Imaging and pathological discordance amongst the plethora of breast lesions in breast biopsies

Introduction: Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis. Materials and Methods: This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed. Results: A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%. Discussion: The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions. Conclusion: In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Impaired liver regeneration and lipid homeostasis in CCl4 treated WDR13 deficient mice / 한국실험동물학회지

WDR13 - a WD repeat protein, is abundant in pancreas, liver, ovary and testis. Absence of this protein in mice has been seen to be associated with pancreatic β-cell proliferation, hyperinsulinemia and age dependent mild obesity. Previously, we have reported that the absence of WDR13 in diabetic Leprdb/db mice helps in amelioration of fatty liver phenotype along with diabetes and systemic inflammation. This intrigued us to study direct liver injury and hepatic regeneration in Wdr13−/0 mice using hepatotoxin CCl4. In the present study we report slower hepatic regeneration in Wdr13−/0 mice as compared to their wild type littermates after CCl4 administration. Interestingly, during the regeneration phase, hepatic hypertriglyceridemia was observed in Wdr13 −/0 mice. Further analyses revealed an upregulation of PPAR pathway in the liver of CCl4- administered Wdr13 −/0 mice, causing de novo lipogenesis. The slower hepatic regeneration observed in CCl4 administered Wdr13 −/0 mice, may be linked to liver hypertriglyceridemia because of activation of PPAR pathway.

Impaired liver regeneration and lipid homeostasis in CCl4 treated WDR13 deficient mice / 한국실험동물학회지

WDR13 - a WD repeat protein, is abundant in pancreas, liver, ovary and testis. Absence of this protein in mice has been seen to be associated with pancreatic β-cell proliferation, hyperinsulinemia and age dependent mild obesity. Previously, we have reported that the absence of WDR13 in diabetic Leprdb/db mice helps in amelioration of fatty liver phenotype along with diabetes and systemic inflammation. This intrigued us to study direct liver injury and hepatic regeneration in Wdr13−/0 mice using hepatotoxin CCl4. In the present study we report slower hepatic regeneration in Wdr13−/0 mice as compared to their wild type littermates after CCl4 administration. Interestingly, during the regeneration phase, hepatic hypertriglyceridemia was observed in Wdr13 −/0 mice. Further analyses revealed an upregulation of PPAR pathway in the liver of CCl4- administered Wdr13 −/0 mice, causing de novo lipogenesis. The slower hepatic regeneration observed in CCl4 administered Wdr13 −/0 mice, may be linked to liver hypertriglyceridemia because of activation of PPAR pathway.

Clinicopathological profile of hepatoblastoma: An experience from a tertiary care center in India

Background: Hepatoblastoma is the most common primary hepatic malignancy in the pediatric population. Advances in pathological evaluation, imaging, risk stratification, neo-adjuvant chemotherapy, and surgery including transplantation have improved survival of these children in the western countries. However, a successful outcome in developing countries such as India with limited resources poses great challenges to the clinician and the family. Histology plays a major role in determining the prognosis of these patients. Methods: A retrospective study was done on 10 children diagnosed with hepatoblastoma between January 2010 and December 2015 in our institution. Clinical, laboratory, radiological, histopathological diagnoses, treatment, and outcome data were collected and analyzed. Results: The median age of these children at diagnosis was 11 months, and only 1 child was premature at birth. Most children were presented with abdominal distension. One child had lung metastasis at presentation. Elevated alpha fetoprotein levels were present in 90% of the children. The histological types were fetal, embryonal, macrotrabecular, and mixed epithelial-mesenchymal types. SIOPEL risk stratification was done, which showed 40% of the children to be of high risk. Three children had PRETEXT 1, 2, and 4, respectively. Conclusion: Our study is significant with respect to the information on PRETEXT staging, risk status, and histological favorability. In developing countries with limited resources and low-socioeconomic status, it is important to have a multidisciplinary team approach and tailor treatment to manage these patients effectively and improve the overall survival.

