient homeostatic mechanism regulating Mn concentrations. Mn exhibited a significant positive correlation with Fe. Infants had a significantly lower brain Mn level compared to adults.

Brain trace element concentrations in aging.

Trace element concentrations were determined in various human brain regions over the complete life span using instrumental neutron activation analysis. Several different patterns of trace element alteration were observed with age. Brain Al, Cl and Na concentrations increase with advancing age, while K, P and Rb decline. Ag, Co, Fe, Sb and Sc concentrations increase up to the 40 to 79 age range then decline. Br, Se and Zn remain relatively constant throughout adult life. Hg, Mn and Cs show no consistent trend with age. In infant brains Br and Cl increase and Al, Cr, Cs, Fe, Mn, P, Rb, Sc, Se and Zn decrease compared to adults. The essential elements that remain within narrow concentration limits throughout adult life suggest the presence of an efficient homeostatic mechanism for their regulation in the brain, while those that are altered with age suggest modifications in control mechanisms or altered relationships with other elements. Increased concentrations of non-essential elements may reflect accumulation from our environment, impaired removal or altered balance with other elements.

Instrumental neutron activation analysis of brain aluminum in Alzheimer disease and aging.

Instrumental neutron activation analysis procedures were used to determine the aluminum content of various brain regions in histologically verified Alzheimer disease (AD) and in controls. The grand mean aluminum level for 74 AD specimens was 0.372 +/- 0.058 microgram/gm and for 137 adult controls, 0.467 +/- 0.033 microgram/gm, both on a wet weight basis. No difference was found at the bulk sample level between AD and adult controls, corrected for age and sex, or when frontal, temporal, and hippocampal specimens were compared. Control specimens (infancy to 85 years) showed an increase in brain aluminum concentration with age. Comparison of freeze-dried to wet weight ratios of AD and controls revealed a small increase in water content in AD brains.