Role of adipokines, oxidative stress, and endotoxins in the pathogenesis of non-alcoholic fatty liver disease in patients with type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is associated with chronic inflammation and oxidative stress, implicated in the pathophysiology of non-alcoholic fatty liver disease (NAFLD). Present study aimed to assess the role of adipokines, oxidative stress, and endotoxins in the pathogenesis of NAFLD in T2DM.Methods: Present cross-sectional observational study included healthy controls (n=50; group 1); T2DM patients without NAFLD (n=50; group 2), T2DM patients with NAFLD (n=50; group 3). Study subjects were age and gender matched.Results: Tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), high sensitive C-reactive protein (hs-CRP), endotoxin, malondialdehyde (MDA) were significantly elevated and adiponectin, ferric reducing ability of plasma (FRAP), and glutathione (GSH) were significantly lower (p<0.001) in T2DM patients with NAFLD when compared to T2DM patients without NAFLD and controls. Endotoxin showed significant positive correlation with TNF-α (r=0.304; p<0.001), hs-CRP (r=0.193; p=0.018), and MDA (r=0.420; p<0.001), and significant negative correlation with adiponectin (r=-0.406; p<0.001). TNF-α and IL-6 showed significant positive correlation with MDA (r=0.526; p<0.001, r=0.229; p=0.005) and significant negative correlation with adiponectin (r=-0.396; p<0.001, r=-0.318; p<0.001), FRAP (r=-0.418; p<00.001, r=-0.170; p=0.038), and GSH (r=-0.353; p<0.001, r=-0.301; p<0.001).Conclusions: Authors observed elevated endotoxin, oxidative stress, inflammation and lower adiponectin levels in T2DM subjects compared to controls. These changes were more pronounced in T2DM with NAFLD when compared to T2DM without NAFLD.  Lower adiponectin levels were found to be a better predictor of NALFD in T2DM and is associated with oxidative stress and systemic inflammation.

A Study On Anatomical Variations In The Formation Of Brachial Plexus And Its Branches

Background: The variable course of the nerves may be the cause of many neuralgic pains of the superior extremity.The knowledge of percentage of variations may help the surgeons in treating the cases of trauma & entrapmentneuropathies.Materials and Methods: The present study in 70 upper limbs of 35 human cadavers over a period 1year at thedepartment of Anatomy at Siddhartha medical college and surrounding medical colleges around Vijayawada.The detailed examination of the following nerves that is musculocutaneous, median, ulnar, radial and axillarynerves was done in the arm and following variations were observed.Results: Communication between musculocutaneous and median nerves in eleven limbs. Musculocutaneousnerve was absent in our limbs. Median nerve supplied muscles of front of arm where musculocutaneous nervewas absent in one limb. Musculocutaneous nerve did not pierce coracobrachialis muscle in seven limbs. TheCommunication between radial and ulnar nerve in one limb.Conclusion: Lesions of communicating nerve may give rise to pattern of weakness that may impose difficulty indiagnosis. So it is important to be aware of the variations that are observed and discussed in our study. Knowledgeof these variations is important for neurologists, orthopaedicians and traumatologists as these may give rise tovariable clinical picture depending upon the variations present.

Assessment of Cardiovascular Autonomic Function in Asymptomatic Obese Young Adults – Prevention is Better than Cure.

Back ground: Obesity is emerging global epidemic in young adults who form the productive group of the society. This has been called as new world syndrome and is a massive reflection of social, economic and cultural problems currently faced by the developing and developed countries. As cardiac autonomic dysfunction often coexists with obesity, early detection of autonomic impairment by simple investigations of autonomic function, can be potentially important to prevent future complications. Objective: To identify cardiovascular autonomic dysfunction in asymptomatic obese young adults. Study design: This study was conducted in the department of Physiology at Kakatiya Medical College, Warangal, A.P, 30 apparently healthy obese subjects of both sex with BMI > 25 kg/sqm were taken as study group. Age and sex matched 30 normal weight subjects (BMI 18.5-22.9 kg/ sqm) taken as control group. Methods: Ewing’s battery of 5 noninvasive cardiovascular reflex tests were done for assessing autonomic function. These autonomic function parameters were correlated with BMI, Unpaired Student‘t’ test and Pearson correlation coefficient test were used for statistical analysis. Results: Mean values of all cardiovascular reflex tests were significantly lower in the study group. Conclusion: The results indicate that cardiovascular autonomic dysfunction is present in otherwise healthy obese young adults.

