Pediatric primary extra-ovarian Sertoli Leydig cell tumor of the retroperitoneum

Ovarian Sertoli Leydig cell tumors (SLCT) accounts for less than 0.5% of all ovarian malignancies. The incidence of primary extra-ovarian SLCT is extremely rare with reported cases occurring in young adult women till now. We report case of primary retroperitoneal extra-ovarian SLCT in a seven-year girl child without any hormonal manifestation. She presented with complaint of left side abdominal swelling associated with intermittent pain for a duration of six months. CT scan revealed a huge retroperitoneal space-occupying lesion abutting the dorsal vertebrae and present posterior to pancreas, spleen and left kidney. The tumor was diagnosed as extraovarian Sertoli Leydig cell tumor with intermediate differentiation on histopathology and immunohistochemistry.

A comparative study of cholecalciferol and vildagliptin on fasting blood glucose level of streptozotocin-nicotinamide-induced Type 2 diabetic albino rats

Background: The lack of vitamin D deficiency has been found to be closely associated with many health problems such as metabolic syndrome, cancer, cardiovascular disease, and type 2 diabetes. This interest has also arisen due to the identification that most cells, along with the pancreatic beta-cells, incorporate the vitamin D receptor. Aims and Objectives: In this study, we tested the potential anti-diabetic effect of cholecalciferol, one of the vitamin D analogs, alone or in combination with vildagliptin in type 2 diabetic rats. Materials and Methods: Type 2 diabetic model rats were induced by intraperitoneal injection of streptozotocin followed by nicotinamide. Rats were assigned into five groups each of six rats divided as follows: Normal (non-diabetic) control (Group A), untreated diabetic group receiving the vehicles only (Group B), cholecalciferol-treated group (Group C), vildagliptin-treated group (Group D), and group receiving a combination of cholecalciferol and vildagliptin (Group E). The treatment course lasted for 1 month. For the estimation of fasting blood sugar, the rats were kept deprived of food overnight and were allowed free access to water. Blood samples were collected from the tail of rat with the help of glucometer. Statistical analysis was performed using SPSS version 20 software. One-way ANOVA test was used to compare the effect of drugs on different group. Post hoc analysis was done using Turkeys HSD (honestly significant difference) test. Differences were considered significant at (P < 0.05). Results: Mean FBS value of vitamin D, vildagliptin, and their combination was 181.50 mg/dl, 95.0 mg/dl, and 84.83 mg/dl on day 28. It showed that the combination of both drugs acquired much closer value of FBS as compared to normal non-diabetic control group and thus achieved normal glucose level more effectively. Furthermore, coadministration showed greater fall in fasting blood glucose at the extent of 61.15% as compared to 56.45% by vildagliptin and 17% by cholecalciferol alone on day 28. Conclusion: Therefore, it may be suggested through this study that vitamin D has blood glucose lowering property and coadministration of vitamin D and vildagliptin potentiate the action of each other.

Comparative analysis of immunohistochemical features of nodal versus extranodal diffuse large B cell lymphoma with respect to cell-of-origin classification

Background: Diffuse large B-cell lymphoma (DLBCL) represents a heterogeneous group of lymphoid malignancies with distinct oncogenic events and clinical behavior that cannot be unraveled by morphology and immunophenotype alone. Simple biological segregation such as the Hans classifier helps to explain the heterogeneous responses to standard treatment and provides a rationale for the investigation of novel targeted therapies. Aims and Objectives: In this study, we tried to estimate immunohistochemical (IHC) features of nodal and extranodal DLBCL using cell-of-origin classification (Hans Algorithm) with the markers CD10, Bcl-6, MUM1. Materials and Methods: Blocks of the patients with a histological diagnosis of DLBCL over the past 3 years were retrieved and submitted for IHC analysis to classify into germinal center B cell type (GCB) and non-GCB type. Results: Mean age for nodal DLBL was 48.19 � 14.68 years, extranodal were 55.7 � 13.22 years. Mean age for GCB were 56.6 � 15.66 years whereas for non-GCB were 51.45 � 12.85 years. Among nodal lymphomas cervical was the most common site and among extranodal lymphomas, intestinal lymphomas were commonest (including colorectal). Relative proportion of GCB among extranodal was 28.78%, whereas in nodal DLBCL it was 16.67%, relative risk of getting GCB type DLBCL was 1.72 times higher in extranodal compared to nodal DLBCL (P = 0.081). Total positivity of MUM1 was 17%, whereas for Bcl6 and CD10 it was 29% and 15% respectively. Ki67 was considerably higher in GCB type and for extranodal DLBCL in our study. Conclusion: Proportion of extranodal GCB type DLBCL compared to nodal DLBCL is considerably higher in our study population, though it varies greatly among Asian and world data. Uniform meta-analysis and systematic review is necessary to stratify.

