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.

Clinicopathological Study of Chronic Kidney Disease of Unknown Etiology in Odisha

Introduction: Chronic kidney disease (CKD) is emerging as a serious health problem in Odisha, India. A new form of severe CKD affecting adults, not due to traditional risk factors like diabetes, hypertension, glomerulonephritis, has been reported in Sri Lanka, Central America, and Egypt in the last two decades. This has been named CKD of unknown origin (CKDu), and it is fatal due to late recognition and rapid disease progression. The aim of the study was to elucidate the association between different sociodemographic, and biochemical parameters with renal morphology in CKD of unknown origin patients. Methods: A cross-sectional study was conducted on 124 consecutive patients with CKD from the period January 2018 to December 2018. Patients in the age group 18–60 years who met clinical criteria for CKD were included. Participants answered a questionnaire. After the necessary history, clinical evaluation, and blood and urine analyses, a kidney biopsy was undertaken. Kidney biopsy was feasible in 51 patients as the rest 61 patients had shrunken kidneys and 12 patients did not give consent. Patients with diabetes mellitus (DM), hypertension, glomerulonephritis, polycystic kidney disease, obstructive kidney disease or any other congenital diseases, snakebite, pregnancy, malignancy, gout, primary hyperparathyroidism, infectious diseases like human immunodeficiency virus (HIV), TB, Hepatitis B and C, malaria, syphilis, leprosy and coagulopathies were excluded. Among the 51 patients, 23 had CKDu, 25 had chronic glomerulonephritis and three biopsies were inconclusive. Results: The mean age of CKDu patients was 36.78 ± 9.85 years. Males (73.9%) were predominantly affected. A family history of CKD was seen in 82.6% of CKDu cases. Hyponatremia and hypokalemia were predominant biochemical abnormalities in our CKDu cases. Binary logistic regression showed rural residence, family history of CKD, exposure to smoke from burning coal, charcoal, or biomass fuels, low socioeconomic status, and low body mass index were strongly associated with CKDu. There was an increased risk of developing CKDu in persons with a family history of CKD [p = 0.003, odds ratio (OR)— 17.58], persons exposed to smoke from burning coal, charcoal or biomass fuels (p = 0.003, OR- 32.4), and patients with low socio-economic status (p = 0.001, OR- 15.87). Interstitial fibrosis (IF), interstitial inflammation with mononuclear infiltration, tubular atrophy (TA), and global glomerulosclerosis (GS) were pertinent histopathological findings in our study. Conclusion: There is no strong evidence for a single cause for CKDu, and multiple environmental, occupational and social factors are probably involved. We need to design consistent and comparative multisite studies to identify etiologies of CKDu, across high-risk populations that may help elucidate the importance of region-specific vs global risk factors.

Comparison of physical fitness in male and female medical students

Background: Students entering medical college find it difficult to cope with the burden of studies and go into depression. They cannot maintain their study habits as before due to extreme tiredness and fatigue following their regular classes. Aim and Objectives: The present study aims to evaluate the physical fitness status of male and female medical students. Materials and Methods: A total of 70 students, 35 male and 35 female, were selected randomly from the first two phases of this college. Their age, height, weight, and BMI were recorded. Their resting pulse rate was recorded after 15 min of resting. Then, each was made to undergo the Modified Harvard Step Test for 5 min or till exertion. Then, their immediate post-exercise pulse rate was recorded. VO2max was calculated and compared to find the physically fit group. Results: We found from the study that female students were similar to males in age, weight, and resting pulse rate. The height and maximum pulse rate post-exercise are more in males and BMI more in females and VO2max was found more in males. Conclusion: The male students are more physically fit than females and can cope with the different strenuous situations better than females. Females need to do regular exercise to increase their fitness.

Differential expression of cyclin E, p63, and Ki-67 in gestational trophoblastic disease and its role in diagnosis and management: A prospective case–control study

Background: Gestational trophoblastic disease (GTD) constitutes a spectrum of tumors and tumor-like conditions, characterized by proliferation of pregnancy-associated trophoblastic tissue of progressive malignant potential. It is very difficult to differentiate these complex groups of lesions basing on histomorphology alone. Immunohistochemistry (IHC) with cyclin E, P63, and Ki-67 has a definite role in the identification of different trophoblasts and entities of GTD and also in the determination of biological behavior. Aims: The aim of this study is to find the differential expression of cyclin E, p63, and Ki-67 in normal placenta, hydropic abortus (HA), and various entities of GTD. Design and Settings: A prospective case–control study conducted in a government medical college. Methods: Total 96 cases, divided into Group A (48 histologically confirmed cases of GTD) and Group B (controls comprising 8 HA and 40 normal placentas of different trimesters), were studied. The histological samples were subjected to IHC using cyclin E, Ki-67, and p63. Statistical Analysis: Results were analyzed using SPSS statistical method. Results: Among the three immunomarkers used, Cyclin E and Ki-67 show statistically significant difference (P < 0.05) when compared between GTD and control groups, but it was insignificant for p63 (P = 0.369). Strong staining intensity of cyclin E and Ki-67 is seen in complete moles, choriocarcinoma, and placental site trophoblastic tumor. Conclusion: This study was done to evaluate the role of cell cycle regulatory proteins such as cyclin E and p63 and proliferation marker Ki-67 in the detection of various trophoblasts and differential diagnosis of the lesions associated with them.

