Primary Mammary-Analogue Secretory Carcinoma of the Lung: A Rare Entity With an Unusual Location.

This is a case of a 55-year-old female with past medical history of tobacco smoking, hypertension, and lupus who presented with a left lung nodule, found on computed tomographic scan of the chest during workup for a recently diagnosed squamous cell carcinoma in a cervical lymph node. Resection of the lung nodule showed a 2.3-cm well-defined pale-tan mass, and histologic examination showed a well-circumscribed lesion with papillary, solid, and gland-like architectural patterns, with eosinophilic secretions, areas of comedonecrosis, and increased mitotic activity. Immunohistochemical stains showed the lesion to be positive for cytokeratin 7, S100 protein, and focally positive for mammaglobin. Fluorescence in situ hybridization studies confirmed rearrangement of the ETV6 gene at 12p13.2. To date, our case is the second reported case of a primary mammary-analogue secretory carcinoma arising in the lung, and the first to show evidence of tumor necrosis: an unusual feature in an unusual location.

Gene variant profiles and tumor metabolic activity as measured by FOXM1 expression and glucose uptake in lung adenocarcinoma.

BACKGROUND: Cancer cells displaying aberrant metabolism switch energy production from oxidative phosphorylation to glycolysis. Measure of glucose standardized uptake value (SUV) by positron emission tomography (PET), used for staging of adenocarcinoma in high-risk patients, can reflect cellular use of the glycolysis pathway. The transcription factor, FOXM1 plays a role in regulation of glycolytic genes. Cancer cell transformation is driven by mutations in tumor suppressor genes such as TP53 and STK11 and oncogenes such as KRAS and EGFR. In this study, SUV and FOXM1 gene expression were compared in the background of selected cancer gene mutations. METHODS: Archival tumor tissue from cases of lung adenocarcinoma were analyzed. SUV was collected from patient records. FOXM1 gene expression was assessed by quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). Gene mutations were detected by allele-specific PCR and gene sequencing. RESULTS: SUV and FOXM1 gene expression patterns differed in the presence of single and coexisting gene mutations. Gene mutations affected SUV and FOXM1 differently. EGFR mutations were found in tumors with lower FOXM1 expression but did not affect SUV. Tumors with TP53 mutations had increased SUV (p = .029). FOXM1 expression was significantly higher in tumors with STK11 mutations alone (p < .001) and in combination with KRAS or TP53 mutations (p < .001 and p = .002, respectively). CONCLUSIONS: Cancer gene mutations may affect tumor metabolic activity. These observations support consideration of tumor cell metabolic state in the presence of gene mutations for optimal prognosis and treatment strategy.

Adverse Local Tissue Reaction After a Metal-on-Metal Total Hip Prosthesis Without Elevated Serum Metal Ion Levels.

In the 1990s, metal-on-metal (MoM) bearings were reintroduced in total hip arthroplasty (THA), having the proposed advantages of decreased wear and improved stability. However, catastrophic adverse local tissue reaction (ALTR) secondary to metal debris from both the bearing surface and the head-neck junction is a well-recognized complication. The measurement of metal ion levels in the serum is often a first-line test to identify failure of a MoM bearing. The authors describe a 70-year-old man who presented with a multiply revised MoM THA and a large periprosthetic fluid collection incidentally seen during computed tomography for renal nephrolithiasis. The patient reported painless, progressive swelling over the lateral aspect of the hip. An infectious workup including serum erythrocyte sedimentation rate, C-reactive protein, and intraarticular hip aspiration yielded negative results. Metal ion levels in the serum, including a minimally elevated cobalt level, were unremarkable, and metal-lymphocyte transformation testing yielded negative results. Radiographic imaging revealed progressive osteolysis around the proximal femur, and magnetic resonance imaging showed large fluid collections with irregular wall thickening surrounding the gluteal and iliopsoas musculature. At revision surgery, a large fluid collection and corrosion at the head-neck junction were present. Pathology specimens confirmed the presence of an ALTR. This report presents a previously undescribed case of an ALTR secondary to MoM THA in the absence of elevated serum metal ion levels. This indicates the necessity of considering all aspects of a patient's clinical presentation, imaging modalities, and laboratory testing in the evaluation and diagnosis of a symptomatic MoM THA. [Orthopedics. 2018; 41(3):e438-e441.].

Self-directed learning and research attitudes among medical students.