Primary cutaneous lymphoma of scalp in a child: a case report.

Cutaneous lymphomas are a heterogenous group of lymphoproliferative disorders with involvement of skin and form a separate group under Non-Hodgkin’s lymphoma. Skin may be involved along with other organs but if the initial manifestation is in the skin, it is referred to as primary cutaneous lymphoma (PCL). One year eight months child brought with a scalp swelling of three months duration. Histopathology revealed a lymphoma and immuno- histochemistry studies were positive for T-cell lymphoma. The case is presented due to the rarity of primary cutaneous lymphoma at the age of one year eight months.

Primary monophasic synovial sarcoma, a rare pulmonary mesenchymal neoplasm: report of a case with review of literature.

Synovial sarcoma is an uncommon malignant soft tissue tumour which occurs primarily in young adults. It most commonly occurs in the extremities near large joints, particularly the knee joint. Primary pulmonary synovial sarcoma has only occasionally been reported in the literature. We report a case of primary pulmonary monophasic synovial sarcoma in a 23 year old male patient presenting with recent onset of hemoptysis, cough and expectoration. Although an uncommon primary site, the characteristic histological and immunohistochemical features, and fluorescence in situ hybridization analysis for the characteristic (X;18) translocation, with thorough clinical and imaging correlation allowed a definitive diagnosis of primary pulmonary monophasic sarcoma. The mainstay of treatment for these unusual tumours remains complete surgical excision followed by adjuvant radiation and/or chemotherapy.

Massive nodular melanoma scalp: a case report.

Melanoma is responsible for 1% to 2% of all cancer deaths around the world. Nodular melanoma often carries a poor prognosis because of no prodromal radial growth phase, early distant metastasis and significant tumour volume. We present a case of nodular melanoma measuring 20x10x8 cm in 28 year old tribal women.

Psammomatous ossifying fibroma of frontal sinus: a case report with review of literature.

Psammomatoid Ossifying Fibroma (POF) is a rare, slowly progressive benign tumor of the extragnathic craniofacial bones representing a subgroup of related fibro-osseous lesions with a tendency towards locally aggressive behaviour unique to the nasal cavity, paranasal sinuses, orbit and is often misdiagnosed. Histologically they are benign, but clinically they are locally aggressive. We report a case of a 17 year-old boy who presented with psammamatous ossifying fibroma of the frontal sinus. The location of this tumor made this case unusual.

Extensive pelvic hydatid disease mimicking ovarian malignant tumour.

Hydatid disease is one of the commonest parasitic infections of the liver, endemic in many countries. Rupture into the peritoneal cavity leading to secondary echinococcosis is a difficult problem to manage. A case of 37 year old female patient presenting with disseminated intra-abdominal hydatid disease mimicking malignant multilocular cystic tumor of the ovary involving the mesentery of the small intestine, omentum and spleen is presented along with a brief review of literature.

Meckel-Gruber syndrome: a case report with review of literature.

Meckel Gruber syndrome is an autosomal recessive disorder, characterized by a combination of renal cysts or cystic renal dysplasia, developmental anomalies of the central nervous system, hepatic dysgenesis and polydactyly. It is a rare syndrome with highest incidence in Gujarati Indians and Finnish population. We report a case of Meckel Gruber syndrome in non Gujarati Indian which was diagnosed on fetal autopsy.

Cytohistopathological and immunohistochemical correlation of soft tissue tumors.