Culture-positive unilateral panophthalmitis in a serology-positive case of dengue hemorrhagic fever

Dengue fever, a mosquito-borne disease commonly found in the tropics, is one of the most prevalent forms of Flavivirus infection in humans. Symptomatically, it is characterized by fever, arthralgia, headache, and rash. Ophthalmic manifestations can involve both the anterior and posterior segment. Panophthalmitis is rare in dengue hemorrhagic fever, and there is no report of culture-positive panophthalmitis in this setting. Here, we report a case of a serology-positive 33-year-old male patient of dengue hemorrhagic fever who developed sudden onset pain, redness, and proptosis in the right eye. The patient subsequently developed panophthalmitis in his right eye, and Bacillus cereus was isolated from eviscerated sample. This case provides unique insights into pathogenesis of panophthalmitis in dengue and highlights the management options.

Hemichorea resulting from single enhancing computed tomography lesion.

A single small enhancing computerized tomographic lesion is a common finding in Indian patients with seizures, particularly focal seizures. A small single enhancing computed tomography lesion also presents with varied non-epileptic manifestations viz. focal neurological deficits, episodic vascular headache, syndrome of increased intracranial pressure, etc. Here we present a case of hemichorea resulting from single enhancing CT lesion. A 12-year-old female presented with acute onset abnormal movements involving right side of body. A clinical diagnosis of right hemichorea was made and patient was subjected to neuroimaging along with other investigations. CT scan showed a single ring-enhancing lesion with perifocal edema in left thalamic area suggestive of neurocysticercosis. Patient was treated with albendazole, steroids and haloperidol therapy. Patient showed marked improvement at follow-up after one month. Repeat CT scan revealed resolution of lesion. This case has been reported because hemichorea in young female is usually caused by post-streptococcal infection and it is quite rare presentation of small ring enhancing lesion.

Electricity and the heart.

Understanding of cardiac rhythm requires application of physical principles governing electricity. Over a period of more than 100 years, application of the knowledge of electric current led to the gradual evolution of electrocardiogram, pacemaker, defibrillator, and ultimately electrophysiology. The discovery of electrocardiogram (ECG) by Einthoven in 1902 and that of pacing by Zoll in 1952 were two landmarks in this field.

Predictive value of routine hematological and biochemical parameters on 30-day fatality in acute stroke.

OBJECTIVE: This prospective study was planned to study the prognostic value of routine clinical, hematological and biochemical parameters, including platelet aggregation in patients of acute stroke, on fatality occurring during the first 30 days. MATERIAL AND METHODS: In this study 116 consecutive patients (77 males and 39 females) of stroke (within 72 hours of onset) were included. After clinical evaluation and neuroimaging, blood investigations, hemoglobin, total leukocyte count, platelet count, platelet aggregation, erythrocyte sedimentation rate (ESR), blood sugar, urea, creatinine, sodium, potassium, serum cholesterol, serum bilirubin, aspartate aminotransferase (SGOT), alanine aminotransferase (SGPT), albumin, and globulin estimations were performed. The patients were followed up for a maximum period of 30 days from the onset of stroke, and patients who expired were grouped as 'expired' and the rest as 'survivors'. Logistic regression analysis was carried out among the significant parameters to identify independent predictors of 30-day fatality. RESULTS: Univariate analysis demonstrated that among hematological parameters, high total leukocyte count and ESR, at admission, correlated significantly with an undesirable outcome during the initial 30 days. Among biochemical parameters, elevated urea, creatinine, serum transaminases (SGOT and SGPT) and globulin levels correlated significantly with death. Logistic regression analysis demonstrated that a low Glasgow Coma Scale (GCS) score along with biochemical parameters such as high serum creatinine, SGPT, ESR and total leukocyte count correlated with death. CONCLUSION: Impaired consciousness, high total leukocyte count, raised ESR, elevated creatinine and SGPT levels, estimated within 24 hours of hospitalization, are the most important indicators of 30-day mortality in patients with first-time ischemic stroke.

Rupture of the sinus of valsalva into the pulmonary artery.

Congenital aneurysms of the sinus of Valsalva are rare lesions that can rupture into any cardiac chamber, due to the central position of the aortic root. Rupture into the pulmonary artery, however, is very rare. We encountered an 18-year-old girl with rupture of the right coronary sinus into the pulmonary artery. During surgical correction, the girl was also found to have a small outlet ventricular septal defect, which was obscured by multiple hypertrophied septal trabeculae in the right ventricular outflow tract.

Posterior leukoencephalopathy in a girl with acute haemorrhagic leukoencephalitis.

