A neural network computational structure for the fractional order breast cancer model.

The current study provides the numerical performances of the fractional kind of breast cancer (FKBC) model, which are based on five different classes including cancer stem cells, healthy cells, tumor cells, excess estrogen, and immune cells. The motive to introduce the fractional order derivatives is to present more precise solutions as compared to integer order. A stochastic computing reliable scheme based on the Levenberg Marquardt backpropagation neural networks (LMBNNS) is proposed to solve three different cases of the fractional order values of the FKBC model. A designed dataset is constructed by using the Adam solver in order to reduce the mean square error by taking the data performances as 9% for both testing and validation, while 82% is used for training. The correctness of the solver is approved through the negligible absolute error and matching of the solutions for each model's case. To validates the accuracy, and consistency of the solver, the performances based on the error histogram, transition state, and regression for solving the FKBC model.

Borderline phyllodes tumor arising in ectopic breast tissue in the axilla: Report of a rare case with brief review of literature.

Development of a neoplasm in an ectopic breast is uncommon, while the development of phyllodes tumor in an ectopic breast in the axilla is even rarer. We report a rare case of a 51-year-old female who presented with a complain of swelling and pain in the right axilla with no associated complaints in other organs. Magnetic resonance imaging suggested a possibility of metastatic lymphadenopathy. Complete excision of the right axillary mass was performed and sent for histopathological examination which was examined thoroughly and sections were given. On microscopic examination, stromal proliferation in a leaf-like pattern with mild stromal atypia and focal permeation of borders were seen, and a diagnosis of Ectopic borderline phyllodes tumor in axilla was made, which is extremely rare and needs to be differentiated from its close differentials like fibroadenoma and periductal stromal sarcoma.

Extranodal Diffuse Large B-Cell Lymphoma (DLBCL) Presenting as Diffuse Joint Pain: A Diagnostic Dilemma.

Diffuse Large B-Cell Lymphoma (DLBCL) of bone is a rare presentation of Non-Hodgkin Lymphoma (NHL), which remains asymptomatic or present late in clinical course as bone pain or pathological fracture. We report a case of a 15-year-old male child presenting with diffuse joint pain and swelling over his left shoulder and elbow, associated with B symptoms. Radiological examination revealed lytic lesions in multiple bones along with collection along the left iliopsoas and hip joint, suggestive of infective etiology. The diagnostic dilemma was resolved on biopsy, which confirmed DLBCL involving bones and soft tissue.

Molecular Classification of Breast Carcinoma in a Tertiary Hospital of India: the Recent Trends.

Breast cancer is a heterogeneous disorder with various subcategories of different cellular compositions, molecular alterations, and clinical behaviour and is dependent on numerous factors like grade, size, and hormonal receptors which influence the overall prognosis and response to the treatment. This study was done to determine the frequency of estrogen receptor (ER), progesterone receptor (PR), and Her2 neu positivity in breast cancer patients, further classifying them into their molecular types (luminal A, B, Her2 neu, and triple-negative) and studying their association with histological subtypes, lymph node status, and other epidemiological parameters. This was a 5-year retrospective study done on 314 patients. All relevant clinical data including the age, sex, and lymph node status along with the histological type and grade of the tumour were recorded, and immunohistochemical evaluation of Her2 neu, ER, and PR receptors was done. The results showed that ER was the most predominant immunomarker, followed by PR, with an inverse relationship between ER, PR, and Her2 neu. Among the molecular subtypes, luminal B showed the maximum prevalence followed by triple-negative and Her2 neu subtype. The least frequency was shown by luminal A. Our study concluded that molecular subtyping of breast carcinoma plays an important role in determining the prognosis, recurrence, and treatment. Increased expression of luminal B subtype can be correlated due to the advancing age of the patients.

Rapid Cytological Diagnosis With Evaluation of Pre- and Post-Therapeutic Fungal Morphological Characteristics in Mucormycosis.