Prevalence of tuberculosis in newly diagnosed HIV patients and its relationship with CD4 count in a tertiary care hospital

Background: Tuberculosis (TB) is the commonest opportunistic infection among Human Immunodeficiency Virus (HIV) positive patients in India and HIV/TB co-infection poses a major public health challenge in developing countries. It is estimated that 60-70% of HIV positive patients will develop tuberculosis in their lifetime. The aim of the present study is to record the clinical, radiological profile of pulmonary and Extrapulmonary Tuberculosis (EPTB) in HIV positive patients.Methods: This was a prospective study conducted in the department of Pulmonary medicine, Kempegowda institute of medical sciences. All newly diagnosed HIV patients during the study period were included and screened for tuberculosis irrespective of whether they had signs and symptoms.Results: Among 44(15.94%) patients among 276 HIV positive patients were diagnosed to have tuberculosis. Males (72.72%) were affected more than females (27.27%). Most common affected age group was 31-40 years with a mean age of 38.08 years. Unprotected heterosexual contact was the most common mode of HIV transmission. Fever, weight loss and cough were the commonest symptoms at presentation. Pulmonary TB was diagnosed in 10(22.7%) patients, EPTB in 30(68.3%) and disseminated TB in 4(9%) patients. All the pulmonary TB patients had CD4 count below 250, EPTB below 150 and disseminated TB patients below 50.6(13.63%) patients had pleural effusion, 5(11.36%) had abdominal TB, 5(11.36%) had tubercular meningitis, 4(9%) had intra thoracic lymphadenopathy and one (2.27%) patient had pericardial effusion. Low CD4 count (<150) had statically significant association with HIV/TB co-infection.Conclusions: The prevalence of HIV-TB co-infection was high. Moreover, HIV positive patients need early diagnosis and treatment of active TB. The study has shown clear correlation between clinical data and the laboratory parameter of immunodeficiency (CD4 count) and the temporal development of TB.

Drug utilization study of antimicrobial agents in patients of neonatal sepsis in neonatal intensive care unit at a tertiary care hospital in western part of India.

Background: Neonatal sepsis is one of the major causes of death and morbidity among neonates in India; however, studies related to neonatal sepsis are somewhat in limited numbers. Furthermore, time to time sensitivity and efficacy of various antimicrobial agents (AMA) change which necessitates studies related to antimicrobial drug utilization in hospitals. The objective of present study was to evaluate the pattern of use of AMAs in neonatal sepsis at the neonatal intensive care unit (NICU) at a tertiary care hospital in western part of India. Methods: It was a prospective cross-sectional study conducted over a period of 6-month duration in NICU at tertiary care hospital. Data were collected and analyzed. Results: It has been observed that 57.67% patients were pre-term, 42.32% full term; 23.28% were of normal birth weight, 58.73% low birth weight and 15.34% were very low birth weight. In 48.7% of patients, two different antibiotics were prescribed while in 40.1% of patients three different antibiotics were prescribed. A total number of antibiotics prescribed were 499, per patient 2.78 antibiotics were prescribed. Amikacin was used in 73.01% cases while cefotaxime was used in 64.55% of cases. Piperacilin + tazobactam combination was used in 41.26% cases. In 50.9% cases, antibiotics were prescribed by generic name. Conclusion: Antibiotic resistance is increasing due to the irrational prescribing habits of physicians, leading to increasing morbidity, mortality and treatment costs. Therefore, the medical professionals as well as government personnel who are related to the health sector need to understand that antibiotics are precious and finite resources. The remedy of this situation requires that regular educational awareness programs should be conducted in hospitals at a regular basis.