An exploration of psychological distress and stigma in frontline workers amidst COVID-19 from Andhra Pradesh, India

Background: Time has evidenced the impact of various pandemics on the human race, and specifically the impact on the healthcare workforce assigned to the forefront. The coronavirus disease 2019 (COVID-19) brought in similar challenges across the globe, and also nationally. Mental health-related distress endured during these trying times in special forces remains an area of interest, but additionally we saw the reports of stigmatisation of healthcare workers working in COVID-19 areas. We aimed to explore the psychological distress and stigma faced by frontline workers in Andhra Pradesh, India. Materials and methods: Data was collected via specially designed Google survey forms, with a consent form and valid tools attached, namely the General Health Questionnaire-12 and a semi-structured questionnaire exploring stigma. Total of 321 nurses, interns, postgraduate trainees, and consultants working in COVID-19 were included in the study. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 20 with descriptive (percentage, mean, and standard deviation) and inferential (chi-square and Fisher’s exact tests) statistics. Results: Young, unmarried males who have done COVID-19 duties for seven days, majority serving in screening areas and having experienced COVID-19-like symptoms formed the larger sample. Younger age, unmarried, females, nursing staff were significantly found to have distress. Prevalence of stigma was noted with significant association of distress with anxiety over testing, discrimination for working in a COVID-19 centre, being afraid to reveal COVID-19-like symptoms, being disliked for living among family and friends post-quarantine. Conclusion: Majority were less than 30 years, unmarried, female who had significant association between psychological distress. Stigma was reported with association to psychological distress.

揈xtant of the living dead� a case report on Cotard抯 syndrome and its treatment aspects from a tertiary care hospital in India

Cotard抯 syndrome has always borne a historical construct, being linked to pure psychosis, affective disorders as well as organic disorders like Parkinson抯, temporal lobe epilepsy, migraine, and cerebral infarction. Emphasis has remained on the psychopathology, involving beliefs of negation, damnation, guilt, and denouncing of body organs. Treatment aspects has been focused on less frequently; moreover, sparsely from India. We present a case of bipolar affective disorder, current episode severe depression with psychotic symptoms (Cotard抯 syndrome) with special focus on treatment.

Geographically distinct North-East Indian Helicobacter pylori strains are highly sensitive to clarithromycin but are levofloxacin resistant

Purpose: Helicobacter pylori causes various gastro-intestinal diseases. Antibiotic resistance to commonly used antibiotics for the treatment of H. pylori infection is the major cause for treatment failure. The aim of this study is to determine the antimicrobial susceptibility pattern for clarithromycin and levofloxacin and find the evolutionary relationship of the partial sequence of 23S rRNA and gyraseA gene of H. pylori by phylogenetic analysis. Materials and Methods: A total of 46 H. pylori strains were tested for clarithromycin and levofloxacin susceptibility pattern and phylogenetic tree were reconstructed by PhyML software. Results: In this study, we observed that only 6.5% of North-East Indian H. pylori strains were resistant for clarithromycin showing mutation at A2143G and T2182C positions of 23S rRNA gene. Resistance for levofloxacin was observed in 89.1% of the H. pylori strains showing mutations at asparagine to lysine at 87 and aspartic acid to glycine/tyrosine/asparagine at 91 positions of gyraseA gene. The phylogenetic tree of the partial sequence of 23S rRNA and gyraseA gene depicts that the North-East Indian strains falls in different cluster when compared to other countries. Conclusions: Resistance for clarithromycin was less in North-East Indian strains but high for levofloxacin indicating that first-line therapy may be best and effective for eradication of H. pylori in this region. This study is the first report that showed antibiotic susceptibility pattern for clarithromycin and levofloxacin by mutation analysis. By partial sequencing of 23s rRNA and gyraseA gene, we found that North-East Indian strains are geographically distinct.

