Utility of serum anti-phospholipase A2 receptor antibody as a biomarker in membranous nephropathy: An experience from a tertiary care center of Eastern India

Background: Membranous nephropathy (MN) is a pattern of glomerular injury. Exact categorization into primary membranous nephropathy (PMN) or secondary membranous nephropathy (SMN) is essential for treatment. An endogenous podocyte antigen, M-type phospholipase A2 receptor (PLA2R) has been discovered to be involved in the pathogenesis of PMN. Aims and Objectives: In this article, we aimed to analyze renal tissue PLA2R and serum anti-PLA2R antibodies in MN cases and determined the diagnostic utility. Materials and Methods: The study was of prospective type carried out from March 2019 to August 2020. Analysis of cases of MN was performed with PLA2R paraffin immunoflourescence and serum anti-PLA2R antibody ELISA. Results: Overall sensitivity, specificity, PPV, and NPV of serum anti-PLA2R ELISA for PMN was 91.3%, 80%, 75%, and 93.3%, respectively, and of tissue PLA2R staining for PMN was 91.67%, 81.08%, 75.86%, and 93.75%, respectively. There was strong concordance between two methods. In the patients that were followed up, we found baseline serum anti-PLA2R antibody was less in complete remission group than that in non-remission group and the reduction in serum anti-PLA2R antibody was more in complete remission group than that in non-remission group. Conclusion: Routine light and immunofluorescence examination are incapable of giving exact categorical opinion regarding PMN and SMN. Serum anti-PLA2R antibody detection and renal tissue PLA2R analysis are sensitive and specific in detecting PMN. Baseline serum anti-PLA2R antibody and anti-PLA2R antibody quantification trends are related to prognosis of PMN. So they can be incorporated as additional biomarker.

Diagnostic and prognostic utility of SF-1 in adrenal cortical tumours

Background and Aims: Superior imaging techniques have increased the recognition of adrenal pathology. Distinguishing benign from malignant adrenocortical tumors is not always easy. Several criteria and immunohistochemical markers have been discovered which help to differentiate between adrenocortical adenoma (ACA) and adrenocortical carcinoma (ACC). Our aim here was to evaluate the diagnostic and prognostic role of steroidogenic factor-1 (SF-1) in adult adrenocortical tumors (ACT) diagnosed using the Weiss criteria. In this cohort, we have also analyzed Ki67 and p53 expression and the extent of agreement between SF-1 and Ki-67. Methodology: This was a retrospective, observational study comprising 24 cases of adult ACT over 10 years. Immunohistochemical staining for SF-1, Ki67, and p53 was done in all the cases, and the results correlated with the morphological diagnosis made using Weiss criteria. Results: SF-1 was 100% sensitive and 80% specific as a marker of malignancy. Increased SF-1 expression correlated with worse survival. There was a moderate degree of agreement between Ki-67 labeling-index and SF-1 as a marker of malignancy with the kappa coefficient being 0.75. The sensitivity of p53 was lower than Ki67 in diagnosing ACC. Conclusion: In adult ACTs, SF-1 has diagnostic significance and prognostic implication. SF-1 is a crucial, dosage-dependent survival factor in ACC. There is a moderate extent of agreement between Ki-67 and SF-1 as a marker of malignancy.

Prevalence and Susceptibility Profiles of Nonfermentative Gram-negative Bacilli Infection in a Tertiary Care Hospital of Eastern India.