Production and partial purification of antifungal chitinase from Bacillus cereus VITSD3

The current work was designed to isolate and characterize chitin degrading bacteria. Among the 55 bacterial colonies isolated from 7 different soil samples, 4 isolates were capable of degrading chitinase, among which one strain VITSD3 was found to be potent. Based on the morphological, biochemical and molecular characterization of VITSD3 the isolate was confirmed as Bacillus cereus (Genbank accession number: KC961638), designated as Bacillus cereus VITSD3. The crude enzyme had a total activity of 220 U, precipitated with 44.8 U and 22.5 U for dialysed sample. The hydrolysed product NAG (N-Acetyl Glucosamine) from chitin was analysed by high-pressure liquid chromatography (HPLC).The molecular weight of the chitinase was determined using SDS PAGE and found to be 55 kDa. The partially purified chitinase produced from Bacillus cereus VITSD3 showed antifungal activity against Aspergillus fumigatus (18 mm), Aspergillus niger (6 mm) and Aspergillus flavus (15 mm). Hence the investigation suggests a potential benefit of partially purified chitinase extracted from Bacillus cereus VITSD3 which will serve as an excellent antifungal potential with therapeutic use.

O presente trabalho atual foi delineado para isolar e caracterizar bactérias degradadoras de quitina. Entre as 55 colónias bacterianas isoladas a partir de 7 amostras de solo diferentes, quatro isolados foram capazes de degradar quitinase, entre os quais uma estirpe, VITSD3, mostrou-se potente. Com base na caracterização morfológica, bioquímica e molecular de VIT D3 a soluto foi confirmada como Bacillus cereus (número de acesso Genbank: KC961638), designada como Bacillus cereus VITSD3. A enzima bruta tinha uma actividade total de 220 L, precipitou-se com 44,8 L e 22,5 L de amostra dialisada. O produto hidrolisado NAG (N-acetil-glucosamina) a partir de quitina foi analisado por cromatografia líquida de alta pressão (HPLC) .O peso molecular da quitinase foi determinado, utilizando-se SDS-PAGE e verificou-se ser 55 kDa. A quitinase parcialmente purificada produzida a partir de Bacillus cereus VITSD3 mostrou actividade antifúngica contra Aspergillus fumigatus (18 mm), Aspergillus niger (6 mm) e Aspergillus flavus (15 mm). Por isso, a investigação sugere um potencial benefício de quitinase parcialmente purificada extraída de Bacillus cereus VITSD3 o que poderá servir como um excelente potencial antifúngico para uso terapêutico.

Recurrent breast abscess due to Salmonella paratyphi A: an unusual case.

Bacterial mastitis is the most common variety of mastitis and is often caused by Staphylococcus aureus. Chronic mastitis is usually seen as a complication of tuberculosis & syphilis. A 31-year-old female presented with lump in the right breast for the past two years with pain for the past 15 days and discharge for the past two to three days. On examination, the lump was measured and was approximately 4x4 cm in size with a discharging sinus just lateral to the areola. No regional lymphadenopathy was noticed. A clinical diagnosis of “Lump in the right breast” with sinus probably due to tuberculosis was made. The lump had been excised surgically. Salmonella paratyphi A was isolated after repeated culture. She had responded to ceftriaxone, hence, unnecessary use of anti-tubercular drugs could be avoided. In chronic mastitis and breast abscess Salmonella species should be considered as one of the etiological agents.

Optimization of medium composition for the production of mosquitocidal toxins from Bacillus thuringiensis subsp. israelensis.

Optimization of chicken feather (CF) based culture medium for the production of Bacillus thuringiensis subsp. israelensis (Bti) biomass in combination with the agro industrial by-product (coconut cake, CC) and manganese chloride (MnCl2) has been evaluated. The biomass yield of Bti spore/crystal toxin was highest (12.06 g/L) from the test medium (CF+CC+MnCl2) compared to the reference medium (Luria Bertani, LB). Toxicity assay with Bti produced from the test medium against mosquito vectors (Culex quinquefasciatus, Anopheles stephensi and Aedes aegypti) was also satisfactory and results were comparable with bacteria produced from LB. The results suggest that Bti can be produced to the maximum extent possible as a potential mosquitocidal activity as suggested by the test medium (CF+CC+MnCl2).

