PD-L1 expression in muscle invasive urothelial carcinoma: Comparison of SP142 and SP263 assay

Introduction: High-grade urothelial carcinoma has a different molecular pathway than superficial low grade urothelial carcinoma, and is characterized by genomic instability. The high tumor mutation burden leads to neoantigen formation, evoking an immune response. The immune response has been keenly studied in last two decades and programmed death ligand-1 (PDL-1) has emerged as acceptable immunohistochemical marker for assessment of response to therapy, prognostication and patient selection for immunotherapy. The targeting of PD-1 and PDL-1 by checkpoint inhibitors (CPIs) is an attractive strategy to unblock the inhibitor and induce cytotoxic cell death. However, the presence of complementary and companion diagnostic testing with multiple PDL-1 assays and platforms for various CPIs make a diagnostic quagmire. Thus, it is the need of hour to harmonize these assays. In this undertaken study we evaluated the concordance in PD-L1 expression between the two PD-L1 clones: SP263 and SP142, in treatment naïve muscle invasive bladder cancer (MIBC). Methods: We evaluated Ventana PD-L1 “SP263 and SP142” qualitative immunohistochemical assay using rabbit monoclonal anti-PD-L1 clones in evaluation of PDL-1 immunoexpression on Ventana autostainer platform. The study includes 30 muscle invasive urothelial carcinomas, with 10 of 30 having nodal metastasis. Results: SP263 assay was statistically more sensitive than SP142 for tumor cell (TC) scoring (P = 0.0009), whereas SP142 was more sensitive for immune cell (IC) scoring (P = 0.0067). There was no statistical significant discordance for TC or IC scoring between primary tumor and metastatic lymph node. Conclusion: PD-L1 testing status can be done on both primary tumor and metastatic site, however in metachronous metastatic setting, testing on recent metastatic site should be preferred. The harmonization of immunoexpression between 2 PD-L1 clones could not be achieved.

Incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon

Introduction: ectopic pregnancy (EP) is the leading cause of maternal mortality in the first trimester of pregnancy in our environment. This study aimed at evaluating the incidence, risk factors, clinical presentation and treatment of ectopic pregnancy in the Limbe and Buea Regional Hospitals in Cameroon. Methods: this was a retrospective nested case control study carried out from December 2006 to December 2016. A ratio for control vs cases of 3:1 was obtained. Any pregnancy implanted outside the normal uterine cavity was considered as an ectopic pregnancy. Student's t-test was used to compare continuous variables and Pearson's Chi-square test for categorical variables. The association between EP and the demographical and clinical variables was estimated using logistic regression. Statistical significance was set at p-values<0.05.Results: a total of 247 cases of EP were registered out of 17221 deliveries giving an incidence of 1.43% in ten years. History of pelvic inflammatory disease (OR = 3.10, CI (1.76-5.44), p < 0.001), previous EP (OR = 10.22, CI (2.61-14.82), p < 0.001), History of induced abortion (OR = 2.68, CI (3.32-9.73), p< 0.001), history of adnexa surgery (OR = 4.37, CI (2.17-10.32), p < 0.001) and history of appendectomy (OR = 2.16, CI (0.99-6.64) p< 0.001), were also found to be associated with increased risk of EP. More than five percent (5.52%) of the patients were in shock at presentation. Diagnosis was confirmed mainly by use of ultrasound (78.53%) and treatment was principally by laparotomy (97.55%) with salpingectomy (95.60%). Most (90.18%) of ectopic pregnancies were ruptured at presentation. Only 2.45% of cases were manage medically with the use of methotrexate. Conclusion: the incidence of ectopic pregnancy (EP) in our environment is within the global range (hospital-based incidence of 1.43%) and is rising. Late presentation, lack of modern diagnostic and management tools have made laparotomy with salpingectomy the principal method of management of ectopic pregnancy in our environment

Awareness and practice of patients' rights among hospitalized patients at Wad-Medani Teaching Hospital, Sudan