Background: Nonfermentative gram-negative bacilli (NFGB) have emerged as a major cause of nosocomial infections.This study was undertaken to know the prevalence of nonfermenters isolated from different clinical samples along with their susceptibility profile. Material and methods: Conventional bacteriological methods were used for identification and susceptibility testing of nonfermenters. Susceptibility testing was performed by methods as recommended by Clinical Laboratory Standard Institute (CLSI). Results: Out of the total 1,650 clinical samples received NFGB were found in 201 samples with an isolation rate of 12.18%. Nonfermenters isolated were Pseudomonas aeruginosa (50.24%), Acinetobacter baumannii (24.87%), Acinetobacter lowffii (5.47%), Pseudomonas fluorescens (1.49%), Pseudomonas stutzeri (1.99%), Burkholderia cepacia (6.96%), Stenotrophomonas maltophilia (2.98%), Achromobacter xylosoxidan (3.98%) and Shewanella putrefaciens (1.99%). Most of the isolated organisms were multidrugresistant (MDR). P. aerurginosa showed good sensitivity to imipenem (91.08%), cefoperazone sulbactum (68.31%) combination, amikacin (69.30%) and colistin (100%). A. baumannii showed 90% sensitivity to imipenem and 94% to colistin. Conclusion: Our study showed that prevalence of NFGB amongst different clinical isolates is significantly high especially in this part of the world and these organisms are often MDR. In this scenario, we propose all laboratory samples should be screened for NFGB even in clinically unsuspected cases. P. aeruginosa showed good sensitivity to colistin, imipenem, amikacin and cefoperazone sulbactum combination while A. baumannii showed good sensitivity to imipenem and colistin.

Efficacy of topical and systemic itraconazole as a broad-spectrum antifungal agent in mycotic corneal ulcer. A preliminary study.

PURPOSE: To evaluate the efficacy of topical (1%) and systemic itraconazole against common fungi such as Aspergillus and other filamentous fungi that cause mycotic corneal ulcer. METHODS: A prospective randomised, controlled study was done in 54 clinically suspected cases of fungal keratitis of which 44 were culture proven. Half the cases (n=27) with superficial involvement were treated with only topical itraconazole (1%) and the other half were treated with both topical and systemic itraconazole. RESULTS: Aspergillus, Penicillium and Fusarium were the most common fungi isolated. The ulcer resolved in 42 eyes (77%) and 12 eyes (23%) did not respond well to treatment. Four of 12 non-responding eyes were caused by Fusarium species. CONCLUSION: Itraconazole, given either topically or systemically, is effective in treating mycotic corneal ulcers.

Neovascularisation offers a new perspective to glutamine related therapy.

Angiogenesis or the generation of new blood vessel, is an important factor in the growth of a solid tumor. Hence, it becomes a necessary parameter of any kind of therapeutic study. Glutamine is an essential nutrient of tumor tissue and glutamine related therapy involves clearance of circulatory glutamine by glutaminase. Therefore, using different murine solid tumor models, the present study was undertaken to find out whether the S-180 cell glutaminase has any effect on angiogenesis of solid tumor, or not. Result indicates that the purified S-180 cell glutaminase reduces tumor volume and restrict the generation of neo blood vessels. Therefore, it can be concluded that this enzyme may be an effective device against the cancer metastasis.

Alterations in large gut associated lymphatic tissues (LGALT) during experimental colorectal carcinogenesis.

Alterations in large gut associated lymphatic tissues (LGALT) were studied histologically during 20-methylcholanthrene (MCA) induced colorectal carcinogenesis. Precancerous changes in LGALT included hyperplasia, hyperchromasia of lymphocytes and enlargement of lymphoid follicles. In addition, follicular invasion in muscular layer and cellular disorganization of diffuse lymphatic tissues were observed in neoplasia. Since, LGALT showed remarkable changes during carcinogenesis, this aspect may be considered during assessment of preneoplastic lesions, along with other histologic features of early neoplasia.

Modulation of humoral immune responses by Tinospora malabarica in experimental animals.

Effect of alkaloidal fraction of aqueous extract of T. malabarica (Tm) was studied on humoral antibody responses in rats and guineapigs. The anti-SRBC haemagglutination titre was found to be enhanced in rats pretreated with Tm (2.5 mg/kg). Passive cutaneous anaphylaxis (PCA) in rats was also increased in Tm treated group. In vitro experiments with sensitized rat peritoneal mast cells showed a significant decrease in antigen-induced various spasmogens on isolated guineapig ileum.