In children, posterior leukoencephalopathy is frequently associated with hypertensive encephalopathy, anticancer chemotherapy, treatment with immunosuppressive drugs in patients with organ transplantation, transfusion or human immunodeficiency virus infection. Posterior leukoencephalopathy in these children appears as a complicating illness and resolves once precipitating factor (e.g. cancer chemotherapy) is removed. Here we are reporting a fatal case of acute haemorrhatic leukoencephalitis in a 13 year old girl, imaging abnormalities are also suggestive of posterior leukoencephalopathy. Posterior leukoencephalopathy in our patient possibly, is a part of post-infectious haemorrhagic leukoencephalitis, rather than because of ischaemia or cerebral oedema secondary either to abrupt increase in blood pressure or following administration of immunosuppressive drugs.

Calcification of the thoracic ligamentum flavum: a rare cause of myelopathy.

Compressive myelopathy secondary to ossification or calcification of the ligamentum flavum is a rare entity. Clinical features and magnetic resonance imaging findings of a patient of dorsal cord compression who improved remarkably with surgery are reported.

Long-term performance of single-pass physiological pacing.

BACKGROUND: Single-pass physiological pacing has several advantages over dual-lead physiological pacing. The present study evaluated the long-term performance of single-pass pacing using the overlapping biphasic impulse stimulation technique. METHODS AND RESULTS: A total of 30 patients with single-pass VDD pacing and 8 patients with single-pass DDDC pacing were followed up for 1 year by basal and magnet electrocardiograms and real-time telemetry. All the patients showed satisfactory atrial sensing and pacing capture threshold. The atrial sensing thresholds at implant and at 1 month, 3 months, 6 months and 12 months of follow-up were 2.5+/-0.67 mV, 1.6+/-0.6 mV, 1.1+/-0.5 mV, 1.0+/-0.5 mV and 1.0+/-0.04 mV, respectively. The corresponding values for atrial pacing threshold at a pulse wave of 0.5 ms were 2.5+/-1.0 V, 4.4+/-0.9 V, 3.8+/-1.2 V, 3.6+/-1.4 V and 3.8+/-1.4 V. Of the patients with DDDC pacing, 88% showed stable pacing capture in the supine position, 75% in the upright position and 62% in both positions. Diaphragmatic contraction was seen in 25% of cases with DDDC pacing. No such event was seen in patients with VDD pacing. CONCLUSIONS: Single-pass pacing is safe, technically easy and cheap as compared to dual-lead systems. However, it would be prudent to recommend DDDC pacing in patients who require predominantly VDD pacing and only occasionally atrial pacing, as the latter showed a low percentage of stable atrial pacing capture in both upright and supine positions as well as a significant percentage of diaphragmatic contraction.

Butyrate induced alterations during development of the strain ln(1)BM2(reinverted) of Drosophila melanogaster.

The polytene male X chromosome of D. melanogaster, has a unique morphology, which is correlated with the property of increased transcription of the sex-linked genes of the male X chromosome. This ensures equalization of X-linked gene products between males (XY) and females (XX). Till date, an invariable correlation between the structure and transcription of the male X chromosome has been reported. However, the strain In(1)BM2(reinverted) of D. melanogaster presents a caveat to this invariable correlation. In this strain, although the male X chromosome appears puffy and diffuse, the transcription remains at the wild type level. This observation suggests the perturbation in the function of a regulator that controls the structure of the male X chromosome. In this report the response of the strain to butyrate, an inhibitor of histone deacetylase, has been studied, with specific reference to development, sex ratio and chromosome morphology of the strain. Two important conclusions arise from these experiments : (a) exposure to butyrate has more severe consequences on the development of the mutant strain and on the survival of females. (b) rearing on butyrate induced a temporal series of structural alteration of the polytene chromosome of the wild type, with the male X chromosome being most vulnerable to structural changes. The butyrate-interaction of In(1)BM2(reinverted) together with our current biochemical analyses of a chromosome coiling protein recovered from this strain, provide data for a working hypothesis explaining the sex and chromosome specific alteration of the structure of the male X chromosome of In(1)BM2(reinverted).

The newer unconventional indications of permanent pacemakers.

In recent years, the indications for permanent pacemakers have expanded. The interest has focussed on hypertrophic cardiomyopathy, dilated cardiomyopathy and a new entity called hypertensive hypertrophy with cavity obliteration (HHCO). Pacemaker therapy is establishing itself for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope with newer pacing mode has encouraging datas. Pacemaker for long QT syndrome, after cardiac transplant and for haemodynamic improvement in occasional cases of first degree atrio-ventricular block is getting attention. The AHA and ACC guidelines updated in 1998 for implantation of cardiac pacemakers, now include several of these newer indications.

Neurocysticercosis like presentation in a case of CNS tuberculosis.

A clinical picture consisting of seizures, multiple non-tender subcutaneous nodules, and multiple 'nodular or ring' enhancing lesions in computed tomography of the brain is considered characteristic of neurocysticercosis in an endemic area. 1,2 A case with a similar clinical picture, in whom serological tests and histopathological examination of subcutaneous nodule established tuberculosis as a cause, is presented.