Molecular subtypes of invasive breast carcinoma of no special type, their correlation with histopathological features, Ki 67 index and tumor budding: A retrospective comparative study

Context: Tumor budding (TB), poorly differentiated clusters (PDCs), and Ki 67 index are proven adverse prognostic factors in breast carcinoma. Though the relation of Ki 67 index with molecular subtypes of breast carcinoma have been extensively studied, there is very limited information on the role of TB and PDCs. Aims: To grade TB, PDCs, and Ki 67 index and assess histological features and relationship of all these with molecular subtypes of invasive breast carcinoma of no special type. Methods and Material: Retrospective study of 148 cases from 1/1/2019 to 30/12/2019. Division of molecular groups – Luminal A, Luminal B, Her2 neu positive, and triple-negative breast carcinomas (TNBC), and Ki 67 index grades based on St Gallen criteria, intratumoral and peritumoral TB and PDC grades as per the International Tumor Budding Consensus Conference (ITBCC) criteria for colon and correlation between these and other histological features with the molecular subtypes were done. Statistical Analysis: Chi-square test, univariate and multivariate logistic regression models were used. Results: Significant correlation was seen between TB and lymphovascular emboli, Luminal B tumors with high-grade TB and PDCs, Her 2 neu positive and TNBC tumors with low-grade TB, circumscribed tumor margins, tumor necrosis, and Luminal B, Her 2 neu positive and TNBC tumors with larger tumor size and high nuclear grades.Conclusions: TB and PDCs are useful in the prognostication of Luminal A and B tumors when the Ki 67 index values are low/intermediate. Her 2 neu positive and TNBC tumors have a high nuclear grade with necrosis and no association with TB or PDCs.

Early hospital discharge and readmission jaundice in term babies

Background: Hyperbilirubinemia is a common and often benign disease in the neonatal period. It is the most common cause of readmission in early neonatal period. Prolonged hyperbilirubinemia can result in chronic bilirubin encephalopathy. Increasing the hospital stay of otherwise healthy neonates is not an acceptable solution for medical, social and economic constraints. So, identifying the risk factors for readmission assumes importance. Aim of our study is to identify the risk factors for readmission jaundice in our hospital.Methods: In this study, authors used a questionnaire to find out the risk factors for readmission in those babies who were readmitted with jaundice within 3 weeks of life to our hospital. During the study period, routine treatment practices were followed and there was no deviation from the standard of care for the purpose of research.Results: Of the 2297 deliveries during this study period, 93 babies (4%) were readmitted with jaundice.Among the 93 babies, prevalence of blood group incompatibility was one of the common causes of neonatal jaundice. 46.2% of the babies had an early discharge. Total Serum bilirubin levels were measured by a hospital-based bilirubin assay. Babies with serum bilirubin level above photozones as per American Academy of Pediatrics practice guidelines 2004 were identified and subjected to photo therapy. All the babies in this study responded to photo therapy. No other interventions were needed.Conclusions: Though an early discharge is the most cost-effective strategy in this era of high medical expenditure, we can identify certain high-risk babies, prone for readmission. Blood group incompatibility, infants of primiparous mothers and GDM mothers are more prone to readmission jaundice. Identifying these high-risk babies and educating the mothers is a more cost-effective strategy than prolonging the hospital stay for all babies.

Prevalence of Overweight and Obesity Among Students of a Medical College in South India: A Pilot Study.

Background: Obesity is emerging as a serious problem throughout the world, not only among adults but also children, teenagers and young adults. Of the factors contributing to obesity, stress seems to be particularly important as stressful condition leads to irregularity in diet, lack of exercise and addiction, each being considered an independent factor leading to obesity. Medical education is stressful throughout the whole course of training. The amount of material to be absorbed, social isolation, pressure of examination, discrepancies between expectation and reality all can be anticipated to bring psychological stress. Hence, this study was undertaken to find out the prevalence of overweight and obesity among undergraduate medical students. Aims and objectives: To assess the prevalence of overweight and obesity among medical students in Azeezia Medical College and also to find the relationship of the following risk factors with obesity; a) Physical inactivity, b) sleeping habits, c) diet, d) stress and e) association with other diseases (thyroid disorders, menstrual disorders). Study design: A cross-sectional study was conducted in selected sample of 89 subjects. Settings: The study setting was in a rural area in Kollam district of Kerala. Material and methods: Anthropometric measurements including height and weight were taken as per WHO criteria. Body mass index were calculated and classified accordingly as normal, overweight and obese. Details of factors influencing were obtained using a pretested questionnaire in a pilot study. Results and conclusion: The study revealed overall a high prevalence of overweight (44%) and obesity (10%). In males 35% were overweight and 11% were obese, while in females 49% were overweight and 9% were obese. Relation with increased frequency of meals (p = 0.007), increased sleep duration (p = 0.003) and regular exercise (p = 0.047) were found to be significant. Increased prevalence of overweight among females and obesity among males in rural area were observed. The importance of regular physical activity and certain aspects of healthy aging need to be emphasized in the elderly population. Growing old is not an end to everything but an opening for challenges and approach.