OBJECTIVE: To describe the correlation between Self-directed Learning (SDL) and medical students' attitude towards research, based on the premise that self-directed learners are independent, motivated, and curious learners. STUDY DESIGN: Observational cross-sectional study. PLACE AND DURATION OF STUDY: Rawalpindi Medical College, Rawalpindi, from August 2011 to January 2012. METHODOLOGY: One hundred and ninety-four students of final (5th) year class at Rawalpindi Medical College, Rawalpindi participated in this cross-sectional study. SDL ability of students was measured using Oddi's Continuing Learning Inventory (OCLI) whereas Attitude Towards Research (ATR) scale was used to measure their research attitudes. Spearman's rank-order analysis was performed to measure correlation between SDL scores on OCLI and all the 18 items on ATR scale. RESULTS: Statistically significant relationships with correlation coefficients ranging from +0.12 to +0.32 were found for the correlation between scores on the OCLI and eleven statements highlighting research use and positive attributes of research (14 items). Those students who participated in extra-curricular research projects (n=58, 29.9%) had relatively higher scores on OCLI as compared to those who did not participate (n=136, 70.1%, p=0.041). CONCLUSION: Self-directed learners show a positive attitude towards research, though the relationship is not strong.

Knowledge, attitude, and practice of water-pipe smoking among medical students in Rawalpindi, Pakistan.

OBJECTIVES: To assess knowledge, attitude and practice of water-pipe smoking among medical students. METHODS: The cross-sectional study using self-administered questionnaire was conducted at Rawalpindi Medical College, Rawalpindi, in 2011, and included all five batches of medical students. SPSS 17 was used for statistical analysis of the data. RESULTS: The final sample comprised 724 participants; 505 (69.7%) being female and 219 (30.2%) being male students. Besides, 625 (86.6%) participants knew about shisha smoking, and 140 (22.4%) reported to have smoked shisha. Curiosity (n = 44; 31.4%) and social trends (n = 41; 29.2%) were cited as main reasons for shisha smoking. Overall, 572 (91.5%) participants thought shisha was dangerous for health, with majority 261 (41.8%) believing it to be more dangerous than cigarettes. CONCLUSIONS: There was awareness among medical students about the hazards of shisha smokng. Even then water-pipe smoking was relatively common among them.

How has problem based learning fared in Pakistan?

OBJECTIVE: To conduct a systematic review of primary research in undergraduate medical education in Pakistan in order to evaluate PBL programs, examine outcomes and competencies influenced by PBL, and compare them with conventional learning (lecture based learning, LBL). STUDY DESIGN: Qualitative content analysis. PLACE AND DURATION OF STUDY: Rawalpindi Medical College, Rawalpindi, from June 2010 - February 2011. METHODOLOGY: Literature was searched using online resources. Studies evaluating outcomes influenced by PBL, or comparing PBL with lecture based learning (LBL) were selected. Due to heterogeneity, a qualitative content analysis was performed in which studies were classified according to the methods of assessment; results were then summarized by outcome and frequencies were calculated. RESULTS: Eleven studies were included. Apart from knowledge acquisition, students gave high ratings to PBL in selected outcomes, alone, and in comparison with LBL. There was a disagreement among results of studies that evaluated knowledge acquisition alone. CONCLUSION: Based on student perceptions, PBL has many advantages. However, the results of this review are limited due to heterogeneity and methodological weakness of studies, specially the studies that compared exam scores to assess knowledge acquisition.

Dissection videos do not improve anatomy examination scores.

In this quasi-experimental study, we describe the effect of showing dissection videos on first-year medical students' performance in terms of test scores during a gross anatomy course. We also surveyed students' perception regarding the showing of dissection videos. Two hundred eighty-seven first-year medical students at Rawalpindi Medical College in Pakistan, divided into two groups, dissected one limb in first term and switched over to the other limb in the second term. During the second term, instruction was supplemented by dissection videos. Second-term anatomy examination marks were compared with first-term scores and with results from first-year medical students in previous years. Multiple linear regression analysis was performed, with term scores (continuous, 0-200) as the dependent variable. Students shown dissection videos scored 1.26 marks higher than those not shown. The relationship was not statistically significant (95% CI: -1.11, 3.70; P = 0.314). Ninety-three percent of students favored regular inclusion of dissection videos in curriculum, and 50% termed it the best source for learning gross anatomy. Seventy-six percent of students did not perform regular cadaver dissection. The most frequent reason cited for not performing regular dissection was high student-cadaver ratio. Dissection videos did not improve performance on final examination scores; however, students favored their use.