Background: Mucormycosis necessitates rapid diagnosis and treatment. Microscopy and culture have been considered the gold standard for diagnosis but both take time of 3 - 5 days. KOH mount is another method for fungal identification that takes 1 - 2 h, but it has its own limitations. This study evaluated crush smear as a means of rapid cytological diagnosis. Methods: Biopsy tissue (pre-treatment) from clinically suspicious mucormycosis patients (n = 52) was received in normal saline and crush/imprint smears were prepared; the remaining tissue was processed as routine biopsy specimen. After the rapid initial cytological identification, the patients were managed according to the standard clinical protocol. Random post-therapeutic biopsy samples of some of these patients (n = 19) were also obtained and again evaluated cytologically. Results: Crush smears showed sensitivity/specificity of 77.7%/75.0% with histopathology and 72.2%/62.5% with culture, respectively, while KOH mount had values of 71.4%/70.5% with histopathology and 79.3%/69.5% with culture, respectively. Degenerative fungal morphological characteristics and cellular inflammatory infiltrate (predominantly neutrophilic) in the vicinity of fungal hyphae were compared in pre- and post-treatment groups, and we found a statistically significant difference (P < 0.05) between them. Conclusion: Our preliminary results suggest that crush smear cytology is a simple, rapid, cost-effective and easily available method for diagnosing mucormycosis. Moreover, crush smears also demonstrated morphological alteration in hyphal structure and accompanying immune cell infiltration which may provide valuable insights into mechanism of therapy/host immune response against fungal pathogen.

A Study to Evaluate the Effectiveness of "Mindfulness-Based Stress Reduction Therapy(MBSRT)" in Reducing Symptom Severity and Improving Quality of Life in Patients Suffering From Irritable Bowel Syndrome.

INTRODUCTION: Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high prevalence. IBS is considered a disorder of brain-gut interaction. Mindfulness-Based Stress Reduction Therapy (MBSRT) is a form of treatment that uses meditation and relaxation to foster awareness and acceptance of the present moment. This kind of therapy requires individuals to practice noticing and observing details about their surroundings without passing judgment or reacting to triggers in the environment. MATERIAL AND METHODS: After making the diagnosis of IBS, 30 patients were subjected to concomitant MBSRT in addition to pharmacological therapy(Case Group) while the remaining were given only pharmacotherapy (Control Group). MBSRT was performed by a Clinical Psychologist. Seventeen patients were given only pharmacological therapy (Control Group). Scores were assessed using the IBS Symptom Severity Scale (IBS-SSS), Five Facets of Mindfulness Questionnaire(FFMQ), and World Health Organisation Quality Of Life-BREF (WHO-QOL-BREF) before and after the completion of MBSRT sessions. RESULTS: The study included 47 patients (30 in the case group and 17 in the control group) who presented to Medicine OPD and were diagnosed with IBS. Kendall tau correlation test was applied for IBS-SSS scores, which showed significant improvement in IBS-SSS scores postmindfulness therapy in the case group with P value of <0.001. McNemar test was applied for FFMQ scores, which showed significant improvement in FFMQ scores postmindfulness therapy in the case group with a P value of <0.001. A logistic regression model was also generated, which showed a significant change in QOL scores after MBSRT. CONCLUSION: IBS patients who received MBSRT had a greater improvement in the quality of life and mindfulness components and reduced IBS symptoms as compared with the control group.

Unusual Sites of Leiomyosarcoma: A Study of 3 Interesting Cases.

Leiomyosarcoma malignant tumours arise from the smooth muscle cells. They are rapidly growing tumours with aggressive behaviour and poor prognosis. Although relatively rare, they pose a diagnostic challenge as they comprise a large spectrum of diagnostic entities. Herein, we describe three cases of leiomyosarcoma developing at unusual sites and posing diagnostic challenges. Our first case is a leiomyosarcoma developing at the post-burn scar site; the second case is of primary pulmonary leiomyosarcoma, and the third is retroperitoneal leiomyosarcoma. Histopathological examination is not sufficient all the time for making the diagnosis of leiomyosarcoma because there is a morphologic overlap with other malignancies. Immunohistochemistry acts as an adjunct to arrive at a definite diagnosis and hence, proves to be the most important ancillary technique in the diagnosis of such tumours. Though these tumours arise most commonly from the uterine smooth muscle, but rarely encountered at unusual sites posing diagnostic difficulties. Key Words: Leiomyosarcoma, Retroperitoneal, Pulmonary, Post-burn scar.