Understanding Below-replacement Fertility in Kerala, India.

Kerala is well-known globally for the unprecedented fertility transition in the Indian subcontinent towards the end of the last century. The state has already reached below-replacement fertility level in the 1990s while the rest of India was experiencing high or mid-level fertility. With this backdrop, an attempt was made in this paper (a) to explore the plausible factors associated with sub-replacement fertility and consequent population momentum in Kerala and (b) to trace their socioeconomic and health policy implications. The underlying factors that led to the fertility transition was explored and discussed in some detail. An enhanced level of human development achieved during the last quarter of the 20th century, mainly through developments in social and health sectors, is likely to be the main contributor. Unlike other states in India, there were historical factors as well that functioned as a catalyst for this, such as widespread education and women’s empowerment. As an inevitable demographic impact, population growth due to momentum is expected to be very strong in Kerala with an age-structural transition favouring the old. The so-called ‘demographic dividend’ invoked by the increase of labour-force derived from the youth bulge in the age-structure is being lost in the state due to very limited capital investments and political will. Again, as a direct consequence of population growth, population density in Kerala will take a staggering level of 1,101 persons per sq km in 2026. The ill effects of environmental deterioration and consequent changes in morbidity patterns will have to be dealt with seriously. The very foundations of health policy needs revamping in the light of demographic changes associated with sub-replacement fertility. The tempo of population-ageing is very high in Kerala. The proportion of population aged 60+ years is likely to be 20% in 2026 whereas it will be around 12% only in India. The current level of social and health infrastructure in the state may not be sufficient to cope with the emerging demands of population-ageing since the financial and morbidity burdens of the elderly are already quite high. To conclude, Kerala portrays a typical case of the vagaries of the onset of sub-replacement fertility level in the absence of reasonable structural changes in the economic and health fronts.

The newborn with seizures -- a follow-up study.

OBJECTIVE: To determine the sequelae of neonatal seizures in a cohort of newborns, recruited over a six month period. DESIGN: Prospective hospital based study. SETTING: The neonatal intensive care unit (NICU) of a tertiary care hospital. PARTICIPANTS: 135 babies were recruited of whom 10 died and 25 were lost to follow up. METHODS: The cases were followed up over four months. RESULTS: 68% of the babies followed up were normal; 32% had an abnormal neurological outcome. Seven (7%) developed post-neonatal epilepsy. Hypocalcemia was significantly associated with mortality (OR: 21.9; 95% CI: 1.2-391.2). No risk factors could be identified for post neonatal epilepsy. Presence of spike waves in the EEG was significantly related to abnormal neurological outcome (OR: 3.5; 95% C.I. 1.2-10.8). CONCLUSIONS: Majority of neonates with seizures have a normal outcome with no developmental delay or neurological deficit. Predominantly spike waves in the EEG is predictive of abnormal neurological outcome.

Traditional journal club: a continuing problem.

OBJECTIVE: To evaluate the pattern, motivation and facilities for choosing journal club topics by residents in two medical institutions in India. METHOD: A self-appraisal questionnaire was used to compare motivation for choice of topics, availability of infrastructure, sites and type of articles accessed and formal training in computer based literature search in two medical institutions- a postgraduate institute (PGI) and medical college (MC) which provided mainly specialty and superspecialty training respectively. RESULTS: One hundred and fifty five out of two hundred and fifty five residents responded to the questionnaire. Super-specialty training was pursued by 58 and specialty training by 97 residents. The residents in PGI more frequently selected journal articles which they considered good and in MC, faculty guidance determined the choice of journal club topics. The super-specialty residents, however, more frequently selected patient management related topics compared to specialty residents. MEDLINE and MD Consult were more frequently accessed by PGI residents where infrastructure and training in literature search were superior to MC. CONCLUSION: In both the institutions surveyed, journal clubs were of traditional type. Better infrastructure and training at PGI were not reflected in quality of journal club. Successful journal club should focus on current, real patient's problem of most interest to the group.

Socio-demographic profile of leprosy patients in two districts of western Uttar Pradesh.

