An Insight into Survivin in Relevance to Hematological, Biochemical and Genetic Characteristics in Tobacco Chewers with Oral Squamous Cell Carcinoma.

BACKGROUND: Survivin is an inhibitor of apoptosis protein (IAP), encoded by the Baculoviral IAP Repeat Containing 5 (BIRC5) gene located on q arm (25.3) on chromosome 17. It is expressed in various human cancers and involved in tumor resistance to radiation and chemotherapy. The genetic analysis of the BIRC5 gene and its protein survivin levels in buccal tissue related to oral squamous cell carcinoma (OSCC) in South Indian tobacco chewers has not been studied. Hence, the study was designed to quantify survivin in buccal tissue and its association with pretreatment hematological parameters and to analyze the BIRC5 gene sequence. METHOD: In a single centric case control study, buccal tissue survivin levels were measured by ELISA. A total of 189 study subjects were categorized into Group 1 (n = 63) habitual tobacco chewers with OSCC, Group 2 (n = 63) habitual tobacco chewers without OSCC, and Group 3 (n = 63) healthy subjects as control. Retrospective hematological data were collected from Group 1 subjects and statistically analyzed. The BIRC5 gene was sequenced and data were analyzed using a bioinformatics tool. RESULTS: Survivin protein mean ± SD in Group 1 was (1670.9 ± 796.21 pg/mL), in Group 2 it was (1096.02 ± 346.17 pg/mL), and in Group 3 it was (397.5 ± 96.1 pg/mL) with significance (p < 0.001). Survivin levels showed significance with cut-off levels of absolute monocyte count (AMC), neutrophil/lymphocyte ratio (NLR), and lymphocyte/monocyte ratio (LMR) at (p = 0.001). The unique variants found only in OSCC patients were T → G in the promoter region, G → C in exon 3, C → A, A → G, G → T, T → G, A → C, G → A in exon 4, C → A, G → T, G → C in the exon 5 region. CONCLUSIONS: The tissue survivin level increased in OSCC patients compared to controls; pretreatment AMC, LMR, and NLR may serve as add-on markers along with survivin to measure the progression of OSCC. Unique mutations in the promoter and exons 3-5 were observed in sequence analysis and were associated with survivin concentrations.

Detailed Review of Chronic Kidney Disease.

BACKGROUND: Nephropathy problems in the Udhanam region of Andhra Pradesh in India have motivated researchers to investigate the various factors related to chronic kidney disease (CKD). Initially, studies came across the markers of identification of CKD, i.e., glomerular filtration rate (GFR) and albumin creatinine rate, as global markers of identification. Cystatin C (Cys C) and its reciprocal (1/Cys C) are used to calculate GFR. This is a very easy method compared to the more accurate methods such as radiolabelled tracer clearances, which are invasive, may involve radiation, and require several hours to perform, e.g., 99-diethylene triamine penta-acetic acid (99mTc-DTPA) and 51Cr-EDTA. This article provides the causes (or risk factors), symptoms, and complications of CKD in a clear manner such that even common people can easily understand. Once a patient is detected and proved to be affected by CKD then the patient as well as the caretakers, including doctors, must follow some constraints. Thereby it is possible to prevent CKD progression in the patient. Modern methods are needed to prevent the pathogens which are responsible for CKD. SUMMARY: With the help of various engineering techniques one can easily design controllers to assess as well as to prevent CKD permanently. The easiest procedure for identifying CKD is to screen people. Current recommendations suggest screening of individuals with diabetes, hypertension, cardiovascular disease, and family history of kidney diseases in the course of routine health check-ups. Much work has been done in medical sciences in the area of CKD, but there is still scope for further research. From the recent studies, advanced tools such as data mining, etc., are considered to be the current trend in the area of CKD. KEY MESSAGE: From this article, the authors propose that patients who are already affected by urinary tract infection, acute kidney injury, and a family history of CKD should be examined via some basic tests for the presence of CKD.

Evaluation of histomorphological and immunohistochemical parameters as biomarkers of cervical lymph node metastasis in squamous cell carcinoma of oral cavity: A retrospective study.

INTRODUCTION: Oral squamous cell carcinoma (OSCC) is seen worldwide but is more common in India. Lymph node (LN) metastasis has been shown to be the strongest prognostic factor in OSCC. Many histopathological and immunohistochemical markers have been studied to predict the LN metastasis. AIMS: To identify clinicopathological factors and immunohistochemical (IHC) biomarkers which predict cervical metastasis in OSCC patients. STUDY AND DESIGN: A total of 105 cases of OSCC were taken up for our study. Histopathological parameters such as tumor thickness, depth, degree of differentiation, pattern of invasion (POI), lymphovascular and neural invasion were assessed. IHC was done on all cases using antibodies against Ki-67, cyclin D, E-cadherin, p53, CD31 and each antibody was assessed according to the standard protocol. STATISTICAL ANALYSIS: To calculate the relation between clinical, histopathological parameter, IHC marker and the occurrence of LN metastasis, chi-square test was used. Variables were tested using multivariate logistic regression method to assess the predictive significance. RESULTS: Out of 105 cases studied, 29 cases showed LN metastasis. Maximum numbers of cases affected were females with involvement of buccal mucosa. We found significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression. In our study; tumor depth, thickness, extent of peritumoral lympho-plasmacytic infiltration, presence of eosinophils, tumor nest type, p53 and microvessel density (MVD) showed no significant correlation. CONCLUSION: Significant association of cervical LN metastasis with high grade of differentiation, lack of E-cadherin expression, high Ki-67 and cyclin D1 expression was seen.

Evaluation of Bacillus cereus and Bacillus pumilus metabolites for anthelmintic activity.

OBJECTIVE: To assess the anthelmintic acivity of Bacillus cereus and Bacillus pumilus metabolites. MATERIALS AND METHODS: The successive solvent extractions with petroleum ether, ethyl acetate and methanol. The solvent extracts were tested for anthelmintic activity against Pheretima posthuma at 20 mg/ml concentration. The time of paralysis and time of death of the worms was determined for all the extracts. Albendazole was taken as a standard reference and sterile water as a control. RESULTS: All the sample extracts showed significant anthelmintic activity in paralyzing the worms comparable with that of the standard drug. The time of death exhibited by BP metabolites was close to the time exhibited by standard. CONCLUSION: The study indicates both bacteria Bacillus cereus and Bacillus pumilus have anthelmintic activity indicating potential metabolites in them.

Primary splenic sarcoidosis.

Here we report a case of primary splenic sarcoidosis presenting with isolated splenomegaly with multiple splenic nodules. The sarcoidosis was diagnosed and treated by splenectomy.

Impact of metabolic syndrome on global left ventricular function: As evaluated by the myocardial performance index.

BACKGROUND: Metabolic syndrome is associated with the development of diabetes mellitus and cardiovascular disease. The impact of metabolic syndrome on the progression of atherosclerosis has been well documented. This study was designed to evaluate the impact of metabolic syndrome on global left ventricular function by using left ventricular myocardial performance index (LVMPI). METHODS: The diagnosis of metabolic syndrome was made as per the criteria of the International Diabetes Federation. Echocardiography was performed with a Philips IE33 machine using a 1-5 MHz transthoracic probe. LVMPI was calculated by adding isovolumic contraction time with isovolumic relaxation time and dividing it by ejection time. RESULTS: The mean LVMPI value in metabolic syndrome was 0.64 ± 0.09, while that in controls was 0.48 ± 0.06 (p < 0.001). Metabolic syndrome was seen to have more significant influence on LVMPI. CONCLUSIONS: Metabolic syndrome is a strong predictor of sub-clinical myocardial dysfunction in subjects free of clinically apparent heart disease.

Expression of vimentin in breast carcinoma, its correlation with Ki67 and other histopathological parameters.

CONTEXT: Vimentin is a mesenchymal marker, known to express in some epithelial carcinomas. AIMS: 1. To find out the expression of vimentin in infiltrating ductal carcinoma of breast (not otherwise specified), 2. To find out the correlation between expression of vimentin and prognostic markers such as tumor size, tumor grade, lymph node status, proliferation index (measured by Ki 67), and Nottingham prognostic index (NPI). MATERIALS AND METHODS: Study was done at Department of Pathology; 50 cases of infiltrating ductal carcinoma (NOS) were studied for tumor grade; immunohistochemistry was done using antibodies against vimentin and Ki 67. Percentages of positive cells were documented. An immunoscore was also calculated for vimentin. Vimentin expression was correlated with tumor size, lymph node status, Nottingham prognostic index, and Ki 67. STATISTICAL ANALYSIS USED: statistical correlation was done using Pearson's chi-square test. A P value less than 0.01 was considered significant. RESULTS: Vimentin expression was seen in 18% of cases. Its expression correlated with high tumor grade and high growth fraction (P value < 0.01). It did not correlate with lymph node status, tumor size, and NPI. CONCLUSIONS: Increased vimentin expression is associated with bad prognostic factors. Immunohistochemistry with vimentin may be helpful in knowing the prognosis in cases of infiltrating ductal carcinoma of breast (NOS).

Primary testicular lymphoma with rupture: An unusual presentation.

Primary testicular lymphoma usually presents as a unilateral testicular mass with occasional bilateral involvement. The tumor show contiguous spread to rete testis, epididymis spermatic cord and rarely to tunica albuginea. We report a case of primary testicular lymphoma which showed rupture of tunica albuginea with involvement of inguinal lymph node which is unusual. A 50-year-old male patient presented with right inguinal swelling and right side scrotal swelling of five months' duration. Fine needle aspiration of the right inguinal lymph node was done and was suggestive for lymphoma/seminoma. Histopathology of right orchiectomy revealed non-Hodgkin's lymphoma (NHL). Further investigations did not reveal any other organs involved with non-Hodgkin's lymphoma. Primary testicular lymphoma usually shows spread to extranodal sites like skin, central nervous system and Waldeyer's ring at presentation and at relapse. Whereas, less common sites are lung, bone, liver, gastrointestinal system and nodal sites, especially the paraaortic lymph nodes. Testicular lymphoma with involvement of the inguinal lymph node is unusual. Clinical presentation of such cases may mimic germ cell tumors.

Secondary Chondrosarcoma of the Lumbosacral Region: Are any Bones Spared in the Multiple Hereditary Exostoses?

Osteochondromas are the most common benign bone tumors. Usually solitary, multiple osteochondromas (exostoses) are seen in patients with Multiple Hereditary Exostoses (MHE). Chondromatous transformation of lumbar osteochondroma in a patient with multiple exostoses is a rare phenomenon. We present a rare case of secondary chondrosarcoma of lumbar exostoses with patient presenting with symptoms of pain in the right lumbar region and paresis of right lower limb. Patients with multiple exostoses are prone to develop chondrosarcoma early in life. These patients need long term follow up with regular clinical and radiological examination.

Significance of Hematological Scoring System (HSS) in Early Diagnosis of Neonatal Sepsis.

Neonates are easily prone for bacterial infection. Diagnosis of neonatal septicemia may be difficult as the early signs of sepsis may be subtle and different at different gestational ages. The present study was undertaken to assess the significance of the hematological scoring system (HSS) for early detection of neonatal sepsis. About 50 peripheral blood smears of all newborns collected were analysed for neonatal sepsis using the HSS of Rodwell et al. (J Pediatr 112:761-767, 1988). Analysis in our study found that an abnormal immature to total neutrophil ratio (I:T) followed by an abnormal immature to mature neutrophil ratio (I:M) were the most sensitive indicators in identifying infants with sepsis. The HSS is a simple, quick, cost effective tool which can be used as a screening test for early diagnosis of neonatal sepsis.

Exflagellated microgametes of Plasmodium vivax in human peripheral blood: an uncommon feature of malaria.

In the life cycle of malarial parasite exflagellation of microgametes occur in mosquitoes. Usually this will not occur in the peripheral blood of human beings. However, exflagellation can occur in the collected blood and may create diagnostic dilemma. We report a case of vivax malaria with exflagellated microgametes, which were mistaken for a double infection of vivax malaria and borrelia.

Pattern of cancer in adolescent and young adults--a ten year study in India.

BACKGROUND: Cancers in adolescent and young adults are different from those in older adults and are more likely to relate to genetic predisposition and exposure to risk factors early in life. They also have the greatest impact on those individuals who have most of their potential years of life ahead of them. OBJECTIVE: To determine the incidence and pattern of cancers in adolescent and young adults. METHODOLOGY: A ten year retrospective study from January 1997 to December 2006 was performed at the Department of Pathology. All malignancies diagnosed between the ages of 15-44 years were retrieved from our records and socioepidemiological data regarding each case were collected from the hospital record section. The cases were analyzed for incidence, site of involvement, age/sex distribution and year wise distribution by descriptive analysis. RESULTS: In this study, cancer in adolescent and young adults accounted for 26.6% of all the cancers diagnosed. Maximum cases were seen between 35-39 years age group in both genders. The male:female ratio was 1:2. Year wise there was steady rise in number of cases from 1997 to 2006 in both genders. The top five common sites in males were cancer of mouth, stomach, testis, bone and penis and in females were mouth, cervix uterus, breast, thyroid and stomach. CONCLUSION: In the present study, cancer of mouth predominated in both genders, followed by stomach in males and cervix uterus and breast in females, reflecting potential lifestyle and environmental factors.

Spectrum of gastro-intestinal cancers--a ten-year study.

Pattern of gastro-intestinal malignancies differ in different geographical areas and depends upon the genetic, cultural, dietary and socioeconomic factors. Therefore studying pattern of gastro-intestinal cancers help to identify high risk groups, recommend preventive measures or advise appropriate screening in high risk population. The present study was undertaken to determine the pattern of gastrointestinal malignancies at Kolar, situated in south-eastern part of Karnataka. A ten-year retrospective study from January 1997 to December 2006 was done at the department of pathology at Sri Devaraj Urs Medical College, Kolar, Karnataka. All the gastro-intestinal malignancies diagnosed were retrieved from pathology department records and socio-epidemiological data regarding each case was collected from hospital record section. The cases were analysed for site of involvement, age distribution, histological types and yearwise distribution by descriptive analysis. Gastro-intestinal malignancies constituted 22.96% of all the malignancies diagnosed. Males were more frequently affected than females, M:F ratio was 1:0.6. Peak incidence was in 7th decade. Stomach was the commonest site (48.4%) followed by oesophagus (27.7%), rectum (6.5%), colon (5.0%) and primary liver cancer (4.76%). Majority of histological type was adenocarcinoma. Yearwise distribution showed gradual increase in incidence of cancer. In the present study gastro-oesophageal malignancies was the most common gastro-intestinal malignancy in this part of Karnataka which in turn reflects on potential lifestyle and environmental factors.

Malignant peripheral nerve sheath tumor with divergent differentiation.

A malignant peripheral nerve sheath tumor (MPNST) is an uncommon spindle cell sarcoma accounting for approximately 5% of all soft tissue sarcomas. A 55-year-old female with a right suprarenal tumor showed MPNST with additional foci of epithelioid, rhabdomyoblastic, osteogenic and lipogenic differentiation. Although the capacity of MPNST to undergo epithelioid, rhabdomyoblastic, osteogenic and very rarely lipogenic differentiation is reported in literature, the occurrence of all these differentiation in one case has not been described in literature before. To the best of our knowledge, this is only the second MPNST case with lipomatous differentiation.

Malignant hypertension, dissection of aorta, cardiac tamponade and monoparesis--unusual presentation of Takayasu's arteritis: clinicopathological correlation.

We report a case of a 24-year-old woman with an unremarkable past medical history who was presented to the emergency department with acute onset of breathlessness and weakness of right lower limb. Clinical examination was suggestive of malignant hypertension with acute left ventricular failure and acute ischemia of right lower limb. Colour Doppler and CT findings were consistent with dissection of entire aorta with extension into its major branches. She died in less than 18 h after admission following cardiac tamponade. Autopsy revealed left renal artery stenosis with features of Takayasu's arteritis with intimal rupture in the abdominal aorta with Stanford type A dissection of aorta extending to all the major branches of aorta, and hemopericardium. This case demonstrates a rare example Takayasu's arteritis involving left renal artery leading to secondary hypertension presenting as malignant hypertension with fatal dissection of aorta with cardiac tamponade and emphasizes the varied presentations of this disease and importance of early diagnosis and interventions to prevent these fatal complications.

Ovarian pregnancy.

Ovarian pregnancy is a rare form of extrauterine pregnancy contributing < 3% of ectopic pregnancies. We report an ovarian pregnancy in a 23-year female.

Plasma cell leukemia presenting as acute renal failure: a case report.

Plasma cell leukemia is a rare form of malignant plasma cell dyscrasia. It can occur as a primary form without prior evidence of multiple myeloma or as a secondary form which is a terminal event in multiple myeloma. A case of primary plasma cell leukemia presenting as acute renal failure is reported here.

Factors influencing quality of semen: a two year prospective study.

In the recent years, male infertility and subfertility has increased, which is attributed to many factors. So our study focuses the effects of age, occupation, smoking, alcohol and varicocele on the semen quality. Detailed history and examination of 93 cases (fulfilled inclusion criterion) was done. Semen analysis of these cases were compared with above parameters using statistical tools like mean, standard deviation, standard error of mean and significance was tested by student's 't' test. The mean sperm density, total motility and rapid progressive motility in control group were 68.95 x 10(6)/ml, 59.9% and 30.5% respectively. Reduction of sperm density was statistically significant (p value < 0.05) in both tobacco users + alcoholics and in varicocele patients in comparison with controls. Age and occupation did not alter semen quality significantly. Our study concluded that semen quality is decreasing in the past few decades and combined tobacco + alcohol use, and varicocele have more detrimental effect on semen quality.