Natural Product Co-Metabolism and the Microbiota-Gut-Brain Axis in Age-Related Diseases.

Complementary alternative medicine approaches are growing treatments of diseases to standard medicine practice. Many of these concepts are being adopted into standard practice and orthomolecular medicine. Age-related diseases, in particular neurodegenerative disorders, are particularly difficult to treat and a cure is likely a distant expectation for many of them. Shifting attention from pharmaceuticals to phytoceuticals and "bugs as drugs" represents a paradigm shift and novel approaches to intervention and management of age-related diseases and downstream effects of aging. Although they have their own unique pathologies, a growing body of evidence suggests Alzheimer's disease (AD) and vascular dementia (VaD) share common pathology and features. Moreover, normal metabolic processes contribute to detrimental aging and age-related diseases such as AD. Recognizing the role that the cerebral and cardiovascular pathways play in AD and age-related diseases represents a common denominator in their pathobiology. Understanding how prosaic foods and medications are co-metabolized with the gut microbiota (GMB) would advance personalized medicine and represents a paradigm shift in our view of human physiology and biochemistry. Extending that advance to include a new physiology for the advanced age-related diseases would provide new treatment targets for mild cognitive impairment, dementia, and neurodegeneration and may speed up medical advancements for these particularly devastating and debilitating diseases. Here, we explore selected foods and their derivatives and suggest new dementia treatment approaches for age-related diseases that focus on reexamining the role of the GMB.

The Microbiota-Gut-Brain Axis-Heart Shunt Part II: Prosaic Foods and the Brain-Heart Connection in Alzheimer Disease.

There is a strong cerebrovascular component to brain aging, Alzheimer disease, and vascular dementia. Foods, common drugs, and the polyphenolic compounds contained in wine modulate health both directly and through the gut microbiota. This observation and novel findings centered on nutrition, biochemistry, and metabolism, as well as the newer insights we gain into the microbiota-gut-brain axis, now lead us to propose a shunt to this classic triad, which involves the heart and cerebrovascular systems. The French paradox and prosaic foods, as they relate to the microbiota-gut-brain axis and neurodegenerative diseases, are discussed in this manuscript, which is the second part of a two-part series of concept papers addressing the notion that the microbiota and host liver metabolism all play roles in brain and heart health.

The Microbiota-Gut-Brain Axis Heart Shunt Part I: The French Paradox, Heart Disease and the Microbiota.

It has been well established that a vegetarian and polyphenol-rich diet, including fruits, vegetables, teas, juices, wine, indigestible fiber and whole grains, provide health-promoting phytochemicals and phytonutrients that are beneficial for the heart and brain. What is not well-characterized is the affect these foods have when co-metabolized within our dynamic gut and its colonizing flora. The concept of a heart shunt within the microbiota-gut-brain axis underscores the close association between brain and heart health and the so-called "French paradox" offers clues for understanding neurodegenerative and cerebrovascular diseases. Moreover, oxidation-redox reactions and redox properties of so-called brain and heart-protective foods are underappreciated as to their enhanced or deleterious mechanisms of action. Focusing on prodromal stages, and common mechanisms underlying heart, cerebrovascular and neurodegenerative diseases, we may unmask and understanding the means to better treat these related diseases.

Progression of Fibroadenoma to Malignant Phyllodes Tumour in a 14-Year Female.

