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.

Storage induced changes in coliform, heterotrophic groups of bacteria and nutrient levels of human urine for its safe use in biological production.

Human urine is a potential source of various nutrients, minerals and trace elements. Its use as a fertilizer is growing popular among farmers. Here, we examined the pattern of changes in the counts of coliform, heterotrophic bacteria as well as physico-chemical characteristics of human urine during different days of storage under closed conditions at ambient temperature. We observed that after 253 days of storage under closed condition, the coliform counts were reduced significantly and remained within the safe limit to be used as fertilizer. With increase in storage period, the concentration of phosphate showed decline coupled with rise in pH, alkalinity and electrical conductance. Our study revealed that human urine can be used as safe fertilizer after 8 months of storage under closed conditions at ambient temperature ranging 25-35ºC.

Bile salt incorporated polypyrrole thin film for ethanol sensing.

Polypyrrole (PPy)-bile salt composite was used for sensing ethanol vapor. PPy was synthesized by interface polymerization for subsequent fabrication of thin film of its composite with bile salt, by in-situ co-dispersion method and then exposed to ethanol vapour. Sensing was visualized through changes in morphological, structural and optical characterizations. The ethanol exposed film showed larger agglomeration as revealed in its surface morphology on scanning electron microscope (SEM) and greater crystallinity as seen through X-Ray diffraction (XRD). Fourier transform infra red (FTIR) and nuclear magnetic resonance spectroscopy (NMR) of the ethanol incorporated film also gave signature of the presence of bile salt and alcohol. Alcohol incorporation pattern resulted in increase in electrical conductance from 7.08539 × 10-5 mA/V to 8.0356 × 10-5 mA/V, as determined from current voltage characterizations. Average molecular weight (Mn) obtained from gel permeation chromatography changed from 6160 to 10300 on ethanol intake. Photoluminescence (PL) intensity was quenched and the PL peak shifted from 430 to 409 on ethanol exposure. Changes in morphological, structural, optical and electrical properties of the composite on ethanol exposure showed its prospective application for sensing ethanol.

Isolated tubercular splenic abscess: Can we defer splenectomy? Our single experience with anti-tuberculous therapy alone.

Isolated splenic tuberculosis is an exceedingly rare clinical condition. Microbiological confirmation of diagnosis in such cases is quite difficult. We encountered the case of a 35-year-old female, who presented with persistent low-grade fever and weight loss. The CT scan of the abdomen revealed multiple hypodense splenic lesions. No primary focus of infection was detected in any other organs. Fine needle aspiration of splenic lesion revealed acid-fast bacilli on Ziehl-Neelsen stain. With anti-tuberculous therapy, the lesions regressed significantly in size. We stress that splenic tuberculosis should be considered as a diagnostic possibility even in immunocompetent individuals and choose combination antituberculous therapy as the first line treatment with consideration of splenectomy depending on response.

Anticholesterol antibody: the way for reduction of hypercholesterolemia.

Antibodies specific to cholesterol was first reported in 1925. It may develop in the body naturally and it is believed that this antibody has a protective role against harmful forms of cholesterol, such as LDL & VLDL. An immunoglobulin protein, anticholesterol may be found in both circulation as well as digestive tract. Many studies have been done on anticholesterol antibody. Our immune system may produce anticholesterol antibodies in response to elevated levels of cholesterol rich particles, such as LDL & VLDL. It can be induced in animals by conjugating or incorporating the cholesterol antigen into a variety of structures. Immunization markedly decreases the risk of developing atherosclerosis. In comparison to non-tumorous normal subject, the antibody is found to be significantly higher in non-small cell lung cancer (NSCLC). Elevated anti-cholesterol antibodies might be applicable for the serodiagnosis of NSCLC. Some studies showed that LDL immunization induces T-cell dependent antibody formation that protects atherosclerosis. Origo Biosciences scientists had identified a dietary antibody to cholesterol. This protein, when ingested, binds to cholesterol in the human digestive tract and blocks its absorption into the bloodstream. These studies may lead to us to realize the importance of anticholesterol and to find the way for reduction of hypercholesterolemia and thereby reduction of morbidity and mortality.

Effect of alternate nostril breathing exercise on cardiorespiratory functions.

Pranayama (breathing exercise), one of the yogic techniques can produce different physiological responses in healthy individuals. The responses of Alternate Nostril Breathing (ANB) the Nadisudhi Pranayama on some cardio-respiratory functions were investigated in healthy young adults. The subjects performed ANB exercise (15 minutes everyday in the morning) for four weeks. Cardio-respiratory parameters were recorded before and after 4-weeks training period. A significant increment in Peak expiratory flow rate (PEFR L/min) and Pulse pressure (PP) was noted. Although Systolic blood pressure (SBP) was decreased insignificantly, the decrease in pulse rate (PR), respiratory rate (RR), diastolic blood pressure (DBP) were significant. Results indicate that regular practice of ANB (Nadisudhi) increases parasympathetic activity.