Analysis Of Fatty Acids From Oil Of Green Tea (CAMELLIA Sinensis L) By Gas Chromatography Coupled With Flame Ionization Detector And Its Anticancer And Antibacterial Activity In Vitro

Objective: Tea is a widely consumed beverage worldwide. The effect of green tea is mainly due to its high polyphenols-(-) epigallocatechin-3-gallate (EGCG) content in the culture of cancer cell and bacterial cells. The present work was carried out to investigate the efficacy of green tea oil (GTO) against cancer cells and bacterial cells. Methods: In this study green tea oil was prepared from green tea for different experiment and determination of fatty acids profile from green tea oil. In the present study, peripheral blood lymphocyte (PBL) was chosen as human peripheral blood lymphocytes and blood cancer MCF-7 cells were chosen as human cancer cells. To fulfill our aims and also to evaluate the activity of this phytomedicine against normal lymphocytes and cancer cells the cell samples were divided into 26 experimental groups in the following ways. Each Petri dish contains 2 X 105 cells. Results: GTO shows a potent anticancer agent but nontoxic to normal cells. The GTO decreases the reduced glutathione (GSH) level and increase the oxidized glutathione (GSSG) level significantly (P<0.05) in MCF-7 cells. But in lymphocytes the GSH level and GSSG level were almost the same with the control group but doxorubicin (DOX) significantly decreased the GSH and increase the GSSG level. Green tea oil treatment causes generation of reactive oxygen species (ROS) in MCF-7 cells revealed by DCFH2DA staining. Agar diffusion test shows the GTO is effective against multi-drug resistant bacteria. Conclusion: This phytomedicine has a potent anticancer activity without damaging the normal lymphocytes. So, this drug can be used for further treatment of anticancer and antibacterial.

A method for early detection of antibiotic resistance in positive blood cultures: Experience from an oncology centre in eastern India.

Purpose: For antibiotic susceptibility results, conventional culture and sensitivity methods takes 48 hours after a blood culture is fl agged positive by automated systems. Early initiation of targeted antibiotic therapy is essential for effective management of sepsis to reduce morbidity, mortality, cost of treatment and prevent antibiotic resistance. Objective of this study was to evaluate Direct Sensitivity Test (DST) as a potential tool to get reliable antibiotic susceptibility results 24 hours earlier. Materials and Methods: Blood cultures fl agged positive between May 2011 to December 2012 by BacT/ALERT were Gram stained. All uni-microbial gram-negative blood cultures were simultaneously cultured and processed for DST from broth using disk diffusion method using British Society of Antimicrobial Chemotherapy (BSAC) guidelines. DST results available next day were compared with conventional antibiotic susceptibility test (AST) performed by Vitek-2 on isolated colonies. Results of DST (test method) and AST (reference method) were compared for agreements or errors. Results: Of the 840 antibiotic gram-negative organism combinations tested, Categorical and essential agreements were 83.7% and 96.2% respectively. Minor, major and very major errors were 12.5%, 3.33% and 0.47%, respectively. Conclusions: DST using disk diffusion from positive blood culture broths helps to initiate early targeted antibiotic therapy. There is high concordance between DST and AST.

Prevalence, Clinical Predictors, and Outcome of Hypocalcaemia in Severely-malnourished Underfive Children Admitted to an Urban Hospital in Bangladesh: A Case-Control Study.

Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely- malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled. Those who presented with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the cases (n=87), and those admitted without hypocalcaemia (n=246) constituted the control group in our analysis. The prevalence of hypocalcaemia among severelymalnourished under-five children was 26% (87/333). The fatality rate among cases was significantly higher than that in the controls (17% vs 5%; p<0.001). Using logistic regression analysis, after adjusting for potential confounders, such as vomiting, abdominal distension, and diastolic hypotension, we identified acute watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p=0.030), convulsion on admission (OR 21.86, 95% CI 2.57-185.86, p=0.005), and lethargy (OR 2.70, 95% CI 1.633-5.46, p=0.006) as independent predictors of hypocalcaemia in severely-malnourished children. It is concluded, severely-malnourished children presenting with hypocalcaemia have an increased risk of death than those without hypocalcaemia. AWD, convulsion, and lethargy assessed on admission to hospital are the clinical predictors of hypocalcaemia in such children. Presence of these features in hospitalized children with severe acute malnutrition (SAM) should alert clinicians about the possibility of hypocalcaemia and may help undertake potential preventive measures, such as calcium supplementation, in addition to other aspects of management of such children, especially in the resource-poor settings.

Seroprevalence of Hepatitis G Virus IgG Antibody among Blood Donors, Pregnant Women, Neonates and Apparently Healthy Population.

This cross sectional and observational study was conducted in the Department of Microbiology, Sylhet MAG Osmani Medical College, Sylhet, during the period from 1st January 2012 to 31st December 2012 with a view to explore the seropositivity of Hepatitis G virus (HGV) in blood donors, pregnant women, new born and apparently healthy subjects. For this purpose 45 blood donors, 45 pregnant women, 45 new born babies of same mothers and 45 apparently healthy subjects were selected according to the inclusion and exclusion criteria. The HGV antibody was measured in venous blood from blood donor, pregnant women and apparently healthy subjects; and cord blood from newborn babies with a commercially available enzyme-linked immunosorbent assay (ELISA) method. The mean age of the blood donors, pregnant women and healthy subjects was 24.9 (SD ± 3.5) years; 24.9 (SD ± 3.5) years and 22.1 (SD ± 1.5) years respectively. The overall seropositivity of HGV was 3 (1.7%). The seropostivity of HGV of blood donors, new born babies and healthy subjects was 1 (2.2%) in each group but no HGV antibody positivity among the pregnant women (p=0.797). Among the male patients 2 (2.2%) patients were seropositive for HGV; while in female patients, 1 (1.1%) patient was seropositive for HGV (p=0.547). Among the patients with previous blood transfusion 1 (1.9%) patient was seropositive for HGV; while among patients without previous blood transfusion 2 (1.6%) patients were seropositive for HGV (p=0.882). This study yielded that there is high prevalence of HGV seropositivity among population in this region of Bangladesh. So, screening of blood units for HGV would deserve consideration.

Hepatoprotective activity of the methanolic extract of Fagonia indica Burm in carbon tetra chloride induced hepatotoxicity in albino rats

Objective: To investigate hepatoprotective activity of the methanolic extract of Fagonia indica Burm. on CCl4 induced hepatotoxicity in albino rats. Methods: Animals in Group 1 served as vehicle control, Group 2 served as hepatotoxin (CCl4 2ml/kg, s.c) treated group, Group 3 served as standard (Silymarin 50mg/kg, p.o.) treated group. Group4 and 5 served as methanolic extract of Fagonia indica (MEFI) in different doses (200 mg/kg and 400 mg/kg b.w., p.o).The degree of protection was determined by measuring levels of biochemical marker like SGOT, SGPT, ALP, Bilirubin (Total & Direct) and Cholesterol. The histopathological studies also show the hepatic protection of the test extracts. Results: The levels of the biochemical parameters such as SGPT, SGOT, ALP, Total bilirubin, Direct bilirubin and Cholesterol were significantly increased in CCl4 treated rats when compared with the normal group (P<0.05), but the MEFI (400 mg/kg, bw) treated rats showed maximum reduction of SGOT (114.83±1.51), SGPT (164.33±1.25), ALP (154.83±1.53), Total bilirubin (1.55±0.01), Direct bilirubin (0.65±0.009) and Cholesterol (193.00±1.06) in a significant manner. Histopathological studies also reveal the hepatoprotection property of MEFI in a dose dependent manner. Conclusions: These results suggest that MEFI in different doses showed significant hepatoprotective activity against CCl4 induced hepatotoxicity and this might be due to the presence of flavonoids and tannins. Further research is sought to explore the exact mechanism of action and phytoconstituents responsible for the pharmacological response.