Patients' rights are a fundamental human right and an important part of modern health care practice. This is a cross-sectional descriptive analytic study, conducted amongst 263 patients at Wadi-Medani Teaching Hospital, Sudan, in March-April 2015. Most patients [95.2%] did not know about the Bill of Rights and most of them [92.8%] were not able to mention any of the patients' rights. The most practiced rights were: the right to be asked for permission before examination [88.1%], proper handling [87.8%], safety of the hospital [87%], presence of a third person when examining a female by a male doctor [85.6%], and admission file confidentiality [75.5%]. The awareness of Sudan FMOH Patients' Bill of Rights was very low among patients at Wad-Medani Teaching Hospital, yet they showed a high satisfaction rate probably due to their low socioeconomic status, educational level and expectations. Therefore, awareness of patients' rights must be increased

[Morphological and molecular characterization of ephedra species found in Syria]

Ephedra is a dioecious, drought- and frost-resistant, perennial, evergreen shrub with high medicinal value due to its content of ephedrine alkaloids. It became quite clear throughout referential studies that this significant medical plant which is spontaneously widespread in Syria and there have been an increased international demand on it hasn't been studied yet. The objective of this research was study Ephedra species found in Syria, using morphological traits and molecular markers. Ephedra plants were collected from different locations of Syria. Morphological characters male flowers, ripe female cones, and the edges of leaves and sheaths bracts were observed by naked eyes and magnifier. The DNA of all genotypes was extracted and amplified using seven randomly amplified polymorphic DNA [RAPD] primers to study genetic variability at the molecular level. Morphological data showed differences between three species: E.alata, E.aphylla, E.foemina. Tested RAPD primer gave repeatable polymorphic products producing a total of 55 bands, 51 of them were polymorphic. The level of polymorphism was 92% with an average of 7.28 bands/ primer. The similarity coefficient matrix of seven Ephedra genotypes based on the data of 7 RAPD primers using the UPGMA method was used to construct a dendrogram. Two major clusters were obtained from the dendrogram belonging to studied genotypes; Cluster I and cluster II. Cluster I comprised two genotypes, Cluster II comprised the other five minor genotypes. The highest value about 0.70 of similarity was observed between genotypes D and B. The lowest value of similarity 0.18 was observed between K and B. A significant correlation was found between morphological distances, genetic distances and geographic distances of the studied genotypes

Role of polymorphonuclear leukocyte in diabetic foot

To study the etiopathogenesis of foot injuries in patients of uncontrolled diabetes mellitus. Retrospective study of tissue samples received from diabetic patients clinically diagnosed as gangrene. This study was conducted in the Department of Ophthalmology, JPMC, Karachi from July 2009 to June 2011. 150 cases of uncontrolled diabetes mellitus with wounds of foot were included. 150 cases of known diabetics with peripheral neuropathy and history of loss of sensation were subjected to follow up of 2 years follow up was done on the cases. As a first step blood sugar was brought under control and broad spectrum antibiotic was given. Wound debriment was done in all cases. The specimens were subjected to H/E and Gram's staining. In H/E, liquifactive necrosis, polymorphonuclear leukocyte, mononuclear cell infiltrate, few lymphocyte plasma cells and fibroblasts were seen. New blood capillaries were few or absent. both gram positive and gram negative organisms were isolated. 79% were gram positive and 21% were gram negative. Hyperglycemia causes relative anoxia in the micro environment of the tissue due to damage of peripheral neurons. Lack of adequate circulation leads to ischemia, which is super added by infection of the subcutaneous tissue. The resultant effect is liquifactive necrosis and complete lysis of tissue. Removal of such putrefied tissue is mandatory to stop further damage to the tissue

Risk profile for breast carcinoma and tumour histopathology of medical uninsured patients in Pakistan