Phyllodes tumours are uncommon breast tumours which account for less than 1% of all breast neoplasms. High-grade malignant phyllodes tumour is a very rare but aggressive breast malignancy and forms approximately 15-30% of all phyllodes tumours. The transformation of a benign fibroadenoma into a malignant phyllodes tumour in a teenaged female is even rarer. We report here an interesting case of malignant phyllodes tumour in a 14-year female patient who was operated twice previously with the diagnosis of complex fibroadenoma in the same breast. There was a large tumour involving whole of the breast and infiltrating the skin. The patient was operated and total mastectomy was done. Diagnosis was confirmed after histopathological examination and immunohistochemistry of the resected specimen. Patient received adjuvant radiotherapy and there was no recurrence on 6-month follow-up. Owing to the rare occurrence of malignant phyllodes tumour in this age group along with previous operations for complex fibroadenoma, this case is being reported here.

Cytodiagnosis of ChondromyxoidFibroma of the Metatarsal Head: A Case Report.

Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumor with a predilection for the bones of lower extremities and about one fourth of the tumors involve the foot. Radiologically, an eccentric lytic lesion with well-defined margins is seen in the metaphysis of the bone. We hereby, report an 18 yr old young male who presented to Orthopedic Outpatient Department, JN Medical College, Aligarh Muslim University, India diagnosed with giant cell tumor of the third metatarsal bone of right foot on radiography but on fine needle aspiration cytology (FNAC) the diagnosis of CMF was made. Preoperative diagnosis of this benign condition helped in doing minimum surgical intervention in the form of curettage along with bone grafting. Histopathology further confirmed the diagnosis of CMF. The case is being discussed to highlight the importance of FNAC to diagnose these uncommon benign bone lesions.

Granulomatous Response with Breast Cancer: A Case Report.

Granulomatous response in association with breast cancer and within the cancer draining lymph nodes is an extremely rare phenomenon. Granulomatous inflammation is an immune response commonly seen against infectious agents and certain non-neoplastic conditions. The etiopathogenesis of granulomas associated with malignancies is not clear but it may be because of an immunologic reaction to tumour antigens. We hereby report a 50-yr-old postmenopausal female presented to Surgical Outpatient Department, Aligarh Muslim University, India, with complaints of lump and pain in her left breast for 6 months. We have also discussed about its etiopathogenesis, final diagnosis, treatment & patient outcome.

Challenges in the diagnosis and management of spontaneous bile duct perforation: A case report and review of literature.

We report a case of 14-year-old male, who presented to us with complaints of severe pain in abdomen, vomiting, and inability to pass feces and flatus. He was diagnosed as a case of peritonitis after careful history, examination, and investigations. The exact cause of peritonitis was not known. Exploratory laparotomy was done, and it was found that there was perforation of the right hepatic duct about 1 cm proximal to its confluence with the left hepatic duct. Perforation was closed around the T-tube. Postoperative T-tube cholangiogram was done after 3 weeks which confirmed the free passage of dye into the duodenum, and there was no leakage of dye. T-Tube was removed 4 weeks after the operation, and the patient was discharged in satisfactory condition. Postoperative follow-up was done for 3 months, and it was uneventful.

A case of coexisting carcinoma and tuberculosis in one breast.

Coexistent carcinoma and tuberculosis in a breast is a rare entity. It poses problems right from the diagnosis and staging of carcinoma to treatment and patient compliance. Proper clinical examination and investigations should be performed in such cases as both carcinoma and tuberculosis are major diseases with no definite symptoms or signs to distinguish the two. Herein, we report the case of a 45-year-old female who presented with complaints of a lump and pain in left breast, weight loss and weakness for the past 4 months. Fine needle aspiration cytology from the breast lump showed clusters of malignant cells along with many loose clusters of epithelioid cells on a background showing caseous necrosis. A diagnosis of coexisting breast carcinoma and tuberculosis of the breast was made and antitubercular treatment was started. The patient was operated and histopathology confirmed the diagnosis.

Megaloblastic anemia: A common but often neglected cause of pyrexia of unknown origin.