Despite achieving the goal of national elimination of leprosy, it remains a serious public health problem in the high prevalence states of Uttar Pradesh, Bihar and Orissa. A significant percentage of newly detected cases are Multibacillary. It underscores the importance of developing a more effective strategy to combat the disease in high prevalence pockets of the country. A glance into sociodemographic profile of the leprosy patients of one the high prevalence states might help in understanding the current ground situation better. A questionnaire based study was conducted at health care center of two districts of Uttar Pradesh (Rampur and Moradabad).Data on demographic profile of leprosy patients attending these centers were collected. The leprosy patients were more frequently males (63.8%). The duration of time before presentation was significantly longer for semiskilled workers (Kuppuswami Scale classification), p = 0.029. Patients with multibacillary disease were younger (mean age 31.04 yrs) as compared to paucibacillary leprosy (mean age 38.7yrs), p value = 0.041. These observations suggests that a specific population based approach is required to detect new cases early. Certain groups of the population might benefit from active surveillance.

Callosal agenesis and Open lip Schizencephaly.

We report a case of a new born who presented with neonatal seizures; and who had coexistence of a Corpus Callosum Agenesis with a bilateral Open lip Schizencephaly and a Dandy Walker malformation. The investigations for an underlying etiology, however was futile.

Cranial neuropathy and bone involvement in primary systemic amyloidosis.

Bone involvement in primary systemic amyloidosis is rare. Intracranial involvement in primary amyloidosis has not been reported so far. We report two cases of bone involvement in primary amyloidosis. The first patient also had combined deficiencies of factor IX and XII, while the second patient had associated intracranial involvement and XIIth cranial nerve palsy. Both these cases are unique in that, destructive bone lesions with intracranial involvement and combined factor deficiencies have not been reported in primary amyloidosis previously.

Undifferentiated carcinoma of the submandibular salivary gland with fulminant clinical course: a case report.

Undifferentiated carcinoma of salivary glands is too poorly differentiated to be classified as any of the specific group of carcinomas. This is a rare disease, the incidence of which is rather low-to-very low in the Indian subcontinent. The tumor can assume an aggressive clinical behavior characterized by disseminated metastases. The prognosis is rated as dismal; as evidenced by this clinical report of a tumor in the submandibular salivary gland with synchronous metastases to the skull bones and in to the intracranial fossa. The putative relationship of the tumor to Epstein-Barr virus (EBV) infection is discussed.

Indomethacin prophylaxis for intraventricular hemorrhage in very low birth weight babies.

OBJECTIVE: To study the efficacy and complications of low dose indomethacin in the reduction of major intraventricular hemorrhage (IVH) in very low birth weight (VLBW) babies. DESIGN: prospective randomized controlled trial (interim analysis) SETTING: Level III neonatal intensive care unit of a perinatal tertiary care center. PATIENTS: Newborn babies with birth weights between 750-1250 g were randomized into indomethacin or control groups. They were further stratified into two birth weight groups 750-999 g and 1000-1250 g for subgroup analysis. INTERVENTIONS: 3 doses of indomethacin were administered to the indomethacin group at the dose of 0.1 mg/kg/dose intravenously. The control group did not receive any specific intervention other than standard neonatal intensive care. OUTCOME MEASURES: The primary outcome measure was the occurrence of IVH and the secondary outcome measures were necrotising enterocolitis, symptomatic patent ductus arteriosus (PDA), bleeding episodes, renal failure, chronic-lung disease and death. RESULTS: Out of 115 eligible newborn babies, 56 babies received indomethacin and 59 were controls. Perinatal characteristics were similar between the two groups. There was no difference in the incidence of IVH between the groups but on subgroup analysis the incidence of major IVH (grades III and IV) were significantly increased in babies in the lower birth weight category who received indomethacin P = 0.03). The incidence of chronic lung disease was significantly higher in the indomethacin group (P = 0.005) and bleeding episodes other than IVH were also significantly increased in the indomethacin group (P = 0.04) in the lower birth weight category. The incidence of PDA was lower in the indomethacin group but only reached significant level in the higher birth weight subgroup (P = 0.02). There were no significant differences in the other outcome measures studied. CONCLUSIONS: Indomethacin prophylaxis did not confer protection against IVH in very low birth weight babies. Instead it showed an increase in the risk of IVH, other bleeding episodes and chronic lung disease. Based on this data we felt that we were not ethically justified in continuing the use of indomethacin and have since terminated this study.

Retinopathy of prematurity in VLBW and extreme LBW babies.

OBJECTIVE: This is a hospital-based, prospective clinical study to determine the incidence, risk factors, and outcome of extreme low birth weight and very low birth weight pre-term babies with retinopathy of prematurity (ROP) at the Sultan Qaboos University Hospital, Oman. METHODS: All babies with a birth weight =/< 1500 g and gestational age =/< 32 weeks admitted in the Neonatal Unit, were screened for ROP between 4 to 6 weeks of age and staged according to the international classification and were followed up until complete vascularization of the retina. Fifty nine babies formed the study group. RESULTS: The overall incidence of ROP was 25.4% (15 out of 59), of which 6 babies had severe ROP and underwent cryotherapy/laser. All babies with ROP had a birth weight < 1250 g and were born before 31 weeks of gestation. CONCLUSION: ROP is a multifactorial disease, the immature retina of the pre-term baby being the primary factor. Incidence and severity was inversely proportional to birth weight and gestational age. Multiple logistic regression analysis showed that sepsis and total parenteral nutrition to be highly significant risk factors. Repeated blood transfusions, hypotension and congenital heart disease with left to right shunt were seen to be considerably associated with the development of ROP. A decrease in overall incidence and severity of ROP was observed in this study.