Breast carcinoma is an unpredictable disease in the sense that some patients may die at early disease stage due to wide-spread metastasis within six months to one year, while others may survive longer. This study was aimed to evaluate the risk factors for breast carcinoma occurrence and histopathological features of breast carcinoma developed in the social and economical conditions of Pakistan. A total of 224 female breast cancer diagnosed patients with uncovered medical insurance visiting at the Oncology clinic of a teaching hospital at Karachi, Pakistan were selected for the study. Two hundred and twenty-four [224] healthy female subjects free of any cancer diagnosis were selected as control from different areas of the city. Information on stress, occupation, life history, and life style was obtained through personal interviews. Breast tumour pathology was evaluated for histological grade, lymph node metastasis and hormone receptor status by using standard methods. Student's t-test, Chi-square test and ANOVA were used for comparison. Breast cancer patients in significantly high percentage reported early marriages, abortion occurrence, stressful life style, family cancer history and past disease suffering from diabetes and hypertension. Life style including aerosol chewing and fat rich food intake was significantly high among the patients [p<0.05]. On histopathological analysis, patients at the age of 40 years and below were identified in significantly high percentage with tumour grade III, 1-3 lymph node metastasis and hormone receptor negative type. Increasing age was associated with low tumour grade and less percentage of lymph node metastasis. Significantly high percentage of patients were presented with hormone receptor positive tumour [p<0.05]. The contributing factors for breast carcinoma occurrence were related to life history and life-style of the patients. Medical insurance uncovered patients at initial diagnosis were presented in significantly high percentage with advanced disease including high tumour grade and lymph node metastasis due to less use of preventive and screening service which delays the diagnosis, effecting both survival and treatment cost

Relationship of brain natriuretic peptide with serum lipids and body mass index in healthy adult males

Prevalence of morbid obesity has increased dramatically world wide during past three decades. BMP a cardiac lipolytic hormone is found to be decreased in obese hypertensive and heart failure patients. Increasing values of BMI are associated with dyslipidemia. To find out the relationship of BMP with increasing values of BMI and individual serum lipid fractions in apparently healthy adult males. Study Observational, cross-sectional Department of Physiology at Basic Medical Sciences Institute, Jinnah Post Graduate Medical Center, Karachi. Study included 85 adult males, aged between 20-60 years. All were non-smokers, non- diabetic, having no other chronic illness and not taking any lipid lowering therapy. Study participants were evaluated for lipid profile and divided into three groups for the calculated BMI values according to WHO and International Obesity Task Force. Brain Natriuretic Peptide was assayed by AxSym technology. Brain Natriuretic Peptide developed a negative correlation with BMI, total and LDL-cholesterol and a positive relation with HDL-cholesterol and triglycerides. This study concluded that Brain Natriuretic Peptide is negatively related with increasing values of BMI and degree of dyslipidemia in apparently healthy adult males

Pathophysiology and appropriate management of acute asthma

To study pathophysiology and guidelines for the diagnosis and management of acute asthma. Prospective study of management of known cases of acute asthma for a period of 3 months. Department of Chest Medicine, Jinnah Post Graduate Medical Centre, Karachi. 300 cases of known acute asthma were included. Management was initiated with saturated oxygen and Salbutamol nebulizer. Subsequent treatment was added if sign and symptom did not regress. Hydrocortisone [after 15 minutes], Ipratropium [after 30 minutes] and Aminophylline [after 1 hour]. 190/250 [76%] males and 40/50 [80%] females, total 210/300 [70%] patients became stable after initial treatment. 3 0/60 [50%] males and 10/10 [100%] female, total 40/70 [57%] were stable after Hydrocortisone was added. 20/30 [66%] male patient became asymptomatic after treatment with Ipratropium. 10 patients became asymptomatic after 1 hour of treatment with Arninophylline. No adverse effects were observed. Acute asthma is highly variable clinical condition therefore the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted. It includes symptomatic relief as well as arrest of pathophysiolgical mechanism of asthma

Brain natriuretic peptide, systolic and diastolic blood pressures

Hypertension is an increasingly important medical and public health issue. Because of life time risk of hypertension Joint National Committee-7 introduced a new term "Pre-hypertension" for those with systolic blood pressure 120-139 mmHg and diastolic blood pressure 80-89 mmHg. Individuals prone to the development of hypertension often have a hyperdynamic circulation antedating the onset of hypertension by several years. Brain Natriuretic Peptide is a new promising cardiovascular risk marker due to its association with high blood pressure via its key role in salt and water homeostasis and hence blood pressure. This study was designed to find out the levels of plasma Brain Natriuretic Peptide in normotensive, pre-hypertensive and newly diagnosed hypertensive and to observe its association with increasing values of blood pressure. This was an cross-sectional study conducted in the Department of Physiology Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi. Study included 85 adult males, aged between 20-60 years, non- smokers, non- diabetic and having no other chronic illness. Systolic blood pressure and diastolic blood pressure values were measured and divided into three groups on the basis of normotensive to hypertensive as stated by Joint National Committee -7. Brain Natriuretic Peptide was assayed by AxSym technology. Brain Natriuretic Peptide developed a positive and statistically significant correlation with both systolic and diastolic blood pressures and was also found out to be significantly raised in prehypertensive group. His study concluded that Brain Natriuretic Peptide is positively related with increasing values of both variables i.e. systolic as well as diastolic blood pressures. It also concluded out Brain Natriuretic Peptide to be significantly elevated in pre-hypertensive stage which may remain increased in sustained hypertension