A novel cost-effective medium for the production of Bacillus thuringiensis subsp. israelensis for mosquito control

Abstract. Bacillus thuringiensis subsp. israelensis (Bti) has been used for mosquito-control programmes the world-wide. Indeed, the large-scale production of Bti for mosquito control is very expensive due to the high cost of its culture. In the present study, we attempted to widen the scope in developing cost-effective culture medium for Bti production, based on the raw materials available on the biosphere, including coconut cake powder, CCP (Cocos nucifera), neem cake powder, NCP (Azadirachta indica) and groundnut cake powder, GCP (Arachis hypogea). Among these raw materials, the biomass production of Bti, sporulation and toxin synthesizing from ‘CCP’ in combination with mineral salt (MnCl2) was comfortably satisfactory. Bioassays with mosquito species (Culex quinquefasciatus, Anopheles stephensi and Aedes aegypti) and field trials were also satisfactory. The present investigation suggests that coconut cake-based culture medium can be used as an alternative for industrial production of Bti in mosquito-control programme. Therefore, the study is very important from the point of effective production of Bti from cost-effective culture medium for the control of mosquito vectors.

A tool for rapid socioeconomic assessment.

OBJECTIVE: To validate a simple wealth index scale (WIS) based assessment of socioeconomic status and compare it with existing kuppuswamy(KUP) scale. METHODS: Families of 300 children aged 6 to 59 months of acute diarrhoea enrolled in a cross-sectional study were interviewed for socio economic status using both 8 item ownership scale (WIS) and Kuppuswamy (KUP) scale, validated against a reference standard Income Scale (IS). RESULTS: Out of 111 people classified as low based on Income scale (IS), 17% were identified by WIS, and 21% by KUP. In the upper low, 69.4% were identified by WIS and 84.3 % by KUP. Amongst the low middle group the WIS identified 27.6% while KUP identified 10.6% and amongst upper middle patients 30% were identified by WIS and 15 % by KUP. There were none in the upper income of WIS or KUP category. The WIS performed well in all income categories whereas the KUP was better for upper low and low income categories. The agreement between WI and KUP was 55.56%. CONCLUSION: KUP scale is lengthy and difficult to administer by pediatric students and biased towards professional qualifications and education, rather than actual standard of living. It can be replaced by a simple 8 item ownership scale (WI) which is robust for all income groups and also shows good agreement with KUP.

Efficacy of breast milk gastric lavage in preterm neonates.

OBJECTIVE: To evaluate effects of gastric lavage with mother's milk starting 4 hours after birth, in hospitalized preterm newborns otherwise on exclusive parenteral fluids. METHOD: Study design: Randomized controlled trial. Sick preterm babies were assigned to receive in addition to parenteral fluids, either gastric lavage with mother's milk within 4 hours of birth and subsequently every 3 hours till tolerance of nutritive enteral feeds (intervention or BML group, n = 40), or remain nil per orally till tolerance of nutritive enteral feeds (control or NPO group, n = 40). The main outcome was the mean number of days of parenteral fluids till successful tolerance of nutritive enteral feeds. They were also evaluated for mean duration of hospital stay, development of new complications, and mortality. RESULT: Despite sicker babies in the BML group at baseline, the mean duration of exclusive parenteral fluid was significantly less (P = 0.003) in BML (3.9 +/- 1.5 days as compared to 5.4 +/- 2.6 days in NPO). In the NPO group 60% of the babies stayed longer than 3 weeks in hospital compared to only 30% in the BML group. The risk of development of new complication after randomization was also significantly less in BML group [RR 0.61 (95% CI 0.40-0.95) (P=0.03)]. Incidence of sepsis was 44% less in BML group [30% in BML, 55% in NPO group; RR 0.58; 95% CI 0.35-0.97; P = 0.02]. On multivariate logistic regression, BML group, birth weight and absence of complication at the time of hospitalization were strong predictors of improved outcome. There was no difference in mortality between 2 groups. CONCLUSION: This study showed that early exposure to even small amounts of mother's milk in sick preterm neonates significantly reduced the days on parenteral fluids, risk of sepsis and the duration of hospital stay without any adverse effect.

Quality of life in children with sickle cell hemoglobinopathy.