Studies on serum lipid profile in hypertensive patient.

The study was carried out to appraise the serum total cholesterol, triglyceride, HDL-C and LDL-C values in hypertensive patients for providing information to the health-policy planners and also to the clinical practitioners about the importance of routine monitoring of lipid profile in hypertensive patients for prevention of coronary heart disease and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. It was a cross-sectional study. The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital and in the community of Sadar, Mymensingh District. The period of the study was January 2005 to December 2005. A total number of seventy subjects were included in this study. Out of them 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Most of the hypertensive patients (65%) were taking treatment irregularly. Serum total cholesterol, serum triglyceride and serum LDL cholesterol were greater in hypertensive than those of normotensive .The differences of mean of serum total cholesterol, serum LDL cholesterol in between two groups were statistically significant and in case of serum triglyceride it was statistically highly significant. Serum HDL cholesterol was less in hypertensive than those of normotensive. The differences of mean of serum HDL cholesterol in between two groups were statistically highly significant. Among 40 hypertensives the number of "Getting treatment- regular" & "Getting treatment-irregular" was 14 (35%) & 26 (65%) respectively and the values are not statistically significant. Similarly in patients "suffering less than 5 years" and "suffering 5 years & above" the differences are also not statistically significant. Conclusion: The observations of this study has revealed that most of the hypertensive patients are taking treatment irregularly and there was significant alteration of serum cholesterol, triglyceride, HDL-C and LDL-C in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the coronary heart disease (CHD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.

Studies on Serum Creatinine and Creatinine Clearance in Hypertensive Patients.

Objectives: To assess the serum creatinine and creatinine clearance values in hypertensive patients for providing information to the health-policy planners, clinical practitioners about the importance of routine monitoring of serum creatinine and creatinine clearance in hypertensive patients for prevention of ESRD and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. Study design: It was a cross-sectional study. Setting: The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital. Study period: The period of the study was January 2005 to December 2005. Participants: A total number of seventy subjects were included in this study. Out of 70 subjects, 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Intervention: The subjects were selected on the basis of history and clinical examination. Convenient sampling technique was applied. During visit the available hypertensive patients and controls (normotensive & healthy) those who were present were selected. Having received their written consent they were interviewed & examined by prepared personal data sheet and sample of blood (after overnight fasting) was drawn for biochemical examination. Main outcome measure: Mean values of serum creatinine and creatinine clearance. Result: Serum creatinine was greater in hypertensive than those of normotensive. Creatinine clearance was less in hypertensive than those of normotensive. Serum creatinine & creatinine clearance in between males hypertensive & control shows that CrCl were statistically significant but not the serum creatinine. In females of hypertensive & control shows no differences in case of SCr & CrCl. Among 40 hypertensive the number of “Getting treatment - regular” & “ Getting treatment-irregular” was 14 (35%) & 26 (65%) respectively. Similarly in patients “suffering less than 5 yrs” and “suffering 5 yrs & above” the differences are also not statistically significant. Conclusion: The observations of this study revealed that most of the hypertensive patients were taking treatment irregularly and there was significant alteration of biochemical parameters in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the end stage renal disease (ESRD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.

Comparison of cardiac output in OPCAB: bolus thermodilution technique versus pulse contour analysis.

The study was designed to evaluate the clinical agreement between intermittent bolus thermodilution technique and pulse contour analysis technique. Sixty patients with normal left ventricular function undergoing elective off-pump coronary bypass surgery were included in this prospective study. In addition to routine monitoring, a 7.5F pulmonary artery thermodilution catheter via right internal jugular vein and a 4F arterial thermodilution catheter into femoral artery were also placed. Cardiac output measurements were compared before induction, after induction, after sternotomy, during the various anastomoses, post-protamine and post-sternal closure. Statistical analysis was performed using analysis of agreement to assure bias distribution of differences between the two methods by using Bland and Altman analysis. The cardiac output values obtained at preinduction, post-induction, and post-sternal closure time points showed good agreement, whereas the values obtained during the various anastomoses showed significant differences (p <0.05). Therefore it was concluded that pulse contour analysis cannot be relied upon completely whenever there is a change in the position of heart or alteration in systemic vascular resistance. But the trends in cardiac output were in complete agreement during the entire procedure.

A comparative study of body mass index (BMI) in diabetic and non-diabetic individuals in Nepalese population.