Transabdominal and transvaginal ultrasonographic evaluation of cervical incompetence

In [15] healthy controls and [25] women with a history of habitual midpregnancy abortion [the study group], transabdominal [TAS] and transvaginal [TVS] ultrasonographic examinations were done for cervical parameters during the first trimester of pregnancy [8-12 week]. In the aborters [TVS] showed a more significant [P < 0.05] widening of the mean internal os [I.O.] [12.8 vs 9.7 mm] and also the cervical diameter [32.4 vs 28.9 mm] with shortening of the cervical length [28.4 vs 32.8 mm] with shortening of the cervical length [28.4 vs 32.8 mm] than that detected by TAS. But in the controls TVS compared to TAS gave only a significant shortening of the cervical length [47.6 vs 53 mm] without any significant variations in [I.O] and cervical diameter. In comparing the aborters with the controls examined by TAS, only [I.O] was a significant widening [9.7 vs 5.8 mm] while cervical diameter and length were of non significant changes, but TVS showed a significant variations in the three cervical parameters either widening of [I.O] [12.8 vs 7.1 mm] and cervical diameter [32.4 vs 29 mm] with shortening [28.4 vs 47.6 mm] in the habitually aborting women in contrast to the controls so TVS is the ideal approach for diagnosis of cervical incompetence

Parasitic infestations during pregnancy in Zagazig

In a study of parasitic infestations in [1041] pregnant women in Zagazig, more than half of the cases [553:53.3%] were infested while 182 women [17.48%] were infested with more than one parasite. The detected helminthes were Schistosoma mansoni [129:12.39%]. Schistosoma haematobium [38:3.56%], enterobius vermicularis [167:16.04%] Ascaris lumbricoides [108:10.37%], H. heterophyes [40:3.84%], Hymenolepis nana [14:1.34%], Strongyloides stercora lis [5:0.48%] and Trichuris trichura [1:0.096%]. Protozoa were entamaeba histolytica [103:9.89%]. Giardia lamblia [54:5.19%] while Toxoplasmosis was detected in 17 cases from 45 cascs of abortion. More incidence of bacteriuria [15.37% vs 6.96%], albuminuria [11.21% vs 3.48%] and anaemia [63.47% vs 15.37%] was found in the infested than in the non-infested cases. Also obstetric complications such as abortion [8.5% vs 3.69%], premature labour [3.8% vs 1.43], puerperal sepsis [3.26% vs 0.41] and postpartum haemorrhage [1.08% vs 0.41] were of more incidences in the infested than in the non-infested cases

A Case of Scrotal Reconstruction in Male Pseudohermaphroditism Using Skin Flap and Silicone Prosthesis / 대한비뇨기과학회지

A technique is described for reconstructing the scrotum in patient who was diagnosed as male pseudohermaphroditism. Scrotal reconstruction with skin flap and silicone prosthesis was done in 3-year old child and had acceptable cosmetic result. Herein we present a case of scrotal reconstruction with some literature.

retrospective study of 3896 burned patients

3896 burned patients are retrospectively studied from 1969 to 1976. Females slightly predominate males as regards incidence [57.3%: 42.7%]. Most patients are young [10. 30 years] and 41.1% of the cases have less than 10% S.A.B. Scalds, as a cause, comes first on the list followed by flame burns, while electric and chemical burns are least. Burns are mostly domestic in origin; industrial and traffic accident burns are minimal in our series. The overall mortality rate is 19.45% and the causes of death are acute renal failure, pneumonia, bronchopneumonia, septic shock, pulmonary embolism, secondary haemorrage and severe haematemesis. The average stay in hospital is 33.2 days