OBJECTIVE: To identify specific domains and traits that are most affected in patients with sickle cell anemia and traits with respect to normal children. METHODS: Children attending the regional hemoglobinopathy center at IGMC, Nagpur in age group of 8-14 years were assessed. Of 52 children studied, 25 had sickle cell anemia (SCA), 12 had sickle cell trait (SCT) and 15 wre normal control. The (quality of life (QOL) was assessed using multidimensional interview based questionnaire. RESULTS: All domains, physical, psychosocial, cognitive and morbidity were affected. In SCA playing and mobility were most affected. There was feeling of sadness or disinterest and lack of support from teachers. The school attendance, vocational achievement perception, entertainment and participation in cultural activities were also affected. The intensity of weakness and pain was greater in SCA children who left that they were affected by a major illness. The unusual finding was that the SCT children also showed affection of all domains as compared to normal children, which was perhaps due to the stigma of the disease. CONCLUSION: QOL is affected in children with sickle cell disease (SCD) and to a lesser extent in SCT. Interventions to improve QOL should target the affected items. Improving awareness of the disease and its manifestation will help to alleviate the psychosocial affliction of children with SCT.

Therapeutic evaluation of zinc and copper supplementation in acute diarrhea in children: double blind randomized trial.

OBJECTIVE: To test the hypothesis that daily supplementation of zinc and copper mixed with the oral rehydration solution (ORS) reduces the duration and the severity of acute diarrhea in children. METHODS: In a randomized, double blind, placebo controlled trial children aged 6 months to 59 months in an urban hospital with acute diarrhea, were assigned to receive the intervention of once daily 40 mg of zinc sulfate and 5 mg of copper sulfate dissolved in a liter of standard ORS (n = 102) or placebo (50 mg of standard ORS powder) dissolved in a liter of ORS (n = 98). RESULT: The baseline characteristics in the two groups were similar. The mean survival time (days) (SE) with diarrhea was not significantly different in the treatment (4.34 (0.2)) as compared to the placebo group (4.48 (0.2)), nor was there any difference in the median time to cure. Cure was less likely with longer duration of diarrhea prior to enrollment (P < 0.001), if the time taken for rehydration was more (P = 0.001) and if intravenous fluids were used (P = 0.03) regardless of the micronutrient supplementation. The proportion of children with diarrhea > 4 days was 46% in the placebo group with an adjusted odds ratio (OR) (95% CI) of 1.19 (1.58, 0.9; P = 0.2) as compared to 39% in the supplemented group. The most important risk factor for diarrhea > 4 days was diarrheal duration prior to enrollment with OR = 6.25 (3.7, 11.1). The supplemented group however had less severity of diarrhea with a lower proportion of children requiring unscheduled intravenous fluids (OR = 0.4; 95% CI 0.05, 2.2), with weight loss (OR = 0.7; 95% CI; 0.4, 1.3), with complications (OR = 0.15; 0.01, 1.3) and had no deaths as compared to two in the placebo group. CONCLUSIONS: This study showed that the most important predictor for duration of diarrhea in children was the severity of the disease at enrollment, and, not the supplementation. There were clinical beneficial effects of supplementation on rate of any complications and mortality. A larger trial is warranted before supplementation of micronutrients mixed with ORS are recommended for management of acute diarrhea.

Sickle cell disease in central India.

OBJECTIVE: The incidence and the risk factors of sickle cell disease (SCD), vaccinated with Pneumococcal vaccine and on penicillin prophylaxis has not been previously reported in India. METHODS: This prospective hospital based study followed 325 children on penicillin prophylaxis, of which 161 were vaccinated for pneumococci, over 146.84 person years to determine the incidence and determinants of crisis (SCC) and infections. The average age at presentation was 7.05 +/- 3.26 years with male preponderance below 2 years. RESULTS: The main causes for hospitalizations were for blood transfusion, SCC and infections. The incidence of SCC was 1.25 per patient per year and that of infection was 1.38 per person per year. The risk factors for SCC were Mahar caste (p = 0.007) non-compliance (p = 0.000) and protein energy malnutrition (PEM) (p = 0.0015) and for infection were also PEM (p = 0.023), Mahar caste (p = 0.021) and noncompliance (p = 0.001). CONCLUSION: Malnutrition and non-compliance with medication increased the patient's susceptibility to SCC and infections.