INTRODUCTION AND OBJECTIVES: Diabetes Mellitus (DM) is the most common endocrine disorder world-wide. The prevalence of diabetes mellitus is increasing. In the present study an attempt has been made (i) to examine the relation between obesity and diabetes mellitus in Nepalese people, (ii) to find out whether BMI cut-off points for determining over weight and obesity as per WHO criteria are applicable in Nepalese study population. MATERIALS AND METHODS: The present study was carried out in Manipal College of Medical Sciences (MCOMS) and Manipal Teaching Hospital (MTH), Pokhara. The Diabetic patients of Pokhara and surroundings who attended the 'Diabetic Clinic' and Out Patient Department (OPD) during August 2004 to November 2004 at Manipal Teaching Hospital were included in the present study. The number of diabetic patients was two hundred (200), out of which, one hundred and fourteen (114) were male and eighty six (86) were female. In addition one hundred (100) non-diabetic subjects who attended the OPD at MTH were taken for comparison with the diabetic patients, of which, forty seven (47) were male and fifty three (53) were female. Age, height and weight were recorded for every subject. BMI was calculated by the standard formula. In the present study, body mass index (BMI) of the diabetic subjects was found to be more than that of non-diabetic subjects. BMI of non-diabetic males and females were found to be around 22 kg/m2 which is within normal range as per WHO recommendations. On the other hand, diabetic subjects' BMI were found to be around 25 kg/m2, which denotes borderline obesity. It is clear from the present study that 51.5% of the diabetic subjects were within the normal range (BMI 18.5-24.9 kg/m2). More diabetic subjects were found in over-weight (25-29.9) category than non-diabetic subjects. As per WHO criteria 56% of the non-diabetic subjects were within the normal BMI range (BMI 18.5-24.9 kg/m2). It is also evident that when BMI in the range of 25.0-29.9 kg/m2 is considered as over-weight, only 33% were found to be over-weight in diabetic subjects. But when BMI > or =23 kg/m2 (as recommended for Asians) is taken as the determining factor for overweight, 64% of overweight male subjects and 72.09% of overweight female subjects were found to be diabetic. Conclusion: According to the observations of the present study on Nepalese it can be concluded that BMI cut-off points for determining over-weight and obesity should be lowered to 23 kg/m2 or less which can provide an adequate basis of taking action on risks related to overweight and obesity in Nepal.

Primary neurological manifestations of lung cancer--a retrospective analysis of 8 patients.

Neurological manifestations are reported in 5 to 10% of cases of lung cancer. We present a series of 216 consecutive patients of lung cancer of which 8 patients presented first with neurological manifestations without overt respiratory symptoms. The present study aimed to identify the number of patients of lung cancer presenting with primary neurological symptoms, the nature of the presentations, and the outcome of these patients among 216 patients who presented over a 2 year period in the Institute of Postgraduate Medical Education and Research, Kolkata. Out of 8 patients, 3 patients presented with seizures, 3 patients with hemiparesis and 2 patients with paraparesis. Thus, 3.7% (8/216) of patients in our series presented with a neurological manifestation. We concluded that primary neurological manifestations are rare in lung cancer. The lungs should be the first site of evaluation in a case of a cerebral metastasis with an unknown primary.

Insulin resistance and urinary excretion of sodium in hypertensive patients with non-insulin dependent diabetes mellitus.

BACKGROUND: Hyperinsulinemia has been implicated in the pathogenesis of hypertension both in non-diabetic and diabetic patients. A causal relationship between renal sodium retention and hyperinsulinemia is speculated to play role in the development of hypertension in diabetes mellitus. MATERIAL AND METHODS: Twenty patients (12 males; 8 females) with hypertension and non-insulin dependent diabetes mellitus (NIDDM) and twenty normotensive patients (11 males, 9 females) with NIDDM were included in the present study. Blood samples for glucose and immunoreactive insulin (IRI) assay were collected at 0, 30, 60 and 120 minutes after 75 g of glucose per oral. Urinary sodium excretion in 24 hrs was estimated by flame photometry. Insulin response to glucose and correlation between basal insulin secretion and urinary sodium excretion were evaluated. RESULTS: Mean fasting plasma glucose value was significantly raised in hypertensive group in comparison with normotensive group of diabetic patients. Patients with diabetes and hypertension and significantly higher level of serum IRI than normotensive patients with diabetes mellitus. Urinary sodium excretion was significantly lower in diabetic patients with hypertension than in diabetic patients without hypertension. A negative correlation between basal insulin level and urinary Na+ excretion was observed in hypertensive patients with NIDDM. CONCLUSION: A negative correlation between hyperinsulinemia and 24 hrs urinary Na+ excretion was observed in patients with diabetes and hypertension. The study highlights that patients with diabetes mellitus have tendency to retain sodium under the influence of insulin but this needs further evaluation.