Background: Fine needle aspiration cytology has become an established tool in the diagnostic armamentarium of many clinical practices. The initial diagnosis of many mass lesions, both superficial and deep-seated, can often be readily and safely assessed by fine needle aspiration cytology. In our study, we assessed 361 cases of soft tissue tumors by fine needle aspiration cytology during a period of three years. We tried to follow up as many cases as possible to obtain corresponding excision biopsies for histopathological examination. Immunohistochemical studies were also performed on biopsy sections in some cases for confirmation of diagnoses. Aims and objectives: 1) To study the age, sex and site-wise distribution of soft tissue tumors. 2) To assess the utility of fine needle aspiration cytology in diagnosing various types of soft tissue tumors. 3) To assess the sensitivity, specificity, positive and negative predictive values, and overall histological correlation percentage of fine needle aspiration cytology in diagnosing soft tissue tumors. Methods: Aspirations were carried out using a 22 gauge disposable needle and a 10c.c disposable syringe for suction. Wet-fixed smears were stained with hematoxylin and eosin and pap stain. Dry-fixed smears were stained with May-Grunwald Giemsa stain. Periodic Acid Schiff stain was used in some cases of extraskeletal Ewing’s sarcoma. Corresponding biopsy sections were stained with hematoxylin and eosin. Immunohistochemical stains were also used in some of the cases for confirmation of diagnosis. Results: Of the 361 cases recorded in our study, 320 patients could be successfully followed up and excision biopsies were obtained. The remaining 41 patients were excluded from the study due to inability to obtain biopsy. Of the 320 cases, 200 were diagnosed as benign soft tissue tumors, while 120 were diagnosed as malignant on cytological examination. The median age of occurrence of benign soft tissue tumors was 34.23years, while that of malignant soft tissue tumors was 48.33years. Prevalence was highest in the age group of 20-49years, during which majority were benign lesions. Soft tissue tumors were more common in the lower extremities with predominant benign tumors, while malignant tumors were more common in the trunk. Sexwise distribution showed a male:female ratio of 1.76:1. Various patterns were observed in cytology. The commonest tumors were lipomas (55%), followed by benign peripheral nerve sheath tumors (37%). Malignant soft tissue tumors constituted 37.5% cases, among which malignant fibrous histiocytoma was the most frequent tumor. Soft tissue sarcomas were classified into 5 general categories on the basis of predominant appearance in aspiration smears: I. Myxoid II. Spindle cell III. Pleomorphic IV. Polygonal V. Round cell. Immunohistochemical studies were done for some tumors with vimentin, desmin, S-100 protein and Neuron Specific Enolase (NSE), Leucocyte Common Antigen (LCA), cytokeratin (CK) and Epithelial Membrane Antigen (EMA). A comparative analysis was done between the cytology report and histopathology. Conclusion: Final evaluation of the results showed that the diagnostic accuracy of fine needle aspiration cytology in soft tissue tumors was 96.88%, sensitivity was 95.08% and specificity was 97.98%.Thus our study proves the efficacy of fine needle aspiration cytology in the diagnosis of soft tissue tumors as a useful cost-effective procedure.

Mixed germ cell tumour of testis: a case report with review of literature.

Testicular tumours are rare neoplasm. Mixed germ cell tumour is the most common histological variant. Essentially, any admixture of the germ cell tumours as seen in pure form may be seen, one of the most common admixtures being embryonal carcinoma and teratoma. Unfortunately many of these patients present late usually with some complications. We present a rare case of mixed germ cell tumour with predominant embryonal carcinoma and yolk sac tumour in adolescent patient with multiple metastatic foci at the time of presentation.

A study of correlation of expression of ER, PR and HER2/neu receptor status with clinico-pathological parameters in breast carcinoma at a tertiary care centre.