Cultivation of medicinal plants in alley cropping systems with Moringa oleifera in the Virgin Islands

Medicinal and aromatic plants (MAPs) are horticultural crops with socio-economic significance in the Caribbean. People of the Caribbean maintain the tradition of making 'bush (herb) teas' as part of their daily activity. 'Bush tea' is made with a variety of herbs that are combined for their culinary and medicinal properties. Cultivating these plants complements conventional fruit and vegetable production in the Virgin Islands and enhance small-farm productivity. This study was initiated to evaluate the agronomic and economic potential of agroforestry systems involving MAPs with focus on alley cropping. Field experiments were conducted to determine yield and productivity of popular species of medicinal plants and aromatic herbs commonly used in the Virgin Islands. Medicinal plants included 'inflammation bush' (Verbesina alata), 'worrywine' (Stachytarpheta jamaicensis) and 'japana' (Eupatorium triplinerve) ... Data were collected on fresh and dry matter yield ... Results indicated yield of intercropped medicinal plants and herbs were not significantly reduced during the first harvest, but yield tended to decrease in subsequent harvest suggesting that tree-crop competition was minimal during the early establishment stage

Profile of transfusion transmissible infections and associated risk factors among blood donors of Kerala.

Blood transfusion is an important mode of transmission of infections to the recipient. The aim of the study was to assess the prevalence of transfusion transmissible infections and the possible risk factors among blood donors. During the study period (1994-99) donor samples were screened for HBsAg, HIV, HCV and Syphilis. The relevant donor history was examined to identify the risk factors leading to transfusion transmissible infections. The prevalence of infection was 3.1% among donors, with HBsAg constituting 1.3%, HCV 1.4%, HIV 0.2% and RPR 0.2%. In a classification based on occupation, class III donors (drivers, Businessmen & men in uniform) showed a significantly higher incidence of transfusion transmissible infections for HIV (0.38%) and Syphilis (0.36%). Health care workers constituted only a small fraction of the study; prevalence of infections was low among them. History of jaundice or hospitalization was not associated with higher incidence of seropositivity. Seropositivity for HIV is relatively low compared to similar studies conducted in other regions of the country. This finding is attributed to the pre donation counseling in donor selection. An important outcome of the study is that Class III donors form a high-risk group for transfusion transmissible infections.

Hemophagocytic lymphohistiocytosis (HLH) presenting on the 3rd day of life.

Hemophagocytic lymphohistiocytosis (HLH) embraces the frequently indistinguishable conditions, namely familial hemophagocytic lymphohistiocytosis (FHLH), sporadic hemophagocytic lymphohistiocytosis (SHLH) and virus associated hemophagocytic syndrome (VAHS). The disease is very rare and invariably lethal. Evidence suggests that the disease may be due to an inherited defect in immunoregulation that predisposes to an uncontrolled proliferation of activated histiocytes in response to a stimulus such as viral infection. We report here a 3-day-old neonate with confirmed HLH who had a stormy course and a fatal outcome to the disease process, in spite of early chemotherapy. To our knowledge, we believe this is the youngest reported case of HLH from Middle East. No familial or infective cause could be attributed.

High and low molecular weight proteolytic activities in prawn (Metapenaeus brevicornis) muscle.

Muscle extract of prawn (Metapenaeus brevicornis) expressed high azocoll lytic activity compared to extracts of many other prawn varieties; the activity was also inhibited to a small extent by dithiothreitol. Ammonium sulphate precipitation, subsequent extraction at pH 5.6 and chromatography revealed the occurrence of two types of azocoll lytic activities: one, high molecular weight (630 kDa) and the other low molecular weight (< 30 kDa) enzyme. The former was stimulated by dithiothreitol whereas the latter was inhibited. SDS PAGE of high molecular weight preparation did not show homogeneity but the profile was similar to that of the low molecular weight fraction. Gel filtration of high molecular weight enzyme following incubation at high pH revealed the formation of low molecular weight fractions having activity towards azocoll. Chymotrypsin-like activity associated with high molecular weight enzyme was also susceptible to dissociation by high pH. Azocoll lytic activity of both enzymes was strongly inhibited by 1,10-phenanthroline.