Prognostic information of gastric carcinoma using Goseki system in relation to nuclear organizer region (AgNOR) and proliferating cell nuclear antigen (PCNA) expression.

Objective: The present study was undertaken to find out the relationship of Goseki grading system (I-IV) with existing classification of WHO, Lauren and tumour differentiation of gastric carcinoma and its prognostic information in relation to AgNOR & PCNA expression. Materials and methods: To assess the reproducibility and usefulness of Goseki grading system thirty five gastric carcinoma were selected from January 2007 to July 2009 in the department of Pathology, Burdwan Medical College in West Bengal, India and analyzed in relation to existing grading system by chi-squared testing. Mean AgNOR count & mean PCNA leveling index quantities of different tissue sections were assessed according to different classification system of gastric carcinoma and interobserver variations of all data were evaluated from Spearman Rank-order Correlation Coefficient (rs ). Results: Highly significant predictable correlation of Goseki grading system for existing classification of gastric carcinoma was obtained statistically. Increasing values of mean AgNOR count and PCNA leveling index (2.35% & 15.14%, 2.91% & 21.32%, 3.08 %& 24.76% and 3.2% & 25.12 respectively) were observed from Grade I – IV of Goseki grade. Mucin rich (3.05% & 23.22%) and tubule poor (3.14% & 24.76%) tumours higher values than mucin poor (2.71% & 19.95%) and tubule rich (2.63% & 18.23%) tumors. No significant correlations were observed in other grading system. Conclusion: Following Goseki grading system increasing expression of proliferating marker in mucin rich than mucin poor tumours and tubules poor than tubules rich tumors indicate poor prognosis and tumour behavior. Simple system may help to select patients for adjuvant therapy.

Nickel, its adverse health effects & oxidative stress.

Nickel-induced toxicity and carcinogenicity, with an emphasis on the generation and role of reactive oxygen species is reviewed. Nickel is a known haematotoxic, immunotoxic, neurotoxic, genotoxic, reproductive toxic, pulmonary toxic, nephrotoxic , hepatotoxic and carcinogenic agent. This article presents a selective review on nickel and effect of its acute, subchronic and chronic doses on certain metabolically active tissues in human as well as animals. Nickel exposure causes formation of free radicals in various tissues in both human and animals which lead to various modifications to DNA bases, enhanced lipid peroxidation, and altered calcium and sulphydryl homeostasis. The primary route for nickel toxicity is depletion of glutathione and bonding to sulphydryl groups of proteins. Nickel homeostasis, nickel-induced activation of signaling pathways and the protective role of enzymatic and non-enzymatic antioxidants against nickel toxicity and carcinogenicity are also discussed.

Endodontic enigma : mandibular second premolar with three root canals: a case report.

Location and thorough instrumentation of all the canals in the root of a diseased tooth normally ensure success of the endodontic therapy. Present case was referred for endodontic therapy of mandibular second premolar. Clinical and radiographic examination revealed inadequate root canal filling. Three canals were located. Endodontic therapy was performed under aseptic conditions.

Hepatic fibrosis: can we treat it clinically?

Hepatic fibrosis, a reparative response to different types of liver injury, has emerged as the primary determinant of outcome in advancing chronic liver disease, including cirrhosis. Once considered irreversible, today there is enough clinical as well as laboratory data available for us to be optimistic and expect regression of liver fibrosis in clinical situations, with resultant improvement in outcome. The primary premise of this approach to modify liver fibrosis has been its success in treating the basic pathology underlying persistent liver inflammation and injury, often with the reversal of cirrhosis. However, more focussed anti-fibrotics altering the dynamics of collagen deposition and resorption are undergoing evaluation and will be available shortly. In this changing scenario, there is a need for precise, easy to use endpoints of success/failure of anti-fibrotic therapy. A future scenario may be envisaged as one of a more positive, aggressive approach to treatment of chronic liver disease- treating the cause as well as using anti-fibrotics. This "hit the enemy and repair the hut" approach ushers in a new era from the hitherto barren pessimism in the treatment of chronic liver disease.