Background: In English literature it is documented that the expression of ER and PR is low in Asian countries when compared to that of Western countries. HER2/neu over expression is uniform throughout the world. Studies have shown that triple-negative breast carcinomas are aggressive, likely to spread beyond the breast and recur after treatment. Aims and objectives: To correlate the expression of ER, PR and HER 2/neu with clinico-pathological parameters in infiltrating ductal carcinoma and other variants of breast carcinoma. To determine the clinicopathological parameters in triple negative cases. Methods: This is a prospective study for a period of two years in the Department of Pathology, Andhra Medical College, a tertiary care centre. We received 111 mastectomy specimens during this period out of which 52 patients were funded under Arogyasri and were subjected for ER, PR, HER2/neu receptor study. Results: In the present study total cases analyzed were 52. Infiltrating ductal carcinoma was 41/52 (78.84%) and other variants were 11/52 (21.15%). In our institute infiltrating duct cell carcinoma (NOS) type was the commonest type of carcinoma breast with significant group occurring in less than 45 years of age, 95 % of women were multipara with two or more children and triple negative tumors being 54.83%.In infiltrating ductal carcinoma ER, PR positive expression has no association with age and size of tumor. Their expression was higher in grade 1 tumors 83.3%.The ER,PR negative expression was more in size of tumor being greater than 2 cm; (92.5%),positive lymph nodes (51.8%) and stage II and stage III tumors (96.2%). HER2/neu negative expression was seen in 51.61% of cases. Triple negative receptor expression was seen in 54.83% of infiltrating ductal carcinoma. In the English literature medullary carcinoma is negative for HER2/neu expression but in the present study in 2 cases the expression for HER2/neu was positive. Conclusion: In the present study significant group occurred in less than 45 years of age presenting in advanced stage of the disease. Triple negative cases were seen in 54.8% cases of infiltrating duct cell carcinoma indicating bad prognosis.

Mucinous carcinoma of breast with neuroendocrine differentiation: a rare case report with review of literature.

Mucinous carcinoma of the breast is a relatively rare malignancy accounting for 2% of all breast cancers. Mucinous carcinoma of the breast has a favourable prognosis and is usually seen in postmenopausal women. Here, we report a 60 year old female patient presented with right breast lump was diagnosed on cytology as ductal carcinoma of the breast, on histopathology diagnosed as mucinous carcinoma with neuroendocrine differentiation, which was subsequently confirmed on IHC marker synaptophysin and chromogranin A positive.

Proliferating trichilemmal tumour: a case report with review of literature.

Proliferating trichilemmal tumour is a solid-cystic neoplasm that shows trichilemmal differentiation similar to that of the isthmus of the hair follicle histologically characteristed by the presence of trichilemmal keratinization. Proliferating Trichilemmal Tumour (PTT) appears mainly in elderly women and is in general a solitary lesion on the scalp. Proliferating trichilemmal tumours generally have a benign clinical course, and a clinical differentiation from squamous cell carcinoma is often difficult. We report a case of PTT in a 30 year old man presenting as a solitary 10x8 cm ulcerated nodule on the scalp since 3 months clinically resembled a malignant tumour. The therapeutic approach is surgical removal with a wide clear margin.

Splenic artery aneurysm: a case report with review of literature.

Splenic Artery Aneurysm (SAA) is very rare in occurrence and they occur in approximately 1% of the population and are usually an incidental finding, but the necropsy studies have given rates as high as 10%. For its rarity in occurrence here we present a case of splenic artery aneurysm in a 40 year old alcoholic presenting with upper and lower gastrointestinal bleeding. He was diagnosed as splenic artery aneurysm on CT scan and confirmed by laparotomy and pathological examination.

Acinic cell carcinoma of parotid with predominant follicular pattern mimicking follicular neoplasm of thyroid.

Acinic Cell Carcinoma (ACC) was previously called acinic cell tumor and it is a neoplasm demonstrating cytological differentiation towards serous acinar cells. The histological architecture of ACC is diverse and classification consists of various histological subtypes. This is a case of acinic cell carcinoma of parotid gland in a 45 years female patient which showed predominant follicular variant of ACC. It is a least frequent variant of ACC occurring in only 5% and it mimics follicular neoplasm of thyroid.

Incidental papillary carcinoma of thyroid in Graves’ disease.

Traditionally Grave's disease was considered as protection against thyroid cancer. The incidence of papillary carcinoma thyroid in grave’s disease is 2.4%. Thyroid cancer occurring in grave’s disease has higher frequency of persisting or relapsing disease than thyroid cancers occurring in matched euthyroid control patients. Here we present a case of papillary carcinoma in a Grave’s disease patient presented with nodular goiter.

Patterns of epithelial cell abnormalities in Pap smears and its clinicopathological and demographic association: a descriptive study from Visakhapatnam city, Andhra Pradesh, India.