Kinetics of adsorption of denatured protein at alumina-water interface.

The kinetics of adsorption of soluble denatured protein, gelatin has been studied at the alumina-water interface as a function of protein concentration, pH, temperature and ionic strength. The rate of adsorption of gelatin has been compared with rate of adsorption of BSA denatured by 8 M urea or 0.05 M SDS. The initial stage for the adsorption process is diffusion-controlled and the surface diffusion coefficients evaluated from equations of Ward and Tordai and by Bull for globular and denatured proteins are found to be widely different from each other. The kinetic data for gelatin fit into a first order rate equation with two rate constants, k1a and k2a. Using Arrhenius equation, the activation energies delta E1* and delta E2* have been evaluated from the values of k1a and k2a respectively. The corresponding changes in values of enthalpy of activation (delta H*), entropy of activation (delta S*) and free energy of activation (delta G*) have been evaluated using Eyring's equation for absolute reaction rate. It has been found that for both gelatin and denatured BSA, in the first kinetic step delta H1* > T delta S1* and for the second step T delta S2* > delta H2.

Recent kala-azar cases in India: isozyme profiles of Leishmania parasites.

In this study, three WHO recommended reference strains of Leishmania donovani (DD8), L. tropica (K27) and L. major (5 ASKH) were compared by isozyme analysis of 9 soluble enzymes using cellulose acetate electrophoresis (CAE). The isozyme profile of the three species showed distinct electrophoretic mobilities of the enzymes studied. This technique was applied to study the enzyme patterns of 8 clinical isolates of visceral leishmaniasis (VL) and two post kala-azar dermal leishmaniasis (PKDL) collected from the present epidemic (1990s to date). They were seen to be similar to the two isolates of the 1970s epidemic. Interspecies differences were observed in different reference Leishmania species whereas no intraspecies difference was observed amongst the clinical isolates (8VL + 2PKDL) and all of these were found to be similar to L. donovani isolates of 1970s epidemic.

Effect of denaturants and stabilisers on protein adsorption at solid-liquid interfaces.

The adsorption isotherms of different proteins from aqueous solution to the surface of different solids have been compared in the presence of additives such as urea, surfactants and high concentration of various neutral salts. The adsorption isotherms of lysozyme on alumina are not affected much in the presence of 8 M urea showing the rigid structure of lysozyme whereas isotherms of hemoglobin show surface coagulation even in presence of 2 M urea. In presence of 8 M urea, adsorption isotherms of BSA on alumina show two distinct steps. The extent of protein adsorption in the presence of surfactants depends on the nature of surfactants as well as of the underlying surface. The adsorption isotherms of BSA and lysozyme in presence of 2 M concentration of different neutral salts have also been compared with each other. In the presence of denaturants such as NaI and LiCl, the proteins are adsorbed in unfolded beta-conformation whereas in the presence of protein stabilizers such as NaCl, KCl and Na2SO4, amount of protein adsorbed at saturation is zero or extremely small showing that unfolding of proteins at the interface is necessary for initial stage of protein adsorption. The standard free energy change (delta G degrees) per square meter of the surface, signifying relative affinity of adsorption at the state of monolayer saturation, have been calculated. The magnitude of standard free energy of transfer (delta G degrees B) of one mole of protein to the surface in presence of all the additives was found close to 40 kJ/mole.

Kinetics of fusion with cells of reconstituted Sendai virus envelopes lacking hemagglutinin-neuraminidase.

The fusion potential of reconstituted Sendai virus envelopes containing only the F protein (F-virosomes) has been assessed. F-virosomes and F,HN-virosomes were prepared by solubilization of the intact virus in Triton X-100 followed by its removal using SM-2 biobeads. Viral envelopes containing HN whose disulphide bonds were irreversibly reduced (HNred) were also prepared by treating the envelopes with dithiothreitol followed by dialysis. Both F-virosomes and F,HNred-virosomes hemolysed red blood cells in the presence of wheat germ agglutinin. The rates and extent of hemolysis induced by these virosomes were, however, significantly lower than that induced by F,HN-virosomes. Using a fluorescence probe based membrane mixing fusion assay, F- and F,HNred-virosomes were found to fuse with cultured HeLa cells in the presence of wheat-germ agglutinin. A direct comparison of the fusion activity of F,HN-virosomes and F-virosomes was made by using desialylated HepG2 cells as target containing the asialoglycoprotein receptor (ASGP-R) that binds to a terminal beta-galactose moiety of F protein. A 2- to 3-fold enhancement in the fusion rate when HN was included in the viral envelope was observed. Based on the kinetic data, a model for fusion of paramyxo-virosomes with HepG2 cells is proposed.