Non-resolving liver abscess with Echinococcus cross-reactivity in a non-endemic region.

A 40-year-old woman presented with high fever with chills and rigors. Imaging studies revealed multiple liver abscesses with hepatosplenomegaly and gall-stones. Ultrasound-guided aspirate revealed pus that was negative on Gram and acid-fast staining and for amebic trophozoites. ELISA for echinococcus was strongly positive, but she did not respond to albendazole therapy. At surgery, Fasciola hepatica was detected and she responded well to bithinol postoperative.

Characteristics of patients admitted with stroke.

Population based study on stroke morbidity and mortality is lacking in our country. We described the clinical pattern of patients with stroke admitted in Neuromedicine Unit, Chittagong Medical College Hospital, Bangladesh. One hundred and six consecutive patients were included in the study. Clinical diagnosis of stroke, initial assessment, and assessment of outcome of stroke were performed by the neurologists. On admission blood glucose, and creatinine level was estimated, and an electrocardiogram was recorded. Fasting lipid level estimation and CT-scan of brain were performed for patients who could afford the cost. The mean age of the patients was 60.0 +/-13.7 years and the highest occurrence of stroke was found in the age group of 61 - 70 years. The proportions of rural, semiurban and urban patients were 46.2%, 27.4% and 26.4% respectively. A large portion of the patients were found illiterate (47.2%), and only one patient had postgraduate education. The average per capita income was found 1159 +/-762 taka per month. About one-fourth of the patients had diabetes (21.7%). Hypertension, ischemic heart disease and dyslipidemia were found in 59.4%, 18.9% and 11.3% respectively. The cause of hospitalization was altered consciousness (58.5%), right hemiplegia (32.1%), and left hemiplegia (31.1%) either alone or in combination. The mean duration of hospital stay was 5.25 +/-2.19 days. Fifty percent partially and 35% satisfactorily recovered, and 7 (6.6%) patients expired. Patients from lower socioeconomic group were admitted in the hospital. A considerable number of stroke patients had hypertension and diabetes.

Gastroduodenal dysmotility in patients with gallbladder carcinoma: frequency of occurrence and clinical importance.

BACKGROUND: Gastric stasis, common in patients with gall-bladder carcinoma (GBC), results from anatomical obstruction or motor abnormalities. We studied patients with GBC for antroduodenal motor dysfunction using manometry. METHODS: Forty-one patients with GBC without endoscopic gastric outlet obstruction and 10 healthy controls were evaluated using a symptom scoring system for gastric stasis, saline load test and water perfusion antroduodenal manometry. Fasting, post-prandial and post-octreotide motility were recorded and analysed on a computer using GiPC manometry software. RESULTS: Sixteen of 41 patients (39%) with GBC reported recurrent vomiting; patients with vomiting had a higher symptom score (13 [11-17] v. 6 [4-10], p<0.0001] and higher volume of aspirate on the saline load test (460 ml [210-650] v. 160 ml [70-260], p<0.0001) as compared with those without vomiting. Healthy subjects more often had spontaneous fasting migratory motor complex than patients with GBC (9/10 v. 13/41, p=0.002). The amplitudes of contractions in the antrum and duodenum were significantly lower in patients with GBC than in healthy subjects. Patients with GBC had lower fasting (157 [68-284] v. 190.5 [150-284], p=0.01) and post-prandial (200 [96-395] v. 284 [178-395], p<0.0001) antral motor indices than healthy subjects. Patients with GBC and vomiting had significantly lower contraction amplitude and motility indices than those without vomiting. Motility indices correlated inversely with the symptom score and volume of aspirate on the saline load test (Spearman correlation, p = 0.01 for all). CONCLUSION: Antroduodenal motor abnormalities are common in patients with GBC. These may explain the symptoms of gastric stasis and abnormal results of the saline load test in the absence of anatomical obstruction in such patients.