Background: Cervical cancer is one of the leading cancers amongst women. Periodic pap screening is the simplest way to diagnose precancerous lesions. Factors such as ignorance, poverty poorly developed public healthcare delivery system put women in urban slums at a disadvantage for receiving any health screening activity. Objectives of the present study were to know the prevalence of epithelial cell abnormalities of the cervix among the subjects and to study the association with clinical and demographic characteristics. Methods: A camp based descriptive study was conducted in an urban ward. All women above the age of 20 years were included in the study. Data was recorded using a pretested questionnaire. Study variables included socio-demographic characteristics, symptoms of reproductive tract infection, findings of clinical examination, and Pap smear collection and evaluation. The latter was done from 194 women aged between 20-69 years. Pap smears were made by conventional Pap smear technique and reported according to The Revised Bethesda System of classification 2001(TBS). Results: Among the 194 women, in 8 subjects, the smears collected were unsatisfactory for evaluation. Analysis was done in the remaining 186 subjects. Among the latter, in 83.9%, the smears were negative for intraepithelial lesions (NIEL) and 16.1% revealed epithelial cell abnormalities (ECA). Among those with ECA, Atypical cells of undetermined significance (ASCUS) was identified in 66.67%, Low grade squamous intraepithelial lesions(LSIL) in 16.67%, Atypical squamous cells-cannot exclude HSIL (ASC-H) and Atypical glandular cells-not otherwise specified (AGC-NOS) in 6.67% each and High grade squamous intraepithelial lesions (HSIL) in 3.33%. Epithelial cell abnormalities were more common in women in the age group of 30-60 years (80%), they were more common in those with age at marriage between 13-18 years (63.3%) and in those with age at first child birth between 15-19 years (56.7%). Conclusions: Therefore there is a need for Pap screening at regular intervals through camp based approach in these populations to motivate the women, increase their awareness, ensure follow up and referral and timely intervention in appropriate cases.

Giant pleomorphic adenoma of parotid gland.

Salivary gland tumors are rare, comprising less than 3% of all neoplasia of head and neck region. Pleomorphic adenomas are the most common benign neoplasms of the parotid gland. The vast majority are 2-6cms in size, when resected. Untreated pleomorphic adenomas can enlarge in size and weigh several kilograms. There are only few cases of giant pleomorphic adenomas reported in the literature. Here we present one of such case.

Lymphocytic thyroiditis: a correlation of cytological grades with clinical, biochemical and ultrasound findings.

Background: Hashimoto’s thyroiditis sometimes referred to as goitrous thyroiditis is a synonym of chronic lymphocytic thyroiditis or autoimmune thyroiditis. Chronic lymphocytic thyroiditis (Hashimoto’s thyroiditis) is one of the most common cause of goiter and hypothyroidism, it is found most commonly in middle aged and young female, but can also occur in other age groups, including children. Chronic lymphocytic thyroiditis can be graded based on cytomorphology. In this study an attempt has been made to correlate the grades with clinical findings, biochemical levels and ultrasonography findings. Methods: This is a prospective study conducted on 309 patients in the Department of Pathology, Andhra Medical College, Visakhapatnam. The various parameters like patient’s clinical presentation, biochemical levels and thyroid ultrasound were studied. Fine needle aspiration of thyroid gland and grading of thyroiditis was done on smears. The grades were correlated with above parameters and the correlation indices were evaluated statistically. Chi-square tests were used for statistical correlation and p value of <0.05 was considered significant. Results: Most of the patients were females (297, 96.11%) who commonly presented with a diffuse goiter (263, 85.11%). Asymptomatic cases (193, 62.46%) and elevated TSH (194, 62.78%) were common. Most of the cases had grade I/II disease (299, 96.76%) by cytology. Conclusion: FNAC is a simple, safe and cost effective procedure and is a sensitive and specific diagnostic tool in diagnosing chronic lymphocytic thyroiditis. Cytological grading of chronic lymphocytic thyroiditis helps in assessing the severity of the disease and can predict the thyroid functional status. A combined approach of cytological grading of chronic lymphocytic thyroiditis along with ultrasonography and biochemical levels can detect subclinical hypothyroid states and provide a guide to therapy.