OBJECTIVE: The objective was to study megaloblastic anemia as a cause of pyrexia of unknown origin (PUO). MATERIALS AND METHODS: We conducted a study on 15 patients of megaloblastic anemia associated with fever, attending our hospital clinics over a period of 6 months. RESULTS: While 11 patients had symptoms suggesting foci of infection and responded well to intravenous antibiotics, 4 patients had neither any evidence of infection nor responded with empirical broad spectrum antibiotic treatment. They were treated with vitamin B12/folate therapy which led to marked improvement in fever within 48 h. Presenting complaints of the patients and severity/duration of fever along with other epidemiological data were also studied in each case. CONCLUSION: The present study led us to conclude that megaloblastic anemia forms an important and reversible cause of fever and should be ruled out in all patients presenting with PUO. This knowledge would help the physicians in adequate and timely management of these patients.

Primary hydatid disease of the breast clinically masquerading as a galactocele: A case report.

We report a rare case of a 30-year-old breastfeeding woman who presented to our surgical outpatient department with complaints of a gradually enlarging lump in her left breast for the last 2 months. She also complained of difficulty in breastfeeding for 1 week. On examination, the right breast was normal but there was a 4 cm × 4 cm retroareolar soft lump in her left breast. Examination of the bilateral axilla was normal. A provisional diagnosis of galactocele was made and the patient was subjected to ultrasonic mammography and fine needle aspiration cytology (FNAC). Ultrasonic mammography of the left breast showed a heterogeneous, hypoechoic lesion with thick septations and internal echoes suggestive of a complex cystic lesion, leading to a differential diagnosis of either hydatid cyst or breast abscess. On FNAC, the aspirate was not milky and cytological examination was performed, which revealed hydatid scolices, hooklets, foamy macrophages and granular debris, leading to the final diagnosis of hydatid cyst of the breast. The patient was investigated further but there were no cysts at any other site. Chemotherapy with albendazole was started and surgery was performed after 1 month. Histopathology further confirmed the diagnosis. Owing to the rarity of presentation, this case is being reported here.

Cystic glioblastoma multiforme masquerading as a cerebral tuberculoma.

Glioblastoma multiforme (GBM) is by far the most common and most aggressive malignant neoplasm of the primary brain tumours. It arises from the astrocytes and classified as WHO grade 4 astrocytoma. Diagnosis of GBM is sometimes difficult as radiological picture sometimes mimic with cerebral tuberculoma. In both the cases contrast-enhanced CT may show similar finding of a mass lesion with a hypodense centre surrounded by a ring of enhancement and any cyst if present. In the present case, a 45-year-old male patient presented with seizures and headache, a provisional diagnosis of tuberculoma was made on the basis of clinical and CT findings. However, on grounds of suspicion the patient was operated and fluid from the cyst was sent peroperatively for cytopathological examination which suggested the diagnosis of cystic GBM. This helped the surgeon to do maximum debulking of the tumour. Diagnosis was further confirmed by histopathology.

Suprapubic Fecal Fistula Due To Richter's Inguinal Hernia: A Case Report and Review of Literature.

We encountered a 55-year-old man, who presented with an orifice in the suprapubic region, through which fecal material was discharged. On physical examination, the patient was unstable. After resuscitation, thorough evaluation, and laboratory and imaging investigations, he underwent an exploratory laparotomy. The ileum was entrapped at the deep inguinal ring, and there was some pus in the pelvic cavity. The purulent material was cleaned, and anastomosis was done after the resection of the defective ileal segment. In view of the rarity of this presentation and the paucity of published articles, this case is reported here.

Late Post Traumatic Right-sided Diaphragmatic Hernia Presenting with Acute Intestinal Obstruction and Strangulation: A Rare Presentation.

We report a case of 16 year old male, who was presented to Jawaharlal Nehru Medical College, AMU, Aligarh, India as an emergency case with complaints of severe abdominal pain, difficulty in breathing and bilious vomiting. He was diagnosed as a case of late post traumatic right side diaphragmatic hernia with acute intestinal obstruction. He was successfully treated surgically by laparotomy and the defect was closed with polypropylene suture. The patient was followed for 3 months after